A mental health facility in Porirua has been criticised in a report after a patient was found to be living in "cruel and inhumane" conditions.
Chief Ombudsman Peter Boshier carried out a number of surprise inspections at four mental health units in the Wellington region last year.
The Haumietiketike intellectual disability forensic unit came under fire for its treatment of an intellectually disabled client who has been living in effective seclusion for years.
The other three reports covered Rangipapa Forensic Acute Mental Health Unit, Tāwhirimātea Forensic Rehabilitation Unit and Pūrehurehu Forensic Acute Mental Health Unit.
"While some of the conditions I have serious concerns about can be attributed to poor design or a lack of investment in infrastructure, others cannot," Boshier said.
The patient at Haumietiketike, referred to as Client A in the report, was found to be living in seclusion and had not had any face-to-face contact with anyone except through a wire fence for over a year. This was due to an altercation with staff.
The report said Client A had effectively been living in isolation since 2014, despite a number of inspections by Cheif Ombudsmen.
"In 2014 my predecessor reported on Client A’s living conditions, with recommendations for change. During my inspection in 2017 I found Client A was still living in the same de-escalation bedroom they had been in for about 5-1/2 years," Boshier said.
"I am disappointed that Client A was still living in conditions which I regard as cruel and inhuman treatment and could amount to a breach of Article 16 of the Optional Protocol to the Convention Against Torture (OPCAT)."
Client A was moved to new accommodation in the weeks following the 2020 inspection. Boshier made a follow-up visit in February this year to inspect the new living arrangement and to speak to Client A.
"Their living area was more attractive and spacious, there was an activities room, and the use of a restraint belt means they could have contact with staff.
"However, while I acknowledge the progress made in the care of Client A, they were, as of February, still effectively in seclusion. They remained alone, in a locked area, unable to leave. If they needed to use the bathroom at night, then staff need to be called.
"Client A remained in conditions that are not fit for purpose. While I acknowledge CCDHB considers it is following Ministry of Health guidelines, this treatment clearly meets the definition of seclusion and should be understood as such," Boshier said.
There were some positive findings at the unit, the report said other clients felt safe and well treated. The unit was clean and there were a number of good programmes in place.
The Chief ombudsman said in the report he was "seriously concerned about the use of seclusion at forensic units in the Wellington region."
Other issues found across the four units were:
- Clients sleeping in hallways, in a sensory modulation room, and in an office space without natural light, privacy or sufficient ventilation
- Seclusion rooms being used as bedrooms.
- Female clients spending prolonged periods of time in seclusion rooms, due to lack of available bedrooms on the Unit.
- Female clients being admitted directly into seclusion rooms.
- Female clients treated inequitably, particularly by admission into, and long term stays in seclusion rooms.
- One of the seclusion room windows had graffiti of a sexually violent nature.
- Patients in the Rehabilitation Wing were locked in their bedroom if they chose to remain there during the day or evening, but this was not recorded as seclusion.
The Capital and Coast District Health Board (the DHB) were invited to comment and said they considered the reports provided evidence of unmet need within the forensic mental health services. The DHB noted the legal requirement to admit from court and the high acuity of the prison waitlist are such that the bed capacity in the forensic mental health service is continually exceeded.