This report is the 10th report of the National Preventive Mechanisms. It summarises the activities of the NPMs and CNPM during the period 1 July 2016 to 30 June 2017. This report also identifies the areas where we would like to see more progress, including specific changes we want to see within the next five years. These areas are;
Mental health
Those who are detained are more likely to experience mental health issues, and being detained can exacerbate these conditions;
- Ninety one per cent of prisoners have been diagnosed with either a mental health or substance use disorder over their lifetime.
- Between 40 and 60 per cent of youth who have offended have mental health and/or alcohol or other drug disorders.
- As at July 2017, every 24 hours Police respond to 90 calls involving a person having a mental health crisis.
These people can end up detained in police cells due to a lack of other suitable facilities and/or because mental health professionals are not available. Those in prison, youth justice residences, or care and protection residences who have serious mental health conditions should be able to access the treatment and support they require. This may include treatment in an inpatient unit when appropriate. Too often people who are detained do not receive the help they need.
The right to health is a fundamental human right. The International Covenant on Economic Social and Cultural Rights (ICESCR) states there is a right to the "enjoyment of the highest attainable standard of physical and mental health". People who experience mental health difficulties should be receiving the support and treatment they require in an appropriate manner and in the appropriate environment.
Māori
Māori make up 15.4 per cent of New Zealand’s population, but they make up a greater percentage of those detained in New Zealand;
- As at 30 June 2017, 5,171 of the prison population were Māori out of a total population of 10,260. Māori were 50.4 per cent of the prison population.
- Māori accounted for 26 per cent of mental health service users in New Zealand in 2015.
- 60 per cent of those detained in a care and protection residence, and 70 per cent of those detained in youth justice residences, are Māori.
- Māori are involved in 46 per cent of police apprehensions.
We are concerned that our criminal justice system is not responding to the needs of Māori. The Waitangi Tribunal stated that the Crown has a Treaty responsibility to reduce inequities between Māori and non-Māori reoffending rates to protect Māori interests. This responsibility requires the Crown to work in partnership with Māori, not just simply inform itself of Māori interests. Some detaining agencies are making great strides towards reducing inequities while others have some way to go. There needs to be an overarching kaupapa, bicultural frameworks, and strategies that make a real difference for Māori.
Seclusion and restraint
New Zealand has a high use of seclusion, especially when compared to other countries. For example, New Zealand secludes prisoners at a rate over four times the rate of that in England and Wales. New Zealand also uses mechanical restraints, such as tie-down beds and restraint chairs, which are no longer used in countries like England.
Studies have shown seclusion has adverse consequences. Observed effects include panic attacks, difficulties with thinking, concentration, and memory, paranoia, problems with impulse control including self-mutilation, illusions, and hallucinations, and physiological effects such as insomnia, heart palpitations, back and joint pains, appetite loss, deterioration of eyesight, diarrhoea, and tremulousness. These effects can occur after only a few days in seclusion and the risks increase with each additional day spent in seclusion. The detrimental impacts of seclusion and restraint in New Zealand have been well documented in Dr Shalev’s 2017 report Thinking Outside the Box? – A Review of Seclusion and Restraint Practices in New Zealand.
Dr Shalev’s recommendations should be fully implemented. In particular, the use of equipment such as restraint chairs and restraint beds should be abolished, the use of seclusion should be eliminated in mental health facilities, and minimum standards around decent living conditions and access to fresh air, food and drinking water should always be met.
OPCAT designations
The lack of independent monitoring of aged care and dementia facilities has been an area of particular concern. The people in these facilities often have physical and mental vulnerabilities, and there are growing concerns about the treatment of people in these facilities. Applying the OPCAT framework to aged care and dementia facilities will be beneficial.
The NPMs have supported a designation change to allow the Ombudsman to monitor and inspect locked private sector dementia facilities. We are pleased to note that these designations have recently been approved and inspections should commence in 2019/20 after the Ombudsman has scoped relevant requirements and obtained the necessary resourcing.
The NPMs support specialist monitoring of facilities that hold youth. The Children’s Commissioner should be able to monitor youth units in prisons, mothers with babies units in prisons, and child and adolescent mental health units. We will continue advocate for these designation changes.