Report on an announced inspection of Manaakitanga Inpatient Unit, Te Nīkau Grey Base Hospital, under the Crimes of Torture Act 1989

Executive summary

Background

Ombudsmen are designated one of the National Preventive Mechanisms (NPMs) under the Crimes of Torture Act 1989 (COTA), with responsibility for examining and monitoring the conditions and treatment of patients[1] detained in secure units within New Zealand hospitals.

Between 20 and 23 April 2021, two inspectors[2], whom I have authorised to carry out visits to places of detention under COTA on my behalf, made an announced inspection of Manaakitanga Inpatient Unit (the Unit), which is located in the grounds of Te Nīkau Grey Base Hospital, Greymouth.

Patients receive acute mental health services provided by West Coast District Health Board’s (DHB’s) Adult Mental Health Services (the Service).

Summary of findings

My findings are:

• There was no evidence that any patient had been subject to torture or other cruel, inhuman or degrading treatment or punishment.
• The Unit had devoted significant time and energy to reducing the levels of seclusion, and staff in the Unit appeared to be genuinely committed to Zero Seclusion.
• The Unit recorded every instance of locked doors as environmental restraint. Processes for implementing and recording environmental restraint were robust.
• The Unit’s response to the complaint received in the reporting period was thorough, personalised, and addressed the concern raised.
• Files contained the necessary paperwork to detain and treat patients on the Unit.
• The Unit had robust procedures to ensure voluntary patients could enter and exit the Unit at will.
• The Unit was generally clean, tidy and well maintained. The Unit had new furnishings, which was a positive development since my predecessor’s previous inspection in 2015.[3]
• The Unit had an Occupational Therapist (OT) who was responsible for the wellbeing programme which provided structured daily activities. Staff were complimentary of the work done by the OT to increase the activities available to patients on the Unit.
• Cultural and spiritual support was available for patients on the Unit.
• Patients were able to keep and use their cell phones, unless there was a specific reason not to.
• Staffing numbers had increased. Staff said they felt safe and were positive about the leadership of the Unit.

The issues that need addressing are:

• The seclusion area was stark and blinds in the seclusion room could not be independently controlled by patients.
• In the six months prior to the inspection, a patient under the age of 18 was secluded. There was not clear evidence of robust processes to ensure that young people were secluded only as a last resort where all other methods have been exhausted and failed.
• Security personnel had been involved in several restraint events in the reporting period, including where medication had been administered through intramuscular injection (IMI).
• The needs of female patients did not appear to be met by the involvement of male security personnel in seclusion and restraint events.
• Approximately half of the staff were out-of-date with their Safe Practice Effective Communication (SPEC) training[4] at the time of the inspection.
• There was no information about the Complaints Procedure on display on the Unit.
• Consent paperwork for voluntary patients was not always fully completed.
• The paperwork for voluntary patients indicated leave restrictions were placed on voluntary patients.
• Patients and their whānau were not invited to their multi-disciplinary team (MDT) meetings.
• The Unit was not purpose built for its function as an acute mental health inpatient unit. This meant, among other things, there was a lack of appropriate spaces to accommodate different groups of people.
• The low stimulus area was not fit for purpose as a bedroom.
• The potential for patients to share double rooms was inappropriate.
• There was scope to further incorporate tikanga Māori and cultural support in the Unit’s day-to-day operations.
• There was a no process for consultation with other patients when whānau were to stay on the Unit. 
• The lock was not functioning on one of the medication cupboards, where another part of the mental health service was storing controlled medications.

Recommendations

Follow up inspections will be made at future dates to monitor implementation of my recommendations.

Feedback meeting

On completion of the inspection my Inspectors met with representatives of the Unit’s multi-disciplinary team to outline their initial observations.

Consultation

The West Coast District Health Board (DHB) and the Ministry of Health received a copy of my provisional report and were invited to comment. The DHB Mental Health Service and the Ministry of Health responded and I have had regard to that feedback when preparing my final report. I am grateful to the DHB Mental Health Service and the Ministry for their input, which has contributed positively to my final report.