Report on an unannounced follow up inspection of Te Whare Maiangiangi Unit, Tauranga Hospital, under the Crimes of Torture Act 1989 Primary tabs
This report sets out my findings and recommendations concerning the conditions and treatment of people detained in Te Whare Maiangiangi Acute Mental Health Inpatient Unit (the Unit), which was inspected on 16 and 17 August 2021. The Unit is located on the grounds of the Tauranga Hospital campus, Tauranga.
In the Unit, tāngata whai ora receive acute mental health services provided by the Bay of Plenty District Health Board’s (DHB’s) Mental Health and Addiction Service (the Service).
This report has been prepared in my capacity as a National Preventive Mechanism (NPM) under the Crimes of Torture Act 1989 (COTA). Ombudsmen are designated as one of the NPMs under the COTA, with responsibility for examining and monitoring the conditions and treatment of detained people in the relevant places of detention. My responsibility includes hospital units in which people are detained.
This report examines the Unit’s progress implementing the 14 recommendations I made in 2018. It also includes findings on the conditions and treatment of tāngata whai ora who are or may be detained in the Unit at the time of my follow up inspection on 16 – 17 August 2021, resulting in 16 recommendations.
I found that five of the 14 recommendations I made in 2018 had been achieved and nine had not been achieved.
Overall, during the follow up inspection I found that:
- Tāngata whai ora had the necessary legal documentation to be detained and treated in the Unit.
- As an alternative to smoking, vapes could now be used in the Intensive Psychiatric Care (IPC) area and were provided to tāngata whai ora at no cost. Vaping was allowed in the IPC courtyard, and education was provided on vaping and smoking.
- Visiting hours were generous and there appeared to be a measure of flexibility.
The issues that need addressing are:
- Seclusion rooms and the admissions/day room were still being used as bedrooms.
- Tāngata whai ora were being secluded in the IPC courtyard.
- The IPC area is outdated and no longer fit-for-purpose.
- The number of seclusion events in the Unit was high.
- The Unit, which was designated as an open unit, was locked at the time of inspection. This was not being recorded as environmental restraint.
- The courtyard on the ‘open’ side of the Unit was locked throughout the inspection. This was not being recorded as environmental restraint.
- There was no signage for entry and exit at the Unit for voluntary tāngata whai ora (or those tāngata whai ora with approved leave) or visitors.
- Tāngata whai ora spoken with said they did not feel the Unit communicated well or engaged them in their treatment. Tāngata whai ora and their whānau were not invited to attend their multi-disciplinary team (MDT) meetings. Treatment plans viewed by Inspectors were not completed or signed.
- The complaints process was not widely understood by tāngata whai ora or accessible independent of staff.
- There were no completed Consent to Treatment forms on the files of tāngata whai ora.
- Contact details for District Inspectors were not visible on the ‘open’ side of the Unit or the IPC area.
- Bedroom doors could not be locked independently of staff.
- There was no discrete bedroom area for female tāngata whai ora on the Unit to ensure privacy and safety.
- The Unit was not fit-for-purpose.
- The Unit regularly ran over capacity.
- Information about visiting hours for the Unit was inconsistent.
- Adequate privacy was not provided to patients when using the telephone on the ‘open’ side of the Unit or in the IPC area.
- Staff recruitment was an issue for the Unit.
As a result of my follow up inspection, I make 16 recommendations to improve the conditions and treatment of the Unit’s tāngata whai ora. Disappointingly, nine of these are repeat recommendations.
As a result of my 2021 follow up inspection, I recommend:
 ‘Tāngata whai ora’ is used to refer to persons who are the subject of care, assessment and treatment processes in mental health. It means ‘a person seeking health’. This term is often used interchangeably with consumer and/or service user.
 See OPCAT Report on an unannounced inspection to Te Whare Maiangiangi under the Crimes of Torture Act 1989, for my 2018 Report findings and recommendations. The DHB has a full copy of this report.
 The ‘open’ side of the Unit comprises a 20 bed open unit.
 Environmental restraint is where a service provider(s) intentionally restricts a service user’s normal access to their environment, for example where a service user’s normal access to their environment is intentionally restricted by locking devices on doors or by having their normal means of independent mobility (such as wheelchair) denied. Health and Disability Services (Restraint Minimisation and Safe Practice) Standards. Ministry of Health. 2008.