Report on an unannounced inspection of Rangipapa Forensic Acute Mental Health Unit, Rātonga-Rua-O-Porirua Campus, under the Crimes of Torture Act 1989

Executive summary

Background

Ombudsmen are designated as 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 clients[1] detained in secure units within New Zealand hospitals.

Between 14 and 16 July 2020, two Inspectors[2] — whom I have authorised to carry out visits to places of detention under COTA on my behalf — made an unannounced inspection of Rangipapa Mental Health Inpatient Unit (the Unit), which is located in the grounds of Rātonga-Rua-O-Porirua Mental Health Campus, Porirua.

Summary of findings

My findings are:

• There was no evidence that clients had been subject to torture or other cruel or inhuman treatment or punishment.
• Clients spoken with felt safe and that they were treated with dignity and respect.
• There were no instances of seclusion or restraint in the six months prior to the inspection.
• Files contained the necessary paperwork to detain and treat clients on the Unit, with the exception of one client.
• Consent to treatment forms were on file for all clients.
• The complaints process appeared to be well understood by staff and clients. Clients had a good understanding of the District Inspectors’ role.
• Access to leave was encouraged and well utilised.
• Clients were invited to attend their Huihui multi-disciplinary team meetings and provided with feedback of the outcomes of these meetings.
• Worn and damaged carpets had been replaced.
• There were no concerns about the quality or quantity of the meal service.
• There was a wide range of activities available to clients, including group and 1:1 settings.
• Cultural and spiritual support was evident and well received by clients.
• Access to visits and communication was good, including during COVID-19 Alert Levels 4, 3 and 2.[3] Clients had individualised phone plans and could make calls in private.
• Clients had access to primary health care services.
• Staff were identifiable on the Unit.

The issues that needed addressing are:

• Seclusion rooms were being used as bedrooms. This may amount to degrading treatment and a breach of Article 16 of the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (‘Convention against Torture’).[4]
• Female clients were spending prolonged periods of time in seclusion rooms, due to lack of available bedrooms on the Unit.
• Female clients were being admitted directly into seclusion rooms.
• Female clients were 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.
• The outside area in Rangimārie did not have any seating or shade.
• Night Safety Orders (NSOs)[5] were not being recorded as seclusion events and NSO paperwork did not clearly specify the reasoning or rationale for their use.
• Record keeping surrounding the use of NSOs was inconsistent and incomplete. It was difficult to assess when an NSO had been implemented and subsequently terminated. There was also evidence of NSOs being used outside of the period for which they were in force.
• Clients could not access complaint forms independent of staff.
• Client files were generally disorganised and forms were inconsistently completed.
• The Unit had a number of ongoing maintenance issues, including faulty air conditioning and leaks.
• Clients did not have independent access to secure courtyards.
• The courtyard in Aniwaniwa was small, had minimal seating, and did not provide adequate shade.
• Clients were unable to access hot drinks independent of staff.
• The Unit had a high and increasing rate of staff turnover.

Recommendations

I intend to monitor the implementation of my recommendations, including conducting follow-up inspections at future dates. 

Feedback meeting                                              

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

The Service’s Operations Manager and the Acting Director of Area Mental Health Services Forensic and Rehabilitation Service provided Inspectors with additional information about this and two other Te Korowai Whāriki Units[7] inspected at the same time.

They told my Inspectors they faced challenges with COVID-19, recruitment, and service demand.[8] They were aware of a growing waitlist of acutely unwell people in prisons and the community, compounded by patients being directed to the Service by Courts.[9] They said this resulted in:

• patients being admitted to the Service with high needs, requiring more staff attention than those admitted in a timely manner;
• a shortfall of beds, leaving patients accommodated in spaces other than bedrooms, affecting their dignity and privacy;
• increased risks to patients and staff, and
• diminishing staff morale.

District Health Board response

The Capital and Coast District Health Board (the DHB) received a copy of my provisional report and were invited to comment. The DHB responded and I have had regard to that feedback when preparing my final report.

The DHB’s letter and comments responded to a number of common themes from my inspections of the Unit and two other units in the DHB which were conducted at the same time[10], in particular around the use of seclusion rooms as bedrooms and ongoing reliance on night safety procedures (NSPs).

The DHB emphasised that 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.

While I acknowledge the comments, my role as an NPM is to report on the conditions and treatment for people who are being detained, as they are at the time of the inspection. I have, however, highlighted my concerns with the Ministry of Health.[11] I also intend to conduct follow up inspections of all the Units.