Report on an unannounced inspection of Tumanako Mental Health Inpatient Unit, Whangarei Hospital, under the Crimes of Torture Act 1989

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Executive summary

Background

In 2007, the Ombudsmen were 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 tāngata whai ora[1] detained in secure units within New Zealand hospitals.

Between 9 December and 13 December 2019, Inspectors[2] — whom I have authorised to carry out visits to places of detention under COTA on my behalf — made an unannounced inspection of Tumanako Mental Health Inpatient Unit (the Unit), which is located in the grounds of Whangarei Hospital Campus, Whangarei.

Summary of findings

My findings are:

  • There was no evidence that any tāngata whai ora had been subject to torture or other cruel, inhuman or degrading treatment or punishment.
  • Tāngata whai ora felt safe on the Unit.
  • Tāngata whai ora described positive interactions with staff and felt respected by staff.
  • The Whakaora training programme[3] was having a positive impact on reducing the use of seclusion on the Unit.
  • There had been a significant reduction in the use of restraint on the Unit.
  • Files contained all the necessary legal paperwork to detain and treat clients on the Unit.
  • District Inspectors’ contact details were well advertised on the Unit with a brief description of their role.
  • The Unit was clean, tidy and well maintained.
  • Activities areas were equipped and well utilised.
  • The activities programme operated seven days a week with extended hours.
  • Courtyards were accessible most of the time and there was good access to escorted leave.
  • The Unit activities areas and courtyards were unlocked, and were only locked when this was clinically indicated based on individualised risk assessment.
  • The role of the General Focus Nurse appeared to be a positive addition to the team.
  • The diversity of Unit staff, in particular the number of Māori staff, is having a positive impact on the tāngata whai ora on the Unit.
  • The initiative of the Mental Health Auxiliary Worker (MHAW) Team Leader role appeared to be having a positive impact on the functioning of the Unit, with MHAW fully integrated into the Multi-Disciplinary Team (MDT).
  • Staff generally felt well supported.

The issues that needed addressing are:

  • The window blinds in the seclusion rooms were not operational.
  • Tāngata whai ora in seclusion were provided with a cardboard receptacle in which to urinate or defecate. Inspectors noted the receptacle was visible from the seclusion door window, which posed a serious risk to service users’ privacy and dignity.
  • The intercoms in the seclusion rooms were not operational.
  • Voluntary tāngata whai ora had leave restrictions.
  • Tāngata whai ora were not invited to their MDT meetings.
  • Fifty eight percent of staff were out of date with their Safe Practice Effective Communication Training.
  • The complaints process and complaints forms were not available to tāngata whai ora on the Unit.
  • Voluntary tāngata whai ora did not have consent documentation on file for admission to a locked ward.
  • The High Dependency Unit (HDU) lounge area was being used as a thoroughfare for cleaning trolleys and other deliveries to the Unit.
  • An interview room with no natural light, ventilation, or privacy, was being used as a bedroom in the HDU.
  • Tāngata whai ora did not have access to a telephone independent of staff.
  • Tāngata whai ora had no privacy when making telephone calls.
  • The Unit had a high number of medication errors.

Recommendations

I recommend that:

  1. The window blinds in the seclusion rooms be made operational.
  2. The toilet in the seclusion area is accessible by tāngata whai ora in seclusion, unless deemed unsafe based on individual risk assessment. If a tāngata whai ora is not permitted access to the toilet, the reasons are recorded and regularly reviewed.
  3. The intercom in seclusion be made operational.
  4. Leave restrictions are not placed on voluntary tāngata whai ora.
  5. Tāngata whai ora admitted to the Unit on a voluntary basis consent to admission to a locked ward, and this is documented.
  6. Tāngata whai ora are invited to attend their multi-disciplinary team meeting, wherever possible, and be routinely informed of the outcome of their review.
  7. All relevant staff are up to date with their SPEC training. This is an amended repeat recommendation.
  8. The complaints process, including complaint forms, are well advertised and accessible to tāngata whai ora on the Unit and their whānau.
  9. The HDU is not used as a thoroughfare.
  10. The converted room in the HDU is not used as a bedroom. This is an amended repeat recommendation.
  11. Tāngata whai ora have access to a telephone, independent of staff, unless deemed unsafe based on individual risk assessment.
  12. Tāngata whai ora have privacy when making telephone calls.
  13. The DHB continues to actively monitor and work to reduce the level of medication errors.

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 leadership team, to outline their initial observations.


[1]     ‘Tāngata whai ora’ is a person who uses mental health and addiction services. This term is often used interchangeably with ‘consumer’ or ‘service user’.

[2]     When the term ‘Inspectors’ is used, this refers to the inspection team comprising of two Senior Inspectors.

[3]     ‘Whakaora’ is a training programme aimed at upskilling Tumanako HDU frontline staff to improve morale, reduce seclusion and support less experienced staff.

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