Report on an unannounced inspection of Waiatarau Mental Health Inpatient Unit, Waitakere 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 service users[1] detained in secure units within New Zealand hospitals.

Between 19 and 22 November 2019, three Inspectors[2] — whom I have authorised to carry out visits to places of detention under COTA on my behalf — made an unannounced inspection of Waiatarau Mental Health Inpatient Unit (the Unit), which is located in the grounds of Waitakere Hospital Campus, Auckland.

Summary of findings

My findings are:

  • There was no evidence that any service user had been subject to torture or other degrading treatment or punishment. However, I found evidence that some service users were subject to cruel or inhuman treatment due to long-term inappropriate placement in the Intensive Care Unit.
  • Service users felt safe on the Unit.
  • The Service had adopted the Safewards approach,[3] which was well embedded on the Unit.
  • Induction and admission processes were comprehensive, with multi-disciplinary input.
  • Files contained the necessary paperwork to detain and treat service users on the Unit.
  • The use of seclusion and restraint was low.
  • District Inspector contact details were displayed on the Unit.
  • Accommodation was generally clean and tidy.
  • Service users had their own bedrooms, which they could lock.
  • Service users had free access to the courtyards and fresh air throughout the day.
  • A range of activities and programmes were available on the Unit.
  • The Service had recruited staff to provide activities and programmes for evenings and weekends.
  • Service users had access to primary health care services.
  • Staff were complimentary about the Unit’s leadership team. Leadership on the Unit was visible and staff felt supported.

The issues that needed addressing are:

  • The long-term inappropriate placement of service users with high and complex needs and/or intellectual disabilities on the Unit.
  • The long-term inappropriate placement of a service user in the Intensive Care Unit amounted to cruel or inhuman 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]
  • Service users with high and complex needs and/or intellectual disabilities were subject to restrictive management plans.
  • Window blinds in the seclusion room were not operational.
  • Service users 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 and the observation room, which posed a serious risk to service users’ privacy and dignity.
  • Service users in seclusion were unable to maintain orientation to date and time.
  • The Door Locking: Egress of Adult Inpatient Unit Doors Policy was out-of-date.
  • Leave restrictions were placed on voluntary service users.
  • Some staff lacked understanding of what constituted ‘environmental restraint’, and were not recording when environmental restraint was applied.
  • The complaints process, as well as complaint forms, were not displayed on the Unit or readily accessible to service users or their whānau.
  • Consent to Treatment forms were not completed.
  • Service users did not attend Multi-Disciplinary Team (MDT) meetings and were not routinely provided feedback of the outcomes.
  • Some soft furnishings and carpets were damaged and worn.
  • Courtyards and communal areas required maintenance.
  • Bathroom facilities were in a poor state of repair.
  • Food service from the main hospital was poor.
  • There was no dedicated family/whānau liaison on the Unit to provide consistent information and support to whānau.
  • Cultural support and provision was limited on the Unit.

Recommendations

I recommend that:

  1. The DHB continues to work with external agencies to minimise the need for service users with high and complex needs and/or intellectual disabilities to be accommodated on the Unit if no longer acutely unwell.
  2. Service users are not kept in the ICU for prolonged periods of time, unless clinically appropriate.
  3. Service users are not managed in an excessively restrictive manner.
  4. The window blinds in the seclusion room be made operational.
  5. Measures are taken to ensure that service users in seclusion cannot be viewed when urinating or defecating.
  6. A permanent fixture be installed to allow service users in seclusion to orientate to day and time.
  7. The DHB’s Door Locking: Egress of Adult Inpatient Unit Doors Policy be reviewed, and updated.
  8. Leave restrictions are not placed on voluntary service users.
  9. Staff receive training on ‘environmental restraint’ and its use is accurately recorded in the restraint register.
  10. The complaints process, including complaint forms, is well advertised and accessible to service users on the Unit, and their whānau.
  11. Service user consent to treatment forms be completed.
  12. Service users are invited to attend their MDT meetings, where appropriate.
  13. Damaged furniture and worn carpets should be replaced. This is a repeat recommendation.
  14. Maintenance issues are attended to (with particular attention to bathroom facilities).
  15. The quality of the meal service is improved.
  16. The Service allocate dedicated resources to family/ whānau liaison.
  17. Integrated cultural support and provision be made available to service users on the Unit.

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]     A person who uses mental health and addiction services. This term is often used interchangeably with consumer and/or tāngata whai ora. See Mental Health Foundation.

[2]     When the term Inspectors is used, this refers to the inspection team comprising of a Senior Inspector, Inspector and Specialist Advisor.

[3]     Safewards is a model of care, developed in the United Kingdom, designed to reduce conflict (aggression, rule breaking) and containment (coerced medications, restraint and seclusion) in acute adult mental health inpatient units. For a more comprehensive description of the Safewards model, go to the Safewards website at: http://www.safewards.net/

[4]     UN Convention against Torture, Article 16(1): “Each State Party shall undertake to prevent in any territory under its jurisdiction other acts of cruel, inhuman or degrading treatment or punishment which do not amount to torture as defined in article I, when such acts are committed by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. In particular, the obligations contained in articles 10, 11, 12 and 13 shall apply with the substitution for references to torture of references to other forms of cruel, inhuman or degrading treatment or punishment.”

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