Report on an unannounced follow up inspection of Wards 34, 35 and 36, Waikato Hospital, under the Crimes of Torture Act 1989

Foreword

This report sets out my findings and recommendations concerning the treatment and conditions of service users detained in Wards 34, 35 and 36 (the Wards). The Wards are located in the Henry Rongomau Bennett Centre (HRBC) on the Waiora Waikato Hospital campus, Hamilton.

In the Wards, service users receive acute mental health services provided by the Waikato District Health Board’s (DHB’s) Mental Health and Addiction Service (the Service). The HRBC also comprises forensic mental health services, which is provided by the Puawai Midland Regional Forensic Service.

This report has been prepared in my capacity as a National Preventive Mechanism (NPM) under the Crimes of Torture Act 1989 (COTA). In 2007, the Ombudsmen were designated one of the NPMs under the COTA, with responsibility for examining and monitoring the treatment and conditions of detained service users in the relevant places of detention. My responsibility includes hospital units in which service users are detained.

The report examines the Wards’ progress implementing the 12 recommendations I made in 2017. It also includes findings on the conditions and treatment of service users detained in the Wards at the time of my follow up inspection on 16 – 20 September 2019, resulting in
19 recommendations.

I found that of the 12 recommendations I made in 2017, three had been achieved and nine had not been achieved.

During the follow up inspection, I found that:

• All seclusion rooms had natural light.
• The Service had developed a management and contingency plan to address the occupancy levels in the Wards.
• The Service had implemented a structured activities programme in Ward 36 and, to a lesser degree, in the Low Stimulus Area (LSA).

The issues that needed addressing are:

• There continued to be a lack of privacy for service users held in seclusion rooms.
• The Wards were still regularly over occupancy. Seclusion rooms, interview rooms and whānau rooms were still being used to accommodate service users when the Wards were over occupied.
• Restraint data remained inaccurate.
• Service users being placed on ‘sleepovers’ to other wards across the Service when the Wards were over occupancy.
• The Service did not record information on the movement (sleepovers) of service users across the Service.
• The high and increasing use of seclusion, particularly for Māori service users.
• The use of ‘safety gowns’ for service users in seclusion was common practice and documentation on their use did not adhere to the DHB’s Seclusion Procedure.
• The DHB’s Restraint Policy and Restraint – Wrist and/or Ankle Procedure were out-of-date.
• The Service did not record information on the ethnicity of service users who had been restrained.
• The high and increasing use of restraint, particularly mechanical restraint, across the Wards.
• Contact details for the District Inspector were not displayed in the Wards.
• The process to enter/ exit locked Wards was not visible to service users and visitors.
• Service users being placed in shared bedrooms were afforded little privacy.
• Bathroom facilities were in a poor state of repair.
• Staff were not recording service users’ access to fresh air on the Wards.
• The process for service users to access a telephone in Ward 36 and the LSA was not displayed.
• Restrictive practices, such as ‘lock downs’, on Ward 36 and the LSA when staff suspected that a service user had prohibited items.
• The activities programme on Ward 36 and the LSA was not available to service users on evenings or weekends.
• Service users did not have free access to fresh air.

As a result of my follow up inspection, I make 19 recommendations to improve the conditions and treatment of service users. Disappointingly, nine of these are repeat recommendations.

While it is encouraging that the DHB has announced recently approved funding for a new purpose-built mental health facility, I believe the current situation at the adult acute mental health service is untenable. Lack of privacy, high use of seclusion and restraint, inappropriate placements of service users, restrictive practices, compromised care and limited opportunity for recovery are indicators of a facility in crisis.

The ongoing issue of over occupancy across the Wards, and the resulting impacts, is not only unsustainable, but unsafe for service users and staff, which I consider to be degrading treatment and a breach of Article 16 of the Convention against Torture.

It is clear that while a long-term plan must be implemented to make service wide and sustainable changes, the Service needs to immediately introduce new ways of collaborating and planning to address the current pressures.

I will be assessing the Service’s progress in implementing the recommendations in this report with another inspection at a future date.

I wish to express my appreciation to the Operations Manager and staff of the Wards for the full co-operation they extended to my Inspectors. I also acknowledge the work involved in collating the information they requested.