Acute mental health facilities ‘not fit for purpose’

The Chief Ombudsman Peter Boshier says two of three acute care mental health inpatient facilities inspected last year are not fit for purpose and one urgently needs to be upgraded. However, he says a third, newly rebuilt unit, is a fine example of a modern and therapeutic environment for service users.

Boshier has released three reports following inspections of Te Whare Ahuru in Hutt Valley, Tiaho Mai on the grounds of Auckland’s Middlemore Hospital and STAR 1, in Palmerston North Hospital.

The inspections were carried out under the Crimes of Torture Act 1989. New Zealand is a signatory to the Optional Protocol to the Convention against Torture (OPCAT), an international human rights agreement.

Boshier says the building housing Te Whare Ahuru Acute Inpatient Unit at Hutt Hospital is not fit for purpose and the standards of cleanliness and maintenance are inadequate.

“I have made an amended repeat recommendation that the building is upgraded as a matter of urgency, and that cleanliness and facilities maintenance issues are attended to as a matter of priority,” says Boshier.

He also says there has been potentially degrading treatment at Te Whare Ahuru, which was inspected in March last year.

“There were some concerning findings in the report, such as an incident in which a service-user could not access a bathroom and had an undignified incident as a result,” he says.

“I am also disappointed about the ongoing use of non-designated rooms, including seclusion rooms, as bedrooms when the unit is over occupancy. I consider this completely inappropriate. In no other area of a hospital would you expect to see people sleeping in such environments, and nor do I expect to see service users in mental health facilities treated this way.”

Boshier has recommended the issue of over-occupancy is addressed as a matter of urgency and that non-designated rooms should never be used as bedrooms. Hutt Valley District Health Board accepted 12 of the 18 total recommendations made by the Chief Ombudsman, partially accepted five and rejected one.

The STAR 1 (Services for Treatment, Assessment and Rehabilitation) psychogeriatric unit at Palmerston North Hospital has also been found to be not fit for purpose for a number of reasons.

Boshier says the unit has an institutional feel and lacks space for group activities, has no dining room or kitchen for patients, no quiet communal areas, an unsafe outdoor area to which access is restricted and a small and poorly resourced patient lounge.

Concerningly, the use of restraint had increased since the unit was moved to a new location in June last year, Boshier says. The unit was inspected in September last year.

“My report makes two amended repeat recommendation to STAR 1 about the environment not being fit for purpose and not conducive to improving the wellbeing of the service users,” says Boshier.

“The environment was a reason given for the increased use of restraint in the unit. If not addressed, this may affect treatment and conditions.”

MidCentral District Health Board accepted four of the five recommendations made and partially accepted the other.

Meanwhile, the rebuilt Tiaho Mai Mental Health Inpatient Unit, which was inspected in June last year, showed the positive impact of a purpose-built and fit for purpose facility environment.

“I was pleased to find that the new facilities were light, modern, therapeutic, and considered in their design,” Boshier says.

“In my opinion it is a model for recovery and service user-centred care and the thoughtful design of the admission suite, in particular, is commendable.”

However, Boshier says that although his report is largely complimentary, there are aspects of the unit’s administration that need addressing. These include incomplete collation and reporting of seclusion and restraint data. In addition, voluntary service users had no information about the process for coming and going from the unit at will as they are entitled to.

The Chief Ombudsman has made 15 recommendations. Three of them were repeat recommendations from the previous inspection report in 2015. Counties Manukau District Health Board accepted all but one.

“Units such as these provide care for some of our most vulnerable and unwell people. It is crucial that they meet the standards of care and therapy we as a society expect,” Boshier says.