Chief Ombudsman Peter Boshier says he is critical of seclusion because humans are "social animals". Photo / Getty Images
Māori are over-represented in seclusion practices at two mental health facilities in the Bay of Plenty District Health Board, the Ombudsman reports.
Two mental health inpatient units in Tauranga and Whakatāne were inspected by the Ombudsman last year. Reports showed seclusion events at both facilities had increased since their last inspections and there were "high rates" of seclusion, particularly for Māori patients.
Chief Ombudsman Peter Boshier urged the Ministry of Health to "address this as a matter of urgency".
"This should simply not be happening. There is absolutely no reason for Māori patients to be secluded more than any others."
A Māori health leader said the over-representation of Māori in seclusion statistics "absolutely" had to stop and showed their cultural needs were not being addressed.
The Ombudsman visited Te Whare Maiangiangi in Tauranga in July and Toki Maurere in Whakatāne in August last year.
In Tauranga, the inspection found seclusion events had increased since the last inspection, from 59 events in six months to 85 events. However, the number of hours spent in seclusion had dropped from 1413 to 883, which the Ombudsman acknowledged.
Seclusion events had also increased at the Whakatāne unit, from 26 in six months in 2018 to 39 over six months in 2021. However, data showed seclusion was generally reducing over time.
Boshier told the Bay of Plenty Times the use of seclusion needed to be "greatly reduced" at the two facilities.
He said the Tauranga facility was a 24-bed acute unit at Tauranga Hospital. During the inspection, its occupancy was 120 per cent. Forty per cent of admissions to the unit in the six-month reporting period from February to July 2021 were Māori tāngata whai ora.
Of the 46 tāngata whai ora secluded in the reporting period, 26 were Māori compared to 20 for non-Māori.
"When you look at the overall population for a start, the number of Māori being admitted is high and certainly disproportionate when it comes to seclusion."
Boshier questioned mental health authorities: "Why is this happening? What are you doing to address the base cause? How are you applying Treaty principles to see whether Māori can be treated more according to tikanga and manaakitanga."
Boshier said seclusion was when someone was alone for a period of time in a room and not able to leave.
"They're often so that people who are ... having an acute episode aren't able to harm themselves."
Seclusion rooms could be used by patients having an "acute episode" of a mental health condition such as paranoia or schizophrenia. But Boshier was critical of seclusion because humans were "social animals".
"Anyone who is locked up and lonely, your mind begins to play tricks.
"We thrive on company ... and if you're on you're own for periods of time, you would think it would make you worse than better.
"Seclusion should be an absolute last resort. We've got to look to reduce it and if possible eliminate it."
A recommendation in the report for Tauranga urged the district health board to resume planning for a new build in line with best practices for the design of mental health facilities, and in Whakatāne to "urgently" progress the rebuild.
"They've had plans to build too but it hasn't happened ... You're entitled to better facilities than you've got."
Te Mana Hauora o Te Arawa chairman Michael Naera said he knew stories from whānau who had lived experience with seclusion.
"It's terrible for them - they feel isolated, they feel lonely, they feel confused."
He said the findings of the reports showed that "the cultural needs of Māori and Pasifika aren't being looked at".
"That really concerns me. There's no korero with our whānau, there's no kaupapa Māori services for our whānau, there's no whānau support to walk with them through that process.
"This has got to stop - it absolutely has to stop."
Bay of Plenty District Health Board mental health and addiction services business leader Jen Boryer said the reports' findings had been accepted and action plans to address recommendations for improvement were in place.
"Improvements have been made in recent years such as the number of seclusion hours dropping by 41 per cent since the previous inspection, as acknowledged by the Ombudsman."
A clinical nurse specialist was also employed with a "direct focus" on seclusion reduction for Māori.
Boryer said the business case for a new unit to replace Te Toki Maurere was a "top priority" for the district health board.
"As demonstrated by the strong and repeated recommendations within the reports, facility condition and design play an important part in supporting least restrictive practices and creating therapeutic environments."
She said the district health board was committed to the Health Quality and Safety Commission work - "zero seclusion – safety and dignity for all".
Mental Health Foundation chief executive Shaun Robinson said there were "many gaps" in the mental health service but this was not an excuse for using seclusion - particularly when it was "excessively" used for Māori more than non-Māori.
Robinson said mainstream mental health services were often not "approachable", did not seem appropriate or were not there for Māori, and often Māori were seeing mental services at a "much more serious level of distress and acuteness than non-Māori ".
He said the mental health system was "so massively under-resourced" and had been "neglected for so many decades".
"We are now really at crunch point where those decades of neglect are becoming very apparent."
The Ministry of Health's acting deputy director-general of mental health and addiction Philip Grady said the Ministry was "committed to the goal of reducing and eventually eliminating seclusion".
"Our guidelines are clear: seclusion should be an uncommon event, used only when there is an imminent risk of danger to the individual or others, and when no other safe and effective alternative is possible."
Grady said there were national and local initiatives to reduce seclusion and restraints, and he was "pleased to see improvements had been made in some regions".
"However, overall there is more work to be done to address the inequitable outcomes experienced by Māori who come under the current Mental Health Act.
"The Government is currently working to repeal and replace the Mental Health Act, because it has not kept pace with the times and may have contributed to these inequities."
Grady said "significant investment" had been allocated to upgrading current mental health and addiction facilities, as well as building new ones.
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