Tumanako Mental Health Inpatient Unit at Whangārei Hospital went through a thorough inspection by the Ombudsman. Photo / Supplied
Lack of privacy, out-of-date staff training and medication errors are some of the flaws highlighted in a report examining Northland's 29-bed inpatient mental health unit, Tumanako.
However, the report also found there was no evidence tāngata whai ora (patients) had been subject to cruel, inhuman or degrading treatment or punishment - which had been found in two facilities in Wellington and Auckland.
The report on Northland's facility was one of five released by Chief Ombudsman Peter Boshier which examined five secure acute mental health units across the country.
Head to www.ombudsman.parliament.nzfor a copy of the report.
The Te Whare o Matairangi Mental Health Inpatient Unit at Wellington Hospital and the Waiatarau Mental Health Inpatient Unit at Waitakere Hospital were both found to have breached the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
The breaches concerned using seclusion rooms - an area from which tāngata whai ora cannot freely exit - as bedrooms (Wellington), and using the intensive care unit as long-term accommodation for a patient (Auckland).
In an unannounced inspection, officials visited Whangārei's Tumanako in December last year and found no evidence of a breach of the convention and described how tāngata whai ora felt safe and respected.
However, the report detailed a number of serious flaws at Tumanako and deemed one in particular as a potential breach of the convention.
This concerned how tāngata whai ora in seclusion rooms - which contained a mattress on the floor and a cardboard receptacle as a toilet - could be viewed through the door's window as they used the toilet.
While he acknowledged the need to observe tāngata whai ora in seclusion rooms, Boshier stated the "ability to view tāngata whai ora in seclusion urinating or defecating poses a serious risk to their privacy and dignity".
The report also identified a lack of updated training for staff. It found 43 of the 74 staff were out-of-date with their Safe Practice Effective Communication refresher training, which was designed to reduce the incidence of restraints - when a staff member restricts the normal freedom of movement of tāngata whai ora.
This issue had been highlighted in a previous inspection of the facility in 2015.
The report cited data from the facility that between June 1 and November 30 last year, there were 11 events of restraint involving seven tāngata whai ora, which was significantly lower than in the 2015 inspection which found 74 restraint events had occurred involving 10 tāngata whai ora.
Incidents of tāngata whai ora placed in seclusion had risen between 2015 and 2019, rising from 60 incidents involving 37 tāngata whai ora for a total of 1322 hours to 65 incidents involving 47 tāngata whai ora for a total of 1988 hours.
However, Northland District Health Board data showed seclusion incidents had steadily reduced from June to November in 2019, which Boshier commended.
Another issue was how an interview room with no natural light, ventilation or privacy was being used as a bedroom in the high dependency unit (HDU) - an issue also highlighted in the 2015 inspection.
In response to the report's recommendation not to use the room as a bedroom, NDHB said it was only used as a bedroom when there was no alternative space. But Boshier said the room was still not fit for use as a bedroom, even as a last resort.
Boshier also expressed concern over the 22 incidents of medication error, such as prescribing incorrect medication, during the same six-month period - given its potential to cause significant harm.
The report did highlight a number of positives within the facility. Tāngata whai ora described positive interactions with a well-diversified staff, the unit was clean and well-maintained, and activity areas were equipped and well-utilised.
Northland District Health Board mental health and addiction services general manager Ian McKenzie said the majority of the recommendations made in the report had been acted on.
While he acknowledged the problems in the facility, McKenzie was glad to see a number of positive findings.
With reference to the out-of-date training, McKenzie said at the time of the inspection, there was an issue with availability of trainers, which had since been resolved.
Despite Boshier's insistence the HDU interview room was not fit for use as a bedroom, McKenzie confirmed it would still be used as such but only in rare circumstances to avoid tāngata whai ora from having to stay in the community or with emergency services.
"We only use it when we have no alternative space within the intensive care area and only for the shortest time possible to accommodate acutely unwell tāngata whai ora who require admission to that area," he said.
McKenzie also confirmed there were no current plans to implement further measures to ensure tāngata whai ora in seclusion were not viewed as they used their cardboard toilet.
Given how NDHB policy dictated continuous observation was needed for tāngata whai ora in seclusion, McKenzie said their safety had to be prioritised in this case.
"Unfortunately - like many other areas of the hospital - the level of care required in this area does mean that safety concerns are paramount."
However, he did clarify there was a private toilet available to tāngata whai ora in seclusion and he was confident no tāngata whai ora would see each other using their in-room toilet.
McKenzie did accept the medication errors were a concern.
"We acknowledge that any medication error of any nature is of concern, and consideration is given to the type of error and the impact this has on the patient."
In 2019, a total of 49 medication errors were reported. McKenzie said he was pleased 88 per cent (43) were considered to have caused no harm to the patient, with just one having caused temporary harm.
Ngati Kahu Social and Health Services chief executive Marihi Langford, whose organisation aimed to support mental wellbeing for its community, was largely pleased with the findings of the report, particularly as they related to staff.
"When [tāngata whai ora] go into Tumanako, they are not in a well state and from my experience, they tell us they have high anxiety, but for them to say that they've actually enjoyed their time there, that says something about the staff, they are obviously quite respectful," she said.
However, Langford said the idea of tāngata whai ora being watched as they used the toilet was terrible.
"If you think about it as your family member who's in there, they are still entitled to their basic rights of privacy."
She did highlight the number of medication errors as a problem, one which was not helped by people who didn't want to take medication in the first place.
"One thing about our mental health whānau is that they don't actually like taking the medication, and that's why they end up in the inpatient unit in the first place."