Chief Ombudsman Peter Boshier said it was unacceptable painful restrains were still being used to control people with intellectual disabilities at the Mason Clinic. Photo / Supplied
Chief Ombudsman Peter Boshier said it was unacceptable painful restrains were still being used to control people with intellectual disabilities at the Mason Clinic. Photo / Supplied
The Chief Ombudsman has made 11 recommendations to a forensic psychiatric facility in Auckland, criticising their use of wrist locks and prone (floor) restraints on intellectually disabled patients, calling it "unacceptable".
But the clinic's overseeing health agency says the use of wrist locks and prone (floor) restraints are sometimes necessary in especially volatile situations where there is a risk of harm to self or others.
Peter Boshier said it was unacceptable painful restraints were still being used to control people with intellectual disabilities at Mason Clinic's Pohutukawa Forensic Intellectual Disability Unit.
Auckland's Mason Clinic Regional Forensic Psychiatric Services was "one of the few" in New Zealand to still use these techniques, he said.
In a report released today, Boshier made 11 recommendations to unit management and Waitematā District Health Board.
Eight were accepted and three rejected, including a recommendation to end the use of wrist locks and prone (floor) restraints.
"The service says the use of wrist locks, which can cause pain, and prone (floor) restraint, in which the care recipients are restrained with a staff member's body, are the most effective way of establishing and maintaining a safe environment.
"I understand that some individuals have challenging behaviour but there are other de-escalation techniques and methods available that would reduce the risk of pain for care recipients," Boshier said.
"The clinic's own policy states that the use of wrist locks and prone restraints will be eliminated by 2020 but they were still being used in April 2021.
"This is not good enough. At the very least the clinic should implement its own policy to ensure that restraint training aligns with human rights standards."
Other issues identified at the unit included that some care recipients - mostly female - were unable to be accommodated and were sent to other units at the Mason Clinic.
Senior management told the Ombudsman female care recipients were routinely placed in other units due to capacity issues, the physical layout of the Pohutukawa unit and lack of gender separation, and the significant risk factors posed by other male care recipients.
As a result, female care recipients were receiving mental health rather than intellectual disability care, Boshier said.
"In my view, it is inappropriate for care recipients to be placed in other units due to operational and environmental constraints within the service. I will be monitoring this in future inspections."
Te Whatu Ora- Waitematā said the agency had reviewed the report and its recommendations, some of which were administrative or procedural by nature and would help them to continue to provide a level of care that "is safe and consistent with our legal obligations".
The Mason Clinic's overseeing health agency says wrist locks and prone restraints are sometimes necessary in especially volatile situations with a risk of harm to self or others. Photo / Dean Purcell
"The Ombudsman's report acknowledges the therapeutic approach to calming service-users within the unit using sensory items, activities and the provision of cultural support. These methods, part of good clinical care and consistent with Safe Practice and Effective Communication (SPEC) techniques, are very effective in many circumstances and it is pleasing to see their use acknowledged.
"We do not consider SPEC techniques to be robust enough to ensure the high level of safety we require in a forensic setting with this particular cohort of individuals.
"Used sparingly and by professionally trained staff, the use of wrist locks and prone (floor) restraints are, therefore, sometimes necessary in especially volatile situations where service-users are likely to harm themselves or others."
Te Whatu Ora- Waitematā said it was working with the SPEC National Governance Group on additional training options for these exceptional circumstances.
"Our combined efforts in this area will provide valuable guidance around the use of wrist lock and prone floor restraints in the future.
"This work was delayed in early 2022 for Covid-19-related reasons and we look forward to seeing it resume and progress as part of our ongoing commitment to develop and maintain the safest possible environment for those entrusted to our care. It should be noted that prone (floor) restraints are a taught technique in SPEC and remain an option to be used nationally."
On the placement of female patients in other units, the agency said the number of specialist hospital-level beds across the country "is currently insufficient to meet the demand for this type of care" and they had made five beds in other mental health units at Mason Clinic temporarily available to help alleviate the shortage.
"Every care is taken to ensure these services-users are in an environment that is most likely to result in positive outcomes. For example, the current arrangement enables us to place wāhine Maori in Kaupapa Māori units where other wāhine are also present. This is preferable to being an isolated female in an all-male disability unit.
"The Infrastructure Unit of Te Whatu Ora has confirmed the need for development of more secure facilities for the intellectually disabled within the northern region and we have prepared a strategic assessment for a business case to develop more of these on the Mason Clinic campus.
"It is our hope that these facilities will be able to address the needs of tāngata whaikaha hinengaro requiring individualised packages of care and community transition step-down facilities in a more flexible way."
