The Ombudsman is urging action to fix “serious and persistent” problems at New Zealand’s mental health units, after delivering scathing reports on the state of five units, which found a litany of human rights breaches.

The Ombudsman, Peter Boshier, found two such facilities were in breach of the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, despite previous warnings.

Wellington and Waitakere Hospitals were singled out for particularly harsh criticism.

Te Whare o Matairangi Mental Health Inpatient Unit at Wellington Hospital came under fire for using seclusion rooms as bedrooms when over capacity, despite a previous recommendation from the Ombudsman that this should stop.

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“These rooms contain little more than a mattress, and are supposed to be used as a short-term measure for patients who are assessed as an imminent safety risk,” Boshier said.

Boshier’s 2017 report on the facility recommended that seclusion rooms should only be used in an emergency. Returning in 2020, he found this wasn’t the case.

The report found that on the first day of inspection, two people were sleeping in seclusion rooms, while another two people “were sleeping on mattresses on the floor in the TV room and seclusion lounge”.

One of those people had been placed in the seclusion lounge because of a “lack of other appropriate de-escalation areas”

Rather than being an exception, staff who worked at the unit suggested it was the rule.

“Unit staff and senior management advised that chronic over-occupancy on the Unit had meant that seclusion rooms were regularly being used to accommodate clients, despite them not being subject to formal seclusion,” the report said.

Boshier said that putting patients in seclusion rooms for no reason other than a shortage of accommodation has the potential to cause significant physical and psychological impacts.

“I consider the ongoing use of seclusion rooms and other spaces as bedrooms amounted to degrading treatment and a breach of Article 16 of the Convention,” he said.

The report found that it was regularly over occupancy limits, which was “impacting on the safe management of the Unit”.

In a statement, Capital & Coast DHB and the Mental Health, Addictions & Intellectual Disability Service (MHAIDS) acknowledged the Ombudsman’s findings.

MHAIDS general manager Nigel Fairley said the Unit had 30 bedrooms and two extra rooms which could be used for seclusion or “sensory modulation” when necessary.

“During periods of high occupancy, these rooms can be used in a non-restrictive way to accommodate and support clients appropriately and safely to prevent time spent in a less safe environment – such as an ED or uncontained community setting,” Fairley said.

It recognised work was needed to address the Unit’s high occupancy but that was a national issue.

Extra security staff had not “been engaged” to increase staff ratios but “to provide a sense of security for unit staff and clients”, he said.

“These roles are guided by a clear role description setting out expectations and requirements.”

Progress had been made on implementing the Ombudsman’s previous recommendations such as ensuring “safe” staffing levels, ongoing staff training and access to a phone.

Boshier found the Waiatarau Mental Health Inpatient Unit at Waitakere Hospital was using its intensive care unit as long-term accommodation for one patient. He said this “amounted to cruel or inhuman treatment” under Article 16 of the UN Convention.

“The patient was missing out on approved unescorted leave, was unable to attend daily programmes, and had limited access to phone calls.

“While the patient had originally been moved to the ICU because of the risk of violence, there was no evidence this risk still existed. What was clear from clinical notes was that being contained in the ICU for an extended period was causing the patient an escalating sense of hopelessness, frustration and anger.”

Boshier said he had passed his concerns on to the Government.

“‘I have raised my concerns with Parliament, the Ministry of Health, District Health Boards, and the facilities themselves, and will continue to do so to ensure that vulnerable people are treated with dignity and respect that meets international expectations,”

One positive part of the report was that some units were “functioning well in caring for their highly vulnerable patients”

‘Relationships between staff and residents were on the whole positive, and patients generally had good access to activities and health care services. Most of the units also encouraged visits from whānau, which is an important aspect of treatment and recovery,” Boshier said.