National is calling on the Government to speed up a build programme to replace outdated mental health units and do more to fix other ‘unacceptable’ facilities. Oliver Lewis reports in the final article in a five-part series on mental health inpatient units.
Mental health units around New Zealand have been allowed to deteriorate for years, often decades, under successive governments. Matt Doocey, National’s mental health spokesman, said as much in an interview with Newsroom.
However, despite widespread awareness of the problems, Doocey alleged the current Labour Government wasn’t moving fast enough to improve the outdated facilities and lacked the political will to do so. Planned new builds should be fast-tracked where possible and the Government should examine its spending priorities, he said, citing the recent announcement of a $685 million spend on a new cycling and walking bridge in Auckland.
“I think if you were to compare a new cycleway versus new inpatient mental health facilities, I’m pretty sure the public of New Zealand would back mental health,” Doocey said.
“The health minister needs to pull all the levers available to him to fast-track the builds of these new mental health facilities.”
In a statement provided to Newsroom, parts of which were identical to an earlier response from the Ministry of Health, Health Minister Andrew Little said improving mental health facilities was a key priority for the Government.
“We want all health facilities to be high-quality and therapeutic,” he said.
“There are a range of activities underway to ensure our facilities are continuously maintained and improved, including replacement of buildings, refurbishment and improved maintenance.”
Newsroom revealed this week black mould had been found in four leaky mental health units in Auckland. The buildings were “failing significantly” and the fungus could reach unsafe levels “at any moment”, the relevant district health board (DHB) warned.
READ MORE IN THIS SERIES
* Part one: 'Dilapidated’ mental health units undermining care
* Part two: Overcrowded mental heath units breach torture convention
* Part three: Mental health units should provide more than ‘meds and beds’
* Part four: NZ’s first ‘new wave’ mental health unit
New Zealand has some well-designed, therapeutic units, however the condition of many others was “completely unacceptable”, Doocey said. The Waimakariri MP has visited several inpatient facilities, telling Newsroom some looked “more like a prison than a place where people go to get well”.
“It comes down to basic human rights, and I would argue that basic human rights are at times not upheld in some of our older mental health facilities.”
As part of an in-depth investigation, Newsroom has revealed systemic overcrowding and building issues in mental health units, including evidence of vulnerable service users being treated in run-down facilities with mould, leaking, pests and vermin problems. Of 24 mental health units assessed as part of a nationwide stocktake in 2019, the majority - 15 of them - were ranked ‘very poor’ or ‘poor’ against the relevant design guidelines.
The Government recognised health services and infrastructure had been under pressure for many years, Little said. This included mental health facilities.
The Ministry of Health recently established a mental health infrastructure programme (MHIP) within its dedicated health infrastructure unit. The programme is meant to link up the various mental health build projects happening around the country and enable sharing of information, support and best practice advice. Little said it was established to bring together 16 new facility projects, at various stages of completion, with a combined value of $472.3m. His office did not provide a list of the projects. The ministry previously told Newsroom $472m had been allocated (not spent) to refurbish or build new mental health units between 2015/16 and 2019/20.
Five of the 16 projects, at Waitematā, Waikato, Tairāwhiti, Lakes and MidCentral DHBs, were allocated funding out of the $1.9b spend on mental health and wellbeing announced in Budget 2019. All up, the Crown earmarked $235m for the projects. However, like other initiatives funded out of the $1.9b pot, the money has been slow getting out the door. At the end of April 2021, just $500,000 had been distributed, according to figures provided by Little in response to a written question in Parliament.
Doocey wouldn’t commit to increasing capital funding for mental health facilities if National was in power, saying he didn’t have all the information needed to make that decision. However, the Government could look to boost investment by redirecting money from elsewhere, he said.
“They could be committing some of the underspent funding of the $1.9b, and I would also take a step further where I think we need now to review that funding.”
In his response, Little referenced the new Tiaho Mai mental health unit at Middlemore Hospital as an example of what the 16 projects covered by MHIP might look like. Newsroom profiled the $64m unit and its successes as part of this series.
Little and Doocey agreed there also needed to be a focus on providing community alternatives to acute inpatient units.
“We need to not only fast-track new mental health facilities, but also invest in community-based inpatient units as well,” Doocey said.
Poor facilities ‘very concerning’ - Chief Ombudsman
Last week, Chief Ombudsman Peter Boshier issued a scathing press release criticising mental health facilities in Palmerston North and Hutt Valley. The Wellington unit, Te Whare Ahuru, had graffiti on the walls and soiled carpets. It needed to be upgraded as a matter of urgency, Boshier said.
In an extended interview with Newsroom, the Chief Ombudsman said anyone reading his inspection reports over the past few years would have few illusions: when he sees something he doesn’t like, he calls it out.
“I have no doubt that we bring a level of scrutiny that no one else does.”
The former judge and his inspectors have the designation to assess mental health units under the Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, a United Nations tool ratified by New Zealand in 2007.
Since his appointment in 2015, Boshier said he had not seen torture, but he had seen degrading and inhuman treatment in mental health units. Any convention breaches were unacceptable, he said, especially when people were being treated against their will under the Mental Health Act.
“We’ve got a special duty when we detain people like that to really reach out and give them the best conditions that are possible.”
The systemic and prolonged use of seclusion rooms - stark, austere spaces meant for locking up people considered to be a risk to themselves or others - as overflow bedrooms constituted a breach of the convention, Boshier said. As would the use of other non-designated bedrooms like interview rooms and whānau rooms.
Newsroom revealed last week that the majority of DHBs had been using non-designated rooms as overflow bedrooms across their mental health, forensic and intellectual disability units. Just under half also admitted to using seclusion rooms as overflow bedrooms.
However, despite the widespread issues facing the sector, Boshier would not commit to any kind of systemic investigation - something he announced he would be doing this year in relation to the Department of Corrections. Newsroom put it to the Chief Ombudsman that one would be equally useful when it came to mental health units.
“You could certainly put it to me and I’m interested in looking at this issue, but I’m embarking on what I think is a crucial and important systemic investigation into Corrections and I have to cut my cloth,” Boshier said.
The Chief Ombudsman acknowledged “a number” of mental health units around the country were in “poor” condition. Asked what “poor” looked like, he compared it to booking a motel for the night: you know instantly if it’s a place where you want to stay or not. Reading the recent inspection report on Te Whare Ahuru, for example, “You have the impression don’t you that this is somewhere where you and I wouldn’t want to stay if we didn’t have to”. Whereas, Tiaho Mai, the new unit at Middlemore, was somewhere that “feels to me to be hospitable and welcoming”.
There was “no question” that the environment had an effect on people, Boshier said. Asked if he was ever upset at the poor state of facilities, he said: “I vary between being concerned and very concerned”.
Boshier has urged DHBs to upgrade their facilities in his inspection reports, however he was reluctant to comment on whether the Government should be investing more to improve mental health units.
“I’m really, really clear that I report on what I see and what needs to change. Who’s going to change it and how it’s going to be done is not something I’m permitted to get into.”
What he did want to see was greater knowledge-sharing where DHBs with issues could learn from other health boards managing high demand with “a great deal of skill and forethought”. Boshier also wanted mental health services to work more collaboratively with iwi, hapu and whānau to place people back in the community.
It was not his role to suggest DHBs should be penalised for failing to upgrade their facilities. Instead, Boshier said his office took a “nicely coercive” approach by publicly flagging issues then following up to see if they had been resolved.
Want to share your inpatient experience? Email oli.lewis720@gmail.com
This project was funded by Nōku te Ao Like Minds, with support from the Mental Health Foundation
Where to get help:
1737, Need to talk? Free call or text 1737 any time for support from a trained counsellor
Lifeline – 0800 543 354 or (09) 5222 999 within Auckland
Samaritans – 0800 726 666
Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO)
thelowdown.co.nz – or email team@thelowdown.co.nz or free text 5626
Anxiety New Zealand - 0800 ANXIETY (0800 269 4389)
Supporting Families in Mental Illness - 0800 732 825
