‘Unfair’ 12-year wait for discharge
"It's treating intellectually disabled as second or third class citizens.'' Human rights lawyer Tony Ellis
Patients ready for discharge are waiting up to 12 years to be released from a secure mental health facility for adults with intellectual disabilities in Christchurch.
A human rights lawyer says the delay in patients being released is ‘‘outright discrimination’’, ‘‘grossly unfair’’ and could be ‘‘unlawful detention’’, in breach of United Nations conventions.
The Ombudsman is investigating and the Human Rights Commission says it ‘‘would be gravely concerned if people are being . . . held in restrictive environments because a lack of funding or appropriate care options in the community’’.
The Canterbury District Health Board (CDHB) has raised concerns repeatedly with the Ministry of Health (MOH) – which is responsible for planning and funding for disability services – but keeps patients in the facility as there is nowhere for them to go.
The Assessment, Treatment and Rehabilitation (AT&R) unit provides compulsory care to intellectually disabled patients charged with a criminal offence. It has 10 beds but can only take about seven patients for safety reasons.
‘‘Half of our current inpatients have been assessed as clinically ready for discharge. The time delay for these discharges ranges from four months to 12 years,’’ a CDHB report released this month said.
Delays were due to a lack of community placement options for patients ‘‘with significant challenging behaviour’’, the report said.
Human rights lawyer Tony Ellis said the delays were ‘‘alarming’’.
‘‘It’s treating intellectually disabled as second or third class citizens. It’s outright discrimination, grossly unfair and could be unlawful detention.’’
Olive Webb, a clinical psychologist with 45 years’ experience in the disability sector, said a 12-year delay to discharge a patient was ‘‘absolutely horrendous’’.
‘‘Just imagine if you did that with any other group of people.’’
CDHB head of mental health Toni Gutschlag said placements in AT&R were meant to be ‘‘as short term as possible’’.
‘‘We don’t want people to be living in institutions.’’
But there was a shortage of community services for people with complex disability needs. Some were inappropriately placed in mental health services or were held too long in secure units.
The AT&R unit has also been struggling with safety issues, with more than a third of its 27 staff assaulted by patients this year.
New Zealand Nurses Organisation organiser John Miller said earlier this year that the facility was not appropriate for people with acute intellectual disabilities and psychiatric issues.
‘‘It’s not a good building. It’s an awful place and it’s not safe.’’
The ward consisted of a narrow corridor with small rooms on each side and a communal area. There was a contagion effect when a patient became agitated because there was not enough space to safely de-escalate them.
CDHB head of psychiatry Peri Renison and other senior psychiatrists raised serious concerns about secure units for people with intellectual disabilities in a letter to MOH in May.
Chief Ombudsman Peter Boshier said his staff inspected places of detention, including health and disability facilities, and found ‘‘a small number of individuals in inappropriate detention facilities’’.
The AT&R was inspected in 2010 and 2014 and recommendations were made to improve the conditions for patients.
His office was scoping the potential for wider intervention, had looked at individual cases, and listened to patients, advocates, clinicians and administrators.
The MOH said it was aware of a ‘‘small group of high-risk, highneeds individuals under compulsory care who have remained in hospital level services for some time’’. It met with DHBS regularly to develop long-term solutions for those patients.
The Human Rights Commission said the Bill of Rights Act ‘‘affirms the right of New Zealanders not to be arbitrarily detailed’’.
‘‘We would be gravely concerned if people are being unnecessarily detained or held in restrictive environments because a lack of funding or appropriate care options in the community.’’
LEGAL GROUNDS FOR HOLDING PATIENTS IN SECURE UNITS
Under the Intellectual Disability (Compulsory Care and Rehabilitation) Act, secure units deal with people with intellectual disabilities who are:
❚ Pending trial or sentence;
❚ Undergoing assessment to allow the criminal courts to decide whether they should be subject to the act;
❚ Subject to court orders;
❚ Transferred from prisons and from mental health services.
However, the act does not require inpatient treatment – ‘‘in fact the spirit of the act is that as far as possible it take place in a community setting’’, the CDHB said.
The AT&R unit also houses people under the Mental Health (Compulsory Assessment and Treatment) Act.