Ombudsman appalled by seclusion rates for Māori
Chief Ombudsman Peter Boshier says Māori are bearing the brunt of a mental health system which doesn’t have the staff or infrastructure to properly care for everyone in need of help.
He said the staggering ‘‘overuse’’ of seclusion on Māori inpatients, at about five times that of non-Māori patients, is evidence Māori are receiving worse mental healthcare than others.
In less than a week, Boshier has released two reports which highlight that Māori inpatients in mental health wards are being disproportionately placed into seclusion. They showed mental health wards are so old and understaffed, they can be at 150% capacity.
District health boards are meant to be working towards phasing out the use of seclusion entirely. The practice is highly controversial and involves placing patients into bare rooms which they cannot leave.
The Mental Health and Wellbeing Commission said the practice is better described as ‘‘solitary confinement’’. And Boshier said it has ‘‘no therapeutic benefit’’ and is potentially harmful.
His reports followed similar concerns raised in the commission’s report, released in March, which revealed Māori patients were being secluded at five times the rate of any other ethnicity. Leaders in Māori healthcare said was proof of ‘‘institutional racism’’.
Boshier is now calling on the Government and Ministry of Health to front up over the inequitable treatment of Māori patients in mental health wards.
He said the Government needed to respond to the mounting evidence of Treaty of Waitangi breaches and potentially harmful mental healthcare with a plan to end seclusion.
‘‘This really is a matter for the Ministry of Health. They are the stewards of the taxpayers money to oversee and implement acceptable mental health practice. They’re not doing it.’’
He said there was mounting evidence of systemic issues across the mental health sector, showing Māori were not receiving adequate treatment.
He said the mental health units were often overcrowded and understaffed.
The Government has acknowledged these issues. In fact, back in 2019, Prime Minister Jacinda Ardern announced funding for a new mental health ward for Palmerston North, which she said would be finished in 2023.
But Boshier said his team had investigated and found little work had been done.
He said designs had been created, ‘‘but we can see no construction of any new facility’’.
A Ministry of Health spokesperson said construction would start this year, and had been delayed due to a more thorough design process.
Ardern announced $30 million for that new ward. A few months later, in January 2020, she announced funding for the Whākatane and Tauranga acute mental health units as well, with $5m and $30m respectively.
Boshier also joined calls from Māori mental health experts such as Te Rau Ora chief executive Dr Maria Baker, for acute mental health services to employ Rongoa Māori approaches and staff. Baker suggested working with kaumā tua to help Māori patients in distress, inviting whānau to participate, and including a focus on manaakitanga.
Boshier said this should be done urgently and said he’d seen the success of such strategies in his work as a Family Court judge.
National Party mental health spokesperson Matt Doocey said a staffing crisis, coupled with aged and outdated facilities, was hitting Māori patients.
‘‘You have to look very closely at institutional racism,’’ he said.
‘‘We’re seeing a lack of Māoriled healthcare within these facilities as well. When you look at mental health and crisis mental health that is important.’’
He said the Government’s promised spending on mental healthcare, including $1.9 billion in the 2019 Budget, had not brought the new facilities or better outcomes expected.
A spokesman for the Ministry of Health said it had developed clearer guidelines and documents about the importance of human rights in mental healthcare.
‘‘There is more work to be done to address the inequitable outcomes experienced by Māori who come under the current Mental Health Act,’’ he said.
The ministry was aware of the issue and remained committed to reducing the use of seclusion, through clear guidance to the DHBs and work to repeal the Mental Health Act.
‘‘[The act] has not kept pace with the times and may have contributed to these inequities,’’ he said.