Kathryn George / Stuff
The cardboard disposable toilets are used when the hospitalized patients are at risk of injuring themselves, the director of the service said.
According to a new report from the Children’s Commissioner, Rangatahi from a psychiatric facility in Wellington regularly goes to the toilet in solitude in cardboard jars or ‘cowboy hats’.
A visit to the regional 12-bed Rangatahi Adolescent Inpatient Service, located in Porirua in January, found unsafe staffing levels, high levels of seclusion and a unit unfit for purpose, Commissioner Judge Frances Eivers wrote in her report.
The service is intended for young people aged 12 to 17 with acute psychological problems.
ROBERT KITCHEN/Things
The Children’s Commissioner, Judge Frances Eivers, says the situation is very worrying.
The use of seclusion had risen ‘significantly’ since 2020 – there were six seclusion events and 114 coercive measures in the first half of 2020, compared to 14 isolations in 124 coercive measures in the latter half of 2021.
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“Staff said this increase is due to unsafe staffing levels, high occupancy rates and acuity, the physical environment and lack of de-escalation spaces,” Eivers’ report said.
“Our review of isolation data and clinical notes show that mokopuna is regularly given cardboard jars (known as ‘cowboy hats’) while in isolation for no apparent reason or justification.”
VUWSA
Victoria University of Wellington Students’ Association (VUWSA) gathered in the capital to speak out about underfunded and underdeveloped mental health services. (Video first published in August 2018)
Cardboard toilets in isolation seemed to be routine and were in isolation despite sanitation, Eivers said.
Mental health director Karla Bergquist acknowledged that cardboard toilets were inadequate, but dismissed the point that their use was routine.
They were used when rangatahi was at risk of harming themselves or others, when using the bathroom in solitude was considered a safety hazard. The bathroom can be locked from the inside and has no viewing window, “meaning the staff cannot keep in touch with rangatahi who might be very upset,” Bergquist said.
“While we recognize that this process is far from ideal, it remains the safest option.”
BEN BLENNER HASSETT / unsplash
The use of isolation had increased significantly since the Commissioner’s 2021 report, which was mainly due to three customers with very complex needs, the service’s executive director said.
The area, including the bathroom, was awaiting renovation and “part of the renovation will be to redevelop the bathroom to maintain the safety and dignity of rangatahi,” Bergquist said.
The situation at the unit was “very worrying,” Eivers said.
†[P]problems with both the building itself and sufficient staffing are stressful for both the rangatahi and the kaimahi.”
Chronically low staffing levels were a concern, with 6.2 nurse vacancies at the time of the visit.
“Due to staff shortages, management has to work on the floor almost every day,” Eivers’ report said.
The unit recruited aggressively in New Zealand and abroad to fill vacancies, but it was still challenging, Bergquist said.
Isolation was used as a last resort, and the increase was primarily due to three clients “with very complex mental health needs,” Berguist said.
A project that started in August 2021 and aimed to find alternatives to restraint had resulted in a reduction in its use and the service aimed for zero seclusion and restraint.
GOODS
Health Minister Andrew Little said in Christchurch Thursday’s budget will include a $100 million investment in mental health over four years.
On the plus side, Eivers felt that mokopuna was engaged in activities, had a caring and respectful relationship with staff, and was involved in every aspect of their care.
“The staff themselves are clearly key to the well-being of the young people, they do everything they can to give the rangatahi what they need, and see their role as less of a job than a calling.”
Eivers was pleased to see changes made and saw the commitment to keep improving things. “My team and I will follow this closely. But they can only do so much.”
Eivers was hopeful de lachieve an investment of $18.7 million for existing specialist mental health and addiction care for children and young people, announced in May, would make a difference.
“We are all looking forward to seeing this money bring about concrete, tangible change for all the rangatahi who rely on these services to help them turn their faces to the sun and let the shadows fall behind them.
“The unenviable track record of this country” high suicide rate in children and young peopleand the increasing number of children struggling with psychological well-being in the wake of Covid-19 shows how important it is that we do this right, and quickly,” Eivers said.