A Children's Commissioner visit to a Christchurch child mental health facility shows the impact of Covid-19 restrictions on access to care and details a number of issues for the facility to work through, including a dedicated Te Ao Māori strategy
Despite plans to move to new premises next year, the Child Adolescent and Family Unit at Princess Margaret Hospital has been served up recommendations to work through after a visit from the Office of the Children's Commissioner in May.
The outdated Christchurch complex is on its last legs with Te Whatu Ora confident new in-patient premises closer to the adult mental health facility at Hillmorton will open in mid-2023.
But, until then, children aged up to 18 are treated in rooms described in the report as “cold and dreary”. READ MORE: * Māori health pilot brings ‘never seen’ opportunities * The disadvantage passed down through generations
“The current facility needs ongoing maintenance and improvement while it remains operational. The current space has poor ventilation, and the heating system needs improving.
“Some bedrooms do not have carpet or natural light which made the rooms feel cold and dreary,” the report said.
Key facilities were inaccessible to children including the sensory space also known as the ‘moon room’ – an area with bean bags and a night sky painted on the walls.
“However, as an air scrubber was installed in the room in response to Covid-19, the room could no longer be used by mokopuna independently as this has created a ligature risk - points a suicidal person could use to hang themselves.
"This space [had] provided mokopuna an opportunity to self-regulate in a safe and calming environment," the report said, and this had allowed the unit to move towards its goal of not using seclusion as a management tool. "In addition to this, the climbing frame in the playground outside had been removed, because of a health and safety risk. However, Te Whatu Ora leadership advised that this was to be rebuilt and replaced.
“I really just sat in my room all day and did nothing because that’s how boring it was.” - Child staying at CAF unit.
“We consider this problematic as it reduces mokopuna access to important sensory and de-escalation resource on the unit.”
Issues were also identified with the high dependency unit (HDU) – an area where extra care and monitoring is required – because tamariki could see the seclusion room, and there was no way to keep time.
“If mokopuna are in the HDU they can see the seclusion room, which could cause distress. There is only one toilet in the HDU area, this means only one mokopuna at a time can be in either room. There were also no clocks or calendars on the walls for mokopuna to orientate themselves. It is important for mokopuna to know how long they have been in HDU and seclusion,” the report commented.
The report said fewer instances of seclusion had been reported since the last monitoring visit, although the Commissioner advocates for zero seclusion.
The unit (CAF) is a specialist South Island treatment and assessment service for children and adolescents who have severe psychiatric, emotional, behavioural, or developmental disorders.
During the 2021-2022 year it had 160 admissions with the majority of regional admissions coming from the Southern region, followed by Nelson Marlborough and the West Coast.
The Commissioner also said children needed more input into their own care plans, and the complaints process needed work.
“Although there is a rights pamphlet provided to mokopuna upon admission, it is not mokopuna focused. This is a generic document used across mental health services. CAF leadership identified that the complaints data suggests that mokopuna use the complaints system well. The reporting information shows that CAF is proportionally over-represented in the number of complaints received by the complaints committee."
“There is currently a lack of independent advocacy available on the unit. In addition to the challenges identified in [the] complaints process, most complaints are managed internally, which makes it difficult for mokopuna to be honest about the issues that concern them."
Children told the office the food was boring, bland and not cooked properly. The report noted dietary requirements were not always complied with.
The impacts of Covid-19 were also apparent, with a range of activities such as external art classes unavailable.
“Outside of school there were few recreational activities for mokopuna to participate in. CAF has a monthly budget for activities such as card games, television, or nail painting. Staff try to find low- to no-cost activities, including going for local walks or offsite in a van, even if just for the ride.”
“Given the known disparities across the mental health sector for Māori we recommend the development and implementation of a Te Ao Māori strategy.” - Children's Commissioner report.
“Mokopuna requested therapy animals, fast food, internet on the TV, Xbox, and access to social media. Staff are trying to get Chromecast, but therapy animals are no longer allowed on the unit due to health and safety concerns.”
One mokopuna told the inspectors they basically sat in their room doing nothing all day.
Finally the report criticised the lack of a Te Ao Māori strategy.
“Mokopuna said there is not much in the way of māoritanga on the unit. A mokopuna fluent in te reo didn’t get many opportunities to speak te reo. Staff agree there needs to be more focus and conversations around the vision to support mokopuna Māori to live their best lives.
“Given the known disparities across the mental health sector for Māori we recommend the development and implementation of a Te Ao Māori strategy.”
“Despite best intentions of staff, the principles of equal partnership outlined in Te Tiriti o Waitangi mean that Māori should be involved in every decision, including in the design, delivery, and monitoring of health and disability services. We saw limited evidence of mana whenua and kaimahi Māori involvement in developing new policies and procedures.”
Te Whatu Ora Canterbury Specialist Mental Health Service general manager Dr Greg Hamilton said a number of the recommendations were being actively worked on.
“The Pae Ora Ministry of Health initiative and Mental Health division Te Korowai Atawhai Māori Strategy guides our model of care. The Waitaha team is currently seeking funding to appoint a Pukenga Atawhai full-time Māori Mental Health worker who will contribute to the development of a Te Ao Māori strategy."
He acknowledged that young people could have more involvement in their care plans.
“As young people being admitted to an inpatient service are very unwell and tend to have intensive but short stays, this can be challenging. It is important to note that input and consent is sought throughout the treatment and care process.”
Hamilton said the 'moon room' was now re-opened but only when staff were able to supervise.
“This is essential due to safety issues in the current room. New safe sensory area spaces to use for the purpose of self-regulation are being created in the new building.”
He said the report was largely positive and was a credit to the staff working in the outdated environment.
"The report acknowledged that mokopuna have caring, respectful relationships with our staff and that whānau participation is positive and contributes to the care of mokopuna."
A purpose-built outpatient facility is also being built nearby, with funding from the Māia Health Foundation.
Some $2.5 million of a $6m target is still to be raised, although it is expected to be completed in the first quarter of 2024.
