International report slams NZ's "medieval" approach to seclusion and restraint

A segregation unit and a youth facility. Photo: Human Rights Commission.

A damning international report has identified degrading segregation and restraint practices across New Zealand’s detention facilities. But will it lead to any changes?

New Zealand is an alarming user of restraint and seclusion measures on its mentally ill citizens and prisoners, a United Nations-funded report has found.

Ordered by the Human Rights Commission, the report was undertaken by international expert Dr Sharon Shalev and contains concerning observations.

Tie-down beds in prisons and restraint chairs in police cells, contraptions described as “medieval” by the author, are used too frequently, Shalev says.

Māori are over-represented in solitary confinement and restraint incidents, while the practice was not always used as a last resort.

The report includes individual examples.

One man in a health and disability unit was found to have been segregated for more than six years while restrained in a body belt.

Two others were also found to have spent a similar time in isolation, while a self-harming prisoner was restrained in a tie-down bed for more than a month as part of a “behavioural management plan”.

While perhaps the most comprehensive look at seclusion and restraint, this is not the first time New Zealand’s practices have been in the spotlight.

Recently the Ombudsman released his own report into the use of tie-down beds by Corrections, finding it excessive, and in particular instances, cruel and degrading.

The United Nations has also urged New Zealand to change its approach.

In 2013, the UN Subcommittee on the Prevention of Torture recommended an immediate halt to keeping prisoners in prolonged detention in disciplinary cells.

More recently, in 2015 the Committee Against Torture recommended the use of solitary confinement be "a last resort" and called for the halt of its use on youth, the disabled, pregnant women, and those in prisons and health care institutions.

Despite all these warnings, New Zealand has been slow to act.

Chief Human Rights Commissioner David Rutherford says the report makes for sobering reading and it was time for change.

“Many of these concerns have been raised by other monitoring agencies … this report highlights the grim reality [people] can face and it’s time for urgent action to be taken.”

Associate Justice Minister Mark Mitchell, whose responsibilities include the Human Rights Commission, did not respond to Newsroom's requests for an interview.

Here are the report’s findings, and the relevant authorities’ responses.

Prisons

Shalev says that the use of segregation and restraint by Corrections is high.

So high, in fact, that it makes England and Wales – typically considered to be heavy users of the practice – seem moderate.

In the year to November 2016, there were 16,370 recorded instances of segregation in New Zealand prisons.

With an average prison population of just under 10,000 at the time, that meant 167 instances of segregation per 100 prisoners.

In England and Wales, that rate was 37 per 100 prisoners – a quarter of New Zealand’s use.

The report also found women were much more likely to be segregated than men, and for longer.

When discussing the forms of restraint used by Corrections, Shalev is particularly scathing about tie-down beds.

Speaking to Newsroom, she said her reaction was one of shock when discovering the method was being used.

“I have to say, I’ve seen these in the past but not for many, many years. In England and Wales we don’t use restraint beds any more, we haven’t for many years … there seems to be a reluctance to let them go (in New Zealand) and I think the agencies are worried if they let go of those options they’ll be stuck with nothing in an emergency, but other agencies manage without.

“Really [the beds] shouldn’t be in prison in the first place ... there are other forms of restraint if it is absolutely necessary, there are ways of doing it without resorting to all these medieval forms of restraint. Really, they’re quite horrible these beds. If you’ve ever seen one they’re very, very unpleasant.”

Shalev recommends the use of tie-down beds be immediately banned.

In her report, she is also critical of the general state of at-risk and punishment units in New Zealand prisons.

Describing the “pound” units at several facilities, where prisoners are sent as punishment, Shalev says at night they are supervised only by “rovers” who come through at various times but have no ability to unlock doors.

This means it would be difficult to get timely medical attention to prisoners if needed.

Corrections Chief Custodial Officer Neil Beales responded to the report by saying where tie-down beds were used it was often a case of life or death.

He said that, in the past three years, more than 25,000 prisoners had been through the system, with more than 7000 in at-risk units. Of those, only 12 had been tied down.

“These are the most extreme cases where we’ve got someone that quite simply, if we didn’t do that, they’d be dead.”

Beales questioned the validity of the seclusion and restraint statistics from England and Wales, believing they were light.

He said there were also differences in the way the statistics were recorded in both countries.

“In our last business year for the Department of Corrections we’ve had one suicide in prison. If I look at the business year in the English and Welsh system, they’re averaging one every three days. What department would you rather be looking at, you know, in terms of who is getting these things right?”

Regarding the “pound” units, Beales said they were rarely used and there had been no recent deaths in custody in the areas.

Despite all this, Corrections accepted most of the report’s recommendations and said it would work to reduce the use of restraints as part of their commitment to improving the mental health of prisoners.

Police cells

While seclusion and restraint was less prevalent in a police environment than a prison, Shalev still finds failings.

In a six-month period last year, restraint chairs were used 56 times.

Of those incidences, 30 involved people waiting for mental health assessments and 33 involved people who had attempted suicide.

Records about why the chair was used are poor and staff feel they are not trained to monitor mentally unwell people.

“We try to get someone from a company [that does constant watches] but if it’s an emergency it will be one of us, in which case we will sit outside the cell but as we are not mental health trained we will not engage,” one staff member told Shalev.

Particular criticism is levelled at the custody suite in Wellington, situated completely underground and lacking a single window.

The cells are dingy, have poor ventilation and are often freezing.

Despite this, detainees are only given a single blanket because of a lack of resources.

There are also no minimum requirements regarding exercise, showers, a telephone call, or visits.

“They have a right to speak to a lawyer, anything beyond that is at our discretion,” another staff member told Shalev.

Shalev again recommends an immediate stop to the use of restraint chairs.

The police supplied a written statement saying that "the overwhelming majority of detainees are held in police custody for relatively short periods of time, and for less than 24 hours."

The statement said work was being done to improve the Wellington custody unit, including introducing murals, and Wellington police were also considering a library of books, religious scriptures, word and number puzzles, and playing cards.

"Police agrees with the report’s recommendation that police cells are not the appropriate place to assess or hold those who are suffering mental distress," the statement said. "Police are working with the Ministry of Health and relevant District Health Boards across the country to improve mental health support and to ensure those who are detained for mental health assessment are moved appropriately to health facilities or receive the correct treatment and care."

Mental Health Facilities and Youth Facilities

While some people may find the prospect of prisoners locked in a solitary, dingy cell satisfying, most would cringe at the thought of something similar happening to a child.

But the report confirms that this is happening.

Shalev describes segregation rooms at a Care and Protection Unit as “prison-like”, bare and void of any stimulus.

She says separate “timeout” rooms were also worrying, containing nothing other than a concrete slab.

Concerningly, the rooms are sometimes used as bedrooms when no other alternatives are available.

In one unit, Shalev discovered that the call-bell system was not working, meaning children had to wave or bang on a door to get attention.

Her assessment of adult mental health facilities is little better.

Shalev does praise the reduction in the number of people and time spent in seclusion since 2009.

But the number is still high, with 7545 people secluded in 2015, many more than once.

While there is a clear commitment at a higher level to reduce seclusion, the reality is different on the ground, she says.

A lack of resources and a mindset from overworked staff that the reduction of restraints and seclusion would endanger their safety means it remains overused.

Many staff are uneasy about the practice, but feel like they have no choice.

“Overcrowding is not a justifiable reason for locking up a patient in a small, barren room with no personal belongings for days on end,” Shalev notes.

She is also critical of a lack of stimulus or personal belongings in units, with activity typically limited to a short time in a “barren” outdoor yard or room containing a chair and a TV set behind a protective screen.

Asked if patients could have a book, one mental health nurse replied that: “it depends on the client…if someone is able to concentrate on reading a book, they would most likely be out [of seclusion]”.

Finally, Shalev is shocked that decisions about whether to prolong the seclusion or restraint of long-term patients are not subject to robust review, a possible breach of human rights.

“I was concerned to note that discussions of what the future held for these individuals appeared to focus on how to ‘do’ the seclusion/restraint better, or differently – build a better seclusion area, a new living quarter, or design a new restraint belt,” she says.

The Ministry of Health also declined to be interviewed.

In a statement, director of mental health Dr John Crawshaw acknowledged the report and said its commissioning was important to improve transparency in the mental health and justice systems.

“I’ve previously said that seclusion should be used only when there is an imminent risk of danger to the individual or others and no other safe and effective alternative is possible.”

The statement did not directly address any of Shalev’s concerns.

The report’s recommendations

  • The use of seclusion, segregation and all forms of restraint should be significantly reduced.

  • Any decision to use restraint should be regularly reviewed.

  • Degrading forms of restraint, particularly tie-down beds and restraint chairs, should be banned.

  • Minimal living standards for cells and rooms should be met, specifically they should be of reasonable size, clean, safe, well ventilated and lit, and temperature controlled. Access to fresh air, exercise, food and drinking water must be provided.

  • All cells and rooms must have functioning call bells.

  • Facilities not fit for purpose, including prison “pound” units and the Wellington police custody suite should be shut down.

  • Better data about the use of segregation and restraint should be collected and the over-representation of Maori should be investigated as a matter of urgency.

  • The formation of a national oversight body to oversee seclusion and restraint should be considered.