01 March 2017
Release of Ombudsman’s report: A question of restraint
To be attributed to Chief Executive Ray Smith
The Chief Ombudsman today released a report under the Crimes of Torture Act 1989 into the care and management of prisoners at risk of self-harm based upon observations in five prisons over the period July 2015-June 2016.
The report makes observations and findings in regard to Corrections running of specialist units for prisoners at risk of self-harm, the training and staffing of these units, and the use of restraints in the management of prisoners who present an immediate risk of self-harm.
Included in the report are five incidents where tie down beds or waist restraints were used as part of the management of severely at-risk prisoners. One of these five cases was for a prolonged period of 37 consecutive nights.
When I became aware of this case through an alert from the Chief Ombudsman I took immediate steps to review the policy and practice over the use of tie down beds and commissioned a Chief Inspector’s review into the circumstances surrounding this case. I am releasing a summary of the Chief Inspector’s report into the management of this prisoner. Of the five recommendations made in the Chief Inspector’s report, three are completed and two are underway.
I accept that some mistakes were made in the use of the tie-down bed in this case and its use crept from being a last-option to a tool for managing the prisoner’s health and complex behaviours. We have worked through the issues identified in this case and made policy and practice changes. There were also some inappropriate behaviours exhibited by two staff that I regard as a failure of integrity on their part and are not representative of the patience and respect our staff take in such cases. These matters were fully investigated and appropriate action taken.
I have personally met with the prisoner concerned and discussed his care over this time. Although he remains a complex prisoner to manage, he is responding well to a new health management plan and is not presently self-harming.
The Department has developed a comprehensive plan “Investing in Better Mental health for Offenders” to address the increasing demand within prisons for access to mental health services. That plan includes:
- A $300m redevelopment of New Zealand’s maximum security facility (due to open in early 2018) to better respond to the most forensically challenged prisoners.
- An investment of $14m in mental health services delivered by teams of contracted mental health workers who will work in our prisons.
- The employment of social workers and counsellors in our women’s prisons to equip women to better cope in prison and on release.
- A new approach to managing prisoners “At Risk” to ensure not only safety is achieved but an improved investment in therapeutic treatment.
The Chief Ombudsman’s findings in regard to the operations of our At Risk Units (watch our video on At Risk Units) and the training of our staff have been incorporated into a programme of work that I have initiated that will provide more multidisciplinary teams for at-risk prisoners, enhanced training for staff working in these units and a greater emphasis on therapy. I have invited the Chief Ombudsman’s office to work with my staff to examine how privacy for at-risk prisoners can be balanced with necessary monitoring for the purposes of maintaining life.
While the Chief Ombudsman makes findings in respect of the use of restraints in five cases, I am satisfied that our staff took what they saw as appropriate and necessary steps to preserve the life of these prisoners. My staff do an incredibly difficult job with some of the most challenging and complex prisoners. They have obligations to public safety, the safety of their colleagues and the welfare of prisoners that can at times lead to stark choices with very limited options.
I have accepted and responded to the majority of the Chief Ombudsman’s findings. In doing so, I think it is important that Corrections’ actions are put in context.
Over the last three years only 12 prisoners have been restrained on a tie down bed. This is a tiny proportion of the more than 7,000 prisoners who have been through an At Risk Unit, and the 25,573 individual prisoners who were managed by Corrections during that time.
During this time, no prisoner who was considered to be “at risk” and was held in an At Risk Unit has died as a result of suicide or self-harm.
The use of a tie down bed is a last resort for some prisoners with extreme and prolific self-harming behaviour who don’t qualify to be admitted to a forensic mental health unit. This level of self-harming can include people tearing open their stitches, putting objects or faeces inside their wounds, and attempting to inflict serious physical injuries upon themselves.
The behaviour can be very extreme and is often accompanied by violence against Corrections staff.
If Corrections was not able to use a tie down bed, in cases of extreme self-harm, the risk of self-harm and even death among these prisoners would be increased.
An increasing number of prisoners have some form of mental illness and Corrections is taking steps to improve the quality of support offered to them.
Nearly 91 percent of prisoners have a lifelong diagnosis of a mental health or substance abuse disorder, with 62 percent having some issue in the last 12 months.
All offenders are screened for drug and alcohol issues and mental health problems when they enter prison as they have a much higher incidence of mental health disorders and illnesses than the general population. Corrections has a number of preventative measures in place to help reduce the rate of suicide and self harm in prison.
Tie down beds are used in a number of other Western countries that are also signatories of the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment of Punishment, such as Denmark and Norway, and are used in Canada, a country recognised for its delivery of correctional services.
Prisoner A had a history of serious prolific self-harming, generally for drug-seeking reasons. While in the At Risk Unit he was managed by a Multi-Disciplinary Team (MDT) that included the Prison Director, the Mason Clinic prison forensic team, psychologists and health staff.
Numerous attempts were made to have Prisoner A transferred to the Mason Clinic, but he did not meet the criteria for admission. Without the ability to transfer the prisoner to the Mason Clinic, the prison made the decision to manage him in the At Risk Unit.
The approach aimed to manage this prisoner’s volatile behavior to ensure his safety and reduce his risk of self-harm.
The MDT worked to reduce Prisoner A’s time on the bed. This approach was supported by all team members, including specialists from the Mason Clinic.
Prisoner A’s self-harming behaviours include head banging, self-inflicted deep lacerations to his neck, arms, abdomen and groin (using items secreted in his rectum, for example, sharp objects), tampering with wound healing by removing sutures and surgical glue and punching walls and hard objects, causing fractures.