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Mental health patient kept in continuous seclusion

Published: 6:51AM Saturday April 28, 2012 Source: Fairfax

  • Depression (Source: Photos.com)
    Depression - Source: Photos.com

The outdoors is Ashley Peacock's only pleasure in life - but in the past year he has spent fewer than 50 hours outside.

He has committed no offence yet the 33-year-old spends his days in a cell-like room with a mattress on the floor.

"He is an outdoors person, that is his only joy, but it's been denied him," his father David told The Dominion Post.

"He has bad eyesight and won't read and he doesn't like television. He thinks he's in prison and he doesn't understand why."

Peacock's case has been the subject of a "watching brief" from the chief human rights commissioner for several years.

He is in the care of Capital & Coast District Health Board as a compulsory treatment patient, with autism, post-traumatic stress disorder, a mild intellectual disability and mental health problems.

His parents, David and Marlena Peacock, live in Gisborne but rent a flat in Wellington to visit their son in Porirua's Regional Rehabilitation Unit, Tawhirimatea.

In 2006, they told The Dominion Post they held grave fears for their son's wellbeing if he was moved into an institutionalised setting, such as Tawhirimatea.

"This year his physical and mental condition has rapidly worsened," David Peacock said last week.

"He is now in a serious psychotic state; afraid to come out of his room, urinating in cups in his room and assaulting staff.

"Now he is absolutely bizarre, he's so confused he doesn't know what he's doing. It's had a huge emotional and financial toll."

Peacock does not dispute that his son needs care, but he says seclusion should not be a long-term solution. "There is a need, from time to time, for him to be in there, I don't doubt that. But it should be an acute, short-term answer."

He wishes his son could have spent more time outside - rather than in his room, the hallway, the lounge or the small fenced courtyard areas he likens to chicken-coops.

Human rights lawyer Michael Bott, who is acting for the Peacock family, describes Ashley's confinement as disgraceful. He has visited his room, which he says is spartan. "It is devoid of any furnishings. There was a mattress on the floor, no toilet, no access to fresh air, minimal sunlight.

"Now we are in a situation where we have Ashley, who is in his early 30s, who's committed no crime, yet he's in effective solitary confinement - they call it de-escalation."

By the start of this month, Ashley had spent the past year in continuous seclusion, he said. "In that time, the amount of exercise this young man has had is 46 half hours - if that was a prison inmate in our harshest detention regime, that would be deemed cruel and unusual."

Ashley's total outdoor exercise hours - equating to just over seven minutes a day - were compiled by his parents using his hospital seclusion summary sheets.

DHB director of area mental health services Nigel Fairley would not comment specifically on Ashley's case but disputed that any patient would have had only 46 half hours' exercise in a year. The DHB had received two letters from the Human Rights Commission regarding the case, he said.

All clients received multiple reviews from the doctors and nurses to make sure that their treatment plan was working.

"Access to exercise and other outdoor activities depend on the individual client's clinical diagnosis. How well they are determines the activities that are safe and appropriate.

"No patient is kept in a de-escalation room without stimulation. Patients in a de-escalation situation have their care assessed daily, and from that a decision is made about what kind of activities and visits are safe and appropriate."

In March last year, Rosslyn Noonan, who was then the Human Rights Commission chief, wrote to Ashley's doctor, saying: "The commission has maintained a watching brief on Ashley while he has been in Tawhirimatea.

"As I have said to you previously, it is inappropriate for the commission to intervene in treatment decisions but I do have concerns about the use of seclusion, particularly where it is used for excessively long periods, as seems to be the case here."

She wrote another letter in June, asking for Ashley to spend more time out of the unit.

The Health Ministry's director of mental health, John Crawshaw, said seclusion under the Mental Health Act was at times a necessary tool and some instances required seclusion over "sustained periods". "The Ministry of Health is confident that Capital & Coast District Health Board are taking the appropriate steps to meet this man's complex needs."

What is seclusion?

The latest annual report from the office of the Health Ministry's director of mental health states that seclusion should be an uncommon event, and 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.

It says seclusion should never be used for the purposes of discipline, coercion or staff convenience, or as a substitute for adequate levels of staff or active treatment.

The Restraint Minimisation and Safe Practice Standard defines seclusion as the placing of a person at any time, and for any duration, alone in an area where he/she cannot freely exit.

The duration and circumstances of each episode must be recorded in a register, which must be available for inspection by district inspectors.

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