PREV: 1. Seclusion and restraint: background, definitions, human rights standards and key principles for assessing their use.
Summary of findings
Overall, data collected by the Ministry of Health and the Department of Corrections on the use of seclusion and restraint in New Zealand revealed a high use.20 The data also clearly showed that ethnic minority groups, in particular Mäori, were overrepresented in seclusion and segregation units.21 This was very concerning and needs to be investigated further. Some of the restraints which were used included forms of mechanical restraint which several jurisdictions, including England and Wales, no longer use. The use of restraint or tie-down beds in prisons and the use of restraint chairs in police custody was particularly concerning, and I was not convinced that these extreme forms of restraint were reserved as a last resort when all else had been tried and failed. Some of the long-term restrictive measures applied to a small but persistent number of people in health and disability facilities were also troubling. Management plans for these individuals appeared to be focused on variants of seclusion and restraint, rather than thinking outside the seclusion room, or 'the box’, to use the old fashioned term for solitary confinement.
In prisons, the physical design and material conditions in the so-called ‘At Risk units’, where vulnerable prisoners were housed, were mostly identical to those in other solitary confinement units. Given that expert opinion22 and the Mandela Rule 45(2) explicitly prohibit the placement of prisoners with physical or mental disabilities in solitary confinement, it could be argued that these units, as they operated at the time of the visits, breached international standards by their very nature. The deprivation of social interaction which is inherent in all solitary confinement practices, was often made worse by the deprivation of other provisions which could have helped to mitigate the harmful effects of seclusion, including restrictions on family visits, in-room provisions such as books, hobby and craft materials or a TV set, and the generally very limited regimes. Review processes were not always robust, and some stays in restrictive conditions were far too long.23
a. The prevalence of the use of seclusion and restraint in New Zealand
The prevalence of segregation and forms of restraint in Corrections
The use of segregation in prisons across the country, according to data provided by the Department of Corrections, was high. In the year to 30 Nov 2016, there were 16,370 recorded instances of segregation in New Zealand. With an average prison population of 9,798 people, this equals 167.1 instances of segregation per 100 prisoners.
To put these numbers in context, in England and Wales the rate was 36.9 segregation instances per 100 prisoners,24 meaning that, on average, New Zealand segregated prisoners over four times more often than England and Wales. This was a surprising finding, especially considering that the use of segregation in England and Wales itself was found to be high.25
Of the 16,370 stays in segregation, 1,314, or 8 per cent lasted for 15 days or longer, the maximum duration stipulated in the Mandela Rules. This equates to 13.4 instances of segregation of 15 days or more per 100 prisoners.
Women were much more likely (69 per cent) than men to be segregated (269.4 instances per 100 women, compared to 159.7 instances per 100 men), and for longer times: 20.7 for instances of segregation lasting 15 days or longer per 100 prisoners for women, compared to 12.9 instances for men, (or a total of 138 instances for women and 1176 for men). By contrast, in England and Wales, there was little difference between men and women in the use of segregation: 38.1 instances per 100 of women, compared to 36.8 per 100 for men.
New Zealanders of non-European descent were much more likely to be segregated compared to their counterparts of European descent. Between May and October 2016, Mäori and Pacific Islanders made up approximately 80 per cent of Directed Segregations (Management units and Disciplinary segregation). By comparison, New Zealanders of European descent accounted for a mere 15 per cent of prisoners in Directed Segregation. The picture was rather different in At Risk units, where the same ethnic groups made up approximately 54 per cent and New Zealanders of European descent made up 37 per cent of the population.26
Taking all forms of segregation together, Mäori and Pacific Islanders made up for approximately 62 per cent of those segregated, and New Zealanders of European descent made for 30 per cent of the segregated population. While these figures are almost identical to the representation of these groups in prison more generally (62 per cent and 32 per cent respectively), they are grossly disproportionate to Mäori representation in New Zealand’s population, where Europeans make for 69 per cent of the population, Mäori make for 14.6 per cent, and Pacific Islanders make for 6.9 per cent of the population.
Forms of restraint
According to data provided to us by the Department of Corrections, in the six months May-October 2016, a total of 423 incidents involving the use of mechanical restraint were recorded, some involving the use of more than one form of restraint.
The recorded incidents primarily involved the use of handcuffs, but they also included five uses of a restraint bed; 9 uses of spit hoods; 16 uses of waist restraints, and; three uses of head protectors. This data needs to be approached with caution: we found a number of discrepancies in the recording of the type of restraint used, and some of the data did not align with data examined during visits. We are also unable to tell how long people could spend in restraint as the end time was not noted in the data provided to us, but looking at some of the case notes describing the incident it is clear that some people remained in restraint for a long time, sometimes for several hours and even days.27
The prevalence of seclusion and restraint in health and disability settings
In its Annual Report for 2015, the Office of the Director of Mental Health reported that since the introduction of seclusion reduction policies in 2009, the total number of people secluded in adult inpatient services nationally had decreased by 30 per cent, and the total number of seclusion hours had decreased by 58 per cent. This is a substantial reduction, and the Ministry of Health and District Health Boards (DHBs) should be applauded for their continuing commitment to the reduction and eventual elimination of seclusion. But despite the Ministry’s commitment and an overall reduction over the last few years, the Office of the Director of Mental Health’s data revealed that in 2015 the rate of seclusion in adult mental health services remained high:28
“Between 1 January and 31 December 2015, New Zealand adult mental health services (excluding forensic and other regional rehabilitation services) accommodated 7,545 people for a total of 198,525 bed nights.
Of these people, 754 (10 per cent) were secluded at some time during the reporting period.
People who were secluded were often secluded more than once (on average 2.2 times). Therefore, the number of seclusion events in adult inpatient services (1,668) was higher than the number of people secluded.
Across all inpatient services, including forensic, intellectual disability and youth services, 1001 people experienced at least one seclusion event. Of those secluded, 69 per cent were male and 31 per cent were female. The most common age group for those secluded was 20–24 years. A total of 121 young people (aged 19 years and under) were secluded during the 2015 year, in 289 seclusion events”.29
It should be noted that 72 per cent of seclusion events in 2015 lasted less than 24 hours (ibid.)
The prevalence of Secure Care Unit placements in Children and Young Persons’ Care and Protection residences, and in Youth Justice residences
The data below is from the Secure Care Unit registers in the Children and Young Persons’ Care and Protection residence and the Youth Justice residence visited.30 As this data is not usually collected centrally, it was extracted especially for this report. Mechanical restraints are no longer used in Care and Protection residences or in Youth Justice residences. Instead, at the time of the visits residences used the Non-Violent Crisis Intervention (NVCI) system of personal restraint, and were planning to move to the Managing Aggression and Perceived Aggression (MAPA) which focuses more on de-escalation techniques. These were not examined in this report.
Data for Secure Care Unit stays in the Care and Protection residence indicated that between May and October 2016, twenty children spent time in the Secure Care Unit in the course of 76 different occurrences. The duration of stays was as follows:
Frequency and length of stay in a Care and Protection Residence’s Secure Care Unit: May – October 2016
Seven of the twenty children housed in the Secure Care Unit had between 4 and 14 spells at the unit, together accounting for 54 of the occurrences. This finding is similar to findings on the use of solitary confinement in other contexts, demonstrating that people who experienced solitary confinement are more likely to experience it again (see for example the Office of the Director of Mental Health(2015) discussed above.)
Frequency and length of stay in Youth Justice Residence's Secure Care Unit: May – October 2016
Stays in the Secure unit in Te Puna Wai o Tuhinapo Youth Justice residence, tended to be longer. Between May and October 2016, 54 young people were housed in the Secure Care unit on 108 different occurrences, together spending 307 days in the Secure Care unit.
The prevalence of restraints in police custody
The majority of stays in police custody were short. Where stays were longer than 24 hours and the detainee spent the majority of the day in a single cell in separation from others, however, this constituted a form of solitary confinement.
Data on use of force and restraint in police custody units across the country was however collected on the Tactical Options Reporting (TOR) system. This data indicated the following for the six months May-October 2016 Restraints and Incapacitating Agents were used in a total of 144 incidents, as follows:
Tasers (6 times); Spit hoods (9 times); OC Spray (Pepper Spray) (9 times), Restraint chair (56 times) and Handcuffs.
Of the 56 uses of a restraint chair, 30 involved people detained for the purpose of mental health assessment (Code 1M) and 33 individuals were noted as 'attempted suicide' (Code 1X). The number of people with mental health issues amongst those subjected to the application of restraints was concerning and needs to be looked into in more detail as a matter of urgency.
Forty-nine per cent of all restraint incidents involved detainees of non-European ethnic origin (Mäori, Pacific Islanders, Asian and African American). This, too, needs to be looked at in more detail.
b. The use of seclusion and restraints: concerns by institution type
Prisons, health and disability units, children and youth residences, and police custody suites, had issues unique to the populations which they were catering for. These are examined below.
The Corrections Act 2004 stipulates that prisoners can be segregated for the security or good order of the prison (section 58(1)(a)); for the safety of another prisoner or person (section 58(1)(b)); for the purpose of voluntary protective custody (at the prisoner’s request) (section 59(1)(a)); for the purpose of directed protective custody (non voluntary) (section 59(1)(b)); and for the purpose of medical oversight to assess or ensure the prisoner’s physical or mental health. The Act (Sub part 4) also specifies when coercive powers including the use of force and restraints may be used.
At Risk cell
Depending on the reason for their segregation, prisoners could be housed in the prison's At Risk unit, in a Management Unit or in a punishment unit (sometimes called 'separates') or the 'pound' – an old fashioned term for a punishment block, essentially small, free standing, fenced and gated breeze block buildings, containing 3- 6 cells and shower stalls. These punishment blocks contained no office or other space for staff, as staff were not stationed in them, and we were told that they were only used when no other segregation cells were available.
Segregation cells31 – of all types – had an in-cell toilet/basin combination unit. Toilets were usually unscreened, and with two exceptions had no toilet seat or cover. Management units, which were designed for longer stays, often also had an in-cell shower, power point and a TV set, and some had an adjacent yard, with an electronic door which could be opened remotely, meaning that the prisoner could take their daily exercise without direct staff contact. At Risk cells were very similar to those in a Management unit, but with fewer furnishings and without an adjacent yard. Most At Risk units also had two or three ‘round cells’ or ‘dry cells’ which contained nothing at all other than a concrete slab with a thin mattress covered by tear-proof plastic, and a cardboard bedpan. Where the prison was in possession of a tie-down or restraint bed, it was usually located in the At Risk unit. Some At Risk cells had a glass front, and all were monitored by close circuit television.
Some of the issues and concerns around the use of segregation and restraint in the prisons visited, as identified in the course of visits, included:
Impoverished regimes and little contact with staff
Most of the segregation units visited were bleak, and lacked communal areas where congregated activities could take place.32
We observed very little movement and activity within the units, and opportunities for prisoners to engage with staff in a meaningful way or to undertake constructive activities were very limited.33 We did not spend enough time in each unit to offer a considered comment on staff and prisoner relationships or to seek their view of each other. However, whilst we did not observe any adversarial interactions, with one notable exception (Christchurch Women’s), the relationships that we did observe, appeared distant. A typical daily ‘regime’ included only access to a shower, telephone call and solitary exercise in a small, barren yard or cage, though there was a degree of staff discretion and some variation in practices. For example, women serving a disciplinary punishment in Christchurch Women’s prison were offered no telephone calls, whereas men in Christchurch Men’s, Auckland South and Mount Eden Management units could make one 5 minute telephone call daily, and At Risk prisoners in Auckland prison could enjoy up to 15 minutes daily. Management plans, which are meant to be tailored to the individual prisoner’s needs and the challenges they present, lacked detail or individualized reintegration plans.
Conditions in punishment blocks
The use of segregation as a disciplinary punishment ('cellular confinement') was fairly straightforward: a prisoner broke a prison rule, attended a disciplinary hearing and was given a punishment, which could include time in a segregation unit. Data from disciplinary hearings (or 'adjudications') indicated that most punishments involving segregation time were proportionate and relatively short. However, several of the prisons visited (including Christchurch Men’s, Rimutaka,34 Rolleston and Auckland Men's (Paremoremo)) also had a 'pound' unit which was sometimes used for housing prisoners serving cellular confinement. It was unclear whether these stays were appropriately recorded, and the 'pounds' visited felt very isolated. Of particular concern were night time arrangements in the 'pounds', as these units had no staff on site, but were instead supervised by ‘rovers’ who come throughout the night who could only open door flaps but not the doors themselves. This meant that if a prisoner self harmed or attempted suicide at night time, or indeed had another medical emergency (for example, a heart-attack), there was a reasonable chance that they would not be found for some time, and even then there would be further delay whilst the 'rover' called on other staff to make their way to the 'pound' so that the cell door could be opened. At Rolleston prison and Auckland Men's, the night shift visited the pound only twice per night, whereas at Christchurch men’s we were told that they came five times at night.
Other areas of concern included the three punishment cells at Christchurch Men's J Block which were of reasonable size, but the showers were located in the exercise yard and we were told that this had meant that in the winter those three cells could not be used. Finally, prisoners serving disciplinary punishments did not always receive minimum entitlements. Women serving Cell Confinement (CC) at Christchurch Women's, for example, could not receive any visits or make telephone calls and were only entitled to three showers a week. This may constitute a violation of their human rights, and it may also adversely affect the families, and in particular children, of these women.
Lack of clarity on placement in, and exit from, segregation units and inappropriate cells
The reasons for placements in Management units and At Risk units were not always clear, did not always correlate to the stated purpose of the units, and stays tended to be long. Although Management units were not meant to be punitive, the problems of bleak environment and impoverished regimes identified above were very much evident in them too. I was particularly concerned about use of the ‘silver cells’ – small cells made entirely of stainless steel (walls, bed slab, shelves, under-bed storage space, toilet), with a narrow and grilled glass pane overlooking a corridor – in Auckland Men’s Management unit. These claustrophobic cells were not fit for purpose, particularly not for segregated men who had to spend the majority of the day in them. Also of concern was the use of a section of five grill-fronted cells in one of the general population blocks for the segregation of a mixture of Management and At Risk prisoners, some of whom were mentally very unwell, in some cases for many months. These cells were small and windowless, and, though prisoners housed in them could have more personal possessions than was usually the case in segregation, these cells were inappropriate for longer stays.
Segregation of vulnerable prisoners
The most concerning aspect of prison segregation practices were the At Risk units (ARUs), where those deemed to be the most vulnerable in the prison were housed, sometimes for long periods of time. ARUs appeared to be very similar to other segregation units (by whichever name) both in terms of the material conditions, and in terms of the impoverished regimes. But ARUs also had the added disadvantage of potentially degrading practices such as requiring all prisoners housed in them to wear anti-tear gowns ('strip gowns') and use special bedding, or housing vulnerable individuals in glass-fronted cells with nothing in them. Key decisions were undertaken by custodial staff with limited clinical input into the identification of a prisoner as being at risk of self harm, and their management thereafter (for example, setting the frequency of their observation by staff).
The key focus in At Risk units appeared to be on having as little as possible inside the cell so to minimise prisoners' access to materials which they could use to harm themselves with. These 'situational controls' were not accompanied by the necessary accompanying work with the individual on addressing the underlying issues which led to their placement there. Furthermore, in a number of the At Risk units, some of the few in-cell fixtures were not ligature resistant or tamper proof, meaning that they could be used for self-harm, making these cells unsafe. This was extremely concerning and defeats the sole stated purpose of At Risk units- to provide a safe environment for individuals who were at high risk of self-harm.
In short, the appearance, conditions and regime in most of the At Risk units we visited were as impoverished and stark as those in punitive segregation units and units for the management of difficult prisoners. Since segregation is a known risk factor for self harm and suicide,35 it follows that the people at risk of such behaviour should not be segregated. This practice also goes against international human rights law standards which call on states to altogether exclude people who are mentally unwell from segregation (see for example the Istanbul Statement, the Mandela Rules and UN Special Rapporteur on Torture reports), and with current trends to ban altogether the use of solitary confinement for people with mental illness (for example in the US).
Units and cells not always used for their intended purpose
Some people were housed in At Risk or Management units because cells there were accessible to people with disabilities , or because they were newly imprisoned and very anxious, because they needed medical supervision following a medical procedure, or because of other purposes which may be legitimate, but are not stipulated in the prison rules and do not warrant the strict conditions in these units. This was particularly prevalent in the female estate. To illustrate, at the time of our visit, occupants in one At Risk unit included the following: two cells were used for women in wheelchairs simply because "there's no other suitable (i.e. accessible) place for them in the prison" (Officer). Three women were there because this was their first time in prison and they were scared. One woman was ready to go to the General Population but there was no bed for her, "so we need to wait for one. But if we need her bed here, she'll go to Management" (Officer). At the same unit, 'soft cells' (i.e. 'round cells' or 'strip cells'36 ) and cells at the Separates unit were sometimes used inappropriately as an overflow of women from the ARU. We were also told, in several prisons, that prisoners awaiting transfer to a forensic unit would usually be segregated until a bed became available for them, sometimes for many months.
As well as blanket policies which were applied also when there was no obvious rationale for their application (discussed in the following section), there was a high degree of staff discretion and it was not always clear how or why decisions were made on how to manage units, when to allow or disallow certain goods and services to secluded people (from books, art materials, TV sets, curtains and strip gowns through to time out of cell, showers, food items and coffee), or adopt practices such as strip searches (in some segregation units prisoners were strip searched upon placement whereas in others they were not).
Meal times too early
With one exception (Rolleston prison) meals were served much too early, with most facilities serving dinner as early as 15:30. These timings were inappropriate for adults, and the very long gap between the evening meal and the morning meal (8:00-8:30) meant that some individuals, in particular those who did not have access to canteen goods (either because they had no money to purchase them or because their disciplinary punishment included a loss of canteen purchases), could remain hungry.
Food was served to segregated prisoners though a hatch / flap in their cell door, and had to be consumed inside the cell, often in close proximity to an open (cover-less) toilet. This was bad practice and unpleasant for everyone, but potentially particularly problematic for Mäori prisoners.37
We also observed a noticeable variation in the quality and quantity of food served in the facilities we visited despite standardised menus now being offered throughout the prison estate. In most At Risk units food was served in paper plates and with cardboard cutlery as a matter of policy, and in some prisoners were only offered finger food, regardless of their individual risks and needs.
Health and disability units
The physical place where patients and residents in health and disability units could be held in separation from others is called Seclusion. Section 71 of the Mental Health (Compulsory Assessment and Treatment) Act 1993 sets out the conditions that apply when a mental health patient is placed in Seclusion. Additional safeguards are listed in Appendix 3. These include a requirement that Seclusion only be used where, and for as long as, it is necessary for the care and treatment of the patient, or the protection of other patients. Section 60 of the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 stipulates that a care recipient may be placed in seclusion to prevent them from endangering their own health or safety or that of others and /or where the care and wellbeing of other persons would be seriously compromised.
Some of the issues around the use of seclusion and segregation practices in health and disability units included:
The official objective of reducing seclusion was not always accepted by front line-staff
While the Ministry of Health and the DHBs’ high-level commitment to the reduction and eventual elimination of seclusion was clear, the necessary change of mindset was not always evident on the ground, with some patients (or ‘clients’) spending much of their time in seclusion and/or restraint and some staff fearing that reduction in the use of seclusion and restraints would endanger their safety. There also appeared to be some tension over the more ambitious aim of eliminating the use of seclusion altogether. As staff in one of the units visited put it:
‘I’d like to see us not use seclusion at all, but to do that we’ll need more staff/ if you don’t [provide more staff] staff will feel unsupported, no matter what the evidence says’. (clinical Lead)
‘I agree. I don’t like seclusion. It has no therapeutic value. It’s an intervention to stop violence. From my perspective, the culture is still swayed towards staff safety. Fear is a big factor’ (Nursing lead).
Seclusion rooms were not always used for their intended purpose
Seclusion rooms were not always used for their intended purpose. Asked about the purpose of seclusion a mental health nurse in another unit said: 'we don’t view seclusion as a particularly therapeutic tool. It's a management issue'. Another nurse conceded that: ‘it’s about the circumstances of the person, but also about what’s happening on the unit at the time’. In one of the units visited, all three available cells (two 'designated' seclusion cells and one used for overflow) were occupied by people who were 'transitioning and here to sleep'. In another unit, only one of five rooms was officially designated as a seclusion room, but all were identical in appearance and of the four which were occupied at the time of our visit, all appeared to be used for the purpose of keeping individuals separated from others: one man was 'transitioning' back to the main unit, another was a very long term patient who had a bedroom in this unit as well as in the main unit, a third patient, a woman, had been at the unit for over two months because of 'inappropriate behaviour', and the fourth patient 'sleeps here because there is no room for him in the main unit'. This was not good practice. In yet another unit we were told that placements in the low stimulus area were "usually driven by perceived dangerousness; actual assault on staff; overstimulation; risk of escape and overcrowding". Overcrowding is not a justifiable reason for locking up a patient in a small, barren room with no personal belongings for days on end, nor is it provided for under the Mental Health (Compulsory Assessment and Treatment) Act 1992 (section 71(2)).
Seclusion room in a health and disability unit
Stark physical environment and lack of patient control over their environment
In all units visited, seclusion rooms resembled prison segregation cells, and were mostly barren other than a mattress and bedding. In many of the units visited patients had little control over their environment – for example light switches and blind controls were located outside the room and could not be operated by them. Where some control was given to service users, for example, allowing residents of one health and disability unit to choose the colour scheme for seclusion or de-escalation rooms, some of the colour choices made (for example, deep purple) may not be ideal for an area set aside for calming down and de-escalation purposes. Units were mostly in a reasonable state of repair (indeed, two were recently refurbished), but the ICU at Te Whare Ahuru (Hutt Valley DHB) could do with an update.
Lack of personal belongings and things to do
Most seclusion rooms had none of the patient’s personal belongings, and patients were offered very few, if any, activities, typically no more than a short time in a barren outdoor yard or in a so-called ‘day room’ containing a table, a chair and a TV set behind a protective screen. This was contrary to MOH guidelines (2010) proposing that giving patients access to personal belongings and things to occupy themselves with was a desirable practice. Many practices were discretionary. Asked if patients could have a book in one mental health unit, the nurse replied that: “it depends on the client. It’s unusual to give them too much property. If someone is able to concentrate on reading a book, they would most likely be out [of seclusion]”.
Insufficiently detailed recording
The statistical data for restraint incidents did not record the reason for use of restraints. Furthermore, incidents involving the use of restraint were not collated and analysed nationally.
Children and Young Persons’ Care and Protection residences and Youth Justice residences
The physical space where children could be held in separation from other children in a care and protection residence is called a Secure Care unit. Section 368 of the Children, Young Persons and their Families Act 1989 stipulates that a child or a young person may be placed in the Secure Care unit of a residence only if such placement is necessary (a) to prevent the child or young person absconding from the residence or (b) to prevent the child or young person from behaving in a manner likely to cause physical harm to that child or young person or to any other person.
Some of the issues around the use of seclusion in Children and Young People's Care and Protection and Youth Justice residences included:
Children and young people were held in separation from others
My key concern with both types of facilities visited was the very fact that they had a 'Secure Care' unit where children and young people could be held in separation from others, even if for relatively short periods. As previously noted, international human rights law and principles of good practice call for a complete prohibition on the use of solitary confinement with children.
I was also concerned to find that the call-bell system in the Secure Care unit in the care and protection residence was not working. Not only was this a serious failing, it also pointed to wider issues: insufficient safeguards; overreliance on staff availability (previously discussed); acceptance of unacceptable situations (e.g. a child having to wave their hands in the air or bang on a door to attract attention); and for the different monitoring bodies who visited the unit but did not observe this shortcoming.
A Secure unit room in a Children's care and protection residence
Drab conditions and prison-like appearance
Secure Care unit rooms in both facilities were barren and drab, with nothing to distinguish them from prison segregation cells in adult prisons. The Secure Care unit in the care and protection residence also had two ‘timeout’ rooms which contained nothing but a concrete slab. In the youth justice residence, the ‘timeout’ rooms were adjacent to the general units, but they, too, contained nothing other than a slab and had no call bell, and I was concerned to hear that these rooms are sometimes used as bedrooms. Rooms had no curtains and in the Youth Justice residence, young people could not access pencils inside their rooms. We were told that the reason for this was to prevent them from ‘tagging’ or drawing graffiti in the room, but this also meant that they were unable to, for example, do homework or write when they were inside their room. This seemed counterproductive and unnecessarily harsh.
Police custody suites
Police custody suites mostly accommodated detainees for relatively short periods lasting from a few hours and up to 48 hours,38 but this time was mostly spent alone with nothing to do in an empty cell containing a metal toilet/basin combination unit or, if a person was in a ‘high-risk cell’, only a cardboard urinal. The use of restraints in police custody is regulated under section 41 of the Crimes Act 1961. Some of the issues identified included:
In both units visited we were told that the policy was not to give detainees more than one blanket – in Wellington Police custody suite we were told that this was the case because they did not have enough kit, and in Manukau police suite, where there was no shortage of kit, we were told that this is to ensure that there are always enough clean blankets ready for use. Bearing in mind the problem of poor temperature control in Wellington police (discussed later), this was problematic. Also in Wellington, detainees were provided with pillows which were, as one officer commented, “plastic and not very nice, and in short supply”.
No clear minimum entitlements
No clear minimum requirements were set for the provision of exercise, shower, telephone calls, visits, in-cell provisions including books, and so on.39 “They have a right to speak to a lawyer, anything beyond that is at our discretion” (Officer). Another officer explained that “Over the weekend I try to give them showers, but there is no guarantee. We will provide soap and towels”.
Inappropriate conditions and Wellington police custody suite
Conditions in Wellington custody suite were more generally inappropriate . The entire suite was located underground, so that there were no windows anywhere. There was no yard. Cells had ligature proof furniture including sprinklers, but they were covered in graffiti and extremely institutional in feel. Ventilation and temperature control were poor. Cells were self contained with a toilet and a basin with drinking water, but otherwise they had nothing in them, and no activities were offered. The unit also had an ‘association room’ where detainees could spend time together during designated times, but the room was essentially a concrete space fitted with concrete tables and chairs, and an open (but screened) toilet. Four cells were designated for self-harming detainees. These cells were on camera, and were painted in light pink. The women’s shower in the custody suite had stable doors which were inappropriate as they afforded no privacy, especially considering that they were located inside the custody suite. People identified as very vulnerable will be placed on constant watch with someone sitting outside their cell all the time. One officer explained that: “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”. The policy of not engaging with detainees on constant watch needed to be reconsidered.
The custody suite in Manukau was much newer and in a better state of repair than the Wellington custody suite. A joint project with local artists resulted in nine out of the 41 cells in the custody suite being painted using original, colourful designs. The custody suite also contained five ‘high risk’ cells for detainees deemed to be at high risk of self-harm which only contained a concrete slab with a mattress and, two of which were ‘dry cells’ containing nothing at all.
Lack of privacy
Detainees could be strip searched provided the appropriate authorisation was obtained. Strip searches took part in a special holding areas which were more private than the cells – but were still covered by CCTV.
Use of instruments of restraint and poor record keeping
No records were kept of when and why high risk custody cells were used, and the start and end time of the application of restraints (which were recorded) were not prominently displayed in the paperwork.
Both of the custody suites visited had a restraint chair at their disposal, and used it not infrequently (see section on prevalence). Incidents involving the use of the restraint chair were recorded on the Tactical Options Reporting (TOR) system and provided a good level of detail about events leading to their use. However, on closer examination of a sample of incident reports, it was not always indicated on the form that de-escalation and less restrictive options were attempted first and it was not always clear why the most restrictive form of restraint, in particular the restraint chair, were selected in preference to other forms. In this context it should be noted that the UN Committee Against Torture (CAT) has recommended that the use of restraint chairs be abolished altogether as “their use almost invariably leads to breaches of article 16 of the Convention.”40
c. The use of seclusion and restraint in New Zealand: common issues and concerns
In addition to the more specific findings relating to individual facilities discussed above, a number of common themes were evident across several types of institutions. These are addressed in the following paragraphs.
Seclusion and restraints were not always used as emergency last resort tools for the shortest time possible.
The reasons for placing any one individual in seclusion/segregation, or restraining them, were not always clear, nor was it clear that alternative, less restrictive options were explored first. Distressed behaviours were sometimes interpreted as aggressive ones, and responded to as such. A number of prisons and health and disability units across the country housed individuals who were subjected to very long periods in seclusion and/or restraint. Not only were solitary confinement and restraint not reserved as last resort short-term options in these cases, but they appeared to have became the default position and were applied for prolonged times with no clear end in sight.
Examples include a man who had been held in isolative, segregated conditions in a long-term health and disability unit for over six years, two men at another health and disability unit, both also kept in similar conditions for over six years and one of whom was also restrained in a body belt, and a self-harming prisoner who had been restrained in a tie down bed for over a month as part of a ‘behavioural management plan’. For the individuals concerned, prolonged seclusion and /or restraint (and often both) had thus become a chronic state rather than an emergency short term response to an acute situation. Decisions to prolong their seclusion and/or the application of restraint did not appear to be subjected to ongoing, robust external review, and it was not clear if, how and when their seclusion could be terminated. 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. But there appeared to be very little by way of thinking about an entirely different solution to the perceived challenges that these individuals presented (for example that they self harm or that they are unpredictable).
In this context, it should also be noted that this would appear to violate principles established by the Committee on the Rights of Persons with Disabilities’ (CRPD):41
Throughout all the reviews of State party reports, the Committee has established that it is contrary to article 14 to allow for the detention of persons with disabilities based on the perceived danger of persons to themselves or to others. The involuntary detention of persons with disabilities based on risk or dangerousness, alleged need of care or treatment or other reasons tied to impairment or health diagnosis is contrary to the right to liberty, and amounts to arbitrary deprivation of liberty.
Stark physical environments and impoverished regimes in seclusion, secure care and segregation units
The vast majority of the seclusion rooms and segregation cells we visited- in mental health and intellectual disability facilities, in children and young persons’ residences and in prisons- were stark in appearance and feel and contained few furnishings and personal belongings. With one exception, where cells/rooms had a toilet, this was a metal toilet/basin combination unit with no toilet seat or cover. Overall, there was little to distinguish between conditions in a seclusion room in a secure mental health unit, which is meant to provide a therapeutic environment and a place of healing for people who are unwell, and those in a prison segregation unit, a place of punishment for prisoners who broke a prison rule, or indeed in a children’s care and protection residence where vulnerable children are housed. The prison-like environment was particularly concerning in secure care units for children, many of whom are highly likely to have suffered previous trauma and disruption. Children could spend up to three days in these cells.
In prisons, At Risk units also housed very vulnerable people in what can only be described as austere and basic conditions, under constant observation through a CCTV system, all of which could potentially contribute to their distress. The individuals confined in these units were only offered a very basic regime with little or no access to educational or vocational training and limited access to recreational activities. Exercise yards were barren and small, and most units had either very limited communal space for congregated activities or, in the majority of places, no communal space at all.
Outdoor areas in most of the places visited also tended to small and barren. In one mental health unit there was no equipment in the yard and patients were not provided with a ball or other ways to work out in the yard. The seclusion area in another mental health unit had a caged yard, and in another it was an outdoor small barren concrete space, covered with mesh. Yard walls in another mental health unit visited were covered with graffiti, some of which was quite offensive. The length of stay in the yard varied- there were no fixed minimum or maximum times in mental health facilities. One very long-term (six years) resident in a health and disability unit, could not access a yard daily as he was deemed to be too strong and unpredictable to mingle with others. “We try to give him weekly access but realistically he probably only gets it once a month” (Staff). This, of course, is unacceptable.
In prisons, a number of yards were also covered in graffiti, and with few exceptions all were small and mostly barren. For example, at Christchurch men’s ARU, one ‘yard’ was an internal room with no equipment. The ‘yards’ adjacent to cells on the lower tier of Mount Eden’s Management Unit were essentially barren internal rooms which offered neither natural light nor fresh air.42
Access to basic fixtures and provisions was not always not guaranteed
In all types of institutions visited, basic necessities were not always provided including, for example, access to drinking water, natural light and means of communicating with staff whilst isolated.
No in-room drinking water
Seclusion rooms/cells in several of the facilities visited did not have access to drinking water. Rooms in the Secure Care Unit in the children’s care and protection residence had a basin, but we were told that the water was not suitable for drinking. ‘Round cells’ at Auckland Men’s and Rimutaka prisons also had no running drinking water. Instead, prisoners were provided with paper cups filled with water during meal times or “on request” (Officer). The situation was similar in health and disability facilities. In one mental health unit we were told that when someone wanted water, they could press the call button and “we will bring it [water] over, no problem”. In another unit we were told that “we bring through three 250 ml cups every time we enter, to replenish them”. In yet another mental health unit we were told that clients could ask for more water by pressing a call button.
Call bells not installed or not functioning
I was concerned to find that seclusion rooms in several health and disability units and in the Time Out room in the Secure Care Unit at the Youth Justice residence, had no call bell or other means for patients and residents to alert staff. We were told that an intercom system stayed on whenever the rooms were occupied, but it could be turned off by staff: “the intercom system will stay on so that we can hear them, but if someone rumbles on, we can turn it off” (Mental Health nurse). In the Youth Justice’s ‘Time Out’ room, the young person would have to “bang on the door” to get attention (staff). Rooms in the Secure Care Unit in the children’s Care and Protection residence did have a call bells, but worryingly, they did not work and we were told that the system “hasn’t worked for years”. A child wanting attention, we were told, would have to “wave their hands in the air to draw our attention “ (staff). We were told that rooms had microphones connected to an intercom system which stayed on whenever the unit was occupied, but there was some confusion during our visit as to how the system operated and it did not appear to be regularly used.
Internal exercise yard
Limited control of immediate environment
In several of the health and disability units the light switches and blinds for each room could only be controlled from the outside. In the At Risk unit at Christchurch men’s prison light switches were similarly outside the cell, and blue lights stayed on all night. At Rolleston prison, lights in ‘Pound’ units were controlled from the outside only. This was also the case at Auckland prison and Auckland South’s At Risk units, though at Auckland South we were told that prisoners could use the call bell and ask for lights to be turned on or off at any time they wanted.
Poor temperature control
Temperature control was poor in a number of the institutions visited. For example, the de-escalation rooms at Te Whare Ahuru (Hutt Valley DHB) were too hot, whereas the air conditioning in one of the rooms in the Secure Care Unit at the Youth Justice residence was set on too low a temperature on the day of our visit, making the room very cold. The custody suite at Wellington police station, which was located underground, tended, according to officers working there, to get very cold in winter and very hot in summer. This was the case despite there being a forced air ducting system in place with sensors designed to keep temperatures within an appropriate range
Lack of privacy
Most high-risk cells in the facilities visited were continuously monitored by close-circuit cameras which covered the entire cell/room area, including the toilet, affording detainees no privacy. Examples include the ARU cells in Christchurch Men’s and Christchurch Women’s, and the Police custody suite in Wellington.
Lack of individual autonomy and over-reliance on the goodwill and availability of staff in the provision of basic necessities
Where these were not available in their room, access to a number of basic provisions (discussed above) was dependent on the goodwill of staff/officers/nurses. Some examples include: providing drinking water to prisoners, patients and young people who did not have access to it inside their cell/room ; responding to the hand signals of a distressed child in a Secure Care cell (as the call bell didn’t work); escorting a patient to the toilet as their seclusion room/segregation cell is not equipped with one (as was the case in seclusion room in many health and disability units and prison ‘soft’ and ‘round’ cells); providing ARU prisoners with toilet paper “as needed” (Auckland Men’s); relying on prison staff to override the mechanism which only allowed for 10 or 15 or, in one prison, only 3 flushes of the toilet daily (depending on the prison – note also inconsistency)43 ; and relying on police or prison officers to be able and available to give a detainee their asthma inhaler when they had an asthma attack, as inhalers could not be kept in the cell (including at Auckland Women’s ARU, Auckland Men’s, and Wellington Police).
Whilst not doubting the goodwill of staff, they cannot always be available to assist and it is important to have structures and procedures in place to ensure that, to use the examples above, everyone can always access basic necessities such as drinking water and are able to alert someone in cases of emergency or distress or indeed if they need to use the toilet at night when their rooms are locked. In this respect I also note the practice of locking up patients in their bedroom at night in mental health facilities, a practice which, using the Ministry of Health’s own definition, would constitute ‘seclusion’.
Risk aversion and staff safety taking precedence
There were indications of a high level of risk aversion in the units visited, resulting in staff safety taking too much precedence over patients’ and prisoners’ comfort and rights. There appeared to be greater focus on control of individuals than on their treatment, and an anticipation of disruptive behaviour, especially in the case of a number of longer term mental health patients whose behaviours were perceived as wilful rather than distressed. In one or two cases, the management of patients appeared to have a punitive element.44 Though some staff concerns over their own safety were of course legitimate, these needed to be considered and weighed against the individual’s needs and wellbeing, and solitary confinement must not be continued indefinitely.
Blanket restrictive policies applied
A number of standard procedures and practices which applied to all those segregated or secluded appeared unnecessarily restrictive and, when applied to those who did not require them for health or safety reasons, also unnecessarily punitive. Examples included: requiring all At Risk prisoners to wear strip gowns (variously also called ‘stitch gowns’ or ‘anti-rip gowns’ – knee-length smocks made from thick, tear-proof materials), and providing them with finger food only, as was the case in several units; not permitting all women in an At Risk unit to wear a bra; requiring all patients arriving to one mental health unit from court or from prison to be placed in mechanical restraint (body belt/ cuff on side); searching all prisoners returning to their cell, even if just from the Day Room in one women’s prison; strip searching all women who were serving disciplinary punishment (Cellular Confinement) in another, and; not allowing young people to have pencils in the Secure Care room. While some of these may be necessary for a short time, for a specific individual, they must not be applied as a matter of course to everyone.
Written records: some duplicates, little electronic recording and variable quality assurance
Stays in solitary confinement units across the different detention contexts were not consistently recorded, and where they were recorded, this was sometimes done manually in old fashioned large-format paper registers. Across detaining agencies, some data was recorded several times in different registers.
These inconsistencies made reviewing the data for trends, equalities and other issues of potential concern much more difficult and time consuming than necessary. This is partially evidenced also by the length of time it took to provide this review with some of the data requested.
Paperwork and case files related to individuals was of variable quality, sometimes even within the same institution, with examples of both excellent, detailed notes and notes, completed in illegible handwriting with signatures missing, across the different detention contexts. Where paper files (rather than electronic one) were kept, they were sometimes disorganised, making it difficult to access pertinent information and share information between shifts. In one mental health unit, for example, the paperwork examined was mostly of reasonable quality with detailed notes, mostly completed by nurses, but some notes were illegible, and there appeared to be some inconsistency in regime and provisions for two patients: one had a detailed management plan and access to various professionals, including an Occupational Therapist and a social worker, whereas the other patient had none . The Seclusion Authorisation Form for another patient listed a whole array of reasons for their seclusion including: requests to be secluded; homicidal; safety of self; and, needs low stimulus, making it difficult to judge the need for seclusion in that particular individual’s case.
Management Plans in both mental health and prison settings were often laconic and brief, setting generic targets such as ‘improve behaviour’ or ‘not engage in self-harm’. In prisons, the prisoner’s signature was missing on several of the management plans examined, and prisoners did not always get a copy of their management plan, which seemed to defeat the point of having one. In contrast, Individual Behaviour Management Plans for Young People completed daily by Secure Care Unit staff at the Youth Justice facility visited were of excellent quality – see section on Good Practice.
The use of restraint by the police was recorded electronically on the Tactical Options Reporting (TOR). The small sample of individual incident reports involving the use of restraint chairs examined were completed to a good standard and included a detailed account of events.
Limited confidential access to written complaint mechanisms
The health and disability facilities visited provided residents with access to a telephone and free-phone numbers for District Inspectors and the Health and Disability Commissioners were either displayed on the wall or provided to residents as part of an information pack. Prisoners were similarly able to access the Inspector of Corrections and the Ombudsman’s office and their telephone numbers were prominently displayed by the telephones, often in the exercise yard or ‘day room’. However, with the exception of children and youth residences, which were equipped with confidential complaints boxes, seclusion areas in most of the health and disability units, prisons and police custody suites visited had no complaint boxes where people could deposit a complaint in a confidential manner. Instead, anyone wanting to make a complaint had to first ask staff for the relevant form and then hand it to them for further action. This was not good practice. Easily accessible confidential complaints boxes are a necessary adjunct to any phone based complaint avenues, and this access must be safeguarded. Where these were available for us to review, we found that the quality and promptness of responses to complaints received were variable as were processes of quality assurance.
d. Good practice examples
Though the general issues of concern identified above were present in many (and, in some cases, all) of the units visited, there were also pockets of good practice. What follows are good practice examples observed in either one or a number of the units visited (but not in all or even most), joined together to paint a picture of what good practice looks like in a solitary confinement unit.45 These good practice examples can be used by the different detaining agencies as learning points for improving current practices.
People are provided with good information on unit routines and expectations on arrival
In one health and disability unit, newly arrived patients arriving to the de-escalation unit received a welcome pack with toiletries, a pen, a notebook, information on daily routines and activities available in the unit and an information booklet on the complaints system, peer support and so on (Te Whare o Matairangi). Newly arrived residents at Haumietiketike Intellectual Disability Secure Inpatient unit were also provided with ‘housekeeping guidelines’ setting out expectations and the unit’s daily routines, as well as illustrated guidance on making complaints. The Mason clinic provided families of patients with a good information booklet on what to expect. Women segregated in Auckland Women’s Management and Separates units were provided with an induction booklet containing detailed information on unit rules, routines, and on the women’s entitlements.
Beds are kept for patients/prisoners in their sending unit
In a number of units (though not all), where patients were secluded, the bedroom they were originally allocated in the general units was kept for them (Te Whare o Matairangi ). This was also the case in a number of prisons where the stay in segregation (usually to serve a disciplinary punishment) was expected to be short, and where the prisoner was currently residing in a forensic facility. Keeping the person’s original bedroom / cell for them during their seclusion reasserts an expectation that seclusion is a short, temporary state of affairs, and it also ensures that patients/prisoners do not spend longer than necessary away from the general population solely because no beds are available for them back there. Staff at the ARU in Christchurch Women’s went a step further and checked on women once they were back in the general population. This was excellent practice.
Decorated exercise yard
Cells/rooms offer a safe and healthy physical environment and sufficient provisions
A good segregation cell or seclusion room should be clean; in a good state of repair; have a window with a view, which can be opened for ventilation; good fixtures and provisions, and; allow individuals a degree of control of their immediate environment. Exercise yards and outdoor areas should be of a good size, offer some protection from the elements, contain exercise equipment, a sitting area and some greenery.46
None of the units we saw offered all these elements, but many offered one aspect or another. This was a good start, but more needed to be done. Cells in the Management Unit in Auckland South prison had good fixtures and provisions including a couple of power points, a kettle, a television, and ample storage space. Prisoners were provided with a writing pad, pen and envelope on arrival, and could access art supplies with a manager’s approval. Secluded patients at Te Whare o Matairangi mental health unit could operate their own window blinds, and the Tawhirimatea Rehabilitation unit was spotlessly clean. One of the long-term residents in Haumatiketike unit had a bedroom, an activities room, and a vegetable patch. Cells in the Management unit at Auckland Women’s prison were of good size and well furnished, with a window looking out to some trees and grass, a separate shower and toilet with a modesty screen, and an in-cell power point. Cell call bells were checked every week, and the exercise yard had a stationary bike and a basketball hoop. The exercise yard in the Management unit in Rimutaka prison similarly had some fixed exercise equipment, and toilets had a modesty screen. The At Risk unit at Christchurch Women’s had a small garden which women could enjoy during their out of cell time. The unit’s walls were beautifully decorated with murals painted by a former resident of the unit. Doors to the individual yard attached to cells on the top tier of the Management Unit at Mount Eden Correctional Facility remained open throughout the day, enabling detainees to spend as much time there as they wished. The exercise yard in the Secure Care unit at Te Puna Wai o Tuhinapo Youth residence was large, had a basketball hoop and overlooked some trees and greenery. The custody suite at Manakau police included nine cells which were painted by local artists using themes they chose, following a competition judged by the Justice Minister. The resulting wall painted art really brightened up the unit and sent a positive message to both detainees and staff. Also at Manukau, detainees could borrow a book from a small selection of books held by custody staff.
Decorated police cell
Individuals are able to engage in varied daily regime activities
Whilst most of the facilities visited only offered very limited regimes for segregated / secluded people, there were some positive efforts to engage people in some form of activity. At the Mason Clinic, the default position was for secluded people to come out of their room and eat their meals by a table. This allowed the patient to spend some time outside their small rooms and engage, and presented staff a good opportunity to interact with them and assess how they functioned in a normalised situation. Children in the Secure Care Unit in Epuni Care and Protection Residence remained outside of their seclusion room between 8:00-20:00 every day, during which they were expected to follow a daily timetable which included educational, recreational, and house-keeping activities as well as time on the yard or engagement with staff. Where possible, women at the At Risk unit at Auckland Women’s could associate with others (of the same legal status) in the Day Room which was brightly painted and equipped with a television, books and a selection of board games.
Progression out of segregated environments is supported by multidisciplinary work and family involvement
There was a degree of multidisciplinary work in most of the prisons visited, especially in reviewing the segregation of At Risk prisoners. These reviews typically involved custodial staff, health and mental health staff, occupational therapists and representatives from the community mental health facility. For example, weekly meetings were held to discuss prisoners with complex needs at Auckland Men’s, which included mental health, education and custodial staff, as well as representatives from the Mason Clinic. Similarly, weekly High Risk Assessment Team (HRAT) meetings which included Mason Clinic staff, psychology, site nurses, site doctors, social worker and unit staff meet once a to discuss all the women at the At Risk unit in Auckland Women’s prison. Christchurch Men’s also had good multidisciplinary work with monthly Complex Case Meetings to discuss all ARU residents and long-term segregated prisoners. All the women at the At Risk unit in Christchurch Women’s prison were assessed daily by a multidisciplinary team which included nursing staff, senior custodial staff, unit staff and the prisoner herself. Segregation review hearings in Auckland South prison similarly included the prisoner himself as well as a cultural representative, mental health practitioner and custodial staff.
In one Health and Disability Unit (Haumietiketike) family members were invited to participate in six monthly reviews, which also included the patient’s care team, occupational therapist, psychology and psychiatry. This, and in particular the involvement of the patient’s family, was excellent practice.
Staff know the individuals in their care
With one notable exception, staff in all the facilities we visited demonstrated good knowledge of the individuals in their care, though, as noted earlier, staff-detainee relationships appeared to be distant. Segregation and seclusion units in most of the prisons and health and disability facilities had display boards listing all the individuals who were in the unit at the time, with varying degrees of detail. In most cases, boards were appropriately displayed out of general view and included information about the individual’s age, legal status, needs and preferences, for example whether they had any special dietary or health needs, the date of their arrival at the unit and their review dates, and the name of their personal officer or nurse. A good quality board also helped with staff handover and ensured that key information about the individual was passed on.
Individualised work with prisoners / patients/ residents is taking place to address their needs and challenges
As well as a Management Plan, prisoners at Auckland South’s Separation and Reintegration Unit (SRU) set out their goals and plan to achieve them in the ‘Prison Support Plan’- a compact of sorts, signed by the prisoner and by staff. At Risk unit staff at Christchurch Women’s kept a separate file on each of the women in the unit, where all the observations, risk assessment and daily interview notes were held. Staff in both Epuni Children and Young Persons’ Care and Protection residence and Te Puna Wai o Tuhinapo Youth Justice residence clearly knew the children in their care very well, and efforts were made to get to the bottom of the events which led the child to the Secure Care Unit. These attempts included the young person’s perspective and understanding of their role in these events. This meant that time in the unit could be used in a productive way rather than being an entirely wasted, or ‘dead time’. Children placed in the Secure Care Unit at the Children and Young Persons’ Care and Protection residence had daily management plans drawn up, which included triggers, targets and issues. Children housed in the Secure Care Unit were also required to complete progressive workbooks addressing the event/s which led to their placement there, and how they might manage their own return to the open unit, which was very good practice. Individual Behaviour Management Plans for Young People completed daily by Secure Care Unit staff at Te Puna Wai o Tuhinapo Youth Justice residence were also of excellent quality, and included relevant, detailed observations and targets for young people.
Use of force and restraints is minimal, regularly reviewed, and staff are up to date with their training
Force should only be used as little as possible, when other alternatives had been tried and failed. Where force is used, it is crucially important for staff involved and Management to review the incident and learn lessons for it. Arrangements for reviewing use of force incidents in most of the facilities visited were of reasonable quality, and of excellent quality at Mount Eden Correctional Facility. The majority (but not all) of permanent staff in both mental health facilities and prisons were up to date with their use of force / ‘Calm and Restraint’ training.
An easily accessible system of complaints is in place
Both health and disability facilities and prisons provided freephone numbers and reasonable access to a telephone for contacting the District Inspectors and the Health and Disability Commissioners or the Inspector of Corrections and the Ombudsman’s office respectively. Patients, prisoners and residents could also access a form for making a written complaint in all the facilities visits, though confidential complaint boxes were only provided in the Children and Young Persons’ Care and Protection residence and in the Youth Justice residence visited.47 Complaint procedures were explained in an easy to understand language which included illustrations to facilitate the needs of people with learning difficulties.
NEXT: 3. Recommendations.