Behind locked doors: Inside Wellington's forensic mental health units

Youth offenders with mental illness can receive treatment at Nga Taiohi. The national unit costs around $4 million a ...
ROSS GIBLIN/FAIRFAX NZ

Youth offenders with mental illness can receive treatment at Nga Taiohi. The national unit costs around $4 million a year to run.

A cluster of pink stars, and sparkly gold and blue hand-cut paper butterflies float effortlessly up a bedroom wall - an antidote to their spartan surroundings.

Bedrooms in Haumietiketike​ - an adult forensic intellectual disability inpatient unit - are humble and functional. Little more than a single bed, storage cubes and a small shelf.

The term 'inpatient' is a misnomer.  Here, they're referred to as clients.

One of the bedrooms at Haumietiketike, a forensic inpatient unit treating adults with intellectual disabilities.
Ross Giblin

One of the bedrooms at Haumietiketike, a forensic inpatient unit treating adults with intellectual disabilities.

Residents are encouraged to personalise their living areas - a way of introducing colour, light and life into the space. "It's their home," a staffer explains.

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A well-loved black stereo sits inside the room we visit, a glut of discarded clothing lays strewn across parts of the floor.

The generous window above the bed frames a modest grassy clearing, vivid and lush-green in colour.

High fences create a secure outdoor courtyard for youth receiving mental health treatment at Nga Taiohi.
ROSS GIBLIN/FAIRFAX NZ

High fences create a secure outdoor courtyard for youth receiving mental health treatment at Nga Taiohi.

In the lounge area, a Happiness Tree adorns the back wall - the words of bravery, gratitude, positivity and compassion among the virtues which form its branches.

While words, pictures and positive affirmations surround its residents, there are subtle reminders that this community is far from typical.

Televisions in the unit sit behind locked cabinets.

3DHB mental health, addictions and intellectual disability services director of nursing, Toni Dal Din, left, and general ...
ROSS GIBLIN/FAIRFAX NZ

3DHB mental health, addictions and intellectual disability services director of nursing, Toni Dal Din, left, and general manager, Nigel Fairley stand outside the bedroom doors at Nga Taoihi.

Only one door can be opened at a time - a necessary security measure.

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Red duress buttons are fixed to the wall should any disorder erupt.

Workers also carry devices which look like old Nokia brick phones. With just two light presses of a button, help is immediately summoned using GPS.

Inside the classroom at Nga Taiohi national youth forensic mental health inpatient unit in Porirua.
ROSS GIBLIN/FAIRFAX NZ

Inside the classroom at Nga Taiohi national youth forensic mental health inpatient unit in Porirua.

As well as receiving treatment for mental illness, many clients here have had brushes with the law. Others have displayed dangerous, or potentially dangerous behaviour.

"There's the communal areas … but there are also de-escalation areas where people can go to if they pose more of a danger to others," said Toni Dal Din, 3DHB's mental health, addictions and intellectual disability services' director of nursing.

"Within the unit, there's a small area that you can manage people with more challenging behaviours."

A weighted toy dog is among the most popular items used inside Nga Taiohi's sensory unit.
ROSS GIBLIN/FAIRFAX NZ

A weighted toy dog is among the most popular items used inside Nga Taiohi's sensory unit.

The mental health unit can be found at the sprawling Ratonga Rua-o-Porirua campus, near Kenepuru Community Hospital, about 20 minutes' drive from Wellington's central city.

Beyond the imposing translucent, steel-framed walls lay some of society's most misunderstood and vulnerable individuals.

Around 30 of the 125 available forensic beds are taken up by 'special patients' - patients detained under a court order, some having also pleaded not guilty to criminal charges by reason of insanity.

Lighting can be changed to suit the user of Nga Taiohi's sensory room - a forensic unit catering for teenaged offenders.
ROSS GIBLIN/FAIRFAX NZ

Lighting can be changed to suit the user of Nga Taiohi's sensory room - a forensic unit catering for teenaged offenders.

But just as the public need protection from some mentally ill individuals, their safety is also paramount.

As a result, many mental health workers put themselves in harm's way to provide care to a part of the community some wished did not exist.

"I think the challenges that [workers] do face is balancing the need for recovery and autonomy in a person, with the need to provide safety and allow the community to feel safe.

A leather chair is among the items youth offenders living with mental illness can access in Nga Taiohi's sensory room.
ROSS GIBLIN/FAIRFAX NZ

A leather chair is among the items youth offenders living with mental illness can access in Nga Taiohi's sensory room.

"Many people understand their illness and are happy with taking treatment, [while for others] taking treatment doesn't suit them, so we have to balance that too," said Dal Din.

Some are sent to the unit for an open-ended term.

"It is usually a long journey," explained Nigel Fairley, general manager of mental health, addictions, intellectual disability services for 3DHB - an umbrella group which provides care for residents of the Wairarapa, Hutt Valley and Capital & Coast catchment areas.

The colour scheme used a lounge in Nga Taiohi was chosen by the teenagers who live there.
ROSS GIBLIN/FAIRFAX NZ

The colour scheme used a lounge in Nga Taiohi was chosen by the teenagers who live there.

The fragility of the mental health system has been exposed in recent months, as concern deepens for a sector witnessing unprecedented demand for its services.

The $15.3 million Nga Taiohi facility is the only youth forensic mental health unit of its kind in the country, costing around $4m a year to run.

Before its opening in May last year, teenaged offenders with complex mental health issues, including drug and alcohol problems, received treatment in adult facilities or out in the community.

Haumietiketike forensic unit caters for adult inpatients with intellectual disabilities.
ROSS GIBLIN/FAIRFAX NZ

Haumietiketike forensic unit caters for adult inpatients with intellectual disabilities.

A special room allows clients to make court appearances via audio-visual link.

The facility also boasts an indoor basketball court and a brightly-coloured classroom where students' artwork and phrases encouraging people to be kind, caring and grateful are proudly displayed.

The environment at Nga Taiohi can be radically different to what the teenagers have been accustomed to.

All staffers are issued with one of these devices, equipped with GPS, allowing them to summon immediate help should an ...
ROSS GIBLIN/FAIRFAX NZ

All staffers are issued with one of these devices, equipped with GPS, allowing them to summon immediate help should an incident break out inside a forensic mental health unit.

"Many haven't been to school before, [having] been bounced from place to place," Fairley said. "The school gives them stability."

In the communal area of the 10-bed unit, a patient strummed an acoustic guitar, while others ate glad-wrapped club sandwiches off paper plates near the kitchen.

"Generally, there are large communal areas where people are able to mix and mingle and then there are areas where they can sleep, separated male and female," Dal Din said.

"Just what you'd expect in any inpatient unit, people don't get locked in cells like they do in prison. It's a hospital."

The heady aroma of fresh wood hangs heavy in the corridor leading to the sensory room - a room designed to stimulate a person's five senses through special lighting, music and objects.

Sensory modulation rooms have become popular tool in mental health, shown to help prevent and de-escalate situations where residents are in acute distress.

It also helps reduce rates of seclusion and the need for restraints.

Calming music can be piped into the room, while soothing lavender seeps out of an oil burner to create a serene environment for those needing some time out.

Fingers can be run through the shaggy rug on the floor, a plush leather chair provides a contrasting leather texture, while lighting from neon green through to ruby red can be altered to suit its user.

As well as a large spiky ball and heavy blankets, among the most popular items in the room is a weighted full-sized toy dog.

Just like the effect of a firm hug, the toy creates a deep pressure which is thought to ease anxiety and stress, stimulate the body's production of serotonin, and facilitate sleep and relaxation.

'A SIMPLE ANSWER TO A COMPLEX PROBLEM'

Mental health looms as one of the biggest political battlegrounds this election, many categorising the state of the country's mental health system as being at 'crisis point'.

In this year's Budget, finance minister Steven Joyce committed $224 million of Government spending to mental health over the next four years.

From that, $100m was ring-fenced for use by DHBs to support local mental health and addiction services, with the same amount also being put towards a new social investment fund aimed at developing new ways of tackling issues plaguing the sector.

However, those at the coalface aren't convinced throwing more money around is the answer.

Fairley said while he would "welcome" more funding, it's not a straight-forward fix.

"Actually, it's a far more complex question than that. I am obviously aware of all the stuff that's going on [in the sector]," Fairley said.

"You can't apply a simple solution to what is a very complex problem. So, if there is to be more funding, in my view, it needs to be targeted, rather than just kind of thrown in a system."

Fairley believed ring-fencing funding for youth mental health and early intervention would benefit from more direct investment.

"Look, I'm really proud of our services, I've got to say. I think our services are great, but that doesn't mean we can't do better.

"One of the kind of issues is that all the woes and ills of society can potentially be chucked in the mental health bucket ... that's kind of easy, I think, and it's complicated."

 - Stuff

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