Strong Voices

A new national secure facility in Porirua is trying to achieve an uneasy balance between providing privacy and therapy and managing high-risk behaviour.

Manawai, the $13.3 million national individualised service unit, was opened in July by Health Minister Andrew Little. It is for people with intellectual disabilities who may also have significant mental health conditions. It provides individualised treatment for six people under compulsory care orders, whose behaviour has resulted in them becoming involved with the criminal justice system.

Manawai is located next to Haumietiketike, a regional adult forensic intellectual disability inpatient unit. But unlike Haumietiketike , which houses people together in three and four-bed clusters, Manawai has single units, where people are supported in their own living environments.

The new unit was opened against a background of commentary by Chief Ombudsman Peter Boshier about the treatment of people with intellectual disabilities in forensic mental health units. The new secure unit is promising an improvement, offering people more space and privacy, and therapeutic programmes aimed at reintegration into the community.

“This six-unit facility will provide a better quality of life for those receiving care through more individual therapeutic programmes in a more private, home-like environment,” Andrew Little said at the opening.

“These are people who have been engaging in behaviour that can be of high risk to themselves and others. They therefore require long-term care and rehabilitation in a secure setting, and these units will go a long way to better support their rehabilitative gains.”

Paul Oxnam, the Executive Clinical Director for Mental Health, Addiction and Intellectual Disability Service (MHAIDS), says the people who live in Manawai come from one of the five Regional Intellectual Disability Secure Services around the country. “The units in Manawai are for people with mental illness or an intellectual disability and they present in ways that means their behaviour poses a risk to other people.”

MHAIDS provides services across Wellington, Porirua, Kāpiti, the Hutt Valley and the Wairarapa as well as some central region and national services.

Paul says clients will spend much of their time engaging in social and therapeutic activities with staff who will come in and out of their units. They will also take part in vocational activities, such as cooking and gardening, on the Rātonga Rua o Porirua hospital campus and spend time in the local community. How much time each client spends outside their unit will be based on an evidence-based risk assessment.

Paul says the opportunity to live a good life in the community is the goal for every Manawai client, however long that may take to achieve. “The person has to be at a point where it’s possible for them to live with support in a less secure environment. There is no such thing as a home for life. A hospital is not a home for life.” While people may require long-term care in Manawai, Paul says the service’s model of care ensures there is a pathway to community reintegration. Without that constant focus on the community, clients could become stuck.

“Our services should be places where you would want to be cared for, or you would want your family member to be cared for.”

He says MHAIDS has been looking to recruit staff from the United Kingdom with specialised training in intellectual disability. This kind of tertiary training doesn’t exist in New Zealand, with most staff coming from a mental health background and receiving additional on-the-job training.

Architect John MacDonald of McKenzie Higham Architects led the team that designed Manawai. He says a lot of work went into trying to achieve the right balance between safety for the occupants and staff, and privacy. The team members were also conscious that while they were designing a medium secure facility with a lot of hard surfaces and limited soft furnishings, it was also going to be someone’s home.

“I am very pleased with the light and feel, and we were able to get some colour in,” he says.

Each unit measures 51 square metres inside and has a large bedroom with inbuilt storage space; a basic kitchen with sink, a microwave and fridge; an ensuite bathroom/shower room; a living room with purpose-built, secure and colourful seating; a large TV with video camera to allow video calls with whānau; and a private, fully enclosed courtyard with a planter – measuring an extra 14 square metres.

The kitchen has sockets for a kettle and toaster, if it is appropriate to provide these, and people will be allowed to host their families for visits. Whaikaha funds visits from whānau living out of town and there are whānau/family flats nearby for accommodation.

Manawai also has two communal rooms, one for use in art therapy and the other a dedicated Zoom room.

A panel made up of representatives from Whaikaha and clinical experts from around the country decides who will be housed in the units. Four clients have so far been accepted by the access panel and are being transitioned into the unit, two at a time.

The panel will meet again next year to decide who will take up the remaining two units.

Caption 1: Colour and soft furnishings take the edge off the hard surfaces at the Manawai medium secure facility in Porirua.

Caption 2: Manawai is located next to Haumietiketike, a regional adult forensic intellectual disability inpatient unit on the Porirua Hospital campus.