An Auckland needs assessment agency is blaming a lack of knowledge for its part in the incarceration of a woman in a secure health unit against her wishes and without proper legal authority.
In a report released on Tuesday, Deputy Health and Disability Commissioner Rae Lamb said the 43-year-old woman, who has since died, was detained in the unit unlawfully and against her wishes for periods within a 14-month timeframe in 2007 and 2008.
Ms Lamb faults the Taikura Trust, Oak Park Dementia Unit and the Auckland District Health Board.
She has referred the trust, which looks after the needs of 11,500 Aucklanders with mental and intellectual disabilities, for possible follow-up legal action.
Taikura Trust's chief executive Sonia Hawea says there was no intent to disregard rights, and they have now better informed themselves about the law.
A spokesperson for Oak Park, Ashton Parker, says it failed to make the right checks, and has now changed procedures so is confident all clients have their rights respected.
The Auckland District Health Board says it let the patient down, but has made changes since.
In her report, Ms Lamb said the woman, who had complex problems, was discharged from Auckland City Hospital into the Oak Park Dementia secure unit in 2007.
But a breakdown in DHB processes meant legal authority was not obtained.
The woman asked repeatedly to leave and was backed in this by a doctor and some others. Ms Lamb said the woman's detention was not always appropriate to her needs.
Fears case may be 'tip of the iceberg'
The Mental Health Foundation says the case could be just the tip of the iceberg and it suspects others could be similarly detained without the right paperwork and without a legal advocate.
The foundation says those who are mentally unwell are particularly vulnerable and it is tragic when recommendations seem obvious.
It is not known yet whether the independent director of proceedings for the Health and Disability Commissioner will take further action.
