The right to health is a fundamental human right. The International Covenant on Economic Social and Cultural Rights (ICESCR) states there is a right to the “enjoyment of the highest attainable standard of physical and mental health”. People who experience mental health difficulties should be receiving the support and treatment they require in an appropriate manner and in the appropriate environment. Mäori Mäori make up 15.4 per cent of New Zealand’s population,4 but they make up a greater percentage of those detained in New Zealand; • As at 30 June 2017, 5,171 of the prison population were Mäori out of a total population of 10,260. Mäori were 50.4 per cent of the prison population.5 • Mäori accounted for 26 per cent of mental health service users in New Zealand in 2015.6 • 60 per cent of those detained in a care and protection residence, and 70 per cent of those detained in youth justice residences, are Mäori.7 • Mäori are involved in 46 per cent of police apprehensions.8 We are concerned that our criminal justice system is not responding to the needs of Mäori. The Waitangi Tribunal stated that the Crown has a Treaty responsibility to reduce inequities between Mäori and non-Mäori reoffending rates to protect Mäori interests.9 This responsibility requires the Crown to work in partnership with Mäori, not just simply inform itself of Mäori interests. Some detaining agencies are making great strides towards reducing inequities while others have some way to go. There needs to be an overarching kaupapa, bicultural frameworks, and strategies that make a real difference for Mäori. Seclusion and restraint New Zealand has a high use of seclusion, especially when compared to other countries. For example, New Zealand secludes prisoners at a rate over four times the rate of that in England and Wales.10 New Zealand also uses mechanical restraints, such as tie-down beds and restraint chairs, which are no longer used in countries like England.11 Studies have shown seclusion has adverse consequences. Observed effects include panic attacks, difficulties with thinking, concentration, and memory, paranoia, problems with impulse control including self-mutilation, illusions, and hallucinations, and physiological effects such as insomnia, heart palpitations, back and joint pains, appetite loss, deterioration of eyesight, diarrhoea, and tremulousness. These effects can occur after only a few days in seclusion and the risks increase with each additional day spent in seclusion. The detrimental impacts of seclusion and restraint in New Zealand have been well documented in Dr Shalev’s 2017 report Thinking Outside the Box? – A Review of Seclusion and Restraint Practices in New Zealand. Dr Shalev’s recommendations should be fully implemented. In particular, the use of equipment such as restraint chairs and restraint beds should be abolished, the use of seclusion should be eliminated in mental health facilities,12 and minimum standards around decent living conditions and access to fresh air, food and drinking water should always be met. OPCAT designations The lack of independent monitoring of aged care and dementia facilities has been an area of particular concern. The people in these facilities often have physical and mental vulnerabilities, and there are growing concerns about the treatment of people in these facilities. Applying the OPCAT framework to aged care and dementia facilities will be beneficial. The NPMs have supported a designation change to allow the Ombudsman to monitor and inspect locked private sector dementia facilities. We are pleased to note that these designations have recently been approved and inspections should commence in 2019/20 after the Ombudsman has scoped relevant requirements and obtained the necessary resourcing. The NPMs support specialist monitoring of facilities that hold youth. The Children’s Commissioner should be able to monitor youth units in prisons, mothers with babies units in prisons, and child and adolescent mental health units. We will continue advocate for these designation changes. 3