At 6.20am on May 15, 2023, a woman called police and told them she was “hearing voices” and that her children were dead.

Police didn’t arrive until 77 minutes after that call, when they found two preschool-aged children deceased at the Ruakākā address.

An investigation later concluded the children had been dead for several hours before the woman called police, but she was charged with two counts of murder, before being acquitted by reason of insanity.

While being detained and awaiting trial, the woman was found to be in a psychotic state and likely suffering from schizophrenia.

Justice David Johnstone declared the woman legally insane and said the evidence suggested that although the woman knew what she was doing, she decided to end their life based on a delusional belief they would avoid being abused and tortured.

“It is in the context of escalating symptoms of psychosis [that] she had a fear her children would be harmed, which was why they were killed,” he said, noting that she was labouring under a “disease of the mind”.

The woman was acquitted of murder and ordered to be detained in a psychiatric facility as a special patient under the Mental Health Act.

However, the police’s response to the situation on the morning the woman called 105 for help was put under scrutiny by police watchdog the Independent Police Conduct Authority (IPCA).

In a brief decision released today, the authority found that the call centre operator made mistakes when prioritising the woman’s call.

Police investigate a double homicide after two children were found dead at a home on Peter Snell Rd in Ruakākā. Photo / Michael Cunningham

According to the authority’s report, police staff made the call to wait until the on-call rural support officer began his shift at 7am, rather than sending him immediately to the scene.

“Police concluded that district staff did not realise the seriousness of the event until after officers arrived at the scene and discovered the deceased children,” the IPCA’s report notes.

“The authority acknowledges the tragic circumstances of this case, and that, in this instance, police’s delayed response would not have affected the outcome.”

Police say they have addressed the decision-making of staff involved in the incident and they have received further training in responding to urgent situations.

Northland District Commander Superintendent Matt Srhoj said the incident was a deeply tragic event for the whānau and the Ruakākā community.

“Had our response not been delayed, this profoundly sad and tragic outcome would have remained unchanged,” he said.

“Our investigation team established that both children’s injuries were not survivable and been inflicted some hours before police were contacted.”

Srhoj said regardless, a police review identified key lessons from the incident.

“We acknowledge that initial decision-making by our staff did not prioritise the initial call and attendance of the reported incident,” he said.

“Our people are human and mistakes were made around the initial prioritisation of the woman’s call to police, as well as the timeliness in sending staff to the scene.”

Jeremy Wilkinson is an Open Justice reporter based in Manawatū covering courts and justice issues with an interest in tribunals. He has been a journalist for nearly a decade and has worked for NZME since 2022.