By Walsh, Nancy
Clinical Psychiatry News , Vol. 30, No. 7
PHILADELPHIA -- Dramatic decreases in the use of seclusion and restraints have been seen in the Pennsylvania psychiatric hospital system in the 5 years since the inception of an award-winning initiative entitled Leading the Way Toward a Seclusion and Restraint-Free Environment.
The program has been recognized as a creative solution to a public concern by Harvard University's Innovations in American Government award.
The use of seclusion and restraints in Pennsylvania's mental hospitals has shown a decrease of 74% since 1997, Dr. Robert Davis reported in a poster presentation at the annual meeting of the American Psychiatric Association.
One hospital has been virtually restraint and seclusion free for more than a year, and several others have achieved nearly zerouse status, said Dr. Davis, associate medical director of the Harrisburg (Pa.) State Hospital.
During 2001, the nine hospitals combined used a total of 1,440 hours of mechanical restraint and 290 hours of seclusion. During 1996, before the program was begun, the hospitals used 16,465 hours of restraint and 12,384 hours of seclusion. But the total elimination of seclusion and restraint from the care of psychiatric patients is unlikely to occur, according to Dr. Charles Riordan, vice president of medical affairs, Hospital of St. Raphael, New Haven. "Seclusion and restraint are necessary extremely useful tools in the treatment of psychiatric patients. To eliminate them totally will, put both the patients themselves and at times caregivers in harm's way", Dr. Riordan told this newspaper.
"Can there be abuses? Of course there can. And we should have appropriate treatment protocols to make sure that such abuses do not occur," Dr. Riordan said.
A series of articles published in October 1998 in the Hartford Courant chronicled an investigation that found at least 142 deaths during the previous decade related to the use of restraints or seclusion among mentally ill patients as young as 6 years of age.
Two years after the report, President Clinton signed into law the Children's Health Act of 2000, which established standards restricting the use of seclusion and restraints in psychiatric facilities for children and youth who receive federal funds.
The success of the Pennsylvania program can be credited to staff training in crisis intervention techniques, risk factor assessment, and increasing use of the atypical antipsychotic medications, Dr. Davis said.
All direct care staff currently undergo 16 hours of training in behavior management and violence prevention when hired and an additional 8 hours of training annually.
The training focuses on verbal intervention, trauma reduction, and patient involvement in creative problem resolution. Staff members also are trained to recognize precipitants and contexts of assaultive and violent behavior.
Whenever an incident does occur, a "debriefing" session is held once the patient has become calm. Mediators work with the patient to identify precipitants and to find more constructive responses.
"Over the past 10 years a number of consumers of mental health services have found a voice and have spoken up about the trauma associated with the use of seclusion and restraints, and we started to listen," Roberta Altenor told this newspaper. …