Dr' Phillipe Pinel 1794

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Andrew McClain1998
Dr. Phillipe Pinel1794
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Understanding Seclusion and Restraint 

• Seclusion is a behavior-control technique
  involving locked isolation. 
• Physical restraint involves a personal
  restrictionincluding a physical holdthat
  immobilizes, or reduces the ability of an
  individual to move his or her arms, legs, or
  head freely. 
• Mechanical restraint is any device attached or
  adjacent to the residents body that he or she
  cannot easily remove that restricts freedom of
  movement or normal access to his or her body.

From the Children's Health Act of 2000
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Consumer Views

• A number of studies report that consumers
• Had predominately negative reactions to such
  procedures
• Were not aware of the reason why the intervention
  was initiated
• Indicated that it was humiliating, punishing
  depressing and
• Reported that staff control was a primary factor.
  

According to one consumer...putting a patient
in restraints makes them feel like an animal or a
bear in a trap.
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Todays Program
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The Evolution of Seclusion and Restraintas a
National Priority
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Achieving the Promise Transforming Mental
Health Care in America  

• A call for system transformation
• The goal hope for a full life outside the
  hospital
• Services and supports are consumer/child/ family
  centered
• Focus of care must increase childs/familys
  ability to self-manage illness and build
  resiliency

The use of controlling or coercive interventions
is counterintuitive to transformation.
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Mental health care is consumer and family driven.
Goal 2
2.5 Protect and enhance the rights of people with
mental illnesses.
Recommendation
Achieving the Promise provides a mandate to
address seclusion and restraint as a priority
issue.
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The elimination of seclusion and restraint
requires

• A public health approach that redirects the focus
  from safer use to prevention and alternatives
• A consumer-centered, recovery-oriented program
• A concerted effort rather than additional
  resources
• Strong leadership, accountability, commitment,
  and motivation

We must effect a culture change that resonates
with recovery and the goals of transformation.
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Eliminating the use of seclusion and restraint
is a SAMHSA-wide priority

• National Action Plan on Seclusion and Restraint.
• SAMHSA Matrix Workgroup
• A portfolio of programs and activities to provide
  training, technical assistance, and other support
  to States, providers, consumers, and others

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SAMHSA Seclusion and Restraint National Action
Plan
Revised and adopted May 2003
VisionTo reduce and ultimately eliminate
seclusion restraint in mental health
substance abuse care
Long-Term OutcomesReduction in deaths and
injuries resulting from seclusion
restraintReduction in the frequency of and work
toward the elimination of seclusion restraint
use
Initial OutcomesIncreased knowledge, skills, and
abilities of consumers, providers, facilities,
States, and others to prevent and reduce
seclusion restraint use for all ages
Increased knowledge, skills, and abilities of
PAs to monitor seclusion and restraint issues
Increased number of States and facilities
adopting and implementing evidence-based
seclusion restraint prevention and reduction
guidelines and best practices
SAMHSA Goal Capacity
SAMHSA Goal Effectiveness
SAMHSA Goal Accountability
Leadership Partnership Development
Evidence-Based Practices Guidelines
Data Collection
Rights Protection
Training Technical Assistance
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Data Collection
SAMHSA Activities

• Compile research and data on SR use, policies
  and issues
• State Protection and Advocacy programs provide
  annual data on rights violations and
  investigations
• The Alternatives to Restraint and Seclusion State
  Incentive Grant requires extensive data
  collection
• Identify and encourage adoption of SR
  performance measures

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Rights Protection
SAMHSA Activities

• Manage and provide technical assistance to the
  32 million Protection and Advocacy for
  Individuals with Mental Illness (PAIMI) program
  
• Support self-advocacy training for consumers
• Promote the use of advance directives

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Evidence-Based Practices and Guidelines
SAMHSA Activities

• Develop, disseminate and promote the adoption of
  effective staff-training approaches focused on
  prevention, alternatives and de-escalation
• Identify population-specific guidelines for the
  use of SR (e.g., children, older adults, people
  of color, women, persons who are deaf)

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Leadership Partnership Development
SAMHSA Activities

• A National Call to Action to Eliminate the Use of
  Seclusion and Restraint
• Collaboration with the Centers for Medicare and
  Medicaid Services (CMS) and other partners in
  substance abuse, criminal justice and education
• Development of Federal SR standards as required
  by the Childrens Health Act of 2000

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Training and Technical Assistance
SAMHSA Activities

• Conduct Best Practices in Behavior Support and
  Intervention Project
• Pilot Consumer-centered Staff Training Manual

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Training and Technical Assistance
Best Practices in Behavior Support and
Intervention Project

• Concluded a 3-year grant program designed to
  identify best practices in preventing and
  reducing the use of SR in facilities serving
  children and youth.
• Provided a grant of 6 million to enable grantee
  sites to implement training models focused on
  alternatives to the use of SR and to create an
  organizational culture that prioritizes the needs
  of consumers.
• Supported funding for a Coordinating Center to
  provide technical assistance, evaluate outcomes
  and disseminate results.

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Training and Technical Assistance
Best Practices in Behavior Support and
Intervention ProjectLessons Learned

• Strong leadership is critical
• Organizational culture must embrace a
  child/family-centered environment
• Agency policies must prescribe practices that
  contribute to the reduction of SR
• Training is critical
• The treatment milieu must be relationship based
• Tracking the use of SR is essential

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Training and Technical Assistance
Consumer-centered Staff Training Manual

• The manual will provide a practical training
  curriculum to assist facilities in alternatives
  to the use of SR.
• The manual is currently being pilot-tested in 2
  StatesConnecticut and Nebraska. (In Nebraska,
  the facility took down the door to the seclusion
  room at the end of the pilot.)
• Results of the evaluation are being used to
  refine the material prior to publication.

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