Seclusion & Restraint in Ohio

Steve Stone
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The use of seclusion and restraint in mental health care in Ohio is legitimately subject to the assessment, criticisms and recommendations of the United Nations Special Rapporteur of the Human Rights Council on torture and other cruel, inhuman or degrading treatment or punishment.

Each year, thousands of Ohio’s most vulnerable children are placed in institutional settings for months or years at a time in order to treat their mental health issues.  These children often have histories of extreme violence, abuse and neglect and subsequently require substantial support, structure, care and supervision.  Though it is widely believed that measures such as seclusion and restraint protect patients and staff and are, therefore, examples of the support and care these children need, a Summary Report by the U.S. Department of Health and Human Services attributes 50-150 deaths each year to the use of seclusion and restraints. Furthermore, in a 1996 survey of three states, it was found that every 26 out of 100 mental health aides had reported an injury or injuries resulting from administering a restraint.

In addition to the 50-150 deaths that occur nationally each year due to seclusion and restraint, a 2003 SAMHSA report notes that thousands of individuals sustain bruises, broken bones and other physical injuries resulting from the use of physical restraint. The damage doesn’t end there; physical restraint is also psychologically traumatic for the child, the staff members and even for many who witness the event.  Though these incidents and their impact is alarming, the use of seclusion and restraints on children in Ohio’s residential facilities is not only legal, but goes largely unnoticed due to a reporting system described as “…so confusing that even officials in the state Department of Mental Health and Department of Job and Family Services struggle to explain how it works” (Cincinnati Enquirer, March 22, 2004).

There is little consistency among reporting standards in Ohio, leaving the use of seclusion and restraints unchecked and its effects on institutionalized children largely unmonitored. Though Ohio’s residential facilities may seem far removed from most Ohioans, it is with our tax dollars that children are traumatized and physically, psychologically and emotionally harmed in lieu of receiving the effective, therapeutic treatments they need.

Advocates who joined together as a task force in Ohio have been working for more than 8 years to promote legislative and regulatory reforms aimed at reducing and eliminating the use of seclusion and restraint in our state. The current governor and his two predecessors, and their  administrations, have committed to addressing this problem. Twenty-three professional and trade associations have joined this group to advocate for needed changes, yet the state has yet to make any movement to addressing this issue, other then recent reforms that are limited to the public education system which resulted from a lawsuit.

I hope that bringing attention to this important issue will attract someone who is in a position to provide the necessary leadership to bring about changes in Ohio. The unresponsiveness in Ohio is not a result of a lack of funding; it is simply a lack of political will and leadership. To find out more about efforts to address seclusion and restrain in Ohio please look for the advocacy toolkit at www.ashlandmhrb.org.

13 COMMENTS

  1. I have seen numerous governments across the globe say they are going to reduce restraints. The trouble is they often just replace restraints with forced drugging. Forced drugging is 10,000 times the human rights abuse that restraints are, and I hope we don’t see physical restraints merely replaced with brain disabling drug based chemical restraints in Ohio. Decreasing touching the outside of a child’s body by force, in favor of touching and meddling with the inside of a child’s brain by force, is no improvement. It is a hyperinflation of aggravated human rights breaches. There seems to be a belief that has affected people who work in the system worldwide that drugs are somehow less violent and invasive than restraints. It simply doesn’t hold up to scrutiny. I hope such an ethos doesn’t take a hold of Ohio. I don’t have any information that it has, I’m just saying.

    I speak as a first hand survivor forced drugging, seclusion and restraint, and childhood.

    This is a remarkably well written article in terms of structure and pacing. You are a good writer. Welcome to MIA.

      • That is an amazing record. Total Guantanamo Bay level stuff. Sorry to hear it.

        In Australia and the UK ‘rapid tranquilization’, that is giant doses of neuroleptics forced on physically held down victims, that bring rapid complete unconsciousness, replaced restraints. I just generally sense on my radar all the time this feeling among the staff than touching the inside of the body is somehow OK.

        I’ve said in the past I think there is a psychological dynamic at play where restraints look nasty, but forced drugging (after the initial take down and forced injection assault), has no visuals, its all taking place inside the target’s skull, so outsiders tend to be less revolted by it. I hope that one day forced drugging’s reality can be articulated widely.

        • Hi _Anonymous:))

          As a counterpoint to your usual paranoid, inflated generalizations, please read this and maybe we could a real-life discussion on this webzine, about what actually happens to the majority of people.

          About 8pm a female nurse came to offer me the prescribed pill and I explained my decision. We talked about it for while and she advised me I could be restrained and given medication by injection. I acknowledged the procedural issue for the nursing staff and told her I would not resist such action, but on principle I could not place a pill in my mouth and swallow it. She accepted that was I sincere, even commenting that I was surprisingly calm about the issue and left to prepare an injection needle. Fifteen minutes later she returned with three others, two male and another female nurse and asked me to lay face down on the bed. After the talk we’d had I thought it was a typical example of the assumptive and suspicious nature of the mental health environment, rules, regulations, procedures and no trust in personal judgment about another human being.

          I complied with all instructions and was complimented on my reasonable demeanor, soon to become the only acute patient on friendly conversational terms with most of the nursing staff. The next day I started to comprehend the difference in an aspect of mental health I never seen before, the bare minimum environment of acute care. It started with talking to one of the male nurses from the previous night, when I teased him about needing four people to administer one injection.

          ‘You just don’t know what will happen these days, especially on an acute ward,’ he said. Explaining that there had been a ten fold increase in assaults on hospital staff in the previous few years.

          ‘Is that why your all barricaded behind locked doors and a plate glass window?’

          ‘Only for this side, its not like this on the normal ward.’

          ‘So were all these people sectioned too?’ I asked, gesturing around the recreation room at the half dozen or so patients. He looked up from his clipboard assessment sheet, and glanced around the room.

          ‘Afraid so, most I’ve seen in here before, people who go off their meds and become the revolving doors.’

          ‘Non-compliant like me huh?’ He just smiled and gestured that he needed to complete his assessment duty.

          It was a tough day, another when I should have been working and I tried to be productive by reading a book, “Family Therapy in Clinical Practice,” by Murrray Bowen. Bowen’s seminal ideas about the family emotional system, and the generational transmission of emotionality, had been a big influence on my belief in emotional development issues. Ideas that a certain young psychiatrist obviously didn’t give much credence to. I remember watching the nursing staff do their assessment trips into the ward, sitting off to one side observing, ticking boxes and writing a few comments. It made the place feel more like a zoo than a hospital ward, with people making field trips to observe the specimens. It was bizarre considering that most patients sat around and watched TV all day, or chain smoked out in the courtyard.

          ‘Wouldn’t it be better to talk to people, to find out how their doing?’ I asked one female nurse, “best not to antagonize” was her curt response, a thin smile of contempt reminding me that there is always at least one power junkie on a ward. She was true to form a few days later too, when I watched a young female forced into the isolation room. The girl had become hysterical when her room was searched just after a friends visit, presumably on suspicion of drugs.

          Please read more here: http://www.born2psychosis.blogspot.com.au/p/chp-2.html

          Perhaps Robert should re-title this site Medications in America? Although I do understand the need to remain in denial, least we stumble upon the inconvenient truth, of our evolved nature.

          You must have had a really, really bad experience, _Anonymous? Perhaps you could point the readers here and myself towards some writing about the reality of your actual experience?

          Best wishes,

          David Bates.

          • As a counterpoint to your usual paranoid, inflated generalizations, please read this and maybe we could a real-life discussion”

            The subject matter of the article and three others yesterday was torture and coercion. The subject matter was not ‘what happens to most people’. I fail to see how your pasted anecdote of co-operation with the staff during your detention reflects a broad understanding of trends in the area of forced psychiatry.

            Your website seems to be concerned with the study of something other than forced psychiatry, from what I can gather your whole focus is your idea of the ‘the real source of our motivations’ as defined by you. While you’ve been busy finding the real source of human emotions, and spent a lot of time reading about the real source of our motivations, I’ve been reading a lot about forced psychiatry and when I make a statement about it, a pasted anecdote that isn’t even about violent coercion in mental hospitals, but about some cordial chat you had while you were complying at every turn during your incarceration, doesn’t prove I’m a ‘paranoid generalizer’. At all.

            You seem to be someone interested in communicating your ideas to the world. You’ve started a large website with lots of content. You leave a lot of comments in this community. I offer the following, because it is more decent than just ignoring you. The following is this: I recommend you find or pay even, just ten strangers, to read even just one page of your website and critique your writing communication style. Ask them if they can understand it. I find it impenetrable, tangential, and in need of vast, wholesale simplification. Try perhaps, to put yourself in the shoes of someone who hasn’t discovered the one true truth about our unconscious motivation, or whatever it is your believe you’ve discovered. Explain it to me in a succinct way that values the reader’s finite time and doesn’t extend to thousands of words. I am open to trying to understand what you’ve been saying all this time, I haven’t yet, and I blame your writing style at this point. Please avoid calling me a paranoid generalizer again its not all that nice.

          • _Anonymous,

            IMO this was a very compassionate answer you offered David (on June 27, 2013 at 8:08 pm). David Needs People To Lend Him Such Advice As You’ve Just Suggested There.

            I agree, he should seek — even pay to seek — such feedback, on his website — definitely a great idea you’ve offered him (and in a really gentle way, actually).

            IMO you responded to David’s careless barbs with a gift of pure (24k) golden wisdom…

            Very good of you IMO…

            Respectfully,

            ~Jonah

  2. Just how bright are the administrators and managers inside these systems – to set up these protocols for children and youth?

    Let me get this straight… the best idea they can come up with is to physically restrain a kid if he gets out of hand?

    I bet you a thousand bucks that we could come up with much better programs for dealing with these youth if we turned the entire system over to non-medical, non-professional folks… people with no pre-conceived notion of “mental illness”….

    Take the same money and give it to a couple with a ranch, who are willing to work with a half-dozen kids. The kids could work with horses – wear themselves out physically every day and talk over supper at night…. That’s just one of a *million* possibilities.

    The idea that restraining kids is the best we can come up with is horse crap!

    Duane

  3. “Each year, thousands of Ohio’s most vulnerable children are placed in institutional settings for months or years at a time in order to treat their mental health issues.”

    Could you please be more specific? Do you mean their mental “Health” or their mental “Illness”, because there is a difference. And it is my view that people can’t or don’t make the distinction.

    How can someone call a supposed mental “illness” a mental “health” issue? Why are you treating HEALTH?