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.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.