After a training program and policy changes, a 398-bed state psychiatric hospital in North Carolina achieved 98% and 100% reductions in the use of mechanical restraints in its two main units over three years, according to a study published in Psychiatric Services. At the same time, there were no increases in assaults or injuries to staff or patients.
Led by Central Regional Hospital psychologists, the study took place between 2009-12 on a 140-bed acute adult unit (AAU) and a 76-bed community transition unit (CTU) holding patients diagnosed with schizophrenia-spectrum disorders, mood disorders, and substance use disorders. All staff were trained in basic de-escalation techniques, and a special response team was trained and formed to assist in crisis situations. Secondly, a formal policy change was introduced that required upper-management approval for staff to implement routine use of restraints on a patient.
“Mechanical restraint use decreased by 98% on AAU and by 100% on CTU,” the researchers wrote. “At the end of the study, CTU had not used the intervention in 559 days… These strategies were implemented during the study but have become part of the culture and the hospital’s standard operating procedure and have continued beyond the study.”
At the same time, there was no increase in physical violence in the units. “It is important to note that the reduction in mechanical restraint use on both units occurred without increased rates of assaults or injuries to consumers or staff,” wrote the researchers. Simultaneously, the use of “as-needed” or PRN medications for reducing agitation decreased on one of the units; however, for unknown reasons usage increased on the other unit. “It is unclear why PRN use of medications significantly increased on CTU but not on AAU,” wrote the reseachers. “Further investigation of factors that influence prescribing and administering PRN medications seems warranted.”
“The success of this initiative demonstrated that reduction and even elimination of mechanical restraint can be accomplished in a state psychiatric hospital on both acute and rehabilitation units without increasing assaults and injuries to consumers or staff,” the researchers concluded. They also noted that “committed leadership was essential” for implementing the changes. “Recovery-oriented, strong leaders were champions for the initiative.”
Anatomy of a Transformation: A Systematic Effort to Reduce Mechanical Restraints at a State Psychiatric Hospital (Godfrey, Jenna L. et al. Psychiatric Services. Published Online Ahead of Print August 15, 2014. doi: 10.1176/appi.ps.201300247)
But apparently ALL of those restraint uses prior to the protocols, and ALL of the restraints used in other similar venues, were/are justified and unavoidable for safety reasons…
It’s lovely that they’ve done this, but this kind of thing is often looked on as a “nice program they’ve got going over there,” instead of drawing the proper conclusion, namely, that they and most other psych wards are using restraints unnecessarily on an almost daily basis, and harming patients in the process.
Great point. Apparently 98-100% are totally unnecessary. It’s so great when they take their own issues and unprofessional behaviour on patients.
I remember it from my own nightmare – I was drugged and restraint because the so-called doctor said: “I don’t have time to deal with you, I have too many patients” after I refused a physical exam.
The restraints are horrible, horrible, horrible. God forgive the zombie employees and the goons who use them on our children.
What’s especially egregious is when they induce or exacerbate aggressive or otherwise “dysregulated” behavior with their ham-handed “treatments” (usually bombarding the individual’s brain with toxic chemicals) and then punish the resulting drug-induced behavior with seclusion, restraint and more drugging or shocking of the brain. I’ve witnessed it up close and personal, and it’s very sad and infuriating.
Yet I’m thankful for this article and those who promoted this change in policy and practice in at least one hospital. I think we need to celebrate even small advances toward more sound and humanitarian practices, and try to promote this in our own circles of influence however we can.
I am sure that 99.9% (and I’m being generous here) of the so-called patient on staff violence is due to staff’s behaviour which escalates situations or even takes a completely benign event (like a person refusing a drug or physical exam) and abuses people to the point where “aggression” is in fact self-defense. I’m not even mentioning that when a person in a panic attack gets restraint and while in restraints shouts and tumbles that is also called “aggressive behaviour”. I’d love to see how calm and composed would these morons be if that was done to them. I don’t know where these people studied basic psychology but they obviously didn’t learn much.
It’s especially interesting given other recent reports on suicide and psych “treatment”:
Staff provokes, that’s for sure.
When they mistreated me I quickly reminded them that some time in the not so distant future I will be outside in the real world with them away from any panic buttons and the other unfair advantages over me they currently enjoyed so they best be nice and keep hands off me.
Well, that in some cases may end up in someone being committed for the rest of his/her life… It only works if there are people out there, preferably with money for good lawyers. It’s a no win situation.