# Presentation: 131008

## Slide 1

## Dr. Phillipe Pinel1794

**Dr. Phillipe Pinel****1794**

**Andrew McClain****1998**

**Notes:**
(While showing slide 2, tell this story...)Headlines like these have exposed a nationwide trail of injury and death due to the use of seclusion and restraint.  I was struck by one young woman’s story: Jessica had been in and out of mental hospitals her entire life.  When she was 16 years and 4 days old--just past the threshold at which children become adults under NY criminal law--she was arrested for biting her sister’s arm in a fight. While in custody, Jessica kicked a jail guard and was sentenced to prison for second-degree assault. For more than a third of her days in prison, Jessica was subjected to seclusion--either confined to her cell or in the “special housing unit”...what inmates call “the box”...a small barren chamber where the only human contact is a gloved hand that passes food through a slot in the door. During her time in seclusion, Jessica repeatedly attempted suicide. Although she was diagnosed with a bipolar disorder and other mental illnesses, Jessica was repeatedly returned to the small airless cell...where she made repeated suicide attempts. Finally, on August 17, 2002, at the age of 21, Jessica took her own life...in “the box.”  It is tragic that Jessica took her life.  It is inexcusable that the system put in place to protect people like Jessica contributed to this tragedy. 

## Understanding Seclusion and Restraint 

**Seclusion** is** **a behavior-control technique involving locked isolation.
**Physical restraint **involves** **a personal restriction—including a physical hold—that 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 resident’s 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***

## 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.”***

## Today’s Program

**Today’s Program**

## Slide 6

## Slide 7

## The Evolution of Seclusion and Restraintas a National Priority

**The Evolution of Seclusion and Restraint****as a National Priority**

## Achieving the Promise:  

**The goal: hope for a full life outside the hospital**
**Services and supports are consumer/child/****	****family centered**
**Focus of care must increase child’s/family’s ****	****ability to self-manage illness and build ****	****resiliency**

***The use of controlling or coercive interventions is counterintuitive to transformation.***

***Achieving the Promise:  ***
***Transforming Mental Health Care in America ***
** **

## Goal 2

***seclusion and restraint as a priority issue****.*

**Goal 2**

**2.5 Protect and enhance the rights of people with mental illnesses.**

**   ****Recommendation**

**Mental health care is consumer and family driven.**

## The elimination of seclusion and restraint requires—

**A consumer-centered, recovery-oriented program**
**A**** ****concerted effort rather than additional resources**
**Strong leadership, accountability, commitment, and motivation**

**The elimination of seclusion ****and restraint requires—**

***We must effect a culture change that resonates with ***
***recovery and the goals of transformation.***

## 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**

## SAMHSA Seclusion and Restraint National Action Plan

**SAMHSA Seclusion and Restraint ****National Action Plan**

**Vision**To reduce and ultimately eliminate seclusion & restraint in mental health & substance abuse care

**Long-Term Outcomes**Reduction in deaths and injuries resulting from seclusion & restraintReduction in the frequency of and work toward the elimination of seclusion & restraint use

**Revised and adopted May 2003**

**Initial Outcomes**Increased 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 P&As 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

**Data Collection**

**Rights Protection**

**Training & Technical Assistance**

**Evidence-Based Practices & ****Guidelines**

**Leadership & Partnership Development**

**SAMHSA Goal**
**Capacity**

**SAMHSA Goal**
**Effectiveness**

**SAMHSA Goal**
**Accountability**

## Data Collection

**SAMHSA Activities**

**Compile research and data on S&R 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 S&R     ****	****performance measures **

## Rights Protection

**Rights Protection**

**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**

## Evidence-Based Practices and Guidelines

**Evidence-Based Practices and Guidelines**

**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 S&R (e.g., children, older adults, people of color, women, persons who are deaf)**

**SAMHSA Activities**** **

## SAMHSA Activities 

**Collaboration with the Centers for Medicare and Medicaid Services (CMS) and other partners in substance abuse, criminal justice and education**
**Development of Federal S&R standards as required by the Children’s Health Act of 2000 **

**SAMHSA Activities**** **

**Leadership & Partnership Development**

## Training and Technical Assistance

**Training and Technical Assistance**

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

## Training and Technical Assistance

**Concluded a 3-year grant program designed to identify best practices in preventing and reducing the use of S&R 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 S&R 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.**** **

**Training and Technical Assistance**

## Training and Technical Assistance

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

**Training and Technical Assistance**

**Best Practices in Behavior Support and Intervention Project—Lessons Learned**

## Training and Technical Assistance

**The manual will provide a practical training curriculum to assist facilities in alternatives to the use of S&R.**
**The manual is currently being pilot-tested in 2 States—Connecticut 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.**

**Training and Technical Assistance**

## Slide 22