Law center investigation Restraints, seclusion used too often

The Minnesota Security Hospital in St. Peter is using seclusion and restraint in violation of its own policies and license conditions. […]

RestraintsThe Minnesota Security Hospital in St. Peter is using seclusion and restraint in violation of its own policies and license conditions. A 16-month investigation by the Minnesota Disability Law Center, which was released in July, indicates that hospital staff strap patients to restraint chairs, isolate patients in locked rooms and use these and other measures when patients and staff are not at risk of harm.

The nonprofit law center report contends that the measures are used more as punishment than as emergency protection as required. The report also notes that use of seclusion and restraint varies a great deal from month to month, and that there isn’t the consistent downward trend in use that advocates desire. The report echoes many concerns and recommendations made in 2013 when the Legislative Auditor’s Office reviewed hospital operations.

More individualized treatment, added clinical staff, ongoing staff training and more patient involvement in treatment plans are among the report’s 17 recommendations. While some positive changes have been made in recent years, “We do have a number of concerns,” said Pamela Hoopes, legal director of the Minnesota Disability Law Center.

Interviews done as past of the report showed that many patients want to be part of the change, Hoopes said. Patients on average get a little more than one hour of therapeutic activity a day, which advocate see as not being nearly enough.

Another change Hoopes noted, which could be implemented right away, would be for staff to provide more information and documentation of what happened prior to incidents when restraint or seclusion had to be used. In the 103 files studied, 96 had restraint and seclusion intervention data forms. Thirty-four percent of those didn’t identify triggers and stated that incidents were “unprovoked.”

The hospital’s Unit 800, the Admissions and  Crisis Care Unit, and Unit 900, which houses women with a variety of mental illnesses, had most of the restraint and seclusion incidents. One Unit 800 patient told the law center staff he was often “set up for failure.” He and others described the atmosphere as tense and chaotic, when compared to that of other units.

The Minnesota Department of Human Services (DHS) responded to the report after its July 29 release and agreed to meet with Disability Law Center staff for a more detailed review. The statement said, “Minnesota Security Hospital has significantly reduced the use of restraint and seclusion since 2012. But there is still work to do to address this issue while balancing concerns about the safety of our employees.”

DHS has worked with hospital staff over the past few years to greatly reduce use of seclusion and restraint. DHS has also made many changes to improve patient and staff safety, including new security cameras in some areas, setting up a four-bed admission unit to protect new patients from more violent ones and buying more protective equipment for staff. While there has been some progress, Hoopes said the use of restraint and seclusion is still a very serious issue that needs to be addressed.

The report was prepared through review and analysis of DHS records, and patient and staff interviews. Records of incidents from June 2011 to March 2014 were reviewed. It was found that 98 patients were restrained and secluded. Another 17 were secluded only, with 42 only restrained.

Additional research centered on 11 patients who were also being tracked by DHS staff, because of high incident rates of seclusion and restraint for those patients.

The report found that hospitals staff didn’t discuss traumatic restraint and seclusion episodes with patients. Instead of using debriefing as part of patient treatment and suggesting other responses, the investigation found that in many cases patients were blamed for their violent behavior. Six debriefing sessions did not involve the patients because staff said that would’ve been “un-therapeutic.” Eight times, staff recommended electroconvulsive therapy as treatment.

The Minnesota Security Hospital houses about 225 of Minnesota’s most dangerous and mentally ill patients. As of the end of June, there were 68 workplace-related injuries logged for 2015. That could put the facility on pace to break last year’s record number of 101 injuries.

Earlier in July a 16-year-old patient grabbed a staff member by the hair. He repeatedly kicked her in the head and hit her head against a wall. Minnesota occupational Health and Safety Administration (OSHA) officials paid a surprise visit to the facility days later along with representatives of the hospital’s employee union. Gov. Mark Dayton has also raised concerns about the assaults. His chief of staff, Jaime Tincher and state lawmakers recently toured the hospital.

Leaders of the American Federation of State, County and Municipal Employees (AFSCME) union, which represents 790 St. Peter workers, have taken issue with the report and continued to raise concerns about the assaults. They noted that staff go through a chain of command that ensures proper use of restraint and seclusion, and there are incentives that require use of restraint, seclusion or both.

AFSCME officials have contended that current restraint and seclusion policy is too restrictive and puts staff in a position of only being able to respond after they have been assaulted. Policy calls for restraint and seclusion only when a patient is an “imminent risk” to self or others.

Another issue is staffing. In July 20 security counselor posts and about two dozen other jobs were open. Union officials contend that another 54 security counselors are needed. But the report takes issue with the notion of security counselors, noting that those staff members are trained in criminal justice and not in mental health treatment. The report even raised question about the name “security counselor” and the mixer feelings raised by the name.

To read the report, go here.