By Katie Jickling December 15, 2020, 12:45 pm
Restraint and seclusion are used just as frequently on psychiatric patients who choose to get inpatient mental health care at the Brattleboro Retreat as those who go to the hospital involuntarily.
It’s the first time the state has collected use-of-force data for voluntary patients, who make up about two-thirds of Vermont’s mental health patients.
The state, and the public, should take note, said Rep. Anne Donahue. R-Northfield, a mental health advocate.
“It seems on its face somewhat stunning,” she said of the data. “Somebody goes into the hospital voluntarily asking for help, and they can end up in the seclusion room or in restraints.”
Between Oct. 1 and Nov. 9, Brattleboro Retreat employees restrained, secluded or forcibly medicated voluntary patients 79 times. That’s compared to 86 instances with involuntary patients.
Any emergency involuntary procedure, which includes restraint, seclusion and forced medication, is “an intervention of last resort to protect patients and their caregivers,” said Brattleboro Retreat spokesperson Konstantin von Krusenstiern. “Regardless of a patient’s admission status as either voluntary or involuntary, situations may arise when the symptoms of their illness require careful use of an emergency intervention.”
Retreat staff members are “thoroughly trained in the use of de-escalation techniques,” which prevent the need for any use of force in “the vast majority of cases,” von Krusenstiern said.
More transparent mental health system
The state collects little data about the care of patients who choose to seek mental help on their own. Those who are admitted involuntarily — people whose mental illness makes them a danger to themselves or others and who are sent to the hospital against their will — are considered to be in the “custody of the commissioner,” according to state law. That allows the state more oversight of, and offers more transparency about, their care.
Vermont has regularly collected and published data about the restraint and seclusion used with those individuals.
The state has provided a steady flow of money to the Brattleboro Retreat to keep the state’s largest mental health facility afloat. In return, legislators wanted more transparency. Last June, lawmakers passed a bill requiring that the Retreat share data for voluntary patients as well.
In an emailed statement, the Department of Mental Health said the first batch of that information, which runs from Oct. 1 through Nov. 9, is too small a sample to be of much value. “This is raw data for a single month,” the statement read. “It is too soon to make any broad generalizations or to draw conclusions from.”
But Donahue said the data is valuable nonetheless. If she required mental health care, and was strapped down, “I would never go back to the hospital again,” she said. “It would leave me feeling like there’s no place I can get care.”
Donahue plans to introduce a bill next session to require mental health hospitals to ask for “informed consent” from patients, so they know that staff members may restrain them or put them in seclusion if they’re deemed a danger to themselves or others.
Caveats to the data
It’s difficult to draw conclusions with certainty, said AJ Ruben, a supervising attorney for Disability Rights Vermont. The data doesn’t show the rates of use of force, or how often an emergency involuntary procedure is used per 1,000 patient hours.
Voluntary patients include children. Anytime a staff member stopped one child from punching another, for instance, or put a child in a brief hold would be considered a “manual restraint.”
Voluntary patients had fewer instances of emergency medication and seclusion, which is generally considered more invasive.
A few violent or high-needs patients may require seclusion or restraint several times a day, skewing the totals, Ruben said. The deidentified data doesn’t reveal how many times an individual patient might have faced those measures.
However, any use of force is a “treatment failure,” Ruben said. The state’s standard should be zero.
Regardless of the reasons, “uses of forces are traumatic and [set] their treatment back,” Ruben said.