What's in the News

Fox-TV and CBS-TV Examine Care in Psychiatric Facilities and Units

A Message to NAPHS Members and AHA Members with Psychiatric/Substance Abuse Services:

We want to give you advance notice of two television shows that have indicated they are planning to air stories on the care delivered in private psychiatric facilities. A key focus of these stories is likely to be the use of restraint and seclusion for behavioral health services, particularly involving child and adolescent cases.

We want to alert you to these stories in case they are picked up by your local media. Local media may also pursue stories on this subject as a result of issues now before legislative and regulatory bodies. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will soon hold hearings on the use of physical restraint and therapeutic holding in behavioral health care settings (March 29 in San Francisco; April 6 in Atlanta; and April 13 in Alexandria, VA). Federal hearings on this subject are also being planned for later this spring.

A set of talking points to help you address questions about restraint and seclusion is attached.

Fox Files, a new tabloid-style show on Fox-TV, has prepared a segment on "problems encountered by young people in psychiatric facilities." The show's host, Catherine Crier, promoted this segment during a recent Sunday morning talk show with an air date of Thursday, March 11, at 9 p.m. ET. However, Fox's Web site has yet to post this story as an upcoming feature. Other stories on Fox Files have often featured hidden cameras and other "undercover" techniques.

In early February, NAPHS staff met and AHA staff spoke with producers from Ed Bradley on Assignment, a special projects division of CBS-TV News. It is our understanding that they are completing a year-long investigation of "quality of care" issues, particularly restraint and seclusion. While the story could air as an hour-long special, it may air on 60 Minutes II, the new mid-week version of this CBS show. No air date has been set, but the segment could run as soon as late March. Interest in the story, the producers said, grew from the death of a young person in restraints - a subject that has been the topic of other investigative reports, including an ongoing news series by the Hartford Courant.

How You Can Prepare While we are uncertain of the exact direction these stories will take, you should prepare now to respond to any story line that may generate questions from your own local media. Be prepared to describe and discuss:

  • your hospital's policies and procedures, particularly related to seclusion and restraint
  • how hospitalization works - from the time of admission to the time of discharge
  • how you train your staff
  • how the quality of care you provide is reviewed and assured, including what regulatory agencies oversee your facility
  • issues of confidentiality
  • how families are involved in treatment

For additional background, review the February 25 Quality Advisory and "Guiding Principles on Restraint and Seclusion for Behavioral Health Services" that we issued. Both documents are available on the AHA Web site (www.aha.org) and NAPHS Web site (www.naphs.org).


on the Use of Restraint and Seclusion for Behavioral Health Services

Restraint and seclusion are emergency safety interventions that aim to protect patients in danger of harming themselves or others. When used properly, they can be life-saving and injury-sparing emergency interventions. Physicians order these interventions, which are implemented and monitored according to detailed hospital policies and documented in the medical record.

It's important to recognize that individuals who come to behavioral health facilities with mental and addictive disorders may at times be dangerous to themselves or others. For example, individuals may be suicidal, have difficulty handling their anger, or enter a treatment program under the influence of drugs that affect their behavior.

The objective of every facility is to limit the use of restraint and seclusion as much as possible. Facilities need to consider other alternatives and determine they are not feasible before using restraint and seclusion. In fact, facilities accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) must abide by detailed JCAHO standards, which specifically require that physical restraint be applied only when there is adequate clinical justification, and which encourage the use of alternative interventions.

Hospitals and other treatment settings work hard to balance safety and patients' rights issues.

  • Protecting patients' rights is fundamental. Individuals experiencing behavioral health disorders must be treated with respect and dignity in the least restrictive environment possible.
  • Ensuring safety is essential. To be able to provide quality clinical care, hospitals and other treatment settings must provide a safe environment for everyone - patients, families, staff, and community.

There are - and should be - strong oversight mechanisms in place at the federal, state and facility levels. A wide variety of federal, state and local agencies are already empowered to inspect hospitals when a death or major injury occurs - JCAHO, the Health Care Financing Administration, the Justice Department, the Occupational Safety and Health Administration, state mental health departments, licensing bodies, nursing organizations, and patient advocacy organizations, among others.

Any death or serious injury resulting from the use of restraint or seclusion is a tragedy and must lead to constructive change. Any such event must trigger a major internal review of the incident to determine what went wrong and how to prevent similar incidents in the future.

Input from the community - including consumers, families, and regulatory and accrediting agencies, legislators and others - is valued, welcome, and essential to developing an organization policy on restraint and seclusion that serves the community well.


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