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

We want to update you on the timing of a CBS News piece focusing on the care delivered in psychiatric facilities, as well as an upcoming congressional hearing on the issue. A key focus of these events 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 events in case your local media picks them up.

Since our March 11 Media Advisory on this issue:

  • Several bills have been introduced in Congress that call for new regulations on the use of restraint and seclusion and public disclosure of psychiatric patient deaths and injuries related to the use of restraint or seclusion;
  • The General Accounting Office has begun work on a report reviewing federal requirements in this area; and
  • The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is completing hearings on the use of physical restraint and therapeutic holding in behavioral health care settings.

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

April 13 Congressional Hearing
A hearing by the Senate Labor, Health and Human Services Appropriations subcommittee focusing on deaths due to the use of restraint and seclusion is scheduled for tomorrow. Witnesses include the mother of a child who died in a Greensboro, NC psychiatric facility; Sen. Joseph Lieberman (D-CT) and Sen. Chris Dodd (D-CT), sponsors of bills mandating public disclosure of psychiatric patients' deaths and serious injuries related to the use of restraint and seclusion; and JCAHO President Dennis S. O'Leary, M.D. There are no witnesses representing hospitals. We expect strong media coverage and this could, in turn, generate some in your area.

It is our understanding that the fruits of CBS's year-long investigation into "quality of care" issues, particularly restraint and seclusion, is expected to air April 21 on the network's new program 60 Minutes II. In early February, NAPHS staff met and AHA staff spoke with CBS producers. 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 of the congressional hearing and news segment, you should prepare 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
  • the type of patients you are treating in general
  • 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 which regulatory and private accrediting bodies oversee the quality of care at your facility
  • issues of confidentiality
  • how families are involved in treatment decisions

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).

For media relations questions, call AHA's Dionne Dougall at (202) 626-2284 or NAPHS' Carole Szpak at (202) 393-6700, ext. 18.


on the Use of Restraint and Seclusion for Behavioral Health Services

Hospital caregivers care deeply about the health and safety of our patients and are committed to delivering quality health care.

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

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 medical records.

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) -- the national body that inspects hospitals -- 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.

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 triggers a major internal review of the incident to determine what went wrong and how to prevent similar incidents in the future.

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. For example, a team of JCAHO experts including physicians, nurses and administrators, conduct a thorough, top-to-bottom evaluation of a hospital to ensure the facility does the right thing for patients. Patients, their families, caregivers and others are encouraged to share any concerns regarding quality of care issues though the JCAHO's toll free hotline at (800) 994-6610. Recently, the JCAHO strengthened their standards, requiring an immediate investigation into an unexpected death or injury with swift action taken to correct any problems if discovered.

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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