EQUIP FOR EQUALITY RELEASES REPORT ON USE OF PHYSICAL RESTRAINTS ON RESIDENTS WITH MENTAL ILLNESS IN ILLINOIS STATE HOSPITALS
CHICAGO (May 21, 2001) - Equip for Equality has released its final report based on review of physical restraints used on individuals with mental illness who were residents of 10 state hospitals operated by the Illinois Department of Human Services (DHS) between July 1 and Dec. 31, 1997. The findings of the Restraint Monitoring and Policy Project conclude that there have been significant improvements in monitoring and restricting dangerous restraint practices over the past few years, although critical problems remain requiring immediate attention by the institutions and the Office of Mental Health (OMH).
Recommendations in the report address specific means for improving the system. Funding for this extensive initiative was provided by the Woods Fund of Chicago and the U.S. Department of Health and Human Services.
"The excessive, inappropriate and unsafe use of physical restraints in mental health facilities and other settings places individuals at risk for psychological and physical injury, and even death, as well as violates fundamental individual rights and basic human dignity," says Zena Naiditch, President and CEO of Equip for Equality. "It is therefore critical that the state be vigilant in protecting vulnerable people from the abusive use of restraints."
Equip for Equality's unique qualifications for undertaking the Project stem from its federal mandate and its designation by the Governor as the protection and advocacy (P&A) system in Illinois. The nonprofit organization's mission is to advance the human and civil rights of people with physical and mental disabilities. The broad statutory powers include the investigation of safety issues in the mental health system. The study was undertaken in response to concerns raised by individuals with mental illness and family members affiliated with the Illinois Chapter of the National Alliance for the Mentally Ill (NAMI). Recommendations were developed with assistance from an advisory committee.
Originally scheduled for completion last year, the Project was delayed eight months because the State refused to release records for review. It was therefore necessary for Equip for Equality to file suit in U.S. District Court to obtain a court order for release of the records.
During the six-month span of the study, there were 1,994 restraint episodes documented by the state hospitals. A random representative sample of 325 episodes was used for analysis and formulation of the following recommendations:
- It is the responsibility of the state hospital director to impress upon staff that restraints should be used only in emergencies and that unnecessary and inappropriate use may constitute abuse and can be prevented by careful case assessment and treatment planning.
- Clear guidelines and behavioral criteria for the use of and the release from restraints must be communicated to staff.
- State hospital management should monitor incidents to ensure that high-risk situations are being identified and that a wide range of intervention and de-escalation techniques are being tried before restraints are imposed.
- State hospitals should promote best practices in violence prevention.
- All staff dealing with individuals receiving mental health services should be given comprehensive training in restraint law, policies and procedures; early intervention and de-escalation strategies; safe application techniques; monitoring during restraint; release assessment, and documentation requirements.
To safeguard an individual's rights in a state hospital or other mental health facility, Equip for Equality drafted a provision amending the Mental Health and Developmental and Disabilities Code. Enacted into law in 2000, the provision mandates all mental health facilities to advise the individual of the situations when restraint, seclusion or emergency medication may be ordered, and requires documentation and consideration of the individual's preferences. Additionally, this information must be communicated to a guardian, if there is one, as well as to anyone else designated by the individual.
Other key recommendations in the report include:
- The DHS-OMH should issue a comprehensive annual report on restrictive interventions. The report should include comparative utilization rates for restrictive practices in each state hospital, rates of recipient and staff injuries, appropriate statistical and trend analysis, quality improvement initiatives, significant problems and issues, and improvements expected in the coming year.
Among other recommended amendments to the Mental Health and Developmental Disabilities Code are:
- Outright ban of dangerous practices.
- Universal protections for children and adults with disabilities in all public and private facilities, including schools and jails.
- Special protections for vulnerable populations, including children and the elderly.
- Requirements for appropriate documentation to facilitate supervision of each case, as well as external independent oversight of restraint usage.
"Failure to reduce the use of restraints to its absolute minimum reduces the likelihood that individuals will voluntarily seek psychiatric services," says Marsha Koelliker, Equip for Equality's Director of Public Policy. "Many people with mental illness have reported that their experience with restraints was so traumatic that they are reluctant to get help when they need it."
All P&As, including Equip for Equality, are empowered by law to protect individual rights and safety in psychiatric hospitals, including the power to investigate abuse and neglect and advocate for reform. The problem is insufficient funding to carry out independent oversight. Federal and state laws also need to strengthen state P&As' access to clinical records and other necessary information.
Contributing to the Restraint Monitoring and Policy Project final report were Lana Norwood, President, Labor Relations Alternatives, Inc.; Jean L. Summerfield, Public Policy Consultant, and Marsha D Koelliker, Public Policy Director, Equip for Equality. Clarence J. Sundram, former Chairman of the New York State Commission on Quality of Care for the Mentally Disabled, also was consulted.
The entire report is available to download/view inside the Guardianship Reform section of this website. For more information, please contact Marsha Koelliker at (312) 341-0022, (800) 537-2632 or TTY (800) 610-2779.