Operation No Restraint: How I Fought Back Against an Improper Restraint

If it had been just me, I probably could have ignored it. But it wasn't just me. During one of my many psychiatric hospitalizations, I observed what I believed was a systematic pattern of abuse of restraints. Patients were often restrained without the least restrictive means being tried and without a doctor's order or evaluation. They were often restrained for up to an hour, even if they were out of danger. I knew this was illegal. But how was I supposed to fight back?

Step One: Know the rules

Under federal law, restraints should only be used to ensure the physical safety of the individual and/or others, and the least restrictive means must be used to restrain a patient.

In other words, first they should try talking to you, then they should try offering you medication or helping you use coping skills, then they should restrain you if there is absolutely no other way to prevent imminent harm to yourself or others.

Many states also have similar laws. Indiana, where I live, uses guidelines established by the National Alliance on Mental Illness (NAMI). NAMI guidelines state:

1. “A physician trained in psychiatry or a LIP [licensed independent practitioner] should see the patient within one hour after restraints are initiated.”

2. “Restraints should be continued only for periods of up to one hour at a time and a face-to-face examination of the patient by the physician or LIP must occur prior to each time a restraint order is renewed.”

3. “Alternatives to the use of restraint and seclusion should be used. De-escalation techniques and debriefings should be used after each restraint and seclusion incident.”

Some hospitals follow National Mental Health Association guidelines, which state:

1. “Seclusion and restraint should be used only after other less restrictive techniques have been tried and failed, and only in response to violent behavior that creates extreme threats to life and safety.”

2. “Facilities should never use seclusion or restraint as punishment or for the convenience of staff.”

3. “Use of restraints and seclusion should always be implemented by experienced and trained staff, overseen by senior medical staff, approved by a physician, and be well-documented and justified in a consumer’s file.”

4. “Seclusion and restraining procedures should be used only for the amount of time needed to restore safety and security of the consumer and others.”

5. Consumers should be informed that specific behaviors may result in the use of restraining procedures or seclusion. Cooperation of the consumer with the procedure should be sought.

You have to know the rules in order to determine if they've been violated.

Step Two: Contact the authorities

According to NAMI, a series of steps should be followed to fight back against an improper restraint:

•Contact your state’s Protection and Advocacy Program. The phone number is available by contacting the National Association of Protection and Advocacy Systems (NAPAS) at 202-498-9514.

•File a complaint with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) hotline at 1-800-994-6619 and/or complaint@jcaho.org

•File a complaint with your state’s health and hospital licensing agency.

•File a complaint with your U.S. Center for Medicaid and Medicare (CMS) regional office. The number can be obtained by calling the CMS Office of Medicare Customer Assistance, 410-786-7413.

•Consider sharing your story with local media.

•Consider retaining an attorney if you believe your legal rights have been violated.

The results

After researching the law and contacting the above-mentioned agencies, I waited.

Indiana Protection and Advocacy Service contacted me about a month later, IPAS reported that IPAS and the hospital did the following: a notice was placed on all inpatient units noting that hand mitts are a form of restraint; a clarification of the definition of restraint, including the types of restraint, would be presented to all new staff in aggression management training upon hiring and annually; the chart for restraint incidents would add a category for “other” restraints not commonly used; the Behavior Care Services Restraint Committee would monitor that those changes were made.

The Indiana State Department of Health contacted me in February of 2006, and sent me a five-page report detailing all the violations they found. ISDH ruled that I was restrained without a doctor’s order, I was not evaluated within an hour of being restrained, the staff were not trained in the type of restraint they used on me, one staff member on the psychiatric intensive care unit had no crisis intervention or restraint training, and the least restrictive means were not tried. In light of all this, the ISDH cited the hospital.

Sadly, there's not always a happy ending in these situations. In that case, you have to do whatever it takes to find closure.