National group calls for restraint reforms

Psych facilities are focus of remedies

In a move to stem a tide of death resulting from the inappropriate use of physical restraints in psychiatric facilities, the National Alliance for the Mentally Ill (NAMI) is calling for an immediate federal investigation into the problem.

A 50-state survey conducted by a Hartford, CT, newspaper revealed that at least 140 deaths in the past decade were connected to the use of physical restraints or the practice of seclusion. The report also suggested that the actual number of deaths is many times higher because many go unreported. Between 50 and 150 such deaths occur every year, according to a separate statistical estimate conducted by the Harvard Center for Risk Analysis.

To remedy the situation, NAMI recommends the following steps:

• Independent, third-party entities should conduct thorough and immediate investigations into all deaths and serious injuries that occur during psychiatric treatment. The entities should be vested with the authority to recommend and institute changes and practices to prevent future abuses.

• The Department of Justice and Department of Health and Human Services should launch a thorough investigation to determine the magnitude of abusive and harmful seclusion and restraint practices in psychiatric treatment facilities and programs nationwide.

• National standards on the appropriate use of restraints representing best clinical practices should be developed and enforced by the Health Care Financing Administration, and commercial insurance payers should adopt the standards.

• States should adopt laws authorizing the establishment of third-party, independent monitoring groups to conduct unannounced inspections of psychiatric facilities.

• States should allocate funds for training individuals who work with psychiatric patients on the appropriate use of restraints.