Six Core Strategies©The Experience of Restraint and Seclusion: Youth and Family Roles

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The New York State Office of Mental Healthand YOUTH POWER! of Families Together in New York State wish to acknowledge the contributions of the National Association of State Mental Health Program Directors (NASMHPD) and its Office of Technical Assistance (formerly NTAC) for many of the following slides.

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Training Objectives

• To understand the experience of restraint and seclusion as described by the people who experienced it

• To value youth and family voice in treatment

• To improve relationships with youth and staff we work with

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“They should not have out their hands on me. They were wrong for doing so. They gave me bruises on both my arms. That was a trigger and I got a bad flashback.”

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“Eight men jumped on me and wrestled me to the floor. They held me face-down, restrained me, and then shot me up with Thorazine. I waited in restraints for hours until they thought my behavior was appropriate to be released. As a survivor of sexual abuse, I personally have found the use of restraints more traumatizing than being sexually assaulted. Being put in restraints is a much longer, more traumatic ordeal than being raped.”

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“Seclusion made me feel even more angry because it hurt me

and made me worse. I would like staff to respond in a different way such as give you more options during the step before they act too quickly.”

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“I want someone who will acknowledge my pain without trying to fix it. Someone who knows

his/her own pain and is not afraid of it and of yours.”

“ I want someone who can BE with me when I

am in distress; be present with me when I am in pain.”

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“You are terrified and you try to get away from them and you strike out to protect yourself. Then they call

you ‘assaultive’ and that follows you to the next hospital and they say to

you ‘I hear you hit someone.’”

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“I was sent to a residential facility to ‘get better’ but I spent most of my energy on

following the rules so that I would get my points and not get restrained. I

didn’t learn anything about how to manage my

depression or anxiety.”

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Staff Trauma

“We talk about the trauma paradigm for our clients or people in recovery. But not very often, in my 20 years of work in the field of mental health, have I heard much about what happens to us, the workers, and I think that’s an area where we need to do some work. I’ve seen some pretty traumatic things from when I first started 20 years ago. Some of those things still haunt me.”

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Staff Trauma

“I was a nurse manager at the time, and I think it may have been the first restraint I witnessed. It was on a pediatric adolescent unit and involved an 18 year old boy who was deaf and severely depressed. At the time, he was committing a self-injurious act that involved his eyes, and two male staff members ended up ‘wrestling him to the floor’. I was horrified and panicked. Later, I would watch as he had an anaphylactic reaction to an injection. I thought to myself, ‘We’re a treatment center and we caused harm.’”

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“A Teachable Moment”

“Years ago, I was supervising a group of undergraduate nursing students in the dayroom. A young man came in screaming repeatedly: ‘Stop it, I can’t stand it.’ The MHA, who was on the phone, yelled over to the patient, ‘If you don’t stop it, you’ll go into seclusion.’

“I told the MHA that I would be happy to help out. I asked the patient to sit down with me on the couch and tell me what was wrong. I had a student get him a glass of water and assured him that I would help him. My students and I stayed with the young man until he calmed down.” …

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“A Teachable Moment”

…“My point to the students was that people will always tell you what is wrong and what they need, if you only take the time and care enough to listen.”

Wanda K. Mohr PhD, RN, FAAN; Professor Psychiatric Mental Health Nursing (Bluebird,2008)

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“The initiative to reduce the use of seclusion and restraint is part of a broader effort to reorient the state mental health system toward a consumer focused philosophy that emphasizes recovery and independence.

“…Seclusion and restraint with its inherent physical force, chemical or physical bodily immobilization and isolation do not alleviate human suffering. It does not change behavior.”

- Charles Curie, Administrator SAMHSA

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Youth Experience-Building

The value of self-help:EmpowermentIndependenceResponsibilityRespect and Dignity ChoiceSocial Action

…Why is it important that we encourage self-help, self determination?

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Definitions

Self-help is an activity that one chooses to engage in on a completely voluntary basis to improve the conditions of one’s life.

Self-help is never a mandated activity or event.

Self-advocacy is the act of one speaking up for what he or she wants or needs without fear of retribution.

Sometimes self-advocacy includes searching out an advocate for oneself.

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Key Elements of Consumer/Survivor Self-Help

Peer SupportHopeRecovery

(Roadmap to Seclusion and Restraint Free Mental Health Services, SAMHSA 2005)

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Ways to Encourage Youth Involvement

• Youth input on treatment plan, calming plan, sensory assessments, debriefing, discharge and transition planning

• Membership in facility decision-making bodies, steering committees, etc.

• Input on staff hires and evaluations

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We need to encourage youth to have input into their treatment and safety planning.

Empowering youth by allowing them input promotes self-regulation, leadership skills, and recovery!

Can you think of ways to encourage youth to participate?Talk about your facility’s practices around family and youth empowerment.

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Give youth a voice in the way they are treated and in their service planning.

Go out of your way to ask young people what they want, need, and think about what is happening to them.

One of the things young people most often ask for is the ability to be involved in what is happening to them.

Listen to what they say and then create a plan with them that reflects their goals.

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Youth as Formal Members of Treatment Planning Teams

Waiting in the hall for a treatment meeting can be a scary time for young people, as very quickly they often recognize the treatment team as the gatekeepers of their dreams.

Putting young people in the driver’s seat and making them feel like they are an intricate part of the team is essential to empowerment and true youth involvement.

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Resident council, community meeting leadership

• Team building• Responsibility• Ownership• Input

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Ways to Encourage Family Involvement

• Open access to children• Communication• Data sharing• Input on treatment plan, calming plan, sensory

assessment, discharge planning • Training and information on diagnosis, meds,

comfort and sensory factors

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In Summary…

It is essential that we create non-coercive, healing environments that recognize the importance of empowering youth to have input into their own care.

Families must be part of the recovery process.

Peer support strengthens recovery.

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Test Your Knowledge:True or False?1. Allowing children to make choices in their care is not

appropriate.2. Peers cannot represent children unless they were

placed in the same facility.3. Seclusion is less harmful than hands-on intervention.4. Adults often remain traumatized by negative childhood

experiences.5. Unless you have had the experience of being

restrained yourself, you cannot understand how it feels.

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“It is not possible to solve a problem with the same consciousness that created it.”

Albert Einstein

A culture shift is needed to reduce and eliminate restraint and seclusion.

How will you approach this challenge?