Moving from Coercion to Collaboration in Mental Health Services

Moving from Coercion to Collaboration in Mental Health Services

Acknowledgments
Numerous people contributed to the development of this document (see Appendix A). This monograph was edited by David A. Pollack, M.D., under Contract Number 1M008538010 with the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS). Paolo del Vecchio and Carole Schauer, Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), served as the Government Project Of.cers.

Disclaimer
The views, opinions, and content of this publication are those of the editor and the individual contributors and do not necessarily re.ect the views, opinions, or policies of SAMHSA or DHHS.

Public Domain Notice
All material appearing in this document is in the public domain and may be reproduced without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the speci.c, written authorization of the Of.ce of Communications, SAMHSA, DHHS.

Electronic Access and Copies of Publication
This publication can be accessed electronically through the following, Internet World Wide Web connection: www.samhsa.gov. For additional free copies of this document, please call SAMHSA’s National Mental Health Information Center at 1-800-789-2647.

Recommended Citation
Pollack, D. A. Moving from Coercion to Collaboration in Mental Health Services. DHHS Publication No. (SMA) 04-3869. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2004.

Originating Office
Associate Director for Consumer Affairs, Of.ce of the Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857

DHHS Publication No. (SMA) 04-3869
Printed 2004

Foreword
Reducing and ultimately eliminating the use of seclusion and restraint for all age groups in behavioral health care settings, both institutional and community-based, is one of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) program priorities. The use of coercion, seclusion, and restraint in psychiatric practice is controversial. Concerns exist about using physical force and isolation to respond to psychiatric crises to preserve safety and protect patients and others from harm. These practices have resulted in deaths of patients and injuries to staff and patients.

The Department of Public Welfare of the State of Pennsylvania, under the leadership of Charles Curie, then Deputy Secretary for Mental Health and Substance Abuse Services, undertook an initiative to reduce the use of seclusion and restraint in its public psychiatric hospitals. The use of these interventions has nearly been eliminated in some State hospitals. Upon coming to SAMHSA as its Administrator, Mr. Curie, building on his success in Pennsylvania, made the reduction and eventual elimination of the use of seclusion and restraint a SAMHSA goal.

SAMHSA has undertaken numerous efforts to that end, including the establishment of a National Action Plan to Reduce and Ultimately Eliminate Seclusion and Restraint and regional training sessions to develop strategic action plans to reduce and eliminate seclusion and restraint, as well as the development of a consumer-driven staff training manual on alternatives to the use of seclusion and restraint. Another activity is the publication of this monograph based on a 6-hour symposium at the American Psychiatric Association meeting in New Orleans in May 2001.

The symposium, organized by the Consumer Affairs staff of the Center for Mental Health Services within SAMHSA, is a “slice in time,” presenting the views of a wide range of experts at the time of its convening. These presentations discussed issues related to, and offered approaches to, reducing coercion, seclusion, and restraint in various psychiatric settings including health care, correctional, and juvenile justice, and with diverse populations, including those with developmental disabilities, children, adolescents, and older adults. Each chapter summarizes a presentation at the symposium. The views, opinions, and content are those of the individual presenters and do not necessarily reflect the views, opinions, or policies of SAMHSA or the Department of Health and Human Services.

The monograph amplifies that coercion can be eliminated to benefit people receiving care and staff providing the care. This publication continues SAMHSA’s role in providing national leadership to improve mental health care delivery by increasing awareness of the clinical and ethical issues associated with the use of coercion, seclusion, and restraint with people with mental illnesses.

Table of Contents
Introduction
The Use of Coercive Practices: A Personal View
Legislative and Regulatory Overview
State Hospital Perspective
Use of Coercive Practices in Older Populations
Use of Coercive Practices with Persons with Developmental Disabilities
Use of Coercive Practices in Law Enforcement Settings
Use of Coercive Practices in Correctional Settings
Use of Coercive Practices with Children and Adolescents
A Parent’s Perspective
Restraint and Seclusion of Children and Adolescents: Developmental Issues
Use of Coercive Practices in Juvenile Justice Settings
Pharmacological Interventions to Prevent the Use of Force in Children and Adolescents
Commentary
Appendix A: List of Contributors
Appendix B: NASMHPD Position Statement on Seclusion and Restraint

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http://mentalhealth.samhsa.gov/publications/allpubs/sma04-3869/default.asp