1. WELCOME

2. “I crawled under the desk and started to moan
and rock. The faceless creatures hovering
near, invisible to everyone but me, were about
to tear me to pieces. ‘They’re killing me.
They’re killing me! I’ve got to try. Die. Lie.
Cry.’”
Professor Elyn Saks
The Center Cannot Hold

4. 1989 - 1999
142 deaths reported in the United
States
Hartford Courant
1998

5. “Every week in the United States, it’s been estimated
that one to three people die in restraints. They
strangle, they aspirate their vomit, the suffocate, they
have a heart attack. It’s unclear whether using
mechanical restraints is actually saving lives or costing
lives.”
Professor Elyn Saks
2010 TedX Talk

6. Logistics of a
Psychiatric Hospitals

7. - vital signs
- comfort
- body alignment
- circulation
- behavioral status
15 minute safety checks for :
Massachusetts’ Department of
Mental Health (DMH)
Restraint Policy

8. Psychosis

9. 1971 → Wyatt v. Stickney
1982 → Youngberg v. Romeo
US Supreme Court
Cases dealing with
mechanical restraints

10. “The right to be free from undue bodily
restraint is the core of the liberty interest
protected by the Due Process Clause
from arbitrary governmental action.”
Youngberg v. Romeo
457 U.S. 307, 316 (1982)

11. “The Department of Mental Health
(DMH) is committed to eliminating the
use of restraint.”
Massachusetts Department of
Mental Health (DMH)
Restraint Policy

12. Why are mechanical
restraints still used today?

13. TITLE OF LITERATURE REVIEW
The City University of London
2009

14. “Only limited conclusions [could] be
drawn from [the studies]” due to the
“widely differing methods of presenting
[the] information”
The City University of London
2009

22. Outdated Research

23. “Either put yourself in restraints or
we’ll put you in them. It’s up to you.”
Professor Elyn Saks
The Center Cannot Hold

24. Yale Psychiatric Institute
Medical Staff Education
Use of Restraint

25. Yale Psychiatric Institute
Medical Staff Education
Use of Restraint

26. Successful Policies
Exist

27. 1997 → Pennsylvania introduces
revised restraint policy

28. “Restraints shall be employed only
when necessary to protect the
patient/resident from injuring himself or
others.”
Commonwealth of Pennsylvania
Use of Restraints in Treating
Patients/Residents (1997)

29. 74% decrease
in total number of restraints/seclusion
96% decrease
in total hours spent in restraints/seclusion
1997 - 2002 Pennsylvania
Mental Health Care

30. 67% decrease
in total number of restraints and seclusions
1999 - 2001 Creedmoor
Psychiatric Center

31. 15 restraints monthly
1998 - 2000 South Florida
State Hospital
1 or less restraints monthly

32. Six Core Strategies to Reduce the
Use of Seclusion and Restraint in
Inpatient Facilities ©
National Association of State
Mental Health Program Directors
(NASMHPD)

33. 1. Leadership
2. Use of Data
3. Workforce
Development
4. Prevention Tools
5. Outside Support
6. Debriefing Tools
National Association of State Mental
Health Program Directors
Six Core Strategies to Reduce
the Use of Seclusion and
Restraint in Inpatient Facilities ©

34. Roadmap to a Restraint-Free
Environment
National Association of
Consumer/Survivor Mental
Health Administration
2006

35. Advance Crisis Management
Program
National Research and Training Center
University of Illinois, Chicago

36. “Increase self-determination by helping
individuals develop written plans that
identify personal stress triggers and
strategies to manage agitation and anger.”
National Association of Consumer/Survivor
Mental Health Administrators (NACSMHA)
Advance Crisis Management
Program (ACM)

37. 5,627 Registered US Hospitals
403 Nonfederal Psychiatric
Hospitals

38. State Hospitals
Massachusetts
Department of Mental Health
(DMH)
4 state psychiatric hospitals
Texas
Department of State Health
Services (DSHS)
12 state psychiatric hospitals

39. State Hospitals
Massachusetts
Department of Mental Health
(DMH)
4 state psychiatric hospitals
Texas
Department of State Health
Services (DSHS)
12 state psychiatric hospitals
Private Hospitals
Mclean Hospital
Harvard University

40. National Restraint Policy

41. “Supports the national need for the
seclusion and restraint of patients.”
American Psychiatric Association
1985

42. “National intent to see that restraint and
seclusion are used appropriately, as
infrequently as possible, and only when less
restrictive methods are considered and are not
feasible.”
American Psychiatric Association
2003

43. - Fragmentation
- Bureaucratic Issues
- State Rights
- Local Laws
- Private Institutions

44. Elected Officials
● President
● Members of Congress
● House of
Representative

45. Elected Officials
● President
● Members of Congress
● House of
Representative
Non-Elected
Officials
● FBI
● Board of Education
● IRS

46. BUREAUCRACY

47. President

48. President
Secretary of
State

49. President
Secretary of
State

50. President
Secretary of
State
Secretary for
Public
Diplomacy and
Public Affairs
Secretary for Arms
Control and
International Security
Secretary for
Political Affairs

51. BUREAUCRATS

52. State Government

53. State Government
Department
of Health

54. State Government
Department
of Health
State
Hospitals
Hospital
Heads/Directors
Hospital
Employees

55. Massachusetts
State Hospitals
Worcester Recovery Center
and Hospital
Tewksbury Hospital
Hathorne Unit
● Lemuel Shattuck
Hospital
Taunton State Hospital

56. Massachusetts
State Hospitals
Worcester Recovery Center
and Hospital
Massachusetts
Private Hospitals
Mclean Hospital
Harvard University
Tewksbury Hospital
Hathorne Unit
● Lemuel Shattuck
Hospital
Taunton State Hospital

57. 34 Restrained Patients
260 Adult Psychiatric Beds
2 - 3% Significantly Harmed
DMH Hospital Restraint Statistics
February 2016

58. ‘Harmful Crazy People’

59. ● Six Core Steps
● Roadmap to a Restraint- Free
Environment
● Advance Crisis Management
Program

60. State Government
creates policy
Directors of Hospitals
regulates policy
Medical Staff
uses policy
Heads of Wards
regulates policy

61. The Use of
Mechanical
Restraints
Problem

62. The Use of
Mechanical
Restraints
Problem
Good Research

63. The Use of
Mechanical
Restraints
Problem
Good Research Doesn’t Exist

64. The Use of
Mechanical
Restraints
Problem
Good Research Doesn’t Exist
The Use of
Mechanical
Restraints

65. The Use of
Mechanical
Restraints
Problem
Good Research Doesn’t Exist
The Use of
Mechanical
Restraints
National
Policy

66. The Use of
Mechanical
Restraints
Problem
Good Research Doesn’t Exist
The Use of
Mechanical
Restraints
National
Policy Fragmented
System
Bureaucracy

67. The Use of
Mechanical
Restraints
Problem
Good Research Doesn’t Exist
The Use of
Mechanical
Restraints
National
Policy Fragmented
System
Bureaucracy
SOLUTION

68. Local
Government

69. Local
Government

70. Local
Government
National
Government

71. Local
Government
National
Government

72. Local
Government
National
Government
State
Government

73. 164
1
MA is the First
Colony to
Legalize Slavery
177
3
1820
Slaves
unsuccessfully
petition MA
Government
186
5
Slavery is abolished
in all territory above
Missouri
13th Amendment
abolishes slavery
throughout the nation
Abolishing Slavery in the United States

74. 192
4
First American
Gay Rights
Organization
197
9
2003
National March
on Washington
201
5
Massachusetts is
the first state to
legalize gay
marriage
Gay Marriage is ruled
legal in all 50 states
Gay Marriage in the United States

75. - Standardize Tests

76. - Standardize Tests
- Educational Funding

77. - Standardize Tests
- Educational Funding
- LGBTQ Rights

78. Hope for Change
Mechanical Restraints

79. Thank you