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Corrections The most isolated people in our society are those confined in the dungeons, the “holes,” of administrative and punitive segregation in jails and prisons, on death row, and in “supermax” prisons.Many of these people are in seclusion for their own protection, rather than for disciplinary reasons.1 Seclusion exacerbates the suffering of people with mental health conditions, who make up approximately half of the prison population.2 And solitary confinement is a cruel and traumatizing threat to the mental health of anyone so deprived of human interaction.Trauma-informed care and strict safeguards are also needed, to minimize trauma and harm.Unfortunately, despite this progress, there are still insufficient national standards governing how and when to use or avoid seclusion and restraints.
This goal was adopted by SAMHSA in its 2005 “Roadmap to Seclusion and Restraint Free Mental Health Services”7 and by NASMHPD in a comprehensive 1999 position statement.8 State and federal agencies should take a greater role in assuring the safety and protection of children, young people, and adults in psychiatric settings.
Likewise, NASMHPD (the National Association of State Mental Health Program Directors) has called seclusion and restraints “safety interventions of last resort” and “not treatment interventions,” and NASMHPD has put a priority on “prevent[ing], reduc[ing], and ultimately eliminat[ing] the use of seclusion and restraint and . Data gathered by the NASMHPD Research Institute from more than 200 psychiatric facilities between January 2000 and December 2004 showed a 16% reduction in the use of restraint (400 fewer patients per month) and a 45% reduction in the use of seclusion (1,000 fewer patients per month) over that period.12 NASMHPD officials are persuaded that all states would like to achieve major reductions in the use of seclusion and restraints but concede that no funding has been available to help, and evaluation and transparency have languished since 2009, so progress since then is unknown.
As the states work toward eliminating the use of seclusion and restraints in behavioral health facilities, MHA advocates for much more transparency so that states and caregivers are both supported and accountable.
Beers, a person with a mental illness who had experienced restraint and seclusion and was horrified by the abuse that he witnessed and experienced in the back wards of the asylums and mental hospitals of his time.
He founded the organization that now is called Mental Health America to put an end to such needless suffering.
Even in Pennsylvania, which has worked hard to eliminate coercion, restraints continue to be used about 10 times a year.