The following letter was sent to Providence Hospital June 18 by Freedom Center joined by Arise for Social Justice and Out Now organizers. Included with the letter was a great article published by the Child Welfare League of America about effective alternatives to restraints and solitary confinement/seclusion.

Freedom Center Box 623
Northampton, MA 01061
413 582-9948
info@freedom-center.org

6/18/05

Clinical Director Aimee Mitchell
Providence Hospital
1233 Main Street
Holyoke, MA 01040

Dear Director Aimee Mitchell:

We are members of the Freedom Center, a local group run by, and for, people labeled with severe 'mental illnesses.' We are writing to express our concern regarding solitary confinement (“seclusion”) and restraint practiced in the inpatient psychiatric wards of Providence hospital.

As you may know, a number of federally funded organizations have adopted initiatives in an attempt to address the issue of solitary confinement / seclusion and restraint. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) acknowledges that the use of seclusion and restraint on persons with mental health and/or addictive problems has resulted in deaths, serious physical injuries, and psychological trauma, and notes that children appear to be at particularly high risk for death and serious injury. SAMHSA has subsequently launched an initiative to reduce and ultimately eliminate the use of seclusion and restraint practices for all age groups in institutional and community-based behavioral health care settings. In addition, SAMHSA is working in conjunction with the Centers for Medicare and Medicaid Services (CMS) to reduce seclusion and restraint use. On April 11, 2005, the Massachusetts Department of Mental Health formally proposed new regulations with regard to seclusion and restraint, demonstrating an expanding awareness of the link between their use and psychological trauma.

We at the Freedom Center believe that a culture of restraint and solitary confinement/seclusion is not conducive to recovery in any way. Rather, restraint and solitary confinement/seclusion practices consistently serve to exacerbate any existing effects of psychological trauma in individuals, and can lead to new trauma.

Witnesses and patients have reported multiple and recurring uses of restraints at Providence Hospital that are illegal under current law and guidelines. These incidents must stop immediately, with whatever resources or policies brought to bear to ensure that they stop. Because of management's failure to address and adequately prevent these incidents, clients are traumatized and injured, and staff are placed in a position where their job becomes dependent on breaking the law.

Many of our members have experienced restraint and seclusion themselves, and live with the lifelong impacts of this treatment. We have also spoken with many mental health staff, including staff at Providence Hospital, who are concerned about the illegal use of restraints and seclusion and support the goal of creating a treatment environment that allows their prevention and elimination. We understand that the stated rationale for using seclusion and restraint is often safety of staff and patients. As the experience of other hospitals has proven, ending restraint and seclusion can create an atmosphere that is safer for all by preventing escalation before it occurs. Elimination of these practices can also protect staff from the harm incurred by witnessing and/or participating in restraint and seclusion practices. We invite mental health staff to join our efforts because other hospitals have shown that everyone can benefit from eliminating these practices.

There is an abundance of knowledge and training available on how to achieve these changes, and we would be happy to help direct you to these resources. According to “Leading the Way Toward a Seclusion and Restraint-Free Environment – Pennsylvania’s Seclusion and Restraint Reduction Initiative,” (Harrisburg: Office of Mental Health and Substance Abuse Services, 2000):

In 1997, the Pennsylvania Department of Public Welfare instituted an aggressive program to reduce and ultimately eliminate seclusion and restraints in its nine state hospitals. Charles Curie, deputy secretary of mental health and substance abuse services, articulated the philosophy behind the change in policy: "Most of our patients are already the victims of trauma. There is no need to reinforce that trauma, or to re-traumatize." Three years later, Pennsylvania had reduced incidents of seclusion and restraint in its nine state hospitals by 74 percent, and reduced the number of hours patients spent in seclusion and restraints by 96 percent. Its program, which includes both forensic and civil commitments, has the highest standards for S/R in the nation. Pennsylvania’s hospitals experienced no increase in staff injuries. In addition, its changes were implemented without any additional funds, using only existing staff and resources. Pennsylvania's progress defined restraint and seclusion not as treatments, but as treatment failures. Measures they relied on in making these changes included open access to data regarding restraints and seclusion, prohibition of chemical restraints, staff training, and involvement of advocates.

As the example of Pennsylvania shows, the eventual elimination of restraints and seclusion is possible, but does take time. We want to ensure that this goal is being pursued in a timely manner with an urgency commensurate with the unacceptability of these practices.

We are writing to ask the management of Providence Hospital the current status of restraint and seclusion use at your hospital and your existing policies regarding restraint and seclusion. We call for the immediate end of illegal restraints and seclusion and measures to ensure that such practices do not continue. We ask if you share our goal of eliminating restraints and seclusion, if you have established a target date for achieving this goal, what steps you have taken, and what progress you have made.

We invite you to review this letter, and to share with us your own efforts to address this issue within your facility. We ask that you respond to us within 10 days.

Sincerely,


Freedom Center organizers:

Aby Adams
Cheryl Alexander
Amy Bookbinder
Oryx Cohen
Sarah Edwards
Nancy Foley
Will Hall
Mollie Hurter
Catherine Simon

Arise For Social Justice organizers:

Michaelann Bewsee
Kimberly Milberg

Out Now:

Holly Richardson

Individuals:

Stephen & Susan Lawrence