Last month Peter Korn of the Portland Tribune wrote an intriguing story about some new data released by the state Department of Human Services.
READ – Hospital restraint figures (not) revealed, Portland Tribune, November 20 2008
The data, all self-reported by hospitals, shows Oregon hospitals with psychiatric inpatient units in the first quarter of 2008, January through March. The data was released on November 7 to Peter, and then not released on the DHS web site. No data has been made available before or after this quarter – so it’s hard to discern whether if the numbers are high or low without some expert understanding of the situation at each hospital, a point of view only available to the state overseers, and those hospital administrators who share this sort of data on a monthly private conference call.
The data shows the number of times seclusion or restraint, but not the combination of the two, are used divided by patient days. Each hospital sees a different number of patients, so a flat figuring is not meaningful.
Seclusion typically means locking a person in a room alone or with an attendant. Restraint typically means a person is tied by the wrists, ankles and waist to a bed, gurney or wheelchair. A mask to restraint biting or spitting is also used. Seclusion and restraint are approved to be used to stop a person who is being dangerous to themselves or to others, but because they affect personal liberty and are both demeaning and potential dangerous themselves, these tools need considerable oversight – which they do not have.
Are you a clinician? If you practice in a hospital, or with people who have been hospitalized, you should read Maggie Bennington-Davis’ book, Restraint And Seclusion: The Model for Eliminating Use in Healthcare. It’s not cheap, but consider the cost of making a mistake.
There are many reasons why these numbers might be high or low or wrong. If you have an informed opinion, please comment below. Again, this data is self-reported by hospitals, which is insufficient oversight – one of the many effects of underfunding our mental health services.