In February 2009 we wrote to SAMHSA informing them that we are finding that when the desire to eliminate or reduce restraint exceeds the actual realities of the institution and population served, that
1. Either there is an increased use of mechanical and chemical restraint to compensate for the inability of staff to maintain safety through restraint or seclusion, or
2. There is an increase in patient-related violence and assaults resulting in higher worker and patient injuries, increased worker compensation and time off claims.
SAMHSA could not respond because they do not have restraint or seclusion statistics and to not keep track of the relationship between a high (or low) safety climate and assault rates.
A research study conducted by authors affiliated with the department of psychiatry at Bronx-Lebanon Hospital Center and Albert Einstein College of Medicine, confirms, finding that a significant decrease in the total number of episodes of seclusion and restraint has a corresponding significant increase of risk of harm to psychiatric patients and staff due to increased patient violence. The study showed close to a 300% increase in the number of assaults on staff from 31 assaults to 83, and a 26% increase in the number of assaults on other patients. Thus the study supports our finding that reducing seclusion and restraint to artificially low levels presents a risk to both staff and patient. Therefore, a high safety climate and staff training should be included in efforts to reduce the amount of patient violence. http://psychservices.psychiatryonline.org/cgi/reprint/55/11/1311
Tags: patient assault, patient violence, prone restraint, restraint and seclusion