The issue of the restraint use came to national attention through an investigative series published by the Hartford Courant in 1998. As follow up to the Report, Congress, in 1999 requested its first GAO investigation into the use of restraint in Mental Health facilities.
After its first report in 1999 the GAO suggested that HCFA (now CMS) maintain a database on rates of restraint and seclusion by facility. HCFA noted that it was planning to work with other Federal agencies to determine the best way to implement this record keeping. This database was never established. According to CMS, Director of Physicians Regulatory Issues Team CMS is “not aware of a CMS data collection initiative” and advised us to “ask SAMHSA.” This was confirmed by SAMHSA’s Information Specialist who also could not provide any statistics on restraint use or injuries related to its use or non-use.
What is astounding is the amount of pressure being exerted on this issue with absolutely no statistical, empirical, scientific or other factually based evidence. National statistics on institutional violence including school crime and violence does not exist, and the American public is being significantly misled as it is estimated that between one and four out of five school crimes (including crimes and assaults on the students) and assaults on hospital and treatment staff go unreported.
On April 8, 2009 Congress was asked to do what it should have done in 1999 which is impose a data collection initiative headed by CMS and the FDA. In the case of persons with disabilities, the use of restraint for treatment purposes is done in accordance with an individualized education or treatment plan. As the person being secluded or restrained (assuming the seclusion or restraint was an appropriate intervention) has rights as do the other staff, patients, students and educators to protect themselves and others from bodily harm. As all persons are created equal, these rights need to be balanced.
Before actions are considered that unlawfully limits person’s rights, we believe Congress has a responsibility to at least know and make known the scope of the issue supported by reputable statistics.
Tags: National Disability Rights Network, prone restraint, restraint and seclusion