Government recommends limiting use of restraints and seclusion

All patients have the right to be free from physical and chemical restraints or seclusion that is imposed to coerce or discipline them, concludes a report released this fall from the General Accounting Office (GAO).

The 35-page report recommends that the Health Care Financing Administration (HCFA) extend these protections to all patients receiving treatment in Medicaid- and Medicare-funded facilities. However, HCFA isn't obligated to accept GAO's advice.

Several members of Congress requested the GAO report after consumers criticized the practice of restraining and secluding patients following the release of a 50-state survey conducted in October 1998 by The Hartford Courant, a daily Connecticut newspaper. The survey found that 142 deaths had occurred in the past decade during or shortly after the use of restraint or seclusion at facilities for mentally ill and mentally retarded patients.

According to the GAO report, current federal and state regulations governing restraints and seclusion for people with mental illness and mental retardation are inconsistent. The GAO report recommends limiting the use of restraints and seclusion to medical or surgical care, individual behavioral teaching programs or emergency treatment.

The report also states that all patients have the right to receive treatment to reduce their dependency on chemical or physical restraints or seclusion.

HCFA says it is studying the report, but cautioned that implementation must be tailored to each specific treatment setting.

The use of restraints and seclusion is also being discussed by Congress and by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). APA has been working with Congress and JCAHO on this issue.

--L. Rabasca



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