by Amanda Morley
Even though the quality of care in Massachusetts and around the country has greatly improved over the past several years, horror stories persist about psychiatric patients being needlessly abused and even dying as the result of negligence by staff and doctors that can border on cruelty. It is unfortunate to see that a society that prides itself on its advanced medical practices is so lacking in its social consciousness.
There is a movement run by survivors of the system (peers) for those still in the system (also called peers) to protect patients from the horrible tragedies that can occur in the lives of those suffering from mental illness. Peers who are survivors have fought great battles to gain employment by such agencies as the Department of Mental Health, and now work to help their companions to manage their lives. “Nothing about us without us,” they say.
Four bills currently in the State House seek to better the lives of psychiatric patients both in ERs and in inpatient facilities. Together, this legislation also will examine the feasibility of implementing peer-run respite programs.
Restraints in Emergency Departments
House Bill #3585 would require the storage of “Data on the use of behavioral restraint in certified emergency care units.” Currently, there is no law that mandates the collection of data for restraint use, and the employment of illegitimate and unneeded restraints in unneeded cases is common. Often, such action occurs after statements like, “If you don’t do what I ask, I’ll put you in restraints.” But restraints are not just actions, they are threats and coercions. And it is traumatizing not only to be put in restraints, but also to witness someone being tied to a bed. One might think, ‘Could this be me? How could something so inhumane be happening to another human being?’
Sometimes security guards can become aggressive and threaten to arrest patients on charges of assault while restraining them. Deaf people whose hands are restrained are forcefully robbed of their ability to communicate, often for hours at a time.
Restraints are frightful, and can trigger flashbacks to traumatic histories, exacerbating the situation to a great degree. And if not properly monitored during the restraints, patients can suffer serious complications, sometimes due to the medication that they are injected with at the time of the restraint. Others have died from a heart attacks or asphyxiation. This can happen due to ineffective execution of restraint techniques in mechanical, non-mechanical or chemical restraints. According to one article in the Boston Globe, an ER patient died while in restraints when she was injected with sedatives and left alone for 20 minutes by the security guard who was supposed to be monitoring her. “Accidents” like these should not happen.
Rachel Klein, a woman who went into a hospital emergency room for a headache, ended up in the psychiatric ward of the ER when she told doctors she had a history of suicidal ideations. There, she was forcibly stripped of her clothes, injected with 20 mg of Haldol and given shots of Ativan (anti-psychotic and anti-anxiety medications) over a half hour period, and then restrained for a total of 16 hours. “There are lots of stories out there,” she states. “Mine is not the only one. The problem is that it is not unusual.” It’s scary to think that such risky practices would become used so nonchalantly that they become the normal behavior of the staff. Ms. Klein continued to comment on treatment that amounts to intimidation and the problems that it creates for people suffering from psychiatric distress, “When they need to go to the ER, they can’t – they’re too scared.”
The Department of Public Health, not the Department of Mental Health, oversees emergency departments in Massachusetts. If they can begin monitoring the use of restraints in the ERs across the state, then perhaps the staff members will think twice before resorting to restraints, and much unnecessary suffering can be avoided. Currently there is no accountability required for such actions, except in the minds of those suffering from great mental distress. Many patients have complained of all kinds of abuse in the ER–beatings, hand-cuffings, forced-strippings of females by male security guards…the list goes on.
Your Five Fundamental Rights, and a Sixth: The Right to Fresh Air
Patients have Five Fundamental Rights when they go into a psychiatric hospital. (Author’s Note: these rights apply to inpatient units, not emergency departments.) Their rights are being violated every day. The new legislation would create a fair way (which currently doesn’t exist) to appeal violations. The rights look like this:
1) The right to reasonable access to a telephone to make and receive confidential phone calls, in private.
2) The right to send & receive sealed, uncensored mail. Writing materials and stamps shall be available for use in reasonable quantities, and assistance should be provided in writing, addressing and posting letters.
3) The right to receive visitors of your own choosing daily, in private, and at reasonable times.
4) The right to a humane psychological and physical environment. Each person will have accommodations allowing privacy and security in resting, sleeping, dressing, bathing, toileting, and personal hygiene, as well as reading and writing.
5) The right to receive or refuse visits and calls from an attorney or legal advocate, outside physician, psychologist, clergy member or social worker, at reasonable times or otherwise.
The Sixth Fundamental Right would be fresh air. House Bill #1945 and Senate Bill #743 call for “Daily access to fresh air and the outdoors.” Most hospitals currently provide fresh air breaks, but some still do not. Sometimes hospitals claim that if patients are well enough to go outside that they are ready to go home. However, people in favor of the bill say that fresh air is as effective, if not more so, than medicine for treatment. Fresh air is also free of cost and side effects. Advocates also suggest that access to fresh air would get patients out of the hospital sooner and decrease the amount of time and money spent on inpatient units.
For smokers, this is also an incredibly important issue. Addiction is hard, and to truly conquer an addiction, it must come from within, not from an outside source forcing you to stop the behavior. When summed, being in the hospital and having to quit smoking together create an awful equation.
For the average person, being inside for extended periods is unhealthy. You can get sick because of uncirculated stale air and can easily develop a distorted sense of time. It is not uncommon for a patient on an inpatient unit to be unable to give you the time of the day, or even the day of the week, if asked.
Fresh air should be a right, not a privilege. With regard to fresh air, even prisoners in correctional facilities have more rights than psychiatric patients. They, at least, get to go outside every day and enjoy the fresh air.
The hospitals that now provide fresh air breaks consider them privileges that can be taken away at any time by the discretion of the nursing staff. If, for example, you refuse to take your medication because you do not like the side effects, you may be restricted to the ward until you comply with the doctors. If you “mouth off”, it could mean 72 hours of restriction to the ward.
Peer-run Respite Programs
To reduce some of the burden on the hospital emergency departments, there is a movement to create peer-run respite programs, which would be run by peers in residential settings. These would allow participants to stay for up to one week. House Bill # 3584 would authorize and direct the state of Massachusetts to “conduct a study of the feasibility of providing peer-run respite services.” According to an article by Lee Hammel in the Worcester Telegram and Gazette, the average cost of peer-run respites is $211 per day, compared with $600 – $1000 per day in a locked facility. That’s roughly 89% less that the people of Massachusetts would have to pay for police, ambulance transportation, medication, doctors and emergency department beds. There are currently 20 peer run respite beds in seven states in the country, but ideally, Hammel states, there would be 720 respite beds in Massachusetts alone, moving 60-70% of psychiatric patients away from inpatient units to more welcoming environments. In these peer run centers, people with experience could lead those with troubles through hard times. Peer run respites are incredibly effective and economically friendly. H.B. 3584 would explore how to fund such a program.
The admission in a peer run respite center would be completely voluntary and free for those who use it. Only individuals who are a threat to others would be turned away. Patients who are actively suicidal or self-injurious would be welcome. The existence of peer-run respites may increase the likelihood that someone in need will seek help. Many people with psychiatric diagnosis avoid treatment becuase of past experiences in hospital emergency departments or locked facilities, where staff are often untrained and hostile toward patients.
How You Can Help
The following bills will be heard at the State House on September 23rd, 2009, at 1pm in room A-2:
1) Sponsored by Ruth B. Balser of Newton, House Bill #3585 would require the keeping of “data on the use of behavioral restraint in certified emergency care units,” to work on reducing the number of restraints in Emergency Departments, where staff often become aggressive in manner towards the patient, threatening and abusing them.
2,3) Sponsored by Denies Provost and Pat Jehlen of Somerville, House Bill #1945 and Senate Bill #743, calls for “daily access to fresh air and the outdoors” and a 3rd party appeal of your rights. This bill would allow patients on inpatient units to go outside daily. The Five Fundamental Rights currently, however, are being violated every day in hospitals, and there are no consequences. These bills would allow avenues to demand accountability for the violations.
4) Sponsored by Ruth B. Balser of Newton, House bill #3584 authorizes and directs the State of Massachusetts to “conduct a study of the feasibility of providing peer-run respite services.” Peer-run respites, studies say, are cheaper and more effective than inpatient units, because they are run by the same people that have already been through the very experiences that the patients there suffer through. Peers understand issues on a more meaningful level than do professionals.
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Even in an industrialized society such as that of the United States, human rights are violated every day. This is unacceptable, especially in today’s society where people’s rights are a source of pride. In the context of the mental health care system, patients are being abused, both in Emergency Departments and in the inpatient units, by staff who can be aggressive and violent.
In his August 1, 2009 cover article in the street newspaper Streetvibes, Eli Braun makes an interesting point: “People who do not receive sufficient care in the community often show up in other systems. Many land in jails, prisons, homeless shelters or other settings less conducive to recovery.” We want people to get help so that they do not fall into trouble or poverty, so that they can avoid losing everything that they have due to mental illness that goes untreated because of fear.
If you wish to testify at the hearing, contact Cathy Levin at Cathy.Levin@comcast.net for more information on rights regarding Emergency Departments, and Johnathan Dosick at firstname.lastname@example.org for more information on your Five Fundamental Rights and the Right to Fresh Air. Please keep your statements no longer than three minutes long, as there are many people testifying there that day. To search the bills, go to mass.gov/legis and select “Text of House Bills” under “Current Legislation”, then type in the bill number in the space provided. You can also contact your representative to demonstrate support. To find your local representative, visit the following website: http://www.wheredoi votema.com/ bal/myelectioninfo.php.
The Five Fundamental Rights are quoted from and their violations were compiled from a flyer distributed by M-POWER.
The contact information for this organization is: (617)-442-4111 or toll free (877)-769-7693; email: email@example.com.