Acadia director defends policy of not restraining patients

Posted Aug. 27, 2010, at 2:25 p.m.

BANGOR, Maine — People with mental illness who are subjected to the use of physical restraints typically find the experience deeply traumatic and humiliating. David Proffitt, CEO of The Acadia Hospital, said on Thursday that for many patients, it feels similar to being raped.

“People are holding you down, or tying you down, and doing what they want to you,” he said during an interview in his office at the private psychiatric hospital. Nurses and other caregivers have important reasons for wanting to use restraints on out-of-control patients, he acknowledged. “But experientially, for patients, it fundamentally changes your perception of those who say they’re here to help you and how you enter into trusting relationships.”

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But for mental health workers, an acutely ill patient in crisis — angry, hallucinating, suicidal, delusional — poses a serious threat. An accidental blow or a sustained attack can cause life-threatening injuries, and even dedicated caregivers say they shouldn’t have to forgo the use of restraints when their own safety is at risk. And they say in many cases patients find the use of restraints calming and reassuring.

The judicious use of restraints, direct-care professionals agree, is an essential tool for both delivering high-quality care and protecting worker safety.

The Acadia Hospital, and Proffitt’s leadership, have been the focus of intensive public critique this week after news reports revealed an ongoing federal investigation into allegations of an increase in staff injuries at the hands of aggressive patients.

At issue, in part, is Proffitt’s implementation of a policy to limit the use of clinical coercion at the facility, including seclusion and all forms of restraint, a move that many employees say has left them at heightened risk of injury. Many have said the hospital has failed to provide adequate staff training and education to support the move away from the use of restraints and toward a less restrictive model that stresses communication and the building of therapeutic relationships between patients and staff.

People identifying themselves as Acadia employees have weighed in on the matter anonymously to the Bangor Daily News this week via telephone, e-mail and Internet postings, saying they fear retribution if they are identified as being critical of the policy or its implementation.

The use of restraints in the acute psychiatric setting has been discouraged for many years. In 2000, the federal Substance Abuse and Mental Health Services Administration developed regulations aimed at reducing the time patients spend in restraint and requiring detailed patient management and documentation when restraints are present. In 2003, the administration released a “national action plan” with a goal of eliminating the use of all forms of seclusion and restraint.

“Individuals with mental illness should not be confined, restrained or retraumatized by the persons and resources put in place to help them,” reads a summary report of the action plan.

Mental health worker Corey Smith is employed at the state-run Riverview Psychiatric Center in Augusta, where Proffitt held the position of superintendent for four years before coming to The Acadia Hospital.

Under Proffitt’s leadership, Smith said, the use of restraints at Riverview dropped dramatically, with a commensurate rise in both serious and less-severe staff injuries.

In one incident, he recalled Thursday, one out-of-control patient and five staff members ended up at the emergency room with broken bones and other serious injuries after the patient became suddenly aggressive.

In another case, he said, staff took turns trying to subdue a violent patient without injuring him while waiting for a doctor’s order to employ a restraining vest and straps, as required by the hospital’s policy. It took about 45 minutes for the doctor to return the call, he said.

“There we are getting our butts kicked and she’s home in her bunny slippers sipping her tea,” Smith said. Such episodes erode staff morale and ultimately undermine patient care, he said.

An employee complaint from The Acadia Hospital has prompted an investigation by the federal Occupational Health and Safety Administration, which has had staff at the facility for several weeks to review clinical policies and interview employees and administrators.

On Thursday, state inspectors visited the hospital on behalf of the federal Centers for Medicare and Medicaid Services, which pays for the majority of care provided at the 100-bed facility.

Proffitt, who has been at the helm at Acadia for just under two years, said in Thursday’s interview with the Bangor Daily News that insights gained from such inspections may provide valuable opportunities to improve both patient care and employee safety. But he stood by his goal of eliminating the use of restraints.

The “compassionate act of working in mental health” should not entail the risk of personal assault and injury for either patients or staff, he said. In the past, mental health workers have employed many techniques now proven to be more harmful than helpful, he said, including induced insulin shock and ice baths. The use of restraints, he said, is coming to be recognized as one of these misguided techniques.

“I am very proud that at Acadia we are creating an environment where that isn’t the best we can do,” he said.

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