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SAMHSA News - Volume XI, Number 2, Spring 2003

Historic Conference

A clear goal and focused plan to change a controversial practice in mental health and related services emerged at a groundbreaking national conference on May 5 in Washington, DC. Titled "A National Call to Action: Eliminating the Use of Seclusion and Restraint," the conference was sponsored by SAMHSA and the National Association of State Mental Health Program Directors (NASMHPD).

"The use of seclusion and restraint clouds our vision and impedes our mission," SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W., said in his conference address. "I have made it a priority for SAMHSA to work with states, consumers of mental health services, advocates, service providers, and provider organizations ultimately to eliminate the use of such practices. Today we are launching our national action plan to accomplish that goal."

NASMHPD Executive Director Robert Glover, Ph.D., emphasized the organization's position, issued in July 1999, that seclusion and restraint are safety interventions of last resort and are not treatment interventions, and that they "should never be used for the purposes of discipline, coercion, staff convenience, or as a replacement for adequate levels of staff or active treatment."

Conference participants included leaders from national mental health organizations; professional and provider organizations; Federal, state, and local mental health agencies; clinical training programs; federally funded research, training, and technical assistance centers; and mental health service consumers and people in recovery from addictions and their family members. Participants examined solutions, shared experiences and information, and contributed to a national agenda, which SAMHSA will disseminate.

Jacki McKinney, M.S.W., advocate for the National Association of People of Color Consumers, recounted a night in seclusion spent listening to the man locked in the tiny room next door become increasingly distressed, to the point of death. "Each time [an attendant] came I said, 'I'm going to tell them about the man next door.' But I couldn't, I was so scared for myself. Isn't this dehumanizing-to force me to make a decision between my life and somebody else's?"

"The challenge we're still facing is addressing a culture where people believe restraint helps," said Laura Prescott, Executive Director and founder of Sister Witness International, in remarks at the meeting.

Diverse viewpoints also found a forum. Lynn C. DeLacy, M.S., R.N., C.N.N.A., chair of the Task Force on Seclusion and Restraint for the American Psychiatric Nurses Association, expressed concern, in light of the national nursing shortage, about the labor-intensive work required to prevent seclusion and restraint. Charles Riordan, M.D., chair of the American Psychiatric Association's Committee on Standards and Survey Procedures, predicted problems in eliminating seclusion and restraint without a major commitment of money and resources. He warned of possible unintended consequences of proposed reporting requirements, such as hospitals' refusals to admit certain patients.

The conference ended with a session in which participants submitted recommendations for consideration in pursuing SAMHSA's National Action Plan.

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