Series Citation:
Weiss EM, et al. Deadly restraint: a Hartford Courant investigative report.
Hartford Courant 1998; October 11 – 15.
October 12, 1998
Page: A1
Section: MAIN
Edition: STATEWIDE
Type: SERIES
Illustration: PHOTO 1: (color), Richard Messina / The Harford Courant
PHOTO 2: (b&w), Michael McAndrews / The Hartford Courant
GRAPHIC 1: (b&w), GRAPHIC 2: (b&w)
[NO Photos or Graphics are available for posting.
However, their Captions remain included.]
By Kathleen Megan and Dwight F. Blint
With reporting by Dave Altimari.
Courant Staff Writer Eric M. Weiss contributed to this story.
Part Two of a Five-Part Series published in The Hartford Courant,
beginning on October 11, 1998.
She was a 15-year-old patient, alone in a new and frightening place, clutching a comforting picture from home.
He was a 200-pound mental health aide bent on enforcing the rules, and the rules said no pictures. She defied him; the dispute escalated. And for that, Edith Campos died. She was crushed face down on the floor in a “therapeutic hold'' applied by a man twice her size.
Shy and well-behaved as a girl growing up in Southern California, Edith had problems as a teen. She ran away, took drugs, hung with the wrong crowd. Her family hoped treatment at the Desert Hills psychiatric center in Tucson, Ariz., would help.
But Edith Campos died -- as did Andrew McClain and Roshelle Clayborne and countless others -- when a trivial transgression spiraled into violence. Too often, it's a reaction built right into our system that cares for people with psychiatric problems and mental retardation.
The people who make and execute the critical decisions to use physical force or strap a patient to a bed or chair are often aides, the least-trained and lowest-paid workers in the field.
They must make instantaneous decisions affecting patients' physical and psychological well-being against a backdrop of staffing cuts that result more in crowd control than in patient therapy.
``I can't understand why patients don't die more often with all the things that happen on a daily basis,'' said Wesley B. Crenshaw, a psychologist who has conducted one of the few national surveys on restraint use.
“You have people who are ‘cowboying’ it,'' Crenshaw said, “people who really want to get in there and show they're the boss.''
Yet only three states -- California, Colorado and Kansas -- actively license aides in psychiatric facilities. Licensing of aides is nearly non-existent in the mental retardation field, although a handful of states do certify aides.
So while individual states and facilities may set their own standards, there is no uniform, minimum training for aides nationwide -- even in life-saving techniques such as CPR.
In the Edith Campos case, aide Daniel Thomas Walsh successfully fought negligent homicide charges by arguing he had followed hospital guidelines. And the guidelines didn't say he needed to watch Edith's face for signs of distress, the judge found.
“It was a tragedy that this girl died in our care,'' said Kirke Cooper, director of business development for Desert Hills. “But I don't feel there was any wrongdoing on the part of our staff. They are all well-trained in physical control and seclusion.''
Done correctly, a restraint can protect a patient and worker from harm. Done under the right circumstances, patients say, it can be beneficial.
Yet too often, it is done badly and for the wrong reasons. Nowhere is this tragedy more apparent than in the deaths of children.
A Courant investigation has found more than 26 percent of restraint-related deaths over the past decade involved patients 17 and under. Yet children make up less than 15 percent of the population in psychiatric and mental retardation facilities, according to federal statistics.
The death rate should come as no surprise.
“You can't believe how many times a kid gets slammed into restraints because an argument will ensue after calling a staff member a name,'' said Wanda Mohr, director of psychiatric mental health nursing at the University of Pennsylvania.
She and other analysts say children disproportionately bear the brunt of the misuse and overuse of restraints. A 1995 New York study, for instance, found children almost twice as likely as adults to be restrained.
“It's socially acceptable to spank and punish children,'' said Mohr, reflecting the responses of other experts who say our culture tolerates a physical response to unruly children.
Yet children are both a vulnerable and challenging population.
Firm diagnoses often cannot be made until late adolescence or early adulthood, so providers are less sure how to treat children. And many troubled children enter the mental health system with histories of physical or sexual abuse -- so even the threat of physical force can be traumatizing.
For their part, many patients say improper or frequent use of restraints hurts their recovery and defeats the very reason they were admitted. In interviews with more than a dozen children and adults, The Courant's investigation found these patients were left confused, angry and afraid.
They rarely felt better.
Researchers are finding the same. In a 1994 New York study, 94 percent of patients restrained or placed in seclusion had at least one complaint about the process. Half complained of unnecessary force, 40 percent cited psychological abuse.
In a study published this year, Mohr interviewed children after their hospital stays and found many were further traumatized when they were restrained or secluded -- or even watching others undergo the procedure. Usually, she found, children saw such treatment as punishment.
The leader of the nation's psychiatric association acknowledged the problem.
“It must be especially frightening for a child,'' said Dr. Rod Munoz, president of the American Psychiatric Association. “It's a struggle of wills where the most powerful win.''
And troubled children are the ones who lose.
Ms. E. Huckin, 17, of Granby, Conn., is still so disturbed by a restraint five years ago that she can barely speak about it. She was put in a “body bag,'' a sort of neck-to-toe straitjacket.
“They tie you in it. They pull it tighter and tighter. I couldn't move to breathe,'' Huckin said. “I was screaming and pleading, `Somebody, please, somebody take me out.'
“It made you so much more suicidal,'' she said.
As mental health aides take this step that can do such physical and psychological harm, they are poorly monitored much of the time.
Although most institutions require a supervisor to oversee a physical restraint, The Courant found such rules are often ignored.
When 11-year-old Andrew McClain was restrained last March at Elmcrest psychiatric hospital in Portland, Conn., the duty nurse sat nearby eating breakfast. She ignored the initial cries of distress from Andrew, whose chest was crushed during the restraint.
The decision to strap a patient to a bed or chair, or cuff their hands, must be cleared by a doctor, according to many hospital and state policies. If a doctor is not available, efforts must be made to contact one as soon as possible.
But in more than a dozen cases reviewed by The Courant, patients were tied to their bed or chair for several hours at a time without regular review by a physician.
Mental health advocates say doctors must keep a closer eye on how long their patients are restrained.
“The ultimate responsibility falls to the doctors, who are supposedly the kings in these places,'' said Curtis L. Decker, executive director of an organization representing patient advocates nationwide. “They're in control and ought to exercise their authority.''
Yet in certain facilities, physicians give staffers virtual carte blanche by issuing an order to restrain as needed.
“It's a go-ahead to slap restraints on a person without evaluating why the patient was acting up in the first place,'' said Dr. Moira Dolan, a medical consultant in Texas, where standing restraint orders are allowed in certain facilities. “There's no guidance on when to restrain someone.''
Despite such responsibility, minimum hiring standards are few and pay is typically low for aides. A survey by The Courant last spring, for example, found aides were paid as little as $10 per hour in Connecticut.
When federal investigators began looking into the quality of care at Western State Hospital in Staunton, Va., last summer they found the $15,000 starting pay was less than what an employee could make at the nearby department store.
“When you can make $10 an hour working at the new Target,'' asked union representative Allen Layman, “what incentive is there to come here?''
Especially when the work can be demanding and dangerous.
For every 100 mental health aides, 26 injuries were reported in a three-state survey done in 1996. The injury rate was higher than what was found among workers in the lumber, construction and mining industries.
“Depending on the situation, it's scary, it's violent,'' said David Lucier, a veteran mental health worker at Natchaug Hospital in Mansfield, Conn. “Oftentimes, patients are kicking and punching and spitting and verbally abusive.''
Over a 19-year career, Lucier said, he has developed communication skills that allow him to rarely touch patients. The skills described by Lucier are gained by training and by understanding the patients.
At some hospitals, though, staff are moved about like pawns in a chess game, leaving them little chance to know their patients.
To fill less-desirable shifts such as weekends, institutions use less-trained, part-time workers. When faced with wide fluctuations in the numbers of patients, they resort to shuffling workers from one unit to another.
A staff shortage landed aide Spero Parasco on Andrew McClain's unit March 22.
Parasco, who usually worked with adults, had never met Andrew before that morning at breakfast and had not read the child's medical chart. Indeed, Andrew's ward that Sunday was staffed largely with part-time workers.
So when Andrew defied Parasco's instructions to move to another table at breakfast, the dispute escalated into a “power struggle.'' Had workers known more about Andrew, had Parasco been better-versed in ways to calm him, the boy would not have died, a state investigation concluded.
Better staffing also reduces the risk of a restraint, like the face-down floor hold in which Andrew died.
The American Psychiatric Association recommends at least five people -- one for each limb, plus someone to watch -- be involved in any physical restraint.
That would have been nearly impossible in Andrew's case. A total of five staffers were on duty in the unit that Sunday morning, overseeing 26 children. As it was, just two aides were involved in Andrew's restraint.
“A takedown requires four staff members and, with staff cuts being made at many institutions, they end up with only two people doing the work of four people,'' said Tom Gallagher of the Indiana Protection & Advocacy Services office. “That's when problems occur.''
At least six of 23 recent deaths reviewed in depth by The Courant occurred during a restraint executed by only one or two people. Another six patients died in seclusion or mechanical restraints after being left, unmonitored, for several minutes or more.
“Hospitals have cut their staffing to a bare minimum,'' said Dr. David Fassler, a psychiatrist, author and chairman of the Council on Children, Adolescents and Their Families. The same fiscal pressures, he said, have led institutions to reduce training as well.
All this at a time when patients particularly need skilled help. As managed care limits access to hospitals, most analysts say patients are entering the system in more troubled conditions than ever before.
In the wards, staffers feel the pressure.
Pausing during a recent double shift at Western State Hospital in Virginia, a 375-bed facility for adults, nurse Judy Cook talked about the need to devote time to patients.
“Every time we've had a downsizing of staff we've had an increase in restraints and seclusions,'' said Cook, who has seen 23 years of trends at Western. “When you have more staff you can intercede better and you don't have to just place someone in restraints to calm them down.''
But reducing the use of restraints requires a financial and philosophical commitment -- a commitment to use force only as a last resort, and only by well-trained staff who care about the patient.
Across the nation, the commitment is too often absent.
Last summer, a staff shortage at Western State forced nurses to call on security guards to help perform restraints. One guard, who didn't want his name used, showed little interest in the patients he might forcibly restrain.
Or much interest in doing it correctly.
“I didn't get hired,'' he said, “for all this bull-crap interacting with people or tackling psychotic patients.''
[Here ends the BODY of Day Two’s article.
Photo captions and Graphics descriptions follow.]
Caption[s]: PHOTO 1: WESTERN STATE HOSPITAL, a 375-bed facility in Staunton, Va., is part of a federal investigation into the quality of mental health care throughout Virginia. At Western, the $15,000 starting pay for aides is less than what an employee could make at the nearby department store. And last summer, a staff shortage at Western State forced nurses to call on security guards to help perform restraints. Here, a patient in Western's forensic unit, naps in his room.
PHOTO 2: Ms. E. HUCKIN, 17, still has nightmares about being restrained in a body bag -- a sort of neck-to-toe straitjacket -- five years ago. Huckin is once again living at her Granby home, where she posed for this photo with her mother, Karen Huckin.
GRAPHIC 1: AN OFTEN-USED TOOL
[Library note: This graphic was published as a bar graph, and was not available electronically in that form for this database.]
Restraints are used virtually day, sometimes several times a day, at institutions across the country. Even facilities with strong reputations, such as Riverview Hospital for Children and Youth in Middletown use the method with frequency. Here is a look at Connecticut's two major public psychiatric facilities.
RIVERVIEW HOSPITAL FOR CHILDREN AND YOUTH
State institution run by the Department
of Children and Families: 350 patients
Percentage of patients restrained
at least once during their stay: 27.6
Number of restraints per month:
July '97.....31
Aug. '97.....41
Sept. '97....18
Oct. '97.....33
Nov. '97.....55
Dec. '97.....41
Jan. '98.....76
Feb. '98.....93
March '98....44
April '98...144
May '98.....140
June '98....155
CONNECTICUT VALLEY HOSPITAL
State institution run by the Department of
Mental Health and Addiction services: 450 patients
Hours patients spent in restraint per month:
July '97.....700
Aug. '97...1,350
Sept. '97....450
Oct. '97......90
Nov. '97.....310
Dec. '97.....125
Jan. '98......25
Feb. '98.....170
March '98.....90
April '98....320
May '98......650
June '98.....380
[I’m not sure if the following text is a continuation of GRAPHIC 1
… or another GRAPHIC … or a SIDEBAR.]
ONE HOSPITAL'S RECORD
Western State Hospital in Staunton, Va., is among a number of Virginia state facilities under federal investigation for allegations of abuse and neglect. With 375 patients, the hospital has used restraints and seclusion a total of thousands of hours in the past two years.
Here are the total number of hours patients spent in restraint or seclusion per three-month period, and then averaged on a monthly basis.
1996 HOURS OF RESTRAINT MONTHLY AVG.
July -- September 14,500 4,833
October -- December 11,500 3,833
1997
January -- March 11,000 3,667
April -- June 11,500 3,833
July -- September 11,250 3,750
October -- December 10,000 3,333
1998
January -- March 9,000 3,000
SOURCE: Virginia Alliance for the Mentally Ill
[Here ENDS Day Two: Why They Die: Litle Training,
Few Standards, Poor Staffing Put lives At Risk.]
October 12, 1998
Page: A9
Section: MAIN
Edition: STATEWIDE
Type: SERIES; SIDEBAR
Illustration: PHOTOS (3 color) Michael Kodas / The Hartford Courant
Source: DAVE ALTIMARI; Courant Staff Writer
[NO Photos or Graphics are available for posting.
However, their Captions remain included.]
Tina Puziello, 36, of Branford, was restrained while hospitalized during the late 1980s and early 1990s. She was diagnosed as having bipolar disorder. She has been out of the hospital for almost four years and has worked as a volunteer advocate for psychiatric patients. Restrained over a smoke.
First I asked people. I said I wanted to go to the other side of the building. I wanted to go to that side because I wanted to have a cigarette and a cup of coffee or whatever.
I did that a couple of times. I was pretty soft-spoken and very depressed, but after a while of asking to go to the other side, I became frustrated and I banged on the window and I said I wanted to leave. I raised my voice and I have a loud voice.
I guess it frightened them and the fact that I yelled and punched the door. I guess they thought I was out of control. I heard them call a code – “Dr. Strong'' -- and about eight guys came and put me in this thing. It could have been five or six. It was scary.
One guy -- he realized I was petrified. Basically he said: “Don't fight them.'' I was fighting them a little bit because I didn't know what they were doing. Your natural reaction when you have a bunch of guys running toward you is to tense up. It was pretty humiliating.
They didn't throw me on the floor on my face, thank God. They used the other way: where everybody took a limb and then they picked me up and put me into the body bag.
It was like a straitjacket except that it was like a canvas material, a green color canvas. I believe my hands were in front. There are long sleeves and everything and then it has loops and ties that go all the way down from your neck. Like putting a shirt on that's too long and then they tie the ends of the shirt. Your hands are in there and then the whole thing is tightened.
As you wiggle around, they are tightening it more. They tie it all the way down. It went all the way down to your ankles. I guess they called it a body bag because it covers your whole body. Then it's easy for them to lift you. You're like a mummy, except your head isn't wrapped.
It was extremely uncomfortable, but the other thing is I remember thinking, “I hope these people aren't going to bury me alive in this thing.'' Because that's what it seemed to me.
When patients lose control
I think that a lot of times what will happen is that people have difficulty communicating. It builds up and they have all these emotions . . . whether from regular life or delusions or hallucinations or whatever. They need to be with people who will validate [that it's] OK that they have feelings, to ask questions of them and spend time with them.
A lot of love and understanding is needed.
Depression is really swallowed anger. If you release it in small quantities, then it doesn't build up. But if they ignore that person . . . after a while they finally, like, rebel -- like a child who needs some love.
Burned-out workers
There's a lot of burn-out for mental health workers. . . . They put people in restraints or give them medication to keep them quiet so they don't need as much staff.
If they had more people, then they could get more care that they need.
Yelling leads to restraint
I remember being in restraints: lying down with my ankles tied to the bed and my arms tied to the side of the bed in four-point restraint. Basically, all I did was yell. I was in just a lot of pain emotionally.
As soon as I started yelling, that was the immediate reaction. It seemed pretty much standard.
I think they are also afraid [the yelling] might cause a chain reaction. They feel you might be giving the people an idea. So they don't want you to get the other patients riled up.
Can't itch
I can remember [the four-point restraint] had a little key. They would pull it really tight. I realized that if you relaxed your hand, you got more room. If you fight, you're constricting and making it smaller. If you relaxed, it would occasionally come off.
First of all, it hurts a lot of the time if they pull them tight. It hurts your wrists. There's a little piece of metal on a rubbery leathery strap that goes around your wrist. When they close it with the clamp thing, they say it doesn't hurt, but I always feel a pinching.
Plus, if you're itchy you can't always do something about it. You can ask somebody to scratch you, but you don't really want to do that. Your whole attitude is you don't understand why they are doing this.
A different set of rules
I've seen people who are angry pound their fists on a table at a meeting -- and if I ever did that in a hospital, it would be considered very aggressive behavior.
[Restraints are] a way to keep everybody quiet and compliant. It is a way to avoid talking to people.
It took away basically my spirit, my sense of dignity and reinforced the fact that you have to be really loud in order to get heard.
Caption[s]: PHOTO 1: CHRIS CAMPBELL proudly displays the walleyed pike he caught during a family vacation in 1995. The Campbells traveled to Little Canada Camp in Ear Falls, Ontario, each summer so Chris, 11 in this photo, could indulge in two of his favorite hobbies: fishing and eagle watching. It was his last trip to Canada.
PHOTO 2: AT THE GRAVE of their son and brother, members of the Campbell family gather nearly every week to feel closer to Chris. Pat Campbell is hugged by three of her children: Christopher, 9; Crystal, 13; and Amber, 14. Pat's husband, John Campbell, looks on.
PHOTO 3: PAT CAMPBELL comforts her daughter, Kiara, after the 3-year-old asked about her brother. At right, Kiara, who was very close to Chris, remembers him by looking through a box of photographs and cards that were written to the Campbells by the children at the Iowa Juvenile Center after Chris' death.
October 12, 1998
Page: A8
Section: MAIN
Edition: STATEWIDE
Type: SERIES; SIDEBAR
Illustration: PHOTO (color) , Richard Messina / The Hartford Courant
Source: As told to Kathleen Megan Courant Staff Writer
[NO Photos or Graphics are available for posting.
However, their Captions remain included.]
Gary Zera, 42, a nurse manager, has worked with psychologically disturbed children for 20 years for the Department of Children and Families. Since 1993, he has worked at Riverview Hospital for Children and Youth in Middletown. The “art'' of using restraints:
Knowing the patient is what really guides all the interactions and knowing what the risk is.
It's not like a soup-book recipe. It's highly individualized. If you follow a particular play book, you're going to get roped into a particular way of responding.
The most rageful, violent people can be totally out of control, but if you can establish communication with them, they may not need restraints. Patients with a lower level of agitation may need it. It's the individualization. Someone could be seething inside, a walking time bomb. It's knowing their history, knowing the previous ways they manage.
I'm trying to say it's an art.
Frequency of restraints
I would say there has been a pronounced reduction in the number of restraints over the years and the amount of effort made to prevent them has increased [greatly].
There's a lot less of the philosophy of “do it my way'' vs. trying to understand. I guess there's an understanding over the years that strict compliance is not really the way to effect change in kids. Much more effort is put into trying to understand and remove the triggers to acting out or violence.
Prevention methods
We help patients learn alternative coping mechanisms. Sometimes you could teach them writing in a journal, doing exercises like push-ups. Some can be taught to count backwards, . . . generally trying to help them take advantage of relaxing techniques.
Sometimes it's repeating a key message over and over when they feel the rage impulse coming on: “It's not worth it; it's not worth it.''
You can't stop an emotion if you don't provide an alternative. A person who goes to attack you and swings at you is probably experiencing intense anxiety. Unless you offer them something to do with that, you're fighting a losing battle.
You don't want to meet force with force. The kids need to save face. You don't want to pick unnecessary battles.
In the aftermath
After a kid gets restrained, we try to review what was going on in their head. How they felt.
The restraint itself may not be very therapeutic, but the process afterwards. . . . By processing, they learn something: how to manage similar conflict down the line.
More challenging children
The level of aggression and violence by the patient has increased dramatically. The kids in the hospital are actually far sicker than the ones we had years ago.
A lot more kids are neurologically impaired: crack babies. Today we reviewed a kid [who was] a product of fetal alcohol abuse.
The rebound effect
It's extremely common to have a rebound effect.
I'm a victim and I hear another kid screaming and throwing things, I'm brought back to the trauma I experienced.
Initially, you're dealing with only one problem. Now you're dealing with an exponentially increased number of people angry and charged. You have to talk to them and explain this is what's happening to you. . . . If they feel like you understand, they are more likely to calm down.
The need for good training
We want to create an environment where the patient feels safe.
If a staff person is anxious, their anxiety gets transmitted to the patient. The staff person tends to be a little more rigid, a little more controlling. It can cause more conflict with the kid, it can escalate the kid's behavior.
If [staffers] are anxious, they talk quicker, they are more abrupt with the clients. In many cases they are so fearful they take a preventive posture instead of working with the patient and tolerating more.
I think we get better training than in the private sector. . . . It's not unusual for us to get people who have been in restraints for several days in private places.
I think, strangely enough, the union made a difference [for mental health nurses and workers]. It's profound, the difference in pay.
[But] forget about the wages. It's the mandated training. I couldn't even begin to describe the change in values. . . . Admittedly, we didn't know what we were doing back then.
The need to stay calm
I've had patients armed with pool sticks, pool balls. I can't tell you how many chairs thrown at me. I can't tell you how many times I've been spat at in the past. It's one of the most humiliating things. I think I'd rather be punched in the face.
Not only do patients have triggers, staff have triggers too.
I'm very well aware of my breathing. If my breathing is at a fast rate, I work on controlling it. As long as I'm breathing right, I know I'm in good control of my emotions.
Caption: PHOTO: KNOWING THE PATIENT and understanding the individual's emotions are key to providing a safer environment in mental health facilities, says Gary Zera, a nurse manager at Riverview Hospital for Children and Youth in Middletown.
October 12, 1998
Page: A8
Section: MAIN
Edition: STATEWIDE
Type: SERIES; SIDEBAR
Illustration: PHOTO: (color), Rick Hartford / The Hartford Courant
Source: As told to Kathleen Megan Courant Staff Writer
[NO Photos or Graphics are available for posting.
However, their Captions remain included.]
Tina Puziello, 36, of Branford, was restrained while hospitalized during the late 1980s and early 1990s. She was diagnosed as having bipolar disorder. She has been out of the hospital for almost four years and has worked as a volunteer advocate for psychiatric patients. Restrained over a smoke.
First I asked people. I said I wanted to go to the other side of the building. I wanted to go to that side because I wanted to have a cigarette and a cup of coffee or whatever.
I did that a couple of times. I was pretty soft-spoken and very depressed, but after a while of asking to go to the other side, I became frustrated and I banged on the window and I said I wanted to leave. I raised my voice and I have a loud voice.
I guess it frightened them and the fact that I yelled and punched the door. I guess they thought I was out of control. I heard them call a code – “Dr. Strong'' -- and about eight guys came and put me in this thing. It could have been five or six. It was scary.
One guy -- he realized I was petrified. Basically he said: Don't fight them.'' I was fighting them a little bit because I didn't know what they were doing. Your natural reaction when you have a bunch of guys running toward you is to tense up. It was pretty humiliating.
They didn't throw me on the floor on my face, thank God. They used the other way: where everybody took a limb and then they picked me up and put me into the body bag.
It was like a straitjacket except that it was like a canvas material, a green color canvas. I believe my hands were in front. There are long sleeves and everything and then it has loops and ties that go all the way down from your neck. Like putting a shirt on that's too long and then they tie the ends of the shirt. Your hands are in there and then the whole thing is tightened.
As you wiggle around, they are tightening it more. They tie it all the way down. It went all the way down to your ankles. I guess they called it a body bag because it covers your whole body. Then it's easy for them to lift you. You're like a mummy, except your head isn't wrapped.
It was extremely uncomfortable, but the other thing is I remember thinking, “I hope these people aren't going to bury me alive in this thing.'' Because that's what it seemed to me.
When patients lose control
I think that a lot of times what will happen is that people have difficulty communicating. It builds up and they have all these emotions . . . whether from regular life or delusions or hallucinations or whatever. They need to be with people who will validate [that it's] OK that they have feelings, to ask questions of them and spend time with them.
A lot of love and understanding is needed.
Depression is really swallowed anger. If you release it in small quantities, then it doesn't build up. But if they ignore that person . . . after a while they finally, like, rebel -- like a child who needs some love.
Burned-out workers
There's a lot of burn-out for mental health workers. . . . They put people in restraints or give them medication to keep them quiet so they don't need as much staff.
If they had more people, then they could get more care that they need.
Yelling leads to restraint
I remember being in restraints: lying down with my ankles tied to the bed and my arms tied to the side of the bed in four-point restraint. Basically, all I did was yell. I was in just a lot of pain emotionally.
As soon as I started yelling, that was the immediate reaction. It seemed pretty much standard.
I think they are also afraid [the yelling] might cause a chain reaction. They feel you might be giving the people an idea. So they don't want you to get the other patients riled up.
Can't itch
I can remember [the four-point restraint] had a little key. They would pull it really tight. I realized that if you relaxed your hand, you got more room. If you fight, you're constricting and making it smaller. If you relaxed, it would occasionally come off.
First of all, it hurts a lot of the time if they pull them tight. It hurts your wrists. There's a little piece of metal on a rubbery leathery strap that goes around your wrist. When they close it with the clamp thing, they say it doesn't hurt, but I always feel a pinching.
Plus, if you're itchy you can't always do something about it. You can ask somebody to scratch you, but you don't really want to do that. Your whole attitude is you don't understand why they are doing this.
A different set of rules
I've seen people who are angry pound their fists on a table at a meeting -- and if I ever did that in a hospital, it would be considered very aggressive behavior.
[Restraints are] a way to keep everybody quiet and compliant. It is a way to avoid talking to people.
It took away basically my spirit, my sense of dignity and reinforced the fact that you have to be really loud in order to get heard.
Caption: PHOTO: TINA PUZIELLO says the times she endured restraints ``took away my spirit, my sense of dignity.'' Diagnosed with bipolar disorder, she was hospitalized in the late 1980s and early 1990s. Here, she takes in the sea breeze and solitude at the shore in her hometown of Branford.
DAY THREE; October 13: Patients Suffer In A System Without Oversight
DAY FOUR; October 14: People Die And Nothing Is Done
DAY FIVE; October 15: From “Enforcer” To Counselor
Hartford Courant October 17th-published Related Article:
REFORM URGED IN USE OF RESTRAINTS
U.S. LAWMAKERS RESPOND TO REPORT ON DEATHS
Hartford Courant October 24th-published Related Article:
GROUPS CALL FOR REFORM IN USE OF RESTRAINTS
MENTAL HEALTH PROVIDERS REACT TO REPORTS OF 142 DEATHS IN FACILITIES
Hartford Courant DECEMBER 16th-published Related Article:
USE OF IMPROPER RESTRAINTS WIDESPREAD, GROUPS SAY
How the Courant Conducted Its Investigation
“Glossary of Terms” used by the authors
Hartford Courant DEADLY RESTRAINT Investigation DATA BASE
DAY ONE; October 11: A Nationwide Pattern of Death
Email Charly at: c-d-miller@neb.rr.com