Hogg Foundation for Mental Health

Conference Focuses on Consumer Involvement in Texas Seclusion and Restraint Reduction Efforts

September 1, 2007

Imagine you are feeling intensely angry or upset. Suddenly, two people grab hold of you and pin you to the ground or wrap their arms around you so you cannot move. It happens in an instant. Different parts of your body hurt, and it is difficult to breathe. You are scared.

This is what is like to be physically restrained.

Unfortunately, many children and adults with mental illness have experienced this type of scenario or have seen it happen to someone else.

The power of mental health consumers' experiences and voices in reducing Texas facilities' restraint and seclusion use was a major focus of Implementing Seclusion and Restraint Reduction: Sharing the Experience, a meeting hosted by the Hogg Foundation on June 22.

The Austin meeting reconvened representatives of the 29 leadership teams that attended the Foundation's September 2006 Seclusion and Restraint Reduction Training Institute. Over 100 participants representing Texas facilities, several state agencies, advocacy groups, and mental health consumers from across the state attended the event.

The meeting was conceived as an opportunity for teams to share successes and challenges encountered since the 2006 training. When the planning committee polled the teams prior to the event to assess their major lessons learned over the past year, the critical importance of mental health consumers' involvement was one of the top responses.

To convey the impact of consumer voice, presence, and participation in furthering seclusion and restraint reduction efforts, a group of mental health consumers and family members led a session entitled "What Can Providers Do Differently?" at the June conference. The panelists were Ashley Gallardo of Fostercare Alumni and Richard Hansen of NorthSTAR Area Texas Mental Health Consumers, both mental health consumers who have experienced seclusion and restraint. Valarie Garza of the Texas Health Institute, a parent of a consumer who has experienced seclusion and restraint, moderated the session.

Ms. Gallardo, a former foster youth who experienced physical restraint use as a child in residential treatment, spoke about the traumatizing effects of witnessing other foster youth being restrained. She explained that watching adults in her life use restraint as a first-line intervention diminished her trust and made her hesitant to voice her feelings to foster parents and facility staff.

Ms. Garza recounted how her son's experience with repeated restraint and seclusion use in a variety of settings trained him to need outside controls for his behavior rather than requiring him to develop self-control.

"It's still incredibly difficult to think about being restrained even after more than ten years" said Mr. Hansen. Stressing the effectiveness of and need for peer supports in recovery from mental illness, he encouraged facilities to incorporate consumers into all facets of their treatment programs, including their seclusion and restraint reduction efforts.

To further explore the effects of seclusion and restraint use on mental health consumers, attendees viewed Behind Closed Doors, a film portraying four women who overcame childhood abuse only to be retraumatized through seclusion and restraint while seeking help in psychiatric facilities.

In addition to the vital information shared about the importance of consumer roles and involvement in reduction strategies, presenters Kevin Ann Huckshorn, RN, MSW, of the National Association of State Mental Health Program Director's National Coordinating Center to Reduce and Eliminate the Use of Seclusion and Restraint, and Dr. Janice LeBel, Director of Program Management for the Massachusetts Department of Mental Health, provided advanced training on a variety of topics of concern to the facilities represented.

Ms. Huckshorn offered tools for reducing seclusion and restraint use through workforce development strategies. Dr. LeBel supplied attendees with clinical materials on trauma-informed and person-centered care. They joined Aaryce Hayes, Mental Health Policy Specialist at Advocacy, Inc., to provide an overview of the latest seclusion and restraint reduction developments in Texas and around the country and world.

The training materials provided by Ms. Huckshorn, Dr. LeBel, and Ms. Hayes are on the Foundation's website: www.hogg.utexas.edu/programs_ S&Rconf.html.

Ending the conference with a question-and-answer session, Huckshorn and LeBel addressed ways to overcome facilities' barriers to reducing seclusion and restraint use.

Although team members acknowledged that more work is needed, all shared significant successes in promoting their facilities' seclusion and restraint reduction over the months since the 2006 training.

"The achievements in reducing seclusion and restraint use in facilities throughout Texas are truly remarkable," said Hogg Foundation Mental Health Law and Policy Clerk Melissa Cook, who took the lead in coordinating the event.

This conference was part of the Seclusion and Restraint Reduction Leadership Group's ongoing efforts to promote culture change in seclusion and restraint use by facilities serving individuals with mental illness.

Facilities Represented at the Conference

Austin State Hospital
Bexar County Juvenile Probation Department (San Antonio)
Big Spring State Hospital
Cal Farley’s (Amarillo)
Cook Children’s Medical Center (Fort Worth)
El Paso County Psychiatric Center
Kerrville State Hospital
STARRY (Round Rock)
Krause Residential Treatment Center (Katy)
Meridell Achievement Center (Liberty Hill)
Nelson Children’s Residential Treatment Center (Denton)
New Life Children’s Residential Treatment Center (Canyon Lake)
North Texas State Hospital (Vernon)
Presbyterian Hospital of Plano
Rio Grande State Center / South Texas Health Care Center (Harlingen)
Rusk State Hospital
Safe Place Domestic Violence & Sexual Assault Survival Center (Austin)
San Antonio State Hospital
Terrell State Hospital
The Oaks Treatment Center (Austin)
The Settlement Home for Children