Minnesota has turned the corner in a prolonged battle against the use of dangerous restraints and isolation rooms at facilities for people with developmental disabilities.
Eight years after reports first surfaced of metal handcuffs and leg shackles being used as punishment in state facilities, officials are reporting a 40 percent drop in the use of restrictive procedures at group homes and programs for people with disabilities.
Incidents of restraint, seclusion and other restrictive measures dropped from 8,602 two years ago to 5,124 in the most recent fiscal year, according to a report state officials filed last week in federal court.
The sharp drop results from changes in state law and a massive effort by state and county officials to stamp out the use of punitive techniques that are widely seen as inhumane and unnecessary. The issue was also the subject of a Star Tribune series last year that found Minnesota had fallen behind other states in integrating people with disabilities in mainstream life, and often isolated them in group homes far from families and friends.
Though the use of restraints persists, the recent reduction marks a major shift for a state that has long relied on punitive techniques as a way to control behavior at small group homes and other state-licensed facilities. As far back as 1949, Gov. Luther Youngdahl lit a giant bonfire of straitjackets, cuffs and leather straps on the grounds of the state mental hospital in Anoka, while condemning the “barbarous devices and the approach which those devices symbolized.”
“This is a paradigm shift, and something that we have wanted to see for a very, very long time,” said Roberta Opheim, of the state Ombudsman Office for Mental Health and Developmental Disabilities.
In 2008, Opheim’s office reported that scores of residents at a state-operated facility in Cambridge, Minn., were being routinely handcuffed, placed in leg irons or isolated in seclusion rooms as punishment. One resident of the facility, known as the Minnesota Extended Treatment Options (METO), was restrained 299 times in a single year. In some cases, residents were restrained for behavior as minor as touching a pizza box, bumping into someone or threatening to run away.
The findings led to a federal class-action lawsuit by METO residents and their families, and a major legal settlement that forced the state to modernize its rules. At the time, Minnesota had fallen behind other states and generally accepted standards in social services, which held that restraints have little or no therapeutic value and can be extremely dangerous.
After Minnesota changed state law in 2014 to prohibit a long list of restrictive procedures, from leg shackles and handcuffs to prone restraints, the state Department of Human Services launched an unprecedented outreach and training effort across the state. The agency created a special team to train staff at facilities for people with disabilities on identifying the individual needs of their clients, and to de-escalate situations without resorting to restraints.
And, for the first time, the state required providers to report all incidents of restraint and seclusion and began issuing licensing violations against providers that didn’t comply with the law.
Tighter enforcement, combined with increased awareness from the METO lawsuit, led to a “change in thinking,” said Alex Bartolic, disability services director at DHS. “We drew a very hard line in the sand,” she said. “We decided that we no longer wanted to do things that caused people pain and humiliation.”
The impact was immediate. Within months after the new state law took effect, the use of restrictive procedures plunged by more than a third, from 746 incidents a month to fewer than 500. The most dramatic drop, say state officials, has been in the use of forced isolation. Until recently, many providers still thought it was acceptable to use “time out,” or seclusion rooms, to correct unwanted behaviors.
But regulators have also moved to stamp out more subtle forms of punitive restraints, including a category the state refers to as “penalty consequences.” In these cases, residents are punished with the loss of certain rights or privileges, such as visits from family and participation in group activities, if they fail to correct certain behaviors.
“We said, ‘You should never take away something that is a basic right,’ ” Bartolic said.
Despite the improvements, disability advocates remain concerned that state enforcement hasn’t kept pace with the changes in state law. In late 2014, a federal court monitor raised alarm that documented incidents of restraint were not properly investigated, after highlighting the case of a 33-year-old woman strapped to a metal-framed chair in a group home in Crystal for up to nine hours a day. The woman, identified as “Karen H.” in state documents, was deprived of food and bathroom breaks while in the chair and urinated on herself, investigators found.
In a case last year, federal inspectors found that a patient at Anoka-Metro Regional Treatment Center was placed intermittently in a wheelchair restraint, without being evaluated for the restraint and without proper documentation.
The initial gains will be difficult to sustain if Minnesota does not address other issues, such as the statewide shortage of people trained to care for people with developmental disabilities, Bartolic warned. Some providers may resort to punitive methods because they lack staff trained in more positive approaches. “We saw a big drop,” Bartolic said, “but it’s going to take a lot of diligence to keep seeing gains.”
Opheim, the state ombudsman, said she worries that the new rules have not been in place long enough to determine whether all providers are actually reporting all incidents as required under state law.
“I am cautiously optimistic that we’re on the right track,” she said, “but we still have a long ways to go.”