Nearly two years after Minnesota pledged to eliminate the use of mechanical restraints and seclusion at facilities for people with developmental disabilities, a court-appointed monitor has found that the controversial methods continue at the state’s two largest treatment centers.

Mechanical restraints and seclusion “continue to be used to a significant degree” at Anoka Metro Regional Treatment Center and the Minnesota Security Hospital in St. Peter, the monitor’s report said, despite assurances by state officials that such methods would be used only in emergencies.

Court monitor David Ferleger found that a client at Anoka-Metro was placed in a restraint chair on 35 occasions, for a total of 85 hours in a single month, while a client at the St. Peter psychiatric hospital was kept in seclusion for 43 hours in a month.

“Most uses of the restraint chair and seclusion are for fewer hours, but they are used often and with many clients,” according to an Oct. 17th report he filed with the U.S. District Court in Minneapolis.

The revelation triggered dismay among advocates and the state’s top watchdog for mental health and disabilities.

“This barbaric practice has to end,” said Roberta Opheim, the State Ombudsman for Mental Health and Developmental Disabilities. “The state keeps saying they are moving in the direction of eliminating [restraint and seclusion], but I can’t see consistent follow-through or a plan.”

Deputy Human Services Commissioner Anne Barry said the state is committed to moving away from seclusion and restraint and has seen a “slow decrease” in the use of mechanical restraints.

At the same time, Barry warned against eliminating the practices entirely until staff at the facilities are trained how to minimize the use of restraints by using more positive behavioral techniques. She pointed to a 2012 case in which a client at the St. Peter hospital suffered serious injuries after repeatedly hitting his head against a concrete wall. At least nine employees knew about his behavior but failed to intervene in part because they were unsure of when or if to use a restraint. The facility was then cited for neglect by the licensing branch of the Department of Human Services.

“If you take away the tools that people are using to keep others safe and don’t give them new tools, then we know things will go wrong,” Barry said.

The Minnesota Security Hospital in St. Peter is the state’s largest psychiatric facility and home to nearly 400 of the state’s most dangerous mentally ill patients. The Anoka-Metro Regional Treatment Center is a 175-bed state-operated facility for patients needing acute care. Both facilities serve people with mental illness and developmental disabilities.

2011 court settlement

The use of seclusion and mechanical restraints in the treatment of people with mental disabilities has been widely condemned as inhumane, dangerous and largely ineffective. In 1999, the National Association of State Mental Health Program Directors declared that “seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience,” in a position statement.

In December 2011, as part of a federal class action settlement, DHS agreed to “immediately and permanently discontinue the use of mechanical restraint,” including handcuffs and leg hobbles, at a state facility for the developmentally disabled in Cambridge. The agency also agreed to extend the terms of the settlement to all state-operated locations serving people with developmental disabilities.

Then, in July of this year, DHS issued a strong statement committing to prohibit the use of seclusion and restraints for all programs and services licensed by the department, including those for the mentally ill. The state made an exception for the use of restraints in cases when a person posed “an imminent risk of harm to self or others.”

“The goal is freedom from the use of mechanical restraints and seclusion,” Barry said. “And it should never be used as a punishment or a consequence.”

Still, advocates say the state is moving too slowly and questioned why state-operated facilities still have restraint chairs at all. Anoka-Metro Regional Treatment Center has a restraint chair in each of its eight living units; one unit for clients with developmental disabilities has two restraint chairs, Ferleger found.

According to the court monitor, individual clients at Anoka-Metro were held in the restraint chair for monthly totals ranging from less than an hour to 85 hours. At the St. Peter facility, the restraint chair is used rarely — just three instances over 12 months — and for between one and two hours each time, Ferleger found.

However, at St. Peter, seclusion is used more often. Individual clients were put in seclusion for as many as 43 hours in one month for one client, and 17, 11 and nine hours a month for other clients.

“I am stunned to find that there is a need for a restraint chair, given all that we know,” said Derrick Dufresne, a consultant who has worked with Minnesota and other states on restraint-free treatment of people with disabilities. “Why do we find it necessary to use a procedure for which there is sparse or no data showing that it’s effective?”