Minnesota’s troubled psychiatric hospital in St. Peter continues to restrain and seclude patients in ways that violate the hospital’s own policies, according to a report released Wednesday by Legal Aid’s Minnesota Disability Law Center.
In a 16-month investigation, the nonprofit legal advocacy group found that staff at the Minnesota Security Hospital in St. Peter isolate patients in locked rooms, and strap them to restraint chairs, among other measures, even when patients and staff are not at risk of imminent harm. In some cases, the hospital appears to use these measures as punishment rather than emergency protection, according to the report.
Officials with the Minnesota Department of Human Services (DHS), which oversees the hospital, said they have significantly reduced incidents of restraint and seclusion at the hospital since 2012. But the nonprofit law center maintained that usage still fluctuates wildly from month to month and the hospital has failed to demonstrate a “consistent downward trend” in the deployment of seclusions and restraint.
The report comes as the Security Hospital, which houses about 225 of the state’s most dangerous and mentally ill patients, struggles to quell a surge in workplace injuries stemming from violent assaults. Earlier this month, a 16-year-old patient allegedly grabbed a female security counselor by the hair, bashed her head against a wall and repeatedly kicked her in the head. Staff at the hospital have suffered 68 workplace injuries through June, a pace set to surpass last year’s record of 101 injuries.
The surge in injuries, and the continued use of restraint and seclusion, reflect deeper problems at the state’s largest psychiatric hospital, which was placed under a conditional license in 2011 due in part to overuse of seclusion and restraint. That conditional license was extended last year after a patient was fatally beaten in his room — a death that state investigators later blamed on poor supervision.
Though union officials have called for more freedom to use manual restraints in order to prevent staff injuries, disability advocates have long argued that more one-on-one therapy and better training are more effective than restraints in preventing violence. In Florida and Massachusetts, state mental hospitals have reported significant declines in staff and patient injuries while still reducing incidents of restraints and seclusion.
103 incidents reviewed
In its investigation, the Disability Law Center reviewed a sample of 103 incidents of seclusion and restraint at the hospital since June 2011. In about a third of these cases, hospital staff failed to identify any prior events or behavior by the patients that triggered their use. The center also said it found “multiple instances” when such methods were used as punishment for behavior; this, the center argued, violates hospital policy that states that restraint and seclusion should only be used as an emergency measure to prevent risk of imminent harm.
In a 2012 case, a patient was locked in his room for six hours after he entered the room voluntarily. Although the patient was verbally abusive, hospital records do not indicate why the seclusion was necessary to protect staff members or the patient from imminent harm, the report said.
In other incidents, the hospital used restraints and seclusion after it appeared that the risk of harm had dissipated, the center said. In one case, for instance, a patient attempted to strike another patient and then sat down and refused to move. After a few minutes of negotiation with staff, the patient agreed to walk to a restraint chair, where the patient remained for about two hours, according to the report.
“The use of seclusion and restraint after patients have calmed down looks to be more punitive than protective,” said Pamela Hoopes, legal director of the Law Center.
The center’s report echoed similar findings by the state Legislative Auditor, which in 2013 found that the hospital suffered from an unclear mission and a lack of actual treatment. Patients at the security hospital, including those most often restrained and secluded, have an average of just over one hour per day of scheduled therapeutic activities, the Law Center’s report said.
The Department of Human Services said it intends to hire 20 more security counselors, as well as 24 other clinical and support staff, to improve security and the quality of treatment at the hospital.