Person-Centered Crisis Management in the Psychiatric Emergency and Inpatient Settings

The New York City Health and Hospitals Corporation (HHC) is the largest municipal hospital and health care system in the country. The Office of Behavioral Health at HHC provides strategic leadership, planning, and support for the operations and quality objectives of these services. HHC operates 82 forensic and 1,229 civil inpatient psychiatric beds. Since 2005, HHC has focused its attention on seclusion and restraint (S/R) reduction and has achieved significant success. From Quarter 1 (Jan.-Mar.) 2005-Q1 2007 (baseline data), there was a substantial decline in HHC's overall rate of adult inpatient S/R use -- the total duration of restraint rate per 1,000 patient hours dropped by 36% and the total duration of seclusion per 1,000 patient hours decreased by 32%. In fact, some of the behavioral health leadership felt that further reductions in the use of seclusion and restraint could not be achieved. To build on these initial gains and continue the culture change from a medical model to a patient-centered, rehabilitation and recovery-oriented service system in January 2007, HHC initiated a sequenced, intensive series of corporate-wide trainings, leadership learning sessions, and a S/R data collection and reporting system to help focus the behavioral health leadership on the need for continued culture change and increase staff crisis prevention/intervention skills and competencies. The data show a dramatic change. As a result of the initiative, Q1 2007-Q4 2009, this downward trend accelerated with a 76% decrease in total duration of restraint/1,000 patient hours, 62% in seclusion, almost twice the baseline results.