Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

John F. Crilly, PhD, MPH, MSW¹, Virginia Aldige-Hiday, PhD², and Glenn Currier, MD, MPH¹. (1) Psychiatry, University of Rochester, 300 Crittenden Boulevard, Box PSYCH, Rochester, NY 14642, 585-275-0611, john_crilly@urmc.rochester.edu, (2) Sociology and Anthropology, North Carolina State University, Dept. of Sociology, Raleigh, NC 27695

Use of restraint and seclusion (R/S) in state psychiatric hospitals is linked to patient violence and behavioral dyscontrol. To address this violence and to maintain order, state hospitals segregated these patients to highly restrictive and coercive secure care units. Over the last 10 years, hospitals have begun to phase out secure care units, absorbing the staff into general adult services. In the late 1990's, the incidence of patients inflicting injury on staff and use of R/S were simultaneously increasing at Rochester Psychiatric Center, primarily on its secure care unit. A preliminary assessment identified problems and situations created by staff's coercive means which instigated violent or threatening reactions from patients. A specific three-stage plan aimed at changing staff culture and the ward environment both on that unit and throughout the hospital was hypothesized to increase safety and create a consistently calm, orderly environment over a 3-year period. The plan consisted of 1) closing the secure care unit, 2) re-shaping staff philosophy regarding use of restraint and seclusion, and 3) developing a “ward management” initiative to promote and maintain a calm environment. This process of “ward management” specifically replaced negative coercion with a productive interaction with clients using therapeutic leverage. While leverage is important, the primary focus was to both encourage practice of positive social skills and the maintenance of a violence-free environment. Ongoing staff training and close ward supervision must be maintained to prevent the re-encroachment of negative coercive behaviors on the positive therapeutic engagement in the therapeutic “ward management.”

Learning Objectives:

• This overall symposium will provide the attendee with a discussion around different perspectives of coercion, specifically the change from negative coercion to positive coercion (therapeutic leverage) in a restrictive environment.

Keywords: Mental Health System, Management

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation