Creating safer mental health treatment settings: A public health prevention approach

The use of seclusion and restraint is a controversial issue impacting mental health consumers and service providers. The use of seclusion and restraint in mental health settings places both patients and staff at risk of psychological and physical harm. Since 1998, investigative reports, knowledge emerging from research, and continued cases of untimely deaths due to use of these interventions have resulted in calls for reduction and even elimination from Congress, policy makers, professionals, and advocates. Since 2004, the Hogg Foundation for Mental Health has prioritized the promotion of safe and effective alternatives to the use of seclusion and restraint in Texas. The Foundation, in response to concerned state and private agencies, began this work at a statewide conference where policymakers, service providers, and consumers adopted a public health approach to the problem. In 2005, a legislatively-mandated cross-agency workgroup identified a list of best practices and established standards for the use of seclusion and restraint. In 2006, a team of national experts guided 29 Texas mental health agencies in the development of individualized seclusion and restraint reduction plans. These agencies are now actively engaged in the implementation of these plans and most are reporting success. This session will present the public health approach, reviewing outcomes to date, and demonstrating how services research, education, and training activities influenced policy change at the state and local level.