Report: Minn. Security Hospital restraint, seclusion practices violate new policy

A Minnesota Disability Law Center investigation report released Wednesday said the Minnesota Security Hospital in St. Peter continues to use restraint and seclusion to punish patients. The state-run facility, the report said, violated new policies aimed to eliminate old practices that had brought the hospital under fire in 2012.

The 16-month investigation concluded that staff put patients in restraints and seclusion when there was no imminent risk of harm. The center examined Department of Human Services records, interviewed patients and staff and analyzed the incidents.

The report says the Security Hospital failed to discuss traumatic restraint and seclusion episodes with patients, which is a DHS requirement under the current policy to help prevent future violence.

Overusing restraint and seclusion

The Minnesota Disability Law Center reviewed restraint and seclusion records from June 2011 to March 2014 after state mental health treatment facilities came under scrutiny for overuse of those practices. The center is part of Mid-Minnesota Legal Aid, and provides free legal assistance to people on cases related to their disabilities.

The report found that 98 individuals were restrained and secluded and another 42 were subject to restraint only, while 17 were subject to seclusion only.

The center decided to focus its research on 11 patients who were "being specifically tracked by DHS staff because of high incidence rate of restraint and seclusion." In May, July and November of 2014, investigators also interviewed additional patients who had been restrained and secluded. They returned in early 2015 at the request of a some at the Security Hospital.

"One of the things that was both interesting and heartening was the patients' desire to participate in changing things in a positive direction," said Pamela Hoopes, Minnesota Disability Law Center legal director. "The patients that we interviewed and from records that we saw would like to be in a more hopeful and positive treatment environment."

The Minnesota Security Hospital's policy requires staff to talk through or debrief patients as a treatment mechanism. Debriefing records showed that staff often blamed patients for their violent behavior instead of suggesting solutions, according to the report.

Out of 22 reviews in February last year, 16 said patients "should have used coping skills" or "should not have engaged in self-injurious behavior." Six debriefing sessions did not involve the patients because staff said that would've been "un-therapeutic." Eight times, staff recommended electroconvulsive therapy as treatment.

Staff concerns

Tim Headlee, a security counselor and president of the AFSCME Local 404 union, which represents staff at the hospital in St. Peter, said staff go through a chain of command that involves counselors, nurses, nurse practitioners and clinical psychologists. That process ensures proper use of restraint and seclusion, he said.

Headlee said the report finding that addressed the overuse of restraint and seclusion despite recent changes is tough to swallow. "There [are] going to be times when we recognize what we define as imminent risk as opposed to what other people recognize as imminent risk," he said. "I'd rather be pretty cautious than have to wait for someone to get hurt to take action."

The report concluded that the hospital's Unit 800 — also known as the Admissions and Crisis Care Unit — and its Unit 900 — which is its "New Outlook Women's Unit" for women with a wide range of mental illnesses — accounted for the majority of restraint and seclusion incidents.

One patient from Unit 800 told the Minnesota Disability Law Center he was often "set up for failure." He and others described the atmosphere as tense and chaotic, when compared to that of other units.

Although the report found numerous incidents in which restraint and seclusion were appropriately used to prevent assaultive behavior, it found the staff often couldn't identify what led them to restrain and seclude patients. Out of the 103 files, 96 had "restraint and seclusion intervention data forms." Of those, 34 percent did not identify triggers and said the incidents were "unprovoked."

In one 2013 case, investigators found that staff missed an opportunity to warn about a specific trigger in a patient and possibly avoid a subsequent attack.

In another April 2013 incident, staff drafted a patient's treatment plan to call for seclusion if the patient failed to follow directives. The patient didn't follow the unit's policy and took breakfast to the patient's room. After the patient returned the food to staff, yelled profanity and told them to leave the room, the staff put the patient in isolation for one hour.

Role of security counselors

Most of the hospital's staff are security counselors. They are part of the team that controls patients and ensures safety. The report said patients' interactions with security counselors account for most of their daily activities. The counselors, who are trained in the criminal justice system, aren't equipped to offer mental health treatment, the report said.

"Security counselors embody the tension between the needs for 'treatment' and 'safety,'" according to the report. "Even the name 'security counselor' evokes conflicting feelings."

The report concluded that restraint and seclusion trends will likely continue if the Security Hospital doesn't offer more individualized treatment, add more clinical staff and involve the patients in their treatment plans.

The Minnesota Department of Human Services released a statement in response to Wednesday's report. Officials said DHS Commissioner Lucinda Jesson, Forensic Treatment Services Executive Director Carol Olson and Medical Director for Behavioral Health Steven Pratt will meet with the Disability Law Center to go over the report in more detail.

"Minnesota Security Hospital has significantly reduced the use of restraint and seclusion since 2012," the statement reads. "But there is still work to do to address this issue while balancing concerns about the safety of our employees."