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• W2076013604 abstract "Back to table of contents Previous article Next article LettersFull AccessLettersKris A. McLoughlin D.N.P., A.P.R.N.Jeffrey L. Geller M.D., M.P.H.Kris A. McLoughlin D.N.P., A.P.R.N.Search for more papers by this authorJeffrey L. Geller M.D., M.P.H.Search for more papers by this authorPublished Online:1 Jul 2006https://doi.org/10.1176/ps.2006.57.7.1045AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The Recovery Model and Seclusion and RestraintTo the Editor: We are writing in reply to Dr. Liberman's well-articulated letter to the editor ( 1 ) about seclusion and restraint in the April 2006 issue. We agree with Dr. Liberman's observation that the elimination of seclusion and restraint is laudable in idealism but lacking in clinical reality. The aim should be reduction to minimal use, because elimination carries many unacceptable risks, including patient and staff injury; overuse of scheduled, PRN, and stat medication for sedation (in essence, chemical restraint); and premature discharge and blacklists to keep potential users of these last-ditch-effort safety measures from accruing inpatient days or ever being admitted. However, we take issue with Dr. Liberman's point that implementing psychosocial rehabilitation by using rationales of recovery and empowerment cannot contribute to a reduction in the use of seclusion and restraint. Dr. Liberman cites data from California and does so to the best of our knowledge accurately. But the outcome in California may not be a failure of the rehabilitation-recovery model. It may well be a failure in implementation of the model. In our experience, state hospitals have effectively adapted the principles of recovery and empowerment, especially through the use of treatment malls. Outcomes have included fewer patient and staff injuries, fewer missed days of work from staff injuries, and less use of seclusion and restraint accompanied by less use of PRN and stat medication and lower rates of polypharmacy. One such state hospital earned a Significant Achievement Award in 2000 from the American Psychiatric Association for developing a centralized psychosocial rehabilitation program focused on recovery while decreasing staff injuries and the use of restraint and seclusion ( 2 ). Another state hospital received a Best Practice in the Treatment of Schizophrenia Award in 2002 from the American Psychiatric Nurses Association for developing a safety infrastructure to support off-ward recovery-focused rehabilitation programs ( 3 ). We are aware that more research is needed in this area, but let's not throw out a model because one state seems to be struggling with its implementation. Every opportunity is a rehabilitation opportunity.Dr. McLoughlin is a mental health clinical and systems consultant and federal court-appointed special monitor in Honolulu. Dr. Geller is professor of psychiatry and director of public-sector psychiatry, University of Massachusetts Medical School, Worcester.References1. Liberman RP: Elimination of seclusion and restraint: a reasonable goal? Psychiatric Services 57:576, 2006Google Scholar2. Significant Achievement Awards: A rehabilitation program for inpatients in a large institution—the psychosocial rehabilitation program at Eastern State Hospital, Williamsburg, Virginia. Psychiatric Services 51:1439-1443, 2000Google Scholar3. Wilbur S, Tait J, Stevens G: An appreciation of excellence: the APNA 2002 awards and recognition program. Journal of the American Psychiatric Nurses Association 9:35-38, 2003Google Scholar FiguresReferencesCited byDetailsCited ByAnatomy of a Transformation: A Systematic Effort to Reduce Mechanical Restraints at a State Psychiatric HospitalJenna L. Godfrey, Ph.D., Amanda C. McGill, R.N., M.S.N., Nicole Tuomi Jones, Ph.D., Stephen L. Oxley, M.D., and Robyn M. Carr, M.P.A.1 October 2014 | Psychiatric Services, Vol. 65, No. 10Decreasing the Use of Restraint and Seclusion Among Psychiatric InpatientsJournal of Psychiatric Practice, Vol. 13, No. 5Nurse Prescribing, Vol. 5, No. 5LetterWilliam S. Masland, M.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterLarry Davidson, Ph.D.Maria O'Connell, Ph.D.Janis Tondora, Psy.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterChristopher G. Fichtner, M.D.James L. Cavanaugh, Jr., M.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterJohn Junginger, Ph.D.Keith Claypoole, Ph.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterGeorge Parker, M.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterAmy Blank Wilson, L.S.W.Jeffrey Draine, Ph.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterJoseph P. Morrissey, Ph.D.Henry J. Steadman, Ph.D.Kathleen M. Dalton, M.A.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterRobert E. Emerick, Ph.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterFran Reichenbach1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterTia E. Martinez, J.D.Martha R. Burt, Ph.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterStephan Haimowitz, J.D.Jenifer Urff, J.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterHarriet P. Lefley, Ph.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterMona Wasow, M.S.S.W.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterWilliam A. Anthony, Ph.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterDaniel D. Storch, M.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterAntonio Bulbena, M.D., Ph.D.Lili Sperry, M.D.Jordi Cunillera, M.B.Sci.1 October 2006 | Psychiatric Services, Vol. 57, No. 10LetterDaniel J. Luchins, M.D.1 October 2006 | Psychiatric Services, Vol. 57, No. 10 Volume 57Issue 7 July, 2006Pages 1045-1045PSYCHIATRIC SERVICES July 2006 Volume 57 Number 7 Metrics PDF download History Published online 1 July 2006 Published in print 1 July 2006" @default.
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