Mental Health

Only 15 states systematically alert protection and advocacy agencies about mentally ill or retarded people who have died as a result of improper restraint or seclusion in residential treatment settings. Most agencies receive reports only from state facilities, so that even these reporting systems are not comprehensive. Reports of deaths cannot always be thoroughly investigated because the agencies have had difficulty gaining access to medical records. From partial information from 51 such agencies, GAO identified 24 deaths associated with restraint or seclusion in fiscal year 1998. Fragmentary reporting suggests the actual number may be higher. No federal regulations govern the use of restraint or seclusion in psychiatric hospitals, residential treatment centers for children, or community group homes. Most state regulations do not apply to privately run facilities. Some states have found that reducing the use of restraint and seclusion improves safety for patients and staff alike. The Health Care Financing Administration (HCFA) should extend to people in any treatment setting funded by Medicare and Medicaid the same policies on restraint and seclusion that now protect individuals in long-term care settings and hospitals. HCFA should also improve reporting and require staff training in applying restraint and seclusion and in alternative ways to deal with potentially violent situations. This report summarizes the September 1999 report, GAO/HEHS-99-176.

GAO noted that: (1) as GAO recently reported, improper restraint and seclusion can be dangerous to people receiving treatment for mental illness or mental retardation and to staff in treatment facilities; (2) while there is no comprehensive system to track injuries or deaths, GAO found that at least 24 deaths that state protection and advocacy agencies (P&A) investigated in fiscal year 1998 were associated with the use of restraint or seclusion; (3) GAO believes there may have been more deaths because only 15 states require any systematic reporting to P&As to alert them to serious injuries and deaths; (4) GAO also found that federal and state regulations that govern the reporting of injuries and deaths and that govern the use of restraint and seclusions are not consistent for different types of facilities; (5) the experience of several states demonstrates that having regulatory protections and reporting requirements can reduce the use of restraint and seclusion and improve safety for individuals receiving treatment as well as for facility staff; and (6) in GAO's September 1999 report, GAO made several recommendations that, if adopted, should improve the safety of patients and staff in a variety of treatment settings.