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Now Considered 'Treatment Failure,' Colorado Moves Away From Seclusion, Restraint

Joe Mahoney
Rocky Mountain PBS I-News
Julie Reiskin, left, executive director of the Colorado Cross-Disability Coalition, and Marlene Murillo, a Coalition executive assistant, advocate on behalf of people with disabilities.

In 2010, a man named Troy Geske died at the Colorado Mental Health Institute of Pueblo after being wrestled by staff members onto a bed, where he was restrained with straps and left by himself, face down. He asphyxiated.

Geske’s death resulted in the state’s paying a $775,000 settlement to his family and a ban on the use of prone restraint in state hospitals. The tragedy also accelerated a concerted effort in Colorado to limit the use of seclusion and restraint for people receiving mental-health treatment.

Seclusion, or confining a person alone in a room, and restraint, or physically preventing a person’s movement, have long been common tools for controlling people in a mental-health crisis – particularly when violence is a risk.

But state health officials regard the procedures as a “treatment failure,” in which risks include “serious injury or death, re-traumatization of people who have a history of trauma, and loss of dignity and other psychological harm.”

Hospitals, clinics and mental health centers – including both state-funded and private-sector institutions – reported 12 percent fewer instances of seclusion and restraint in fiscal year 2013 than two years earlier.

Still, the state’s latest report on the use of these and other mental-health procedures, released May 23, shows that minorities are more likely to be put into these punishing conditions than whites. The data show:

  • African-Americans make up 11 percent of the 1,498 Coloradans secluded or restrained in hospitals and other mental-health settings last year, according to the annual report by the state’s Department of Human Services.
  • By comparison, only around 4 percent of the total population in the state is black, according to the latest available census data from 2012, while about 8 percent of the instances of mandated mental-health treatment – including 72-hour holds, certifications, seclusion, restraint and involuntary medication – in fiscal 2013 involved black patients.
  • Whites show up more or less proportionally in mandated mental-health treatment. They make up around 70 percent of the state’s population, and were involved in 69 percent of the instances of mental-health treatment last year.
  • However, white patients made up only 53 percent of those put into seclusion and restraint.
  • Hispanics are underrepresented in mandated mental-health treatment, raising questions about Latinos’ access to care. Hispanics make up 21 percent of the state’s population, but were involved in only 13 percent of the instances of mandated treatment.
  • Like blacks, Hispanics are more likely to be subject to the most punitive conditions while in care. About 30 percent of the people put into seclusion and restraint last year were Hispanic.

A series of investigations into the state’s behavioral health care system by Rocky Mountain PBS I-News, “Untreated: How Ignoring Mental Illness Costs Us All,” has found that for many people with mental illnesses, help is hard to find.

While demand for psychiatric services has increased significantly in recent years, the supply of inpatient services has dropped, straining the remaining hospitals and clinics that do provide these services.

Health officials at the Colorado Department of Human Services say they haven’t examined the apparent racial disparity in the use of punitive measures like seclusion and restraint.

Patrick Fox, an official with the department, says he has no insight into why African Americans may be disproportionately subject to the harsh procedures, and the issue hadn’t previously been brought to his attention.

But he said that given documented differences in the treatment of minorities in the criminal justice system – where blacks are disproportionately arrested and given longer sentences – discrepancies in mental-health treatment are “not surprising.”

Credit Joe Mahoney / Rocky Mountain PBS I-News
Rocky Mountain PBS I-News
A bed with restraints in a patient room in the emergency psychiatric services ward at Denver Health in Denver on Nov. 11, 2013.

Recent records of incidents of violence and alleged abuse at the state mental health institutes at Fort Logan and Pueblo show that seclusion and restraint are still used as tools to control patients who are perceived as a risk to others. At times, residents complain that the measures cause injuries.

In December, for instance, a teen patient at Fort Logan was put into four-point restraints after trying to kick and grab staff while experiencing delusions of needing surgery, according to the hospital’s report.

He later complained of feeling numbness in his hands from the restraints – allegations that the hospital said it wasn’t able to substantiate. The Colorado health department investigated and agreed with the institute.

In a separate instance in May 2013, a female patient in her 30s said she knocked for 15 minutes at the window of the room where she was held in seclusion, needing to use the bathroom. Nobody came, and she urinated on the floor.

“I’m used to being in seclusion,” she told investigators later. “But that’s not right that I had to pee on the floor.”

One nurse resigned and another was disciplined as a result of the hospital’s investigation.

Mark Silverstein, legal director at the Colorado chapter of the American Civil Liberties Union, says the practice—and potential for racial bias—deserves a close look.

“Seclusion and restraint are some of the most serious deprivations of liberty that there are in an institutional setting, so there’s certainly a risk of abuse, and there’s a history of abuse,” says Silverstein.

A lack of funding for research into racial disparities in the behavioral-health care arena in Colorado hampers efforts to address the problems, says Julie Reiskin, executive director of the Colorado Cross-Disability Coalition, which advocates on behalf of people with disabilities.

Reiskin says her organization often hears concerns from people of color that they or their family members are ignored, refused treatment or funneled into jails and prisons when they seek help for mental illness.

Marlene Murillo, an executive assistant at the coalition, is one of them. Murillo, who is Hispanic, says efforts to find help for her 31-year-old son – who is schizophrenic, has substance abuse problems, and refuses treatment – have more often resulted in his being jailed than hospitalized.

Others, says Reiskin, say they’re treated more punitively than whites when they are able to access the health care system.

“For anybody with a mental illness, even though there’s understanding that these are illnesses, they’re treated like they’re bad,” says Reiskin. “That’s really exacerbated around people of color.”

Without enough state-directed research into the issue, says Reiskin, complaints are treated as “anecdotal.”

Simone Charles, an African-American Navy veteran who recently trained to become a peer support specialist to people with mental illnesses, says a perception that the mental-health care system is unfair to blacks already deters people from seeking the help they need.

Charles, who is 48 and lives in Denver, recalls being physically restrained by four male staff members as a teenager, when she was a student in a Kentucky school for girls who had been sexually abused. She says she was kept in a quiet room for days at a time. But only in retrospect did she wonder whether she was disciplined more than other girls in the class because of her color.

“I’ve never been restrained as an adult,” says Charles, who has post-traumatic stress disorder, “I learned that you can’t afford to be crazy and violent and black in America, because they’re going to lock you up.”

This report appears in partnership with Rocky Mountain PBS I-News. Contract Kristin Jones a kristinjones@rmpbs.org.

I-News is the public service journalism arm of Rocky Mountain PBS and works in collaboration with news media throughout Colorado.
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