Seclusion and Restraint Data
The Department of State Hospitals (DSH) deems the safety of both patients served and staff to be of paramount importance in our treatment settings. The use of seclusion and restraints has been a safety measure for dangerous and at-risk patients when other less restrictive interventions have failed. However, while maintaining a safe treatment setting, DSH seeks to continually and substantially minimize the use of seclusion and behavioral restraint in the state hospitals, and to prevent the emergency situations that necessitate their use. In addition, patients are viewed as partners and actively recruited to participate in efforts to discover effective ways for them to manage their symptoms and have their needs met without resorting to self harm or unsafe behavior.
DSH operates five state hospitals throughout California. Each state hospital provides inpatient treatment services for Californians with serious mental illnesses.
Restraint and Seclusion Reports
Below are the definitions of seclusion, restraint and related topics used by the state hospitals:
The involuntary confinement of a patient alone in a room or an area from which the patient is physically prevented from leaving. Seclusion does not include a “time-out” wherein a patient agrees to remain in an unlocked room or area and maintains the choice to leave without fear of adverse consequences or of being placed in seclusion or restraints.
The mechanical restraint or physical restraint, used as an intervention when a patient presents an immediate danger to self or to others. Behavioral restraint does not include restraints used for medical or surgical purposes, including, but not limited to, securing an intravenous needle or immobilizing a patient for a surgical procedure, postural restraints, devices used to prevent injury or to improve a patient’s mobility and independent functioning rather than to restrict movement. Behavioral restraint does not include any type of mechanical or physical restraint used by the hospital police or law enforcement for transport, security or custodial purposes.
The use of a mechanical device, material, or equipment attached or adjacent to the patient's body that he or she cannot easily remove and that restricts the freedom of movement of all or part of a body or restricts normal access to the body, and that is used as a behavioral restraint. It does not apply to protective equipment such as helmets, mittens, spit nets, adaptive or postural support used in response to assessed physical needs of the patient, or to any type of mechanical restraint that is used by the hospital police or law enforcement for transport, security or custodial purposes.
A “partial” restraint that allows a patient limited mobility but still prevents harm to self or others; intended as a less restrictive form of restraint (also referred to as an “ambulatory” restraint).
A situation in which action to administer medication over the patients objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to the treatment. The data DSH collects for this purpose is any unscheduled delivery of at least one psychiatric medication in an emergency situation.
Containment Related Injury
Serious injuries (those requiring more than simple first aid) sustained by staff or patients during the use, or placing, of behavioral restraints or seclusion.
The commitment category that allows an individual to enter a state hospital. The following legal classes are referred to in the data tables:
LPS - refers to the Lanterman-Petris-Short Act that is the civil commitment law that allows admission to a state hospital. The county of residence must approve admission.
NGI - Not Guilty by Reason of Insanity.
IST - Incompetent to Stand Trial.
OMD - Offenders with Mental Health Disorders.
SVP/MDSO - Sexually Violent Predator/Mentally Disordered Sex Offender (for purposes of reporting seclusion & restraint data these two legal classes have been combined. ASH, CSH (men) and PSH (women) are the only facilities that treat this population.
California Department of Corrections and Rehabilitation and the Division of Juvenile Justice (CDCR/DJJ)
Individuals that have been transferred to a state hospital from CDCR or the DJJ under an interagency agreement. These individuals are usually treated and sent back to the sending department when they no longer need hospitalization.
This refers to all legal classifications in the hospital.