Photo: Hospital beds

Clinicians and Advocates Discuss the Challenges of Seclusion

After a federal initiative to eliminate restraint and seclusion, the Massachusetts Department of Mental Health's (DMH) received funding to address this challenging issue.

DMH felt it was critical to obtain input from clinicians, patients, families, staff, and advocates such as The Transformation Center, a nonprofit organization of people with mental health conditions and their advocates, most of whom had either been restrained or secluded or had a family member restrained or secluded.

Although discussion about policy had been possible, multiple attempts to have more personal conversations about the deeply complex and highly emotional issue failed. There were numerous complicating factors, starting with the fact that clinicians, patients and advocates had never talked about the issue from a personal perspective. There was real danger of people feeling re-traumatized as they discussed these intense and sometimes traumatic experiences.

Finally, the issue was complicated by long-standing questions and concerns about these techniques as an effective and necessary means of keeping patients from hurting themselves, staff, and each other.

A Dialogue About Mental Health

Essential Partners (then the Public Conversations Project) facilitated a dialogue with senior members of the clinical and administrative DMH staff, most of whom had authorized, administered, and/or witnessed restraints and seclusion, as well as representatives from The Transformation Project.

In essence, EP's charge was to help mental health advocates, people living with mental health conditions, and clinical staff speak about these emotionally charged experiences and develop the trust needed to work together to reduce the use of restraint and seclusion in Massachusetts.

Transformation and Collaboration

Through in-depth work with each group separately, Essential Partners helped participants open up about their hopes and fears. This prepared them for a series of subsequent dialogues.

When the groups finally came together, they were able to share their personal stories and listen to each other in a new way. Relationships were transformed, communication was changed, and the two groups not only worked together, but went on to jointly design and hold a conference.