This may be a hard topic to discuss so if it’s something that’s too intense to read about pleasefeel free to skip or come back later
This post has to do with people’s experiences on psych units when in crisis there, I.E wanting to self-injure, having increased anxiety, agitated, hearing voices ETC. And how the staff responded. Specifically around how they helped you go from that hard place to a calmer one.
Most hospitals for many years have used restraint and seclusion. It is their way of forcefully putting a stop to the behavior, or thinking they are, without it being about the relationships between them and the patient, or teaching the patient to regulate their own emotions.
Restraint is the use offorce such as physical holding, mechanical ropes (sorry don’t know the term for when they tie people down) or shots often continuing a powerful mixture of drugs.
Seclusion is putting someone in basically a bare room. With walls made of a material to where the person won’t tear it apart, in order to hurt themselves, safety glass and a a camera to monitor activity. So the person is just put in there in hopes that if they put them in this one area separate from the rest of everyone, they will first of all not hurt other patients or staff, and that their behavior will somehow calm down in there versus out there. Which is really hard to wrap your head around. You have someone who’s brain is all riled up from whatever they’re emotionally experiencing, they’re extra sensitive to sounds, textures, sights ETC. And you sort of manhandle them into this bare room. There’s nothing for them to direct their emotions into in a healthy way. Usually they’re in there just until the shot kicks in.
In the old days, like the eighties I guess, the units would just use these things like constantly. Like people could be restrained for hours and put in the seclusion/ quiet room for hours and hours. Thankfully that at least doesn’t seem to happen at least at the hospitals I’ve been at. The unit I was on, twice, it was a half hour for each of those things. And they had to do all this documentation on why they ended up putting the person in there, that they had used all other intervention resources they could and everything. So they can’t just use these practices to the extreme.
But that really isn’t good enough because just using them at all is really counterproductive to healing and often makes situations worse.
So some very talented occupational therapists came up with a solid idea. In working with people with developmental disabilities, they had already figured out the value of a sensory environment to help people calm down. Sensory environment meaning a room set up very intentionally to engage a person’s senses. So things like soft furniture, aroma therapy, relaxing music, bright colorful things to look at, tactile objects ETC. So they figured if it works for one population let’s see if it works for another that’s having similar issues around being emotionally in difficult places.
Well believe it or not it worked! They did studies on it and figured out that when they set up these rooms on units it decreased the incidents of violence, self-injury threats, or any other reasons why the person would have originally been sent to seclusion or get restrained. Not only are the practices of the room therapeutic, engaging a person in working with their feelings rather than isolating them and giving them drugs that basically put you to sleep, but it’s also relational. I forget if a staff actually sits in the room with the person while this is going on, but I know there is discussion on what activities would work for that person’s specific needs and you fill out some kind of worksheet. Which is used to track progress.
Also another good thing is the person can have the experience of doing this in the hospital and then creating a similar space at home. So it’s taking something from there and bringing it home in a good way.
I was looking into this when I wanted to set up such a room here at Albany care. We have something where if someone needs to be monitored, as in suicidal, aggressive, has self-injured ETC, they basically have to sit in hard plastic chairs in a staff’s office for like hours. Well sometimes not hours it varies. If someone is going to the hospital and often that takes awhile. And by no means do they deny you things to do. I’ve been able to have my computer as has my friend, I’m sure other people get other stuff to do. But I was thinking hey if we create this room and teach people how to use it they might calm down before they even get to a crisis maybe. With the characters around here it’s hard to say! There would have to be a lot of supervision around not breaking stuff, stealing it, in general just not using the room how it’s meant. But the clinical director who’s extremely creative was just fascinated by it all. I proposed this two years ago and we’re still working on it.
But I’ve been corresponding with Karen More, who pioneered this, the sensory connection program. In order to build her website she’d like personal experience stories around people who have gotten a chance to use these rooms and what they’ve felt after. And/or those who haven’t had the rooms and been in crisis and what went on relative to restraint or seclusion. This would be to show the different and vital need for a different approach.
I’m wondering if any of my readers would be willing to comment on here with stories around this. As much as you feel comfortable writing obviously. I’m not sure what states actually have these rooms. I know Karen’s from MA and they have it in a lot of hospitals as does PA I think. But this would be really helpful on a very important topic. So if you weigh in you’ll be contributing to a huge change for the positive around how crisis is handled on the inpatient level. ,