Mental health patients in Vermont were forcibly restrained, involuntarily medicated, and placed in seclusion at higher rates during the early months of the pandemic. The vast majority of the incidents took place at Brattleboro Retreat.
The number of “emergency involuntary procedures” rose from a low of 56 incidents in February to 161 in June, according to a report from the Department of Mental Health released last month.
Between April and June, Brattleboro Retreat patients spent a total of 136 hours — or nearly six days — restrained, secluded, or medicated involuntarily. The statewide total over that period was 200 hours. More than 60% of the 179 patient “episodes” that required an involuntary procedure also occurred at the Retreat.
“Use of force is a failure of treatment,” said Ed Paquin, the executive director of Disability Rights Vermont.
It’s no coincidence that the “huge increase” in use of force came during the pandemic, said Rep. Anne Donahue, R-Northfield, a mental health advocate. Any other time, Paquin’s organization and Vermont Psychiatric Survivors have independent monitors that can visit mental health facilities in person, and provide accountability about the use of restraints. During Covid, “outside access wasn’t an option,” Donahue said.
According to state policy, restraint and seclusion should only be used in cases of emergency, in situations where other treatment options haven’t worked, and when the patient is about to harm himself or others.
The Brattleboro Retreat cares for a higher number of patients who are hospitalized involuntarily or who are incarcerated, said Konstantin von Krusenstiern, a Retreat spokesperson.
“We do this with the understanding that most of these individuals are experiencing profound psychiatric distress and are statistically at a much higher risk for experiencing an emergency involuntary procedure (EIP) than other patients,” he said in a statement.
EIPs are only used as “a clinical last resort taken only after all other options have been exhausted,” von Krusenstiern added.
Department of Mental Health Commissioner Sarah Squirrell said she had no evidence that the Brattleboro Retreat violated state protocol for use of force. She attributed the increase to a higher number of patients with severe symptoms during the pandemic. “Anecdotally, we were sensing that the acuity of individuals had markedly increased over the past few months,” she said — possibly because people didn’t want to seek mental health care due to fears of Covid, and only went to the hospital when their condition worsened.
This spring, a staffing shortage forced Vermont Psychiatric Care Hospital to close one of its units. The highest needs patients went to the Retreat instead, Squirrell said.
Most of the uses of force statewide occurred in the beds reserved for the most severely ill patients, called Level 1 beds. Vermont Psychiatric Care Hospital has 25 Level 1 beds; Rutland Regional Medical Center has 6; the Brattleboro Retreat has 14.
‘Not that surprising’
The increase is “not that surprising,” said Rob Smith, a mental health worker at the Brattleboro Retreat and head of the staff union.
A few patients can drive up the totals, he added. He told the story of one teenage patient who repeatedly tried to harm herself had to be placed in a restraining chair many times over the course of her stay. “Anything the patient could get their hands on they’d swallow,” Smith said. “It sounds harsh, but in reality, it was protective,” he said.
When he spoke to VTDigger, Smith had taken time off to recover from a shoulder injury incurred from a violent patient, he said.
Von Krusenstiern echoed Smith’s argument that increased use of seclusion and restraint at the Retreat was due to “cases involving just a few individuals.”
The data at least partly backs that up. Across the state, four patients were each put in emergency involuntary procedures more than 21 times between April and June. Fifteen were put in seclusion or restraint or given emergency medication more than 10 times over the same period.
Especially in the early weeks of the pandemic, the heightened uncertainty may have contributed to violent or unsafe behaviors, Smith said. “Certainly people are more stressed out. “High anxiety, that comes across as fear or anger.”
“Whether you’re having mental illness or not, if you’re not freaking out right now you’re just not alive,” agreed AJ Ruben, supervising attorney for Disability Rights Vermont.
According to Paquin, the increase at the Retreat is part of a larger trend. Complaints about patient care have been issues in the past, he said. The facility has been under financial stress for years. There have also been staff shortages and conflicts between staff and the administration, which can lead to increased tension at the facility, he said.. Last week, the Retreat laid off 85 workers.
“If you put all those together, they create a picture that there’s an institution that really needs to strengthen itself. It needs to be rededicating [itself] to reduce the use of, reliance on use of force,” Paquin said.
Greater use of force has come as demand for mental health beds has decreased. Fewer people sought care during the pandemic — perhaps because they were coping in other ways, said Squirrell. Some people who were experiencing homelessness and who frequently showed up for care at the emergency room needed less care once they got a place to stay during the pandemic, Squirrell said.
As of mid-October, 118 beds of the state’s beds were occupied. The state has a total of 187 beds, though 51 of those are not currently available due to Covid-related construction, social distancing requirements, or staffing issues.
That’s the lowest occupancy Squirrell said she’s seen in recent history.
Before Covid, the Retreat routinely filled 119 beds, said Smith. Now, the facility has only 65. But, he added, that doesn’t make the job easier. “We still get the roughest young people,” he said.
Correction: A data graphic has been updated with a corrected number of instances of seclusion in June 2020.
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