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CNMHC News Alert, September 2003

WRITE TO THE GOVERNOR - SIGN SB 130

It started with a Report from the Senate Office of Research entitled Seclusion and Restraint; A Failure Not a Treatment in the Spring of 2002. Then came a Hearing in February 2003 on the use of Seclusion and Restraints. Now SB 130 (Chesbro, D-Arcata), whose aim is to reduce the use of seclusion and behavioral restraints in California, sits on the Governor's desk.

The first finding of SB 130 states, "The use of seclusion and behavioral restraints is not treatment, and their use does not alleviate human suffering or positively change behavior." This sets the tone and intent of the bill. The bill was softened through its legislative progress, due to compromises which occur as a result of stakeholders input and because of financial restrictions. However, its critical substance remains. The major changes, for financial reasons, make the implementation of many of the elements of the bill incremental: the State Department of Mental Health and State Department of Developmental Services begin implementation immediately; all other agencies that utilize seclusion and behavioral restraints will not be "required to implement this section if implementation cannot be achieved within existing resources ---."

SB 130 does the following things:

• A right to be free of chemical restraints and a requirement to document the use of involuntary emergency medication. This reflects the concern of clients and other advocates that decreasing seclusion and restraint may increase the use of chemical restraints and forced medication in general.
• Centralized oversight, one agency, the Department of Health and Human Services, coordinating the efforts of other appropriate state departments (as well as other agencies and stakeholders) to reduce the use of seclusion and restraints.
• Policy changes and oversight to apply to all facilities that use seclusion and restraint: uniform standards for all types of psychiatric facilities.
• Uniform reporting requirements from deaths, injuries, incidents, etc, all of which must be made publicly available on the Internet. Accountability is viewed as a path toward reducing a harmful practice.
• Training, which is essential to change the culture regarding the need for seclusion and restraints. This training involves consumers and is aimed at avoiding the use of seclusion and behavioral restraints.
• Initial assessments of each person entering a facility with his/her involvement, including the patients' advance directive regarding de-escalation, if one exists, any history of sexual or physical abuse, and identifications of early warning signs.
• Prohibiting prone restraints on patients at risk of asphyxiation/ death because of different risk factors and recommending, if possible, that an independent person not involved in a prone containment watch for any signs of physical duress.
• A debriefing session, with the patient's involvement, to develop other ways of dealing with the situation.

The mental health system, as a health system dedicated to helping individuals, must first and foremost do not harm and respect the rights and dignity of people with psychiatric disabilities. This means reducing and ultimately eliminating the use of seclusion and restraints. SB 130 begins this process.

Write, fax, or call the Governor at:

The Honorable Gray Davis
Governor of California
State Capitol Building
Sacramento, CA 95814
Fax: 916-445-4633
Tel: 916-445-2841

All bills must be signed or vetoed by October 12. Do not wait to contact the Governor.