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Federal Action Alert: Grassroots Action Needed To Enact Patient Freedom From Restraint Legislation

Chris Marshall
For Immediate Release
31 Mar 99
On March 25, the NAMI E-News reported on the introduction of three bills in Congress addressing widespread reports on the abuse of restraints and seclusion on patients with serious brain disorders in psychiatric facilities. These reports documented unchecked systemic abuses of the use of physical restraints that has resulted in an alarming number of consumer deaths. In October 1998, The Hartford Courant reported on a 50-state survey conducted by the newspaper that documented at least 142 deaths in the past decade connected to the use of physical restraints or to the practice of seclusion. According to a separate statistical estimate commissioned by The Courant and conducted by the Harvard Center for Risk Analysis, between 50 and 150 such deaths occur every year across the country. NAMI has recently released a summary of reported incidents since the publication of the Hartford Courant article which includes five deaths over the past five months and can be accessed online at the NAMI website,

NAMI has worked diligently with lawmakers and allies in the mental health community to develop legislation that sets national standards that restrict the use of seclusion and restraints to emergency situations in which physical safety is at risk and requires the mandatory reporting of deaths and injuries to legal authorities. Senators Joseph Lieberman (D-CT) and Christopher Dodd (D-CT) both introduced individual legislation in the Senate (Lieberman S. 736, and Dodd S. 750) and cosponsored each others bill. Representatives Diana DeGette (D-CO), Rosa DeLauro (D-CT) and Pete Stark (D-CA) introduced "The Patient Freedom from Restraint Act" (H.R. 1313) in the House and currently has 21 cosponsors.


All NAMI members and advocates are urged to contact their Senators and Representative and encourage them to support and cosponsor these bills (in the Senate S. 736 and S. 750, and in the House H.R. 1313) and end the tragic deaths of consumers in psychiatric facilities from abuse of restraints and seclusion. Restraint legislation should provide national standards that only allow the use of restraints for physical safety and mandate reporting of deaths and injuries. All members of Congress can be reached through the Capitol Switchboard at 202-224-3121. Fax, email and mail addresses can be obtained by going to the policy page of the NAMI website at and click on Write to Congress.


DeGette-Stark-DeLauro Bill - H.R. 1313

NAMI strongly endorses the legislation introduced (H.R. 1313) by Representatives Diana DeGette (D-CO), Rosa DeLauro (D-CT), and Pete Stark (D-CA).

"The Patient Freedom From Restraint Act" represents the strongest and most protective approach being proposed. The legislation:

  • recognizes that restraints never should be considered part of therapeutic treatment, but rather used only in emergency responses, which can only be justified if physical safety is at risk;

  • requires consistency in the regulation of restraints for all Medicare and Medicaid facilities that provide treatment to persons with psychiatric illnesses;

  • requires mandatory reporting of deaths and serious injuries to a legal authority in each state;

  • enacts "best practice" standards; and

  • includes strong sanctions.

H.R. 1313 currently has 21 cosponsors:

Stark (D-CA), Morella (R-MD), Kilpatrick (D-MI), Brown (D-OH), Lantos (D-CA), Johnson (D-TX), Crowley (D-NY), Pelosi (D-CA), McGovern (D-MA), Schakowsky (D-IL), Berkley (D-NV), DeLauro (D-CT), Waxman (D-CA), Miller (D-CA), Sanders (I-VT), Martinez (D-CA), Rangel (D-NY), Capps (D-CA), Ford (D-TN), Wynn (D-MD), and Cummings (D-MD).

Lieberman Bill - S. 736

Senator Joseph Lieberman (D-CT) introduced legislation (S. 736) co-sponsored by Senator Christopher Dodd (D-CT) that also establishes a nationally consistent standard for Medicare and Medicaid facilities, based on recognition that restraints and seclusion are appropriate only in emergency situations that involve physical safety.

This legislation also mandates reporting of deaths and serious injuries to federal and state agencies, and if the facility is accredited, to the industry’s Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).

NAMI regards Senator Lieberman’s leadership as making a significant, positive contribution to the issue; however, we are disappointed by some provisions in the bill. Its approach allows a facility to determine for itself whether a death or injury constitutes an "unexpected occurrence" that requires that it be reported. Only reports of deaths and injuries that are part of an undefined "pattern of poor performance" will become public information. Facility analyses of deaths also will remain "confidential," denying consumers and families access to important information. We hope that these provisions will be modified after further deliberations but we encourage NAMI members to urge their U.S. Senators to cosponsor S. 736.

Dodd Bill - S. 750

Senator Christopher Dodd has also introduced legislation (S. 750), co-sponsored by Senator Lieberman, that would amend the "Protection & Advocacy for Mentally Ill Individuals Act" (PAMII) to require the reporting of restraints- and seclusion-related deaths within seven days.

As a member of the Senate Committee on Health, Education, Labor and Pensions, which has jurisdiction over PAMII, Senator Dodd’s leadership will be important in the legislative process. His focus on PAMII has the potential to broaden dimensions of the congressional debate.

The Lieberman and Dodd bills will complement each other and together provide a foundation for action in the Senate. NAMI member support for S. 750 is also encouraged.


7.8 Use of Restraints and Seclusion

(7.8.1) The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to one's self or others. These extreme measures can be justified only so long as, and to the extent that, the individual cannot commit to the safety of themselves and others. (Revised February, 1999)

(7.8.2) Restraint and seclusion have no therapeutic value. They should never be used to "educate patients about socially acceptable behavior;" for purposes of punishment, discipline, retaliation, coercion, and convenience; or to prevent the disruption of the therapeutic milieu. (Revised February, 1999)

(7.8.3) Restraints shall be used only with a physician's order and only for emergency safety use. In emergency situations, a RN may initiate the use of restraints for the protection of the patient and/or others. Immediately the physician on duty/on-call shall be contacted and a verbal order must be obtained. The physician involved shall see the patient within thirty(30) minutes of the initiation of the restraints and document his/her assessment of the patient in the medical record. Orders shall specify up to one hour. Specific behavioral criteria written by the physician, including the patient's proclamation of safety, shall specify when the restraints will be discontinued, to ensure minimum usage. When a physician's order has expired, the patient must be seen by a physician and his/her assessment of the patient fully documented as an emergency safety use before restraints can be reordered. Restraints may only be continued for periods of up to one hour at a time and each renewal must be made by a face-to-face examination by the physician. (Revised February, 1999)

(7.8.4) Every restraint must be treated as a sentinel event and a root cause analysis must be generated. (Revised February, 1999)

(7.8.5) Following each use of restraints and seclusion, the patient should receive trauma counseling. (Revised February, 1999)

(7.8.6) Treating professional must adhere to the patient's advance directive, if there is one. (Revised February, 1999)