Duration of physical restraints at state mental hospital raises concerns

New data from Massachusetts’ state mental hospital in Worcester is raising concerns about how long patients are being physically restrained.

In an adult care unit in the Department of Mental Health’s largest hospital, when staff used restraints — like straps or vests — to hold people down last year, the patients remained restrained for close to two hours in most instances.

The two-hour time period is the deadline at which state regulations require a doctor’s approval to extend the duration of the restraint.

The data from Worcester Recovery Center and Hospital is prompting concerns among some health advocates and state workers who say staff are holding people down for too long and not based on their individual needs, violating the rights of vulnerable patients.

About 75 percent of the so-called mechanical restraints in the state’s adult continuing care unit last year lasted between 105 and 120 minutes, according to data released by the Department of Mental Health.

Only about six percent of the reported restraints lasted longer than two hours, suggesting that staff are aware of the time limits for restraints, and are releasing patients before the clock expires.

State law mandates that restraints should be only used in emergencies. The hospital cares for about 320 adults and teens with severe mental health issues, many of whom are involved in the legal system and need psychiatric assessment or treatment.

Caroline Mazel-Carlton, director of learning opportunities at the Wildflower Alliance, a grassroots peer support organization in western Massachusetts, told GBH News that the restraint durations could be driven by lack of proper training, short staffing or tight spaces with too many patients.

Mazel-Carlton, who says she has personally experienced being restrained, believes staff should be doing all they can to reduce the practice she described as traumatizing.

“Every minute that someone is secluded or restrained … every one of those minutes is terrifying,” she said.

The Worcester data was originally obtained by John Trask, a Paxton resident and director of peer support at the hospital. Trask told GBH News that he requested the information, concerned that too many people were being held for exactly two hours before being released.

Trask says he doesn’t attribute the restraint durations to ill-intentioned staff. Instead, he chalks it up to staff burnout and a challenging work environment.

He says he has been on leave since January because of mental distress caused by his work, which includes debriefing patients after being restrained. He filed a complaint in April with the state Office of the Attorney General, concerned about the practice.

“It substantially impacts civil rights,’’ Trask said. “You don’t tie somebody up any longer than necessary to maintain safety.”

Officials from the Department of Mental Health declined to comment about Trask, citing personnel issues.

They told GBH News in an email that hospital staff use restraints as a “last resort” to protect the safety of patients and workers.

GBH News has requested data on the total number of restraints that occurred but the department has not yet provided the information. The data for this story is based on the percentage of restraint incidents that were reported but does not reflect the percent of patients who have been restrained.

Many patients in the adult continuing care units are involved in the criminal justice system and get transferred over from court evaluation units if they need more treatment.

The data appears to show restraint duration in adolescent units is also heavily clustered around the maximum time limit.

Just over half of restraints among teens last year lasted between 46 and 60 minutes, data shows, hitting the one-hour limit for teens before a doctor’s approval is required for more time. Only three percent of restraints went over that time limit.

The Worcester hospital is the only facility that maintains such records, state officials said, noting that restraint tracking methods vary by facility.

GBH News spoke to some staff who defended their work at the hospital. George Njoroge, a nursing supervisor, told a reporter that patients are always released once they are no longer a danger to themselves or others.

Njoroge said part of the restraint time includes having a doctor come to examine a patient, order medication from the pharmacy, and then administer it.

Part of his role is to debrief staff after a restraint. Njoroge, who has worked at the hospital for nearly 14 years, said patients can be “very aggressive” and threaten staff, making safety a concern. He acknowledged that the practice can be traumatizing.

“I’ve never seen a person who is restrained unnecessarily,’’ he said.

Others said they were troubled by what they’d experienced working at the Worcester hospital. Maeve Whalen, a former peer specialist, said she too had noticed a trend of patients being restrained for the maximum amount of time before being released.

Whalen said she was restrained as a teen, and was made aware of many restraints – some five or six a day – during her seven years at the Worcester hospital. She attributed the restraint durations to short staffing and a punitive attitude towards patients who involved in legal proceedings.

She said she left her position about two years ago, partly because the job negatively impacted her mental health.

“Restraints were some of the most traumatizing things for me to witness,” said Whalen, who worked alongside Trask.

“Regardless of what someone has done to get there, they’re still a human and a person and should be treated with dignity,” Whalen said.

Under Massachusetts law, “Restraint of a person with a mental illness may only be used in cases of emergency, such as the occurrence of, or serious threat of, extreme violence, personal injury or attempted suicide.”

A policy within the Department of Mental Health states staff must continuously monitor a restrained patient, and restraints must not continue for longer than necessary. Patients must be released immediately once they have regained self-control and no longer present risk of harm to themselves or others, according to the policy.

Reasons for extending a restraint can include agitation, thrashing, crying or threats of self-harm or violence, according to Department of Mental Health regulations.

Trask said he was once restrained while hospitalized in his early twenties. “I know the impact that it has. It is lifelong. There are days when I cannot wear a watch because something on my wrist is upsetting,’’ he said.

He said the state data should show a more even distribution in duration considering every patient is different and may calm down at different time intervals.

After being unsuccessful in getting his colleagues and superiors to address the concern, Trask filed a complaint with the Office of the Attorney General’s Civil Rights Division. He claimed the “highly irregular” pattern “strongly suggests that restraint durations are being shaped by policy or administrative thresholds, rather than the real-time clinical assessments.”

In a written response in May, the Attorney General’s office said it “has decided not to further investigate or intervene.”

Frustrated, Trask reached out to GBH News, in hopes of getting some attention to the topic.

GBH News had publishedan investigation showing the state reported a growing number of inpatient restraints, some 9,000 in 2022, despite a state goal of eliminating restraints altogether.

“If any of us saw one of our loved ones tied up and we didn’t think it was necessary, if we had any doubt that it is necessary, we would be appalled,” Trask said.