Associated Press November 19, 2019
New safety
standards aimed at limiting suicide risks have led to overhauls inside
hospitals around the country, with psychiatric facilities and wards removing
bathroom doors, stripping artwork from walls and requiring patients to wear
paper gowns instead of their own clothes.
The changes have
forced costly renovations and caused a backlash, with some critics contending
they've made hospital rooms feel more like jail cells.
Regulators say
the new guidelines leave room to protect patient dignity and privacy, but many
hospital officials tasked with updating facilities and their procedures say
they've gone too far.
"I think we
are moving toward a very prison-like system," said Patricia Rehmer,
president of the Behavioral Health Network for Hartford HealthCare, which
operates Hartford Hospital. "We try and make it comfortable, we try and
have as many things available as we can, but it's not easy."
New suicide
prevention requirements took effect on July 1 on orders of The Joint
Commission, an agency that works with the CMS and accredits the vast majority
of the country's psychiatric hospitals.
A 2018 report by
The Joint Commission Journal on Quality and Patient Safety found an estimated
49 to 65 hospital suicides happen annually. The report was described as the
first data-driven estimate of inpatient suicides per year in hospitals.
In general, now
pictures cannot be hung on walls, doors on bathrooms are either removed or
replaced with polystyrene foam doors, and remotes are removed for televisions
that are now secured behind plastic glass. Ceiling tiles and door handles must
be replaced with risk-resistant ones along with special types of beds and
sheets.
"We're
buying the same furniture and plumbing fixtures as prisons and jails,"
said Dr. Bruce Schwartz, president of the American Psychiatric Association,
adding that the requirements are creating harsher environments in psychiatric
facilities.
Several
organizations with the Michigan Health and Hospital Association have struggled
to comply with the new requirements in the timeframe expected by The Joint
Commission, said Laura Appel, the association's senior vice president and chief
innovation officer. She said empty rooms may be safer but they're also
significantly less comfortable.
"The lack of
doors means an insult to patient privacy," she said.
Mental health
advocates have raised concerns that less comfortable environments for patients
could be less healthy.
Michaela Fissel,
executive director of Advocacy Unlimited, said hospitals could make the
settings more homelike and comfortable by adding yoga or music and letting
patients wear their own clothes instead of a paper garment.
One patient,
Cheyenne Wilson, said she felt as though she were in solitary confinement when
she was admitted to Hartford Hospital's psychiatric unit for half a day when
she was experiencing suicidal ideation. She said she had her belongings taken
and searched and was told to get dressed in a paper garment.
"They took
my clothes away and made me get dressed behind a curtain, not even in another
room," she said.
Her father,
Beresford Wilson, co-chairs the Connecticut Behavioral Health Partnership
Oversight Council. He raised his daughter's experience at a September meeting
and said it had too much of a punitive feeling.
"I think to
make the experience as normal as possible when the person is under that
distress, what they are looking for is normalcy as much as possible, not
restriction or confinement," he said.
After her
experience in the emergency unit, he said his daughter was given a therapy
referral and has been taking classes to become a certified nurse assistant.
Dr. Charles
Herrick, chair of psychiatry for the Western Connecticut Health Network, said
the changes can make patients feel more depressed and can demoralize them.
"If you
perceive the environment as a prison — and prisons are a place of punishment —
then you can't help but think you are being punished, whether consciously or
unconsciously," he said.
In response to
criticism of the new guidelines, Joint Commission officials say they believe
hospitals should be able to protect patient dignity and privacy while meeting
safety standards.
"Balancing
privacy and safety is always an important factor when caring for patients
at-risk," the agency said in a prepared statement. "It is vital for
organizations to develop procedures to ensure that individuals are regularly
reassessed so the level of security/monitoring implemented is appropriate for
the assessed level of risk."
The cost of
renovating spaces and buying new equipment is another reason some hospitals
have objected to the new requirements.
Partly citing
such costs, two hospitals in Ohio and Wyoming closed their psychiatric units
within the past couple of years. Officials from both hospitals declined to
comment.
Thomas Jefferson
University Hospital in Philadelphia had to remove bathroom doors in two-person
rooms in its psychiatric ward, according to Dr. Kenneth Certa, a professor of
psychiatry at the university's Sidney Kimmel Medical College. He said that
meant removing one person from the room for privacy concerns and that decreases
the number of people who can be helped at a given time.
Certa also said
the hospital also had to purchase safety sensors for about 48 doors, costing
$785,600 in total.
On average, the
length of stay for psychiatric patients at a psychiatric facility is seven to
10 days, according to the American Psychiatric Association.
A movement away
from institutionalization over the last half century has led to community-based
mental health services replacing long stays in psychiatric hospitals. That same
trend has also coincided with larger numbers of mentally ill people becoming
homeless or incarcerated, where they receive little treatment — or none at all.
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