Jess Thompson, 27, of Abington views her life in two parts: before she was restrained, and after.
Thompson had been sent to South Shore Hospital by ambulance in September 2020 after staff at an outpatient clinic feared she might be suicidal. Thompson says she was seeking treatment for PTSD, but was not considering suicide in any way.
Moments before the restraint, she'd been told she was on a 72-hour hold. Thompson told the staff she would like to leave.
“I started to walk up to the door and I am bear-hugged by this security guard. I had my arms crossed sort of in front of my chest and I’m trying to free my arms and they had thrown me to the ground. My lip hit the dirty hospital floor and instantly busts,” Thompson told GBH News.
Thompson said more than half a dozen staffers, most of them male, put her on a stretcher in the middle of the hallway where she screamed, begging them to let her go.
“Very quickly I’m being tied down with four point restraints: one arm lifted, I believe, sort of nearby my ear and the other down by my hip, with my two feet restrained at the front of the bed,” Thompson said.
The feelings, she said, were "unimaginable."
Thompson represents one of at least 8,000 restraints of children and adults that happened at Massachusetts inpatient facilities in 2020, and that number has spiked since then, despite the Department of Mental Health's stated goal of eliminating the practice altogether.
Thompson, a yoga instructor, experienced trauma as a teen. In more recent years, she's dedicated her life to wellness and helping others struggling with mental illness. She's also a member of the Council Against Institutional and Psychiatric Abuse.
She said one young nurse, blonde, in her 20s squeezed her hand during the restraint, and said, “I’m so sorry.”
“They walk up with needles and syringes, and I'm like, 'What is that?' They won't tell me… they just stab me in the thigh and then they stabbed me in the thigh again,” Thompson said.
She woke up at Pembroke Hospital, where she completed the remainder of her 72-hour stay. GBH News independently verified Thompson's medical records showing she was transported to both hospitals against her will. Thompson provided photos to GBH showing bruising and cuts on her limbs that she said were a result of the restraint.
Restraints on the rise
Last year, there were more than 9,000 restraints performed across Massachusetts inpatient facilities.
That represents a 20% increase from 2021, when there were 7,300 restraints, according to DMH data obtained by GBH News via public records request. So far this year, 4,700 restraints were already reported between January and August.
A “philosophy statement” on DMH's website says the department aims to eventually eliminate restraints. That philosophy statement was written in 2007, and has not been updated.
A large portion of the spike in restraints comes from Cambridge Health Alliance's Center for Inpatient Child and Adolescent Psychiatry in Somerville, a facility for kids and teens that was opened in June of 2022.
More than 1,000 restraints happened at the center within the first six months after it opened, which is nearly six every day.
So far this year, that rate is holding steady, with nearly 1,000 restraints of kids and teens having already happened at the center between January and August. That accounts for one in five of all restraints statewide.
The high rate is because the center is very large with 69 beds, treats severely ill patients, and a small proportion of patients with dangerous behaviors are restrained multiple times, according to Cambridge Health Alliance. CHA said it is committed to eliminating restraints "wherever possible."
"We are a safety net institution, and what that means is that we will take care of patients who are in great need, who may have been boarding in emergency departments for a long time," said Nicholas Carson, Cambridge Health Alliance's division chief of child and adolescent psychiatry.
Carson said he's concerned about the restraints. "Restraining a patient is very difficult for the patient and very difficult for the staff."
What defines a medical "restraint"
There are different types of restraints:
- Physical restraint involves direct contact where a patient’s arms, legs, head or other body part is restricted.
- Mechanical restraint involves the use of equipment such as straps or a vest to hold a patient down.
- Medication restraint, also called "chemical restraint," happens when sedative medication is given to a patient against their will, and can only be done with physician authorization.
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 restraint is never to exceed six consecutive hours and the Department of Mental Health's policy says a safety check has to be conducted every 15 minutes during a restraint.
The law also says hospitals must give a patient paperwork detailing their restraint within 24 hours, and DMH requires facilities to create an individual crisis prevention plan with each inpatient mental health patient to mitigate incidents.
But Thompson said she never received a restraint form, nor an individual crisis prevention plan.
Thompson wrote a letter to the hospital detailing her experience. A hospital representative wrote back expressing "sincere apologies," saying that behavioral health systems are poorly designed and under-resourced. “These systems affect and influence how hospitals are able to provide care,” the representative wrote. The representative said Thompson's story was being shared with staff as a learning tool.
South Shore Hospital declined to comment on her case, citing patient privacy.
Thompson said her experience worsened her mental health significantly, and she experiences around 50 flashbacks a day. She said she can no longer lie flat in her bed, receive tight hugs or watch movies involving hospital scenes.
"It's the biggest thing that's ever happened to me," Thompson said.
Reporting complaints
If a person wants to lodge a complaint about a restraint, they can file it with the hospital’s human rights officer. Every complaint received by DMH launches an investigation.
However, DMH data obtained by GBH shows a majority of complaints end up “unsubstantiated.”
So far this year, there have been 28 complaints filed with DMH. Only two have been substantiated, and 14 remain open.
Last year, 36 complaints were filed with 9 deemed substantiated and 3 still open. And in 2021, there were 28 complaints with just two substantiated.
Walter Noons, a senior staff attorney at the Disability Law Center who has worked on restraint and seclusion cases for more than a decade, said the low number of complaints is not representative of the restraints that occur. He said some patients don't have faith in the complaint process, so they might not file one.
Noons said keeping restraints a front-burner issue is a matter of life and death.
“I think that if it is not addressed in a meaningful way there will be a disaster, and someone will die, and it will be all over the news and we’ll all be wringing our hands and clutching our pearls to make things right,” Noons said.
Noons said he can’t imagine a situation in which the regulations would lawfully justify both a mechanical restraint and a medication restraint, yet it happens routinely.
“I would ask anyone to draw me a picture of when a person who is in four or five point restraints and very distraught ... [has] the present ability to carry through on the threat” to warrant a medication restraint, Noons said.
"I think that more often than not, in the heat of the day, people are restrained when they perhaps should not have been," Noons said.
DMH data shows between 2019 and 2021, there were 26 injuries as a result of restraint or seclusion at DMH licensed facilities, and at least one restraint-related death at state facilities.
“Do I think there have been times when a restraint prevented something worse from happening? I would say it would had to have," Noons said. "But I also know as a matter of fact that restraints have resulted in serious injury and death of patients. That’s a dangerous tradeoff.”
Noons said Massachusetts has a number of excellent regulations and guidelines on restraint, but those regulations are not always well understood or followed, and now, restraints have started to tick back up for a number of reasons — including impacts from the pandemic, patients with more severe symptoms, longer emergency boarding times and issues with staff training.
Noons said he thinks getting rid of restraint is feasible, but many in the health care field disagree.
Power struggle
Adetutu Owolabi, a Boston-area nurse supervisor who wrote her doctoral thesis on restraints, said she has seen and heard patients making threats and acts of violence toward staff, or toward themselves.
While Owolabi feels restraint should only be used as a last resort, she said the practice can save a life.
She said thin staffing can lead to more restraints because there simply aren't enough nurses and counselors to handle all the patients needs, so the patients get frustrated or agitated.
And sometimes it is just personal.
“There are some restraints I’ve seen that are not necessary, like the staff doesn’t want to deal with the patient or the staff doesn't like a patient,” Owolabi said, adding that some patients taunt the staff.
Rates of restraint and seclusion in Massachusetts are below the national average, according to data from the Centers for Medicare and Medicaid Services.
But issues with the practice in Massachusetts are not new and have been going on for years.
GBH News spoke with five patients who experienced traumatic restraint in Massachusetts over that last decade and beyond. Many said it caused them to lose faith in the health care system, or avoid going back even if they needed more help.
DMH could not make the commissioner available to speak with GBH News about restraints, but provided information saying the department is committed to minimizing the use of restraints, and regularly evaluates restraint policies.
DMH said physical and chemical restraint is only used after evaluating factors like safety, medical factors and comfort, and medication restraint is only given after an authorized clinician has consulted with a doctor.
