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Rights of Texas Residents During Behavioral Interventions in Mental Health Programs

Introduction.

All people have certain basic legal rights.This includes people who have mental illness and people who are in mental health facilities. In some cases, these rights can be restricted by a judge or by your doctor. If you are placed in a mental health facility, this material has information you need to know about restraint and seclusion.

Further reading can be found in this document at disabilityrightstx.org

 

 

 

Voluntary Behavioral Interventions

During your stay in a mental health facility, there may be times when you need assistance controlling your behavior. There are two (2) forms of behavioral interventions that can be used when you begin to feel out-ofcontrol or when your behavior is disruptive. 

Quiet Time

Staff cannot force you to begin or end quiet time. You can end your quiet time whenever you want to. Quiet time is used only when you feel as if you need a place that is quiet and away from other people in order to either calm down or prevent you from getting angry or upset. You must ask staff if you can go to a safe place and stay there until you feel ready to interact with others again. If staff try to block your exit from the quiet time room or threaten you with restraint or seclusion or other consequences if you leave the quiet time room then this is no longer considered quiet time. Instead, it would be considered seclusion and the staff must follow the rules (explained below) regarding seclusion. If your doctor believes that you should not be alone for long periods of time, some restrictions can be placed on where you can go for quiet time. 

Clinical Time Out

When you feel out of control or your behavior is disruptive, staff can ask you to go to a safe place for clinical time out. The difference from quiet time is that the staff asks you to do it. No one can keep you from leaving the clinical time out area if you want to. If anyone blocks your exit from the clinical time out area, then you are being secluded. You do not have to agree to go into clinical time out, and you cannot be physically guided or pushed into it. If you are, then you are being secluded or restrained.

Clinical time out may not be used as a punishment, for the convenience of staff, or as a substitute for treatment. For example, staff cannot ask you to take a clinical time out because there is not enough staff on the unit, or because you choose not to go to classes, or because you choose not to take your medications. Staff can request that you stay in clinical time out for up to 30 minutes. After 30 minutes, the staff has to discuss your behavior with you to determine if you need to continue clinical time out. Remember, you do not have to stay the full 30 minutes, you can leave at any time.

If your behavior is dangerous to yourself or someone else, quiet time and clinical time out may not work, but should be tried before more restrictive interventions are used. 

INVOLUNTARY BEHAVIORAL INTERVENTIONS

Seclusion

Seclusion is a place where there are no dangerous objects with which you can hurt yourself. It also has to be a place where you can be watched, and you cannot leave the area until you are no longer dangerous to yourself or others. Your doctor will determine what changes you need to make in your behavior in order to be released, and he or she must tell you exactly what behaviors you must show in order to be released. Once you are placed in seclusion you must be watched by a staff member who is of your same sex, unless you have a good reason to want someone of the opposite sex. They are required to check on you at least every 15 minutes. If you are given emergency medications and placed in seclusion, you must be watched continuously to receive help if problems occur from the medications. This continuous observation can be done with a video camera. 

Restraint

When you are restrained, it means that all or part of your body movement is restricted. In order to restrict the movement of your body, various devices can be used. Examples are: leather restraints on your wrists and ankles can be used to tie you to a chair or bed, a vest that can be used to tie you to a chair or bed, a body net that can be wrapped around you, a geri-chair or chair that has a tray fastened to it, and other devices that are designed to keep you from moving. All of the devices that can be used on you must be safe, and should be made in a way to cut down on physical discomfort.

If you are placed in restraint, a staff member of your same sex must watch you at all times to make sure you are okay and to keep you safe from others. If you have a good reason to want a staff member of the opposite sex to watch you, then you must tell your doctor.

There are some people who may get worse when treated with seclusion or restraint. Many people who have been physically and/or sexually abused fear being locked up or tied down because of bad memories. If you believe that you have good reason not to have seclusion and/or restraint used as a treatment for you, you must tell your doctor. You need to tell your doctor about the experience or issue that makes you believe you should not be treated with seclusion and restraint. You should tell your doctor before a need for seclusion or restraint arises. There may be times when your doctor believes that you must be secluded or restrained, even though you think it will make you worse. When this happens, the doctor has to justify why he or she thinks seclusion or restraint is the only way to keep you and others safe and must write the reason in your medical record. 

IF YOU THINK YOUR RIGHTS HAVE BEEN VIOLATED

If you believe one of your rights has been violated, you should first contact your treatment team at the facility where you are located. Additionally, you have the right to talk to any of the following:

  • The Consumer Rights Officer, located at all mental health facilities
  • The TDMHMR Office of Consumer Services and Rights Protection at 1-800- 252-8154 or (512) 323-3242
  • Disability Rights Texas

If you believe that you have been abused or neglected in the process of being put in seclusion or in restraint you should call the Texas Department of Protective and Regulatory Services at 1-800-647-7418.