Harms to Consumers of Inpatient Psychiatric Facilities in the United States: An Analysis of News Articles

Abstract

Inpatient psychiatric facilities in the United States lack systematic regulation and monitoring of a variety of patient safety concerns. We conducted a qualitative analysis of 61 news articles to identify common causes and types of harms within inpatient psychiatric facilities, with a focus on physical harm. The news articles reported on patient self-harm, patient-patient violence, and violence between patients and staff, noting that youth, older adults, and veterans were especially vulnerable. Harms occurred throughout the care continuum - at admission, during the inpatient stay, and at discharge - and retaliation towards whistleblowers deterred facility accountability. We recommend 1) addressing staffing shortages, 2) instituting systematic monitoring of critical incidents and the experiences of consumers and staff, 3) improving both inpatient safety and post-discharge community supports, and 4) continued journalistic coverage of harms within inpatient psychiatric facilities.

The Effect of Centers for Medicare and Medicaid’s Inpatient Psychiatric Facility Quality Reporting Program on the Use of Restraint and Seclusion

“…For-profit, nonprofit, and government-owned facilities have all come under scrutiny by federal accountability entities and journalists for issues such as patient death and neglect, unqualified or unsupervised staff, and inappropriate admission. 10 News articles and investigations, however, do not provide unbiased and systematic data on safety; therefore, their ability to inform our understanding of disparities in quality among ownership types is limited.…”

“…Much research and policy attention focused on patient safety in inpatient psychiatry has focused specifically on restraint and seclusion, describing the physical and psychological consequences associated with their use. [6][7][8][9][10] Seclusion (when a patient is involuntarily confined to an area) and restraint (a method that restricts a patient's freedom or ability to move) are controversial methods of containment. They are controversial because while they have a safety rationale (i.e., emergency measures to protect patients and staff if a patient is at risk of hurting themselves or others), they can be traumatizing to patients and can lead to patient and staff injury (or death).…”

“…They are controversial because while they have a safety rationale (i.e., emergency measures to protect patients and staff if a patient is at risk of hurting themselves or others), they can be traumatizing to patients and can lead to patient and staff injury (or death). [6][7][8][9][10] Several prominent professional and patient advocacy organizations (such as the National Association of State Mental Health Directors, National Association of Psychiatric Nurses, and the World Health Organization) have called for the reduction and eventual elimination of seclusion and restraint in inpatient psychiatry. 9,11,12 Seclusion and restraint use can vary in part due to various inner-organizational factors, such as staffing level, culture, and incentive structure.…”

Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures

“…Research on the quality of inpatient psychiatric care has been lacking, despite documented concerns that care in these settings can be unsafe and misaligned with patients’ needs and preferences. 1–6 The causes of safety events can range from medication error to the use of restraint and seclusion, 2 , 3 , 7–10 and are likely experienced disproportionally by minoritized patients. 11 Some people who have experienced psychiatric hospitalization have reported positive experiences, while others have reported disrespectful and dehumanizing care, 12 and news reports have illuminated an array of issues related to substandard care.…”

“… 11 Some people who have experienced psychiatric hospitalization have reported positive experiences, while others have reported disrespectful and dehumanizing care, 12 and news reports have illuminated an array of issues related to substandard care. 7 …”