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CMHI shows restraint on restraints

Monday, November 7, 2005

By Ken Ross, Managing editor

The Cherokee Mental Health Institute, as with other MHIs in Iowa, is reducing incidents of restraining inmates, either manually or through the use of restraining devices.

A report on the reduction of the use of restraint and seclusion was presented at a quarterly meeting of the Citizens Advisory Board at CMHI last week.

Tom Deiker, CMHI superintendent, explained that a national initiative to reduce the use of restraining patients was spurred some years back after an expose by a newspaper in Hartford, Conn., revealed 162 deaths caused from the use of restraints.

Further study revealed that MHIs in Iowa had about twice the average per capita of incidents of restraining patients.

The CMHI is in its fifth year of a six-year program to reduce the need for physical control of patients.

Deiker said the CMHI has reduced such incidents by 78 percent over the last five years. There has been a corresponding reduction of 78 percent in staff injuries and 90 percent in patient injuries.

Staff members who deal directly with patients have been receiving training in avoiding situations requiring the use of physical control over patients.

Dr. Daniel Gillette, clinical director, explained that the training involves staff members becoming intimately aware of what triggers each patient to lose control, what calms the patient and what behavioral or verbal signals precede a loss of control.


Gillette reported that the Physicians Assistant program at CMHI is doing well but the future of the program is in doubt. He said the demands on federal funds created by the hurricane relief measures could dry up funds for such programs as PA training.

The PA program trains assistants to psychiatrists, providing much the same services as the psychiatrists at about half the cost. The PA has to work under the direction of a psychiatrist but the psychiatrist doesn't have to be in the same building or even the same town as the PA.

One thing a PA cannot do on his own authority that a psychiatrist can is prescribing schedule 2 narcotics. Gillette said such narcotics as codeine and morphine are not often prescribed in psychiatric treatment but certain child and adolescent conditions require the prescription of schedule 2 narcotics such as Ritilan.

The position of Advanced Registered Nurse Practitioners in Psychiatry offers basically the same service as a PA although the two categories of caregivers arrive at their positions through different career paths.

Besides being less expensive than psychiatrists, both PAs and Nurse Practitioners tend to go to the under-served rural areas. Gillette said their services are in high demand.

The training program for PAs in Cherokee was the first in the nation. It had originally been funded by the state and is now funded through a federal grant.


A cost saving service that CMHI no longer provides is the transportation of jail inmates for counties. There were 26 counties that used this service. Deiker said it worked well for a time, with the CMHI able to do this at about a third of the cost the counties could do it.

For a variety of reasons, usage slipped for a period of time and the CMHI could not keep the service available around the clock. This caused the use to further slip so that the program was no-longer self-sustaining and had to be discontinued.


A program that never really got off the ground in Cherokee County was a social detox unit to serve a multi-county area. Social detox for those addicted to alcohol or drugs requires monitoring by a nurse. It is far less costly than medical detox which is emergency room care of a person facing potentially fatal complications.

The catch with providing social detox is that a hospital where medical detox can be provided must be less than a mile away. The Cherokee Regional Medical Center is capable of providing this service but the hospital administration decided that it did not want to commit to providing this service to people from a multi-county area, mostly indigent people.

The percentage of people in social detox needing transferred to medical detox is small and the hospital management decided gearing up to regularly provide this service was not worth the potential one or two patients a month.

So most drug patients needing the light supervison of social detox get the vastly expensive intensive care of medical detox.

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