A Closer Look: Security Oversight
A Survey on the Use of Hospital Security and Campus Police Departments on Behavioral Health Units in State and Private Psychiatric Hospitals in Ohio
This survey and recommendations were produced by:
Ohio Legal Rights Service
February 2003
Table of Contents
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Copyright © 2003 Ohio Legal Rights Service. All rights reserved.
This document presents results of an Ohio Legal Rights Service (OLRS) survey on the role and use of hospital security and campus police departments in behavioral health units in state and private psychiatric hospitals in Ohio.
Alarming data in the Ohio Legal Rights Service's Major Unusual Incidents (MUI) database revealed that consumers were being injured by hospital security and campus police departments' use of
- stun guns,
- chemical mace,
- pepper spray,
- handcuffs, and
- batons.
OLRS conducted this survey in order to follow up on these data, and to advocate for individuals with mental health disabilities on behavioral health units in Ohio's state and private hospitals.
OLRS hopes that state and private hospitals, and the Ohio Department of Mental Health, consider these survey results carefully, and adopt the recommendations made herein as first steps to addressing the role of hospital security and campus police departments on behavioral health units.
OLRS will continue to advocate on behalf of individuals with mental health disabilities who are suffering harm.
Survey Purpose
Ohio Legal Rights Services (OLRS) developed a survey to gather information on the use of hospital security and campus police departments in behavioral health units in state and private hospitals in Ohio.
Survey Design
The simple design of the survey was intended to assure a high return rate from hospitals. The survey consisted of:
- seven Yes/No questions;
- one Check the Box question; and
- one Fill in the Blank question.
The survey was mailed with a postage paid return envelope.
Hospitals Surveyed
The survey was sent to Ohio's nine state hospitals and to 87 private facilities with behavioral health units. A requested return date was specified. A reminder and a second copy of the survey were sent to those hospitals that did not return the first survey by the designated date.
Survey Responses
Seventy five percent of hospitals surveyed responded (72 out of 96 surveys were returned). All state hospitals and 63 private hospital administrators responded to the survey. Of those administrators completing the survey, 96 percent wanted the results forwarded to them.
Special Note on Responses
For comparison, survey findings have been divided into state hospital responses and private hospital responses.
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State hospitals
Respondents from the nine state hospitals stated that they have a police department on campus. Responses indicated that the police personnel, while on their daily rounds, are on the behavioral units every day, several times on each shift.
Private hospitals
Of the 63 private hospitals responding to the survey, 52 hospitals indicated that hospital security is used on the behavioral units.
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State hospitals
Respondents from the nine state hospitals stated that they have specific policies for security to follow.
Private hospitals
The survey revealed that not all private hospitals that use security have policies for security personnel to follow while on the behavioral health unit. Only 39 out of the 52 private hospitals that indicated security was used on behavioral units have policies for hospital security to follow.
Recommendation
All private hospitals that use security on behavioral health units immediately should develop and implement policies which assure that hospital staff and security personnel have clear guidelines to follow when interacting with mental health clients. The guidelines should be consistent with all applicable Ohio Department of Mental Health (ODMH) licensure rules for behavioral health units.
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State hospitals
Respondents from the nine state hospitals stated that they have specific policies for who is in charge when security is on the behavioral unit.
Private hospitals
As noted previously, 39 private hospitals have policies for security to follow while on the behavioral unit. Of these 39 hospitals, five responded that they did not have a policy which addressed who is in charge. An additional six hospitals did not respond to this question.
Thus, at least several private hospitals do not have policies which explain who has the clinical authority and/or professional responsibility to direct hospital staff, including security personnel, on the method of intervention to be used during a crisis.
Recommendation
All hospitals with behavioral health units immediately should develop and implement policies that identify who has the clinical authority/ professional responsibility to determine the method of intervention and staff to be used in a crisis.
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State hospitals
Respondents from the nine state hospitals stated that they have specific policies which address Mental Health Training/Crisis Intervention Training for security personnel.
Private hospitals
Of the 39 private hospitals that responded that they have policies for security, all but two hospital policies address training for security personnel. Generally, hospitals which have policies for security personnel reported that they also have a policy for Mental Health Training/Crisis Intervention for security personnel. However, the policies of some hospitals do not provide for on-going training.
Recommendation
All hospitals with behavioral health units immediately should develop and implement policies which assure that security receive training in mental health crisis intervention procedures and techniques, both prior to working on the unit, and on an on-going basis (at least annually). Policies should require up-to-date training.
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In Ohio, private hospitals with behavioral health units lack uniform policies and procedures to address the use of security in those units.
Written policies are necessary to assure that hospital staff and security personnel have clear guidance when interacting with clients who have mental health issues.
Development and implementation of good written policies can help to assure that a person with a mental health disability who goes to a behavioral health unit in a private hospital in Ohio will be protected from the use of inappropriate intervention in a crisis situation.
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The survey asked respondents to check which of the following interventions is security prohibited from using or bringing to the MH unit:
- Chemical Mace/Pepper Spray
- Firearms
- Stun Guns
- Handcuffs
- Batons
- Other
Responses to the survey revealed that:
- 9 hospitals allow security to bring or use pepper spray on the unit;
- 15 allow handcuffs;
- 11 permit security to have batons on the unit;
- 3 allow stun guns; and
- 1 hospital allows firearms to be brought to the unit.
Note: Some facilities responded to this section of the survey by indicating that security may bring items such as firearms, batons, stun guns, handcuffs, and pepper spray to the unit, but that security personnel are prohibited from actually using these on the unit.
The danger with allowing these items onto the unit is that security personnel may use the items, even though their use is prohibited.
State hospitals
State hospitals responded that they prohibit the use of pepper spray, firearms, stun guns, and batons in behavioral health units. Handcuffs are permitted to be used, but only on forensic clients when they are being transported.
Private hospitals
Many private hospitals responded that they allow security to bring pepper spray, handcuffs, batons, and stun guns onto the behavioral health unit. Other private hospitals prohibit the use of such devices by security personnel.
Notwithstanding the survey responses, OLRS's MUI tracking system identified private hospital incidents where these devices were used despite being prohibited. This use resulted in injuries to clients.
Recommendation
All hospitals with behavioral health units immediately should develop and implement policies which clearly specify that chemical mace, pepper spray, firearms, stun guns, handcuffs and batons are prohibited from being brought onto behavioral health units.
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Overall, in both state and private hospitals, unit staff and security do not always conduct collaborative review of incidents in which hospital security personnel are used for intervention.
State hospitals
Seven out of nine state hospitals indicated that they review the incident with security.
Private hospitals
Of the 63 private hospital administrators responding, 48 indicated that staff and security do review the incident. Eight private hospitals responded that they do not conduct a review. Some responded by stating that a review is conducted "if needed" or "informally."
One facility responded that the hospital had not conducted reviews in the past, but that the hospital "will from now on."
Recommendation
All hospitals with behavioral health units immediately should develop and implement policies which require that security and unit staff debrief after every crisis intervention incident in which security is used.
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State hospitals
All of the state hospitals indicated that they monitored the interventions used by security.
Private hospitals
Of the 63 private hospital administrators responding, 47 indicated that they monitor the interventions used by security. Sever private hospitals indicated that they do not monitor the interventions used by security.
Recommendation
All hospitals with behavioral health units immediately should develop and implement policies which require that a Risk Management/Quality Assurance committee review every incident in which security is called to the unit — to assure that interventions used by security comply with all applicable ODMH behavioral health unit rules/policies and to assure continuous quality improvement.
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State hospitals
All of the state hospitals indicated that they maintain a log noting the times security is called to the behavioral health unit.
Private hospitals
Hospital administrators from 17 private hospitals responded that the hospital does not maintain a log of the times security is called to the behavioral health unit.
Many private hospital administrators responded that security maintains a log, but that the unit does not.
Recommendation
All hospitals with behavioral health units immediately should develop and implement policies which require that a log be maintained, on the behavioral health unit, to keep track of the times security is called to the unit for assistance.
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State hospitals
All of the state hospitals responded that they had security on the behavioral unit on every shift, every day, as they conducted their daily rounds.
Private hospitals
48 private hospitals reported that they had security on the unit in the month of September 2002. Five hospitals indicated that security was on the unit during daily rounds — these rounds were not included in the September figures calculated below.
In September 2002, 48 private hospitals reported that they called security to the units a total of 321 times. That means, in each of those 48 private hospitals, security was on the behavioral health unit an average of 6.7 times in the month of September alone.
Considering that hospitals use security as a last resort to intervene in patient care, it is important to note that, approximately every four days in September 2002, private hospitals in Ohio used security to manage the behavior of their mental health clients.
Private hospital administrators estimated that security is called, on average, 106 times per year, per hospital.
Recommendation
All hospitals with behavioral health units immediately should develop and implement policies which require that a log be maintained to track when security is on the behavioral health unit, and what interventions security uses while there. This information should be reviewed by the hospital's Risk Management/Quality Assurance committee, in order to accurately monitor and assess the behavioral health unit's response to crises.
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An overview of the survey findings reveals that in Ohio, hospitals with behavioral health units use hospital security or campus police departments for crisis intervention. But the survey findings also revealed that some of the private hospitals that use security for this purpose
- do not have policies on the role of security in crisis intervention on the behavioral health unit, or
- have policies that do not clearly state what the role of security is for crisis intervention.
The survey reveals that the role of security in a crisis situation on a behavioral health unit is not always clear. This lack of clarity may help explain injuries to clients with mental health issues caused by security's use of stun guns, pepper spray, batons and other restraints, as reported in MUIs.
Security personnel called to a behavioral health unit during a crisis should conform to the rules/policies of that behavioral health unit when they are there. But the survey reveals that, at times, the behavioral health unit's rules/policies may differ from the rules or policies that security personnel typically follow while they are in the general hospital setting. Clear behavioral health unit policies, and good training for security personnel on those unit policies, can help protect clients from injury.
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It is hoped that this document will demonstrate to hospital administrators the need for clear, specific policies for security personnel to follow while they are on the behavioral health unit.
Based on the finding in the survey, Ohio Legal Rights Service has developed recommendations for
- hospitals with behavioral health units, and
- the Ohio Department of Mental Health (ODMH).
Recommendations for Hospitals
OLRS strongly advocates the improvement of policies and practices for crisis intervention on behavioral health units at the hospital level.
OLRS urges hospitals to implement the specific recommendations made throughout this document. These recommendations should help hospitals develop clear, specific policies which
- address the role of security on the behavioral health unit;
- offer clear guidelines for security to follow when interacting with clients with mental health issues; and
- specify procedures to monitor and review compliance with behavioral health unit rules.
Recommendations for ODMH
OLRS strongly advocates that the Ohio Department of Mental Health (ODMH) take a greater leadership role in improving the way in which crisis intervention is addressed on behavioral health units in Ohio's state and private hospitals.
OLRS recommends that ODMH expand and improve current rules to frame more clearly and deliberately the role of hospitals serving clients in crisis.
Specifically, OLRS recommends that ODMH develop rules for private hospitals/psychiatric facilities which require:
- policies that clearly specify the role of hospital security in crisis intervention on behavioral health units;
- policies that prohibit chemical mace, pepper spray, firearms, stun guns, handcuffs, and batons from being brought onto or used on behavioral health units;
- that behavioral health units develop a policy which identifies that clinical staff have the clinical authority/professional responsibility to direct hospital staff, including security, on the method of intervention to be used during a crisis;
- that behavioral health units maintain a log to record the use of security curing crisis intervention on the unit, and then use the information gathered to monitor and assess the unit's response to crises:
- that all hospitals with behavioral health units maintain a log to track when security is used on the unit, and what interventions security uses while there, and that the hospital's Risk Management/Quality Assurance committee review this information, to assure that interventions used by security comply with applicable behavioral health unit and ODMH rules and policies, and to assure continuous quality improvement;
- that security and unit staff debrief after every crisis intervention incident in which security is used;
- that an MUI is filed whenever security is called to the unit to intervene or assist in a crisis situation; and
- that security personnel receive training in mental health crisis intervention procedures/techniques, both prior to working on the unit, and on an on-going basis, and that training is up-to-date and conducted at least annually.
The implications of the survey results are significant and they require immediate attention. OLRS will follow up with ODMH to determine what steps the Department is taking to address the role and use of security during crisis interventions in Ohio's behavioral health units.
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This publication was produced by the Ohio Legal Rights Service, 50 West Broad Street, Suite 1400, Columbus, Ohio 43215-5923. Telephone 614-466-7264/800-282-9181 TTY 614-728-2553/800-858-3542 Web site: http://olrs.ohio.gov
Ohio Legal Rights Service and this publication are funded in part by grants under the following federal laws:
- Developmental Disabilities Assistance (DD) Act, administered by the Administration for Children and Families;
- Protection and Advocacy for Mentally Ill Individuals Act (PAIMI), administered by the Center for Mental Health Services of the U.S. Department of Human Services; and the
- Rehabilitation Act of 1973 as amended, administered by the Office of Education Services and the Rehabilitation Services Administration of the U.S. Department of Education.
Ohio Legal Rights Service does not discriminate in provision of service or employment because of race, color, religion, sex, sexual orientation, national origin, military service, disability, or age.
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