Insulation and application

TOGETHER, TO LEAVE THEMSELVES THERE AND TO DEMOLISH THEMSELVES SOME


Reflexions and recommendations to the elimination of measurements of control:

chemical application , insulation and substances


AGIDD-SMQ May 2006

Association of the groups of intervention

in defense of rights in mental health of Quebec



1. on the way towards elimination , measurements of control


1.1. Article 118.1


In the years 1990, the inadequate use of measurements of control is at the origin of social pressures in favour of the humanization of the care and the protection of the rights of the people. These pressures contributed to  questioning about the use of these measurements and to the birth of the article 118.1 Law on the services of health and social services of Quebec in June 1998.

The article 118.1 Law on the services of health and social services of Quebec is very clear on the nature and the application of measurements of control. They cannot be regarded as measurements of treatment or measurements therapeutic. They are protection measures to prevent a person from causing with others or himself of the lesions. Useless to point out here the context of the urgency which can order a such intervention. Beyond the urgent character, measurements of control must be subjected to the assent free and lit people, because they become interventions within the meaning of the legislative rules which make it possible to lead a person to have a desired behavior.


Definitions of measurements of control

Application:

Measurement of control consists in preventing or to limit the freedom of movement of a person by using the man power, average a mechanics or by depriving it of a means which it uses to mitigate a handicap.


Insulation:

Measurement of control which consists in confining a person in a place, for a determined time, from where it cannot leave freely.


Chemical substance:

Measurement of control which consists in limiting the capacity of action of a person by managing a drug to him.


The groups of promotion and defense of rights in mental health note  that certain speakers of the health and the social services use these measurements for punitive reasons, sometimes for administrative reasons, sometimes for lack of tools and of training or by protection measure of the personnel himself. Who more is, several public investigations testify to a significant degree of the excessive use of these measurements and that for various contrary reasons with the direction and the spirit of the law.


Nevertheless, if extreme measurements of regulation of the behaviors which are measurements of control were finally recognized like such by the Québécois legislator, it is important however to understand that an article of law is, and will remain insufficient, to break the cycle of violence.


2 Ministry for Health and the Social services.

Ministerial orientations relating to exceptional use of measurements of control, 2002, page 14


In effect, a law and orientations are not that the starter of a transformation of the practices and not an end in itself. The example of the law as for the involuntary internment under the terms of the dangerosity of a person for itself or others illustrates this point well. The psychiatrist and American lawyer Paul Appelbaum analyzed this difference between laws on paper, often very legalists, and their practical application. It is that a variety of actors has the potential to modify the application of it. Thus, so certain actors in position of being able judge that they force them too much, they will act according to their role and their responsibilities in order to come to a more satisfactory result in their eyes4... Thus the primacy of the person is sometimes neglected. 


Article 118.1 of the Law on the health services and the social services

“The force, insulation, all average mechanics or any chemical substance cannot be used like measurement of control of a person in an installation maintained by an establishment, but to prevent it inflicting or from inflicting with others lesions. The use of such a measurement must be minimal and exceptional and must take account of the physical and mental state of the person.

When a measure aimed to the first subparagraph is taken with regard to a person, it must be the subject of a mention detailed in its file. Must be consigned in particular there a description of the means used, the period during which they were used and a description of the behavior which justified the catch or the maintenance of this measurement.

Any establishment must adopt a protocol of application of these measurements by taking account of the ministerial orientations, to diffuse it near its users and to carry out an annual evaluation of the application of these measurements.1 »


Mr. Marc Bélanger, of the Commission of the rights of the person and the rights of youth, at the time of his short speech to the international Conference on insulation and the application in 1999, expressed himself in the same direction:

“To want to prevent the use of insulation and measurements which approach some, without taking account of the organisational context in which these measurements are used, a project likely to fail constitutes.

Not to attack the institutional causes of an excessive use of these measurements, to be satisfied to prohibit them without taking the care to identify what gives them birth and to modify them constitute a false track. Because, in fact, the use more or less intense of measurements of control on the person depends closely on the quality of the services offered by an establishment.


The prevention of insulation in the daily newspaper, that rests, of course, on a continuous development of the competence of the people called to intervene with the young people and of their knowledge of the techniques of intervention GUI allow to prevent the crisis or to limit the width of it.


From a systemic point of view, the prevention of insulation is part however of the management of the quality which, nowadays, constitutes an integral part of the management of an organization or a respectful establishment of its customers, debtor at his community and its backers.5 »


3 Law on the health services and the social services, L.R.Q., art.118.1

4 Morin, Paul, Cecile Michaud. Measurements of control in psychiatric medium: three prospects to guide of it the reduction, even L ’ elimination, Mental health in Quebec, XXVIII, 2003, page 130.

5 AGIDD-SMQ Acts of the conference insulation in application: For S ’ to leave there and S ’ to demolish some, Montreal, 2000, page 413.


Thus, adoption of article 118.1 constituted only one first step towards the restriction of the use of these measurements, from where interest of Association to continue the reflexion and the debate on the many stakes caused by the use of insulation, the application and the chemical substances in the institutional daily practices of control.

1.2.International conference on the application and insulation

In 1999,1 ' AGIDD-SMQ was the project superintendent of the international conference on insulation and the application, For of to leave and to demolish itself some, to which share nearly 500 people took coming from Quebec, several provinces of Canada, of the United States, of England and France. More than one forty lecturers and lecturers of quality resulting from fields and various fields of interest, y included/understood of the people users of mental health services, shared their experiments there.

A search for solutions for the elimination of these practices was started: for example, a team of Mohawk Valley Psychiatric Center (New York) had come to present tracks of alternative actions for an effective model of practices in a free environment of application.

The publication of the acts of this conference reflected the whole of the international expertise in addition to being used as reference to work of the MSSS in the development of orientations relating to insulation and the application.

1.3.Ministerial orientations & action plan

Thus, following the success obtained by this international conference, the AGIDD-SMQ continued its actions in this file. It took part in work of the departmental committee charged to work out them ministerial orientations relating to the exceptional use of measurements of control: Chemical application, insulation and substances (2002). An action plan rising from these orientations was also produced the same year by the ministry of the Health and the Social services of

With this action plan, the Ministry affirms the need for managing from there as soon as possible “ to reduce in a substantial way, and to eliminate if possible”, the recourse to measurements of control, “in particular thanks to promotion and to the implementation of practices of replacement6 ».


6 Ministry for Health and the Social services. Plan D ’ action. Ministerial orientations relating to exceptional use of measurements of control: Chemical application , insulation and substances, 2002, Quebec, page 5.


The ministerial plan defines the actions to be posed in order to ensure itself of the appropriation of the ministerial orientations on the use of measurements of control by the groups of people concerned.

Lastly, the plan also contains means of action in order to frame the use of measurements of control, in particular by making so that each establishment adopts protocols of application of measurements.

The AGIDD-SMO had accomodated very favorably the ministerial orientations as well as the promising measurements contained in the action plan. But Association déchanté because of the important delay that shows this last. In addition to the recommendations contained in this document, it is obvious that the AGIDD-SMQ expects that the installation of the action plan is accelerated for a larger respect of the people.

Recommendations of the AGIDD-SMQ for a change culture and a true respect be right fundamental

The AGIDD-SMO recommends to the ministry Health and Social services of Quebec to finance an international conference to the preventive and alternative measures with measurements of control.

The AGIDD-SMQ recommends that there is in any medium having recourse to measurements of control (hospitals, resources intermediate, centers of readjustment for young people, CHSLD, etc) an ascribable person of the framing, evaluation and application of these measurements, and this, in an objective of elimination. This person will have to return account to the ministry for the Health and the Social services of the reports/ratios on these measurements and the objective of their elimination. These reports/ratios will have to be public.

The AGIDD-SMO recommends that the ministry for the Health and the Social services of Quebec supports the action of the Community organizations of promotion and defense of the rights in mental health while making available their intervention to any person undergoing from measurements of control as a whole from the network.

Source: Together, to leave themselves there and to demolish themselves some, AGIDD-SMQ, May 2006