Better treatment for youth with serious mental illnesses. (Legislative Update).

These days, hospitals are bearing less of the brunt of caring for children who require inpatient treatment for their psychiatric disorders. Instead, psychiatric residential treatment facilities are taking on more of this responsibility. The Health Care Financing Administration (HCFA), which is the federal agency responsible for administering the Medicare, Medicaid, and Child Health Insurance Programs in the US and helps pay the medical bills for more than 75 million beneficiaries, views these facilities as a better option, "a less restrictive alternative to a hospital," in treating people with mental illness who require a residential environment.

In spite of this trend toward a "less-restrictive environment," however, HCFA, based on a September '99 report from the General Accounting Office (GAO), acknowledges that children and adolescents with mental illnesses are more apt to be subject to restraint and seclusion measures, even more so than their adult counterparts. (The report goes on to state that this treatment leads to a greater risk of serious injury and death.)

To address this situation, HCFA issued an interim final rule with comment period [public debate held before policy is set], in January of this year, that would legally compel all psychiatric residential treatment facilities, other than hospitals, that serve individuals covered by Medicaid under age 21, to meet new, more humane standards in the use of restraints and seclusion in treating their under-21 population. Ultimately, the goal of this new policy is to help ensure both the physical and emotional health and safety of each of the facility's residents.

As part of this final rule, facility residents are granted the right to be free from the use of restraints or seclusion, of any form, for the purposes of:

* Coercion;

* Discipline;

* Convenience; or

* Retaliation.

Instead, the use of restraints or seclusion may only be implemented during emergency safety situations.

In addition, if the final rule passes public muster, age-specific time limits for restraint or seclusion are to be imposed, and the simultaneous use of restraint and seclusion will be prohibited.

Says Dr. Robert A. Berenson, HCFA's acting deputy administrator, "People with serious mental illnesses, especially children and adolescents, are among the country's most vulnerable citizens. These added requirements will better protect children and adolescents from the dangers associated with the use of restraint or seclusion."

According to Mary Caan, spokesperson for the HCFA, the public debate period has ended; however, the new policy must now be reviewed and approved by the Bush administration. Contact the HCFA at [phone] for more information, or visit their Web site: http://www.hcfa.gov.