Friday Factoid: To Restrain or Not Restrain? That is the Question.

For more than three centuries, physical restraints have been utilized to manage psychiatric patients (as cited in Allen et al., 2018). However, despite increased regulatory pressure and legal action being taken regarding its use, the practice of using physical restraints to prevent patients from harming themselves continues to prevail in acute psychiatric settings (Allen et al., 2018). Physical restraints, according to the Centers for Medicare and Medicaid Services (CMS) are defined as “any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident’s body” which restricts an individual’s freedom to move or have normal access to his or her body (as cited in Allen et al., 2018, p. 1).

Conducting a systematic review of the literature, Allen et al. (2018) identified various methods that could be used to decrease the use of physical restraints on acute psychiatric inpatients. Multiple alternative interventions that could be implemented were identified. These methods included using de-escalation techniques taught to hospital personnel, implementing debriefings following restraint episodes, and employing individualized or patient-specific crisis management plans or tools (Allen et al., 2018). Other methods that were identified included encouraging increased reporting and data sharing, implementing the use of restraint chairs, and forming a team of crisis responders along with instituting a formal policy change which necessitated prior authorization being attained to apply restraints from the chief medical officer (Allen et al., 2018). Utilization of these alternative approaches were shown to substantially decrease the rate of restraints over the course of a 2 to 3-year period. For example, Bell and Gallacher reported a 50% decrease in the hours of restraint use per 1,000 patient bed days, whereas Godfrey et al. (2014) reported a 98% decrease during a 3-year study (as cited in Allen et al., 2018).


Allen, D. E., Fetzer, S., Siefken, C., Nadler-Moodie, M., & Goodman, K. (2018). Decreasing physical restraint in acute inpatient psychiatric hospitals: A systematic Review. Journal of American Psychiatric Nurses Association, 1-5. doi: 10.1177/1078390318817130

Shirreka Mackay, LPC
WKPIC Pre-Doctoral Practicum Student

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Friday Factoid: Severe Mental Illness: A Close and Personal Perspective

Generally speaking, persons who suffer from mental illness oftentimes perceive themselves similar to the way they are seen in their respective environments. Therefore, listening to their narratives and hearing their perspective on personal experiences is likely to increase our understanding of the complexity of their illness (as cited in Vila, Pallisera, & Fullana, 2016).

Interestingly, health and social science research has placed increasing value on the views and experiences as told by individuals with mental illness (as cited in Vila et al., 2016). One such study conducted by Kinn, Holgersen, Borg, and Fjaer (2011) provided participants with the opportunity to explore themselves, their daily life, and their work potential. A few major themes emerged during the study, including “all it takes to have a life, being on the right track, and asking for feedback” (Kinn et al., 2011).

In another case study, Thompson et al., (2008) found that individuals suffering from severe mental illness (SMI) especially highlighted the need to feel productive, enhance their self-esteem, feel that they are of value, feel listened to, jokingly interact with others, and experience physical and emotional safety. These needs were directly related to participants’ existing personal supports (i.e., family and/or professional) (Thompson et al., 2008). Similarly, Wahl found that persons with SMI who experienced discrimination and stigma associated with their symptoms, tended to cope better when advocating and speaking out against the judgments and negative perceptions they encountered (as cited in Vila et al., 2016).


Kinn, L. G., Holgersen, H., Borg, M., & Svanaug, F. (2011). Being Candidates in a transitional vocational course: Experiences of self, everyday life, and work potentials. Disability & Society, 26(4), 433-448. doi: 10.1080/09687599.2011.567795

Thompson, N. C., Hunter, E. E., Murray, L., Ninci, L., Rolfs, E. M., & Pallikkathayil, L. (2008). The experience of living with chronic mental illness: A photovoice study. Perspectives in Psychiatric Care, 44(1), 14-24. doi: 10.1111/j.1744-6163.2008.00143x

Vila, M., Pallisera, M., & Fullana, J. (2016). Exploring the present and projecting the future: People with severe mental illness speaking for themselves. International Journal of Qualitative Studies in Education, 29(9), 1118-1130. doi: 10.1080/09518398.2016.1201164

Shirreka Mackay, LPC
WKPIC Pre-Doctoral Practicum Student

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Friday Factoid: Is Likeness of Mental Health Experiences a Potential Avenue for Treatment Interventions?

Organized peer support with individuals diagnosed with mental illness builds upon naturally occurring encouragement. Maintenance of another’s wellbeing is oftentimes encouraged as a way to promote shared recovery experiences for anyone who has been diagnosed with mental illness, regardless of the diagnosis given ( as cited in Lloyd-Evans et al., 2014). This shared experiential experience is assumed to promote self-efficacy and hope and, likewise, to provide a socialization of coping strategies (Salzer & Shear, 2002).

In a thematic analysis of interviews conducted with peer-related supporters, Salzer and Shear (2002) found individuals who delivered peer support services via the principle of the helper therapy model reported that facilitating another’s recovery was something they both liked and benefited from. Such gains were noted to include a sense of empowerment, increased self-awareness, and facilitation of their own recovery (Salzer & Shear, 2002).

Over time, provision of peer support services has become an increasingly common facet of mental health services, with twenty-seven states in the United States permitting reimbursement of peer-related assistance (Lloyd-Evans et al., 2014). However, the efficacy of these services (e.g., mutual support groups; unidirectional peer-support services, peer mental health service providers) as an addendum to standard care remains in question.

Lloyd et al. (2014) conducted a systematic review and meta-analysis of randomized controlled trials of these peer-provided services. The investigation consisted of evaluating the effects of peer-related interventions across eighteen trials, totaling 5,597 adult participants (Lloyd et al., 2014).  Participants who were included in the investigation were diagnosed with schizophrenia spectrum or bipolar disorder, or were a mixed population of persons who utilized secondary mental health services (Lloyd et al., 2014). Interventions typically lasted from three weeks to two years (Lloyd et al., 2014). Interestingly, findings showed that there was little current evidence regarding the effectiveness of these services in improving outcomes in hospitalizations (Lloyd et al., 2014). However, similar to Salzer and Shear’s (2002) findings, there were some positive results for outcomes related to self-recovery, hope, and empowerment (Lloyd et al., 2014).


Lloyd-Evans, B., Mayo-Wilson, E., Harrison, B., Istead, H., Brown, E., Pilling, S., Johnson, S., & Kendall, T. (2014). A systematic review and meta-analysis of randomized controlled trials of peer support for people with severe mental illness. BMC Psychiatry, 14(1), 1-12. doi: 10.1186/1471-244X-14-39

Salzer, M. S., & Shear, S. L. (2002). Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatric Rehabilitation Journal, 25(3), 281-288. doi: 10.1037/h0095014

Shirreka Mackay, LPC
WKPIC Pre-Doctoral Practicum Student

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Friday Factoid: Cool Beans, Drinking Coffee with Coworkers Improves Group Participation

Move over water cooler talk and bring in the coffee break. Research with 72 undergraduates demonstrated that caffeinated beverages improve one’s views on those around us. These research participants were separated into two groups where one half had a “coffee tasting” before reading and discussing a controversial political topic, while the other half discussed the topic before having a coffee tasting. Those who had a caffeinated beverage beforehand rated their co-discussants and themselves in a more positive manner and were more willing to participate in the group activity compared with those who had the “coffee break” after the discussion. It was theorized that the positive impact of these moderately caffeinated coffees was moderated by a sense of increased level of alertness as those given decaffeinated coffee were less likely to rate their co-discussants as positively.

Unnava, V., Sing, A.S., & Unnava, H. R. (2018). Coffee with co-workers: Role of caffeine on evaluations of the self and others in group settings Journal of Psychopharmacology DOI: 10.1177/0269881118760665

Andrew Goebel, MS, LPA (Temp)
WKPIC Doctoral Intern

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Friday Factoid: Use of Antipsychotics When Not Psychotic: A Look at the Risks

Often children and youths are given antipsychotic medication despite not having symptoms of psychosis. These reasons include depression, ADHD, and other types of conditions other than what these drugs were designed for. Tennessee Medicaid enrollees aged 5 to 24 from 1999 to 2014 were included in a study by Ray, Stein, and Murray (2019). Excluded diagnoses were somatic illness, schizophrenia or related psychoses, or Tourette’s syndrome or chronic tic disorder. Three dosage groups were observed higher than 50 mg, lower than 50 mg, or controlled medications including antidepressants and mood stabilizers. Those prescribed the higher dosages of antipsychotics had a 3.5 greater risk of death compared with the other types of medications and dosages. These results show a need for closer management of prescription of antipsychotics and monitoring if they are given.

Ray, W. A., Stein, C. M., Murray, K. T. (2019); Association of antipsychotic treatment with risk of unexpected death among children and youths. JAMA Psychiatry, 76 (2), 162-171.

Andrew Goebel, MS, LPA (Temp)
WKPIC Doctoral Intern 

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Friday Factoid: “So, You Don’t Want To Be My Neighbor”: Stigma in Action

Stigma can be expressed in various different ways, however, the current understanding of most psychiatric stigma is based on one’s beliefs about a particular condition rather than concrete behaviors. As a way to draw beliefs and feelings to real world settings, a study was conducted to determine how 114 undergraduate students would react to a particular man that they would meet.  Each of the participants completed several measures of self-reported stigma before stepping into an adjacent room and choosing where to sit in relation to a man. Prior to the meeting the man was introduced as a volunteer at a health agency and was told to either have Type 2 diabetes or schizophrenia. As a part of the experiment, the participants were asked to enter the room and select a chair to sit on as they wait for the volunteer with one of the pre-selected conditions to return. On average those who were told they were meeting an individual with schizophrenia chose to sit further than those expecting to meet someone with diabetes. Their self-reporting showed higher levels of fear and appraisals of dangerousness and unpredictability towards the man with schizophrenia compared to the more well-known medical condition.

Thibodeau, R. & Principino, H. M. (2018). Keep your distance: People sit farther away from a man with schizophrenia versus diabetes. Stigma and Health DOI: 10.1037/sah0000156

Andrew Goebel, MS, LPA (Temp)
WKPIC Doctoral Intern

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Friday Factoid: Mouse Hugs over Hard Drugs: Implications of Neuroscience on Addiction Treatment

Neuroscience has only minimally contributed to addiction treatment. One of the factors that may advance research is this rodent model about social interaction and substance use. Researchers trained rats to make an operant level of choice between drugs or social interactions.  The two choices were either to press a lever for a drug (heroin or methamphetamine) or socialize with another rat. Across multiple conditions rats were consistently choosing social time over the drugs. These conditions were differing drugs, dosages, sex of the rat, and rat’s previous level of addictive responses to the drugs. The only time drugs were preferred was when researchers punished the rats for choosing social time with electric shocks or delaying access to other rats. These positive factors of social interaction are included in current treatment methods such as community reinforcement approach (CRA) which use social reinforcers such as support groups and positive work environments. The clinical implications are that they are hoping to use social-media approaches to expand use of social supports during or before drug-seeking episodes.

Venniro, M., Zhang, M., Caprioli, D., Hoots, J. K., Golden, S. A., Conor, H., … Shaham, Y. (2018). Volitional social interaction prevents drug addiction in rat models. Nature Neuroscience, 21, 1520-1529.

Andrew Goebel, MS, LPA (Temp)
WKPIC Doctoral Intern

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Congratulations to the Leadership Class of 2019!

“Leadership is a choice, not a position.” -Stephen Covey

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Article Review: Park, Y. C. et al. (2018). To use the brief psychiatric rating scale to detect disorganized speech in schizophrenia: Findings from the REAP-AP study.

The Brief Psychiatric Rating Scale (BPRS) is one of the most commonly used measures for assessing psychopathy in patients diagnosed with schizophrenia, particularly disorganized speech (Leucht et al., 2005). Conceptually derived from classical ideas originating in German psychopathology, the term disorganized speech, has come to be defined as “switching from one topic to another” in terms of an individual’s manner of communicating, responding to questions in an “obliquely related or completely unrelated” way, or less frequently, speaking in a way that is so severely disorganized that one’s verbalizations are “nearly incomprehensible” and linguistically resembles receptive aphasia (American Psychiatric Association, 2013). Though, despite this definition, difficulties continue to arise with respect to precisely conceptualizing disorganized speech, and the inversely associated formal thought disorder, due to the variableness of its etiology (Park et al., 2018).


The BPRS has been proposed as an evaluative measure for assessing the aforementioned atypical patterns. Regarded as one of the most commonly used measures for assessing psychopathology, this instrument has been frequently used to evaluate disorganized speech in patients diagnosed with schizophrenia (Park et al., 2018). Specifically, the conceptual disorganization item on this rating scale has been used to assess this symptom; however, its ability to accurately detect disorganized speech remains highly controversial (Park et al., 2018). Though, despite this controversy, very few studies have investigated the capacity for the BPRS to accurately distinguish this core symptom.


Thus, in an attempt to assess the psychometric validity of this measure and/or its conceptual disorganization item, Park et al. (2018) recruited a total of 3,744 patients diagnosed with schizophrenia via the REAP-AP study to participate in their investigation. A final total of 1,494 subjects from survey centers spanning across 5 different Asian countries participated. Those who were recruited, were selected based on the following inclusion criteria: diagnosis of schizophrenia, use of neuroleptics and/or psychotropic medications, and availability of a completed 18-item BPRS (Park et al., 2018). However, given differences in their languages, the English version of the BPRS was used to assess for disorganized speech and other psychopathy in each participant (Park et al., 2018). After adjusting for differences noted between patients who displayed this core symptom versus those without, results of their investigation showed that subjects with disorganized speech had significantly higher scores for emotional withdrawal, conceptual disorganization, mannerism and posturing, hostility, suspiciousness, hallucinations, uncooperativeness, unusual thought content, blunted affect, and excitement (Park et al., 2018). Similarly, when accounting for any degree of variability, conceptual disorganization, uncooperativeness, and excitement were shown to be independently associated (Park et al., 2018). Furthermore, results that were yielded from ROC curve analyses showed that scores from each of these scale (four) items, with their “defined optimum cut-off values,” accurately differentiated patients diagnosed with schizophrenia who exhibited disorganized speech from those who did not (Park et al., 2018, p. 118).



American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders   (5th ed.). Arlington VA: American Psychiatric Publishing.


Leucht, S., Kane, J. M., Kissling, W., Hamann, J., Etschel, E., & Engel, R. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry,             187(4), 366-371. doi: 10.1192/bjp.187.4.366


Park, Y. C., Kanba, S., Chong, M. Y., Tripathi, A., Kallivayalil, R. A., Avasthi, A., Grover, S., Chee, K. Y., Tanra, A. J., Maramis, M. M., Yang, S. Y., Sartorius, N., Tan, C. H.,           Shinfuku, N., Park, S. C. (2018). To use the brief psychiatric rating scale to detect                  disorganized speech in schizophrenia: Findings from the REAP-AP study. Kaohsiung Journal of Medical Sciences, (34), 113-119. doi: 10.1016/j.kjms.2017.09.009


Shirreka Mackay, LPC
Practicum Student, Western State Hospital

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Friday Factoids: Mental Health and the Courts

  • In 1980, President Jimmy Carter signed the Mental Health Systems Act of 1980, which provided grants directly to community mental health centers. Though, it was short- lived.
  • Between 2009 and 2012, the US legislatures cut a total of nearly $4.5 billion in services for the mentally ill, even though patient intakes increased by nearly 10%.
  • 6 out of 10 states with the least access to mental health care also have the highest rates of incarceration.
  • 73% of women and 55% of men have at least one mental health problem in state prisons.
  • 61% of women and 44% of men have at least one mental health problem in federal prisons.


If you would like to read more about the mental health system in relation to the courts, here are some additional resources:


Hannah Sutherland, MA, LPA (Temp)
WKPIC Doctoral Intern

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