The METO Settlement

Roberta Opheim: One of the things that was of grave concern to us is that when a person is in a program like that, their family is still their family, and their family will be with them for the rest of their life. The program might be part of their life for a short period of time or maybe a few years, but certainly not their entire life.

Yet families felt they were cut out and alienated, that they weren't listened to, and if they objected, they sometimes had the amount of visiting they could have with their loved one cut back. Or they would be threatened with discharge, which the family, not being professional thought, "Well, I can't handle this person at home, so what can I do?"

And so they were afraid. Or they were even threatened with maybe they would have to go back to court and reconsider whether the guardian was doing their job and whether someone else should be appointed. And the guardian, of course, has the ultimate authority to approve or disapprove of the practices. And when they disapproved of the practices, they were highly pressured. And that was an area where we felt staff needed to develop much more of a team concept. The patient is part of the team, the clinical staff at the facility, as well as the operational staff, but also the family and the county case manager.

We also found that people might have been aware that there were restraints but they were unaware of the type of restraints, they were unaware of the number of times someone was restrained, and so that communication between the decision maker and the facility needed to be significantly improved if it was to ever meet its goal to be a short-term, re-directive stabilization program so the person could return to an integrated setting in the community.