A Virginia facility for the criminally insane has for years routinely used metal restraints such as leg irons and waist chains on its patients, a practice that mental health experts today categorized as an archaic form of control dating back to the 19th century.
After receiving a report on the practice, Joseph J. Bevilacqua, the state commissioner of mental health, today said he has ordered the use of leg irons abolished entirely and was instituting a series of other reforms at the facility, the state forensic unit of Central State Hospital in Petersburg.
The report, prepared by two mental health officials from Pennsyvlania, states that treatment of patients at the 125-bed maximum security unit has been "nonexistent or very limited." Instead, there has been "extensive use" of restraints, particularly metal handcuffs with waist chains.
"My God, it sounds like Devil's Island," said H. Bernard Smith, executive director of the National Alliance for the Mentally Ill. "It was not uncommon in the 1700s and 1800s to use metal shackles on mental patients. It's really a throwback. I'm glad to see Virginia is finally joining the rest of the country."
State health officials were less dramatic today in describing conditions at the facility, a two-story, 43-year-old brick building on the grounds of the Central State mental hospital, although they acknowledged they were troubled by some of the practices there.
Michael Camarata, who took over as director of the facility in June, said that when he learned last month that leg irons were still being used, "I was taken aback." According to new guidelines set down by Bevilacqua, Camarata said he has recently purchased a set of leather restraints, which he described as a more humane way of controling the facility's frequently violent patients.
The Central State forensic unit is Virginia's only facility for housing the criminally insane and is thus home for the state health system's most dangerously ill patients. Of the 124 patients currently housed in the building, 43 have been charged with murder and 38 with violent assault, with the rest of the population consisting of arsonists, rapists and other violent criminals. The patients are watched over by a staff of 154.
Handling the patients, many of whom are paranoid schizophrenics, is a constant problem at the facility, Camarata said. "When no one else can handle the folks, they send them here," he said. "Some of them have such low control, they're liable to violently assault you for no reason at all. They may not like the clock, they may not like your shirt, you may be talking too soft, you may be talking too loud.
"What do you do when a fella says to you, 'If you take these restraints off I'm going to kill you?' " he added.
Nevertheless, Camarata said, the new goals of the facility will be to change from "less of a control model to more of a treatment model." He said he already has cut down on the use of restraints substantially and as of yesterday, only five patients were so confined.
Under the new guidelines announced by Bevilacqua and Camarata today, the use of any restraints at all must be specifically approved by the hospital director and, by Nov. 1, only the new leather controls will be used.
In addition, the guidelines call for scaling down the facility to 113 beds by July 1, 1983, training programs for the staff in the management of violent patients, and increased emphasis by the staff psychiatrists and psychologists on the treatment of patients.
According to the report, prepared by Dr. Scott Nelson, the Pennsylvania deputy secretary for mental health, and Vincent Berger, the Pennsylania director of forensic services, the doctors at Central State have spent "extensive time away from the unit" giving court testimony.