3,181 Comments Posted by Lynne

Ha! Good point, Thad!

What an amazing room!

Feels like the ribs of a spaceship.

Whoa! I can sure feel the humidity from this one!

All we need is Sherman.

I like the perspective on this one.

Good on ya, Bean! :-)

And you'll clean the durned lightbulb off at the same time with all that nice soap! ;-)

StacyMarie, my dear, haven't you ever seen a picture of Big Foot? I could manufacture a "photo" in 5 minutes that would turn that soap dispenser into a lovely light fixture - and how could anyone refute THAT lovely photographic evidence? ;-)

What's with the coming onto someone's site and making rude, unsolicited comments while forgetting basic grammar, punctuation, manners, and showing an obvious lack of awareness that some people have a wider appreciation of aesthetics, yet at the same time making yourself an object of scorn, derision and pity? :-)

angel,

There are several possibilities about why the jets were placed at the sides and you can't see any water controls. One is that staff can control the amount and temperature of the water this way. I have had many a client who has gotten EXTREME joy out of flooding the bathroom. I have also had several clients who have accidentally gotten into the bathtub and scalded the hell out of themselves and had to be hospitalized with pretty serious burns. Many places now require a scald-guard device on all hot water heaters before they will license you for a group home or foster care.

Another idea is that the bather can't hit his or her head on the faucet/tap if the metalwork isn't poking out. We have had problems with that from people being intentionally self-injurious, from people having poor motor control and slipping, or from people having seizures, although obviously we don't have that many folks who have seizure conditions who also have bathing programs. At least, not without a safety strap system like I was commenting on earlier somewhere else. Easiest and safest solution if a seizure condition exists is to use a shower instead of a bath, unless you need the bath for therapeutic reasons.

OK, as you noted, they also used to have hydrotherapy. There were several different types of hydrotherapy. It was initially used where they doused ice-cold water on a person's head to "shock them out of their madness." This was back in the 1700 to 1800s. The idea was to "cool the hot blood in the head" and force a "return to sanity," insanity supposedly being caused by too much hot blood in the brain.

Then there was a period of time where they believed that running cool water over pulse points would help calm an agitated person. It's like we do today if someone is having a heat stroke.

Next, after bathing became a more usual occurrence than several times a year, they observed that many people seem to relax after a warm bath. So they put people in bathtubs in a canvas sling that kept them in the tub and piped body-temperature water in continuously. The idea was to use continuously flowing warm water to calm down and relax the more manic folks, and it actually worked with a number of people. This is before antipsychotics were invented, so again if you look at being placed in a straitjacket, 4-point restraint, or seclusion versus being in a tub, well, I am going to go for the tub. However, sometimes the folks were in the tubs for hours at a time, and in some cases, for several days in a row. The water was continuously cycled through the tubs - current water out, clean water in - so if someone had to relieve themself, the water washed out the tub fairly quickly. Don't ask me how sanitary this was - I have never actually seen it used. I did read somewhere that using hydrotherapy in this form actually reduced the overall percentage of patient hours spent in seclusion or restraint by a third or more, so this was a pretty impressive situation before any "scientific" treatments were discovered or tried.

I am going to hazard a guess that this was the purpose of this particular tub. On the next page you can see the large drain toward the bottom of the far wall of the tub, which was probably where the water drained while clean water came in slightly higher up on the bathtub walls. I don't know if the inverted metal section is a soap holder, but I know that where I work we are only supposed to have soap holders that go into the shower wall, as protruding soap holders are a constant source of accidents and injuries when clients trip or slip and hit them.

Another technique that was sometimes included under "hydrotherapy" was wet sheet packs, where they wrapped cold wet sheets around an agitated person and "cocooned" them in the sheets and restrained them until they warmed up the sheets. I believe this had to do again with the idea that someone who was agitated and manic needed to be "cooled off" physically, so even though this is NOT how I would choose to spend an afternoon, it wasn't initially started as a cruel practice to torture people - there was an initial therapeutic reason behind it - don't know what it was, so I'll probably go look it up later.

Finally there is hydrotherapy as most of us know it today, where the person voluntarily goes into lovely warm or hot water, but it is usually part of physical therapy of some sort for a physical injury or to help with muscle spasms or cramps.

OK, that was definitely WAY more than you asked for. :-)

A time-out room is not supposed to be used as an aversive intervention - it is used to remove someone from a reinforcing environment for a SHORT period of time or to give them a chance to be somewhere they can work on calming themself down. It is generally used for more severe behavioral outbursts, such as aggression against others, and this is even further extended to tissue-damaging aggression against others, not just a slap here or there. This sounds like semantics, but it is an important distinction both legally and clinically.

If you have the time-out room door set up so that when you walk away it will automatically swing open, it prevents a staff person from leaving a client in time-out for a lengthy amount of time. After a certain amount of time has passed and the person is still in the time-out room it becomes obvious you are either using the time-out room because you are angry at the person (retribution) or you want them "out of the way" (staff convenience), and neither one of them is therapeutic. If the staff person has to stand at the door to keep it latched from the outside it means they have to remain in the immediate area, which means they won't be tempted to walk away to do something else, possibly lengthening the amount of time the person is in time-out. When time-out is used there are generally a set of "release criteria," such as being calm and/or quiet for 15 seconds before the door is open. If the staff walks away they can't tell when the client is ready to leave the time-out room, and it may only be a minute or two that the client actually needed to calm down. As well, the staff person needs to be right at the door to either hear or see if the client gets into trouble - if they have a seizure, have a heart attack, engage in self-injurious behavior and need to be removed, etc. I don't believe I ever allowed anyone in time-out past 30 minutes tops - and of course that was only if they continued to threaten others or actually tried to harm someone again when the door was opened. And even on my roughest unit with some pretty tough gentlemen I don't believe we used it for more than a handful of times per month ever.

This is different than a seclusion room. Seclusion rooms are used in mental health facilities and are used in lieu of straitjackets or 4-point restraint. They are utilized if someone is severely agitated or aggressive and needs to be apart from others but won't hurt themself if left alone. The door to the room is locked and the person is left in the room with some form of monitoring, although monitoring is a relatively new requirement. I would certainly support a seclusion room if the only alternative was a mechanical restraint (straitjacket or 4- or 5-point restraint) or chemical restraint (almost always antipsychotics these days). It gives the person the option to calm themself down without being restrained or drugged, and I think that is a very good thing.

There are many times when people are so out of control that they may need one of the more restrictive options, such as if they are huge and strong or if they try to hurt themself and won't stop. Everybody in the general public hates straitjackets and drugs until they have a 300-pound person throwing a bed or file cabinet in their general direction. That isn't meant to be a negative comment toward people who are in such a terrible situation that they have lost control; it is meant for those people who seem to be offended that restraint, meds, or seclusion are ever used without realizing the alternative, which is getting your butt badly kicked or possibly losing your life.

I shoulda taken a picture of the one that I mentioned in one of the above comments, but, as I said, the gentleman for whom it was initially designed ripped it apart after our first trial. We finally took the padding out because the other gentleman who used to require short time-out periods back then would, em, er, uh, well, use the padded wall to relieve himself, just to irritate us, so we took out the padding and just left it a simple little wooden-walled time-out room.

Of course, a "simple little time-out room" has so many legal specifications you can't believe it, as it rightly should. It has to be a certain number of square feet and you need adequate ventilation and lighting and temperature control and you must be able to see the person at all times in case they try to hurt themself or become ill, and you can't latch it shut - it has to be set up so that if the person outside the room walks away, the door must automatically swing open. That's so they don't place people in there and just walk away and leave them for long periods of time, like used to happen in the bad old days before time-out rooms were better regulated.

I haven't needed a time-out room for a client for probably 15+ years - in that short of a time we have been more effective in our techniques, we start more training and education at a younger age, there are more sophisticated behavioral programs, and there are better medications if there are concomitant psychiatric issues. And that's a very good thing to be able to say. :-)

Help! My computer ate this and sent it before I was finished! =8-o

I tried to say, "Isn't that right?" at the end, but the post done went and sent itself before I could do anything! ~Me's orb must be caught up in all this somehows! =8-o

My sweet ~Me, I believe you haven't been wrong yet. is t ;-)

I think those pipes were actually hooked up to empty water directly into the tub, but I have been wrong before (well, three hundred times already today, and that was just before lunch). I worked at a place once with similar old tubs and that is how those worked. These could be totally different, of course.