Experts urge staff at psychiatric centers to physically restrain patients in “protective holds” only as a last resort to keep them from hurting themselves or others.
But during a five-month period, Linda Gulya says, workers at Strategic Behavioral Center in south Charlotte put her teen daughter in a hold at least 38 times.
The girl, who was adopted from Russia, has reactive attachment disorder, a condition generally found in children who were severely neglected before age 5 and do not form loving relationships with caregivers.
Research shows physical restraints can cause unnecessary trauma to patients who are already struggling. The American Psychiatric Nurse’s Association, a leading group, aims to reduce and, ultimately, eliminate the use of staff physically holding patients.
Gulya, 52, said she is angry that Strategic did not inform her each time workers restrained her daughter.
“Who knows how many she had,” said Gulya, who requested the Observer withhold publication of her daughter’s name to protect the teen’s privacy and mental well-being.
Experts encourage staff at facilities like Strategic to use methods other than restraints, including empathetic patient-staff interactions and providing patients with meaningful activities.
Strategic said it cannot address specific patients’ treatment due to privacy requirements. The company said in a written statement that its workers use restraining holds when patients exhibit an immediate danger to themselves or others.
“Sadly, the patients we treat are often troubled, and sometimes act out physically,” the company said. “When this occurs, restraints are our last-resort intervention to assure the safety of the patient, other patients and our staff.”
Linda Gulya and her husband, Chris, run an accounting business from their home in Fuquay Varina, just outside Raleigh.
They took home two babies, a daughter and a son, from Russia in 2002. Because the children received little attention in the Russian orphanage, they developed reactive attachment disorder, the Gulyas said.
Their daughter, the oldest of the two, was in a public school system until she was 15. After several incidents, including her running away from home, she went to the University of North Carolina Crisis Stabilization Center in July 2016, then to Strategic’s Garner facility for acute care. In mid-August of that year, their daughter arrived at Strategic Behavioral Center in Charlotte.
In a detailed spreadsheet, Lunda Gulya documented every time she learned of her daughter being placed in a hold, had a medical exam or was given medicine at Strategic.
A week after arriving, their daughter was placed in a hold for the first time after she was aggressive toward staff, according to Gulya’s notes. It lasted 12 minutes. Other holds occurred because the teenager was trying to break through doors.
Some of the holds lasted only a few minutes, but in other cases the Gulyas’ daughter was restrained for up to 25 minutes.
If she did not calm down, staff would give her medication by mouth or an injection, Linda Gulya said.
Strategic did not contact Gulya about placing her daughter in a hold at least eight times, according to her notes. She learned about some of the holds after the fact at meetings with the treatment team.
Strategic said it is policy to inform parents of any incidents involving their child and inform parents and obtain their approval on medications, although this communication is sometimes delayed in emergency situations.
Paula Yost, chairwoman of the Cabarrus County Child Protection and Fatality Team and an advocate for the disabled, said that 38 protective holds in a five-month stay is troubling.
Yost said she would question whether the girl's treatment plan was effective.
“Sometimes physical restraints are necessary, but that doesn't sound normal,” Yost said. “That sounds like something that could be avoided. If I am her parents, I am asking ‘Why aren't they going to her psychiatrist?’ She's in the facility so things like that don't happen.”
Strategic also didn’t notify Linda Gulya after they heard news reports that a staff member was charged with statutory rape at the center while her daughter was there, she said.
Strategic said in a written response to the Observer that staff immediately notified the state Department of Health and Human Services and has cooperated with the department’s review of the incident, and with the law enforcement investigation. “Our policy is also to notify parents/guardians, and we did so in this case.”