Mental Health Begins Where the Straitjackets End
WHY YOU SHOULD CARE
Because physical alternatives to mental distress might just help us all.
By Eugene S. Robinson
You have a teenager deep in the midst of puberty, with the strength to boot, who is upset. Additionally, the kid is big and, oh yes, autistic. Quick: What do you do?
Well, if you’re anything like one of the mental health professionals currently working with special needs kids, you’re looking at the very clear possibility of having your hair pulled or being bitten or choked, or worse, you’re on your way to doing maybe the least advisable thing with notoriously touch-averse autistic kids: grabbing him. Physically restraining mental health patients has been a playbook standard for so long that there didn’t seem to be a need to look for an alternative.
Enter Christopher Feltner.
With degrees in education, speech and interpersonal communication, the 37-year-old Feltner was on his way to getting a master’s degree in special education right around the time he realized that that wasn’t really the it he had been looking for. Direct care with teens with severe emotional disabilities and trauma histories? That was it, but with a twist: Feltner wanted to combine his course work and his lifelong interest in martial arts. But where?
A tricky question to answer, especially given that America’s attitudes about mental health issues have traditionally not been that progressive, a fact that caught Ruth Birch’s eye back in the 1950s when she discovered her son had a learning disability. Birch looked around for treatment options that were anything other than highly structured, and then she did the only sensible thing she could think of: She started a school, Grafton, for kids with special needs. Fifty-seven years later, Grafton had expanded well beyond Birch’s wildest imaginings into what Virginia’s Department of Behavioral Health and Developmental Services calls a human service provider. With a job opening.
“It was in their training department,” Feltner says from his home in Strasburg, Virginia, where he lives with his wife, a commercial engraver. The first thing he did was to develop a set of techniques to protect his staff from the occupational physical aggression that would inevitably come their way. “Truly our organization was paralyzed about what to do,” says Kimberly Sanders, Grafton’s executive vice president and chief outcomes officer, of the fact that from the late 1990s until about 2004, they had been following an industry standard and were using high numbers of restraint and seclusion options for patients in crisis. People were getting hurt, and directors were in desperate need of a physical way for employees to keep themselves and others safe that wasn’t a restraint.
Feltner, who is 6 feet and 244 pounds, drew on his background in wrestling, Western boxing, Brazilian jui-jitsu, aikido, muay Thai, American kenpo, and tae kwon do to come up with something that used the gentle parts of every one of those martial arts. At first, it was mostly blocking techniques using soft objects and compressed-foam karate kick shields and, more significantly, the notion of comfort versus control. “We really wanted something that had a comforting feel,” says Sanders, which sent the message to the person in crisis that the staff wanted to help them through their difficult time. “We wanted something to strengthen relationships versus tear[ing] them apart.”
Calling it Ukeru, from a Japanese word meaning “to receive,” and based on his understanding of body mechanics and his martial arts experience, Feltner started working on a full set of techniques with Sanders and others of various ages and sizes who “trusted me, and each other, enough to allow hard practice on one another to make sure that the techniques worked and, just as important, that they didn’t hurt the person aggressing toward us.”
Within six months the results had come in, not so much trickling as flooding, from Grafton’s residential services program for kids, their programs for adults, their psychiatric residential treatment facilities and their outpatient services. Those results were overwhelmingly positive and supported Feltner’s idea that it was possible to do this job without restraining and secluding patients and without anyone getting hurt. And beyond the staff’s very real hands-on experience, their success in spreading the good word was great. Moving to facilities in Virginia, Ohio, Alabama and Australia, Ukeru seems to be leading a revolution of sorts (it has also been used in four of California’s developmental centers).
“I can imagine that there are still some situations that you find in a clinical setting that would challenge those techniques,” says Irma Norman, a mental health professional whose work has taken her into New York’s notorious Spofford Juvenile Center. “Patients with pica will eat anything they can get their hands on and this wouldn’t stop them.” She adds that “really violent patients” would probably not benefit from Ukeru, and nor would their caregivers.
There are some situations that are “still challenging” to Ukeru’s techniques, says Sanders. But for those situations, she says, there simply are no safe and effective techniques. “And look, we all could do wonders in our real lives by focusing on de-escalation strategies,” Feltner concludes. All of which, in total, sound better than a straitjacket and a beating. A fact that Feltner, whose vibe is overridingly gentle, despite both his size and martial arts attributes, makes clear when you notice for the first time that his bear paw of a hand has been on your shoulder and you feel nothing but ease. Something needed now more than ever maybe.