"WE ALSO THOUGHT THESE CASES WERE FLUKES," SAID THE FDA'S CAROL HERMAN, "UNTIL WE STARTED DIGGING."

THE F.D.A. NOW CONSIDERS LAP AND WHEELCHAIR BELTS, FABRIC BODY HOLDERS AND RESTRAINT VESTS TO BE PRESCRIPTION DEVICES.

MANUFACTURERS ARE SUBJECT TO F.D.A. INSPECTIONS TO ENSURE QUALITY CONTROL.

SUCH STEPS; ADVOCATES SAY, HAVE BOTH REDUCED AND IMPROVED THE USE OF RESTRAINTS.

IN THE MENTAL HEALTH FIELD, STRONG AND INDEPENDENT GOVERNMENT OVERSIGHT CAN WEED OUT BAD PRACTICES AND BAD FACILLITIES AS WELL, THEY SAY.

"WE CAN'T DO IT ALONE," SAID CURTIS L. DECKER OF THE NATIONAL ASSOCIATION OF PROTECTION AND ADVOCACY SYSTEMS.

"THE ONLY WAY TO TRULY PROTECT PATIENTS IS THROUGH A LARGE, COMPREHENSIVE MONITORING PROGRAM."

THAT MEANS A SYSTEM WHERE GOVERNMENT REGULATORS; NOT THE INDUSTRY ARE CHANGED WITH OVERSIGHT, HE SAID.

MORE THAN MONEY, THOUGH; MANY ANALYSTS SAY A CULTURE IN WHICH RESTRAINTS ARE USED TOO SOON, TOO FREQUENTLY AND FOR THE WRONG REASONS MUST BE CHANGED.

"THE SINGLE BIGGEST PREVENTION METHOD IS THE AVOIDANCE OF RESTRAINTS TO BEGIN WITH,"SUNDRAM SAID.

"IT IS OFTEN THE TRAINING AND OPINIONS OF STAFF THAT DICTATE RESTRAINTS, RATHER THAN PATIENT BEHAVIOR."

IN TENNESSEE,"THE CHANGES WERE TOP-DOWN;BOTTOM-UP AND A HARD SELL EVERYWHERE," SULLIVAN SAID.

BEFORE TAKING THE TOP TENNESSEE JOB, SULLIVAN SPENT 27 YEARS AS AN OFFICIAL IN CONNECTICUT'S DEPARTMENT OF MENTAL RETARDATION.

REDUCING RESTRAINT USE WAS JUST ONE OF MANY CHANGES FORCED ON TENNESSEE BY TWO LAWSUITS FIILED BY THE U.S. DEPARTMENT OF JUSTICE AND BY PATIENT ADVOCATES, "IT WAS A SYSTEM THAT WAS DISINTEGRATING," SAID RUTHIE BECKWITH OF PEOPLE FIRST OF TENNESSEE, A PATIENT ADVOCACY ORGANIZATION THAT SUED THE STATE.

THE STATE RESPONDED WITH NEW LEADERSHIP, MORE MONEY AND STAFF AND AN INTENSIVE TRAINING REGIRMAN EMPHASIZING CALMING WORDS INSTEAD OF BRUTE FORCE.

THE TOTAL COST FOR THE JORDAN CENTER: $12,665 FOR TRAINING IN RESTRAINT USE AND ALTERNATIVE METHODS; $255,372 ANNUALLY IN ADDITIONAL STAFFING TO ADDRESS NOT ONLY RESTRAINT ISSUES BUT MASSIVE DEFICIENCIES IN OVERALL PATIENT CARE.

THE CHANGES IN TECHNIQUE WEREN'T EASY ON STAFF, ABOUT A HALF-DOZEN AIDES QUIT.

"IT WAS A ROUGH COUPLE OF MONTHS," SAID ROBERT ZAVALA, AN AIDE AT JORDAN, "AT FIRST, THEY JUST TOLD US WE COULDN'T PUT OUR HANDS ON THEM; EVERYONE WAS LIKE, 'OH SO ALL I CAN DO NOW IS RUN AWAY"

BERNARD SIMONS, THE CLOVER BOTTOM SUPERINTENDENT WHO OVERSAW THE TRANSITION, REMEMBERS A DEFINING MOMENT.

HE RECEIVED A FRANTIC CALL FROM STAFFERS AT JORDAN SAYING A PATIENT WAS SMASHING FURNITURE AND ASKING WHETHER THEY COULD RESTRAIN HIM.

" I SAID, 'LET HIM BREAK IT' " SIMONS SAID; "SO YOU'RE GOING TO RISK HURTING YOURSELF OR THE PATIENT FOR A $100 COFFEE TABLE? THE STATE WILL BUY A NEW ONE."

THE CHANGES ARE BOTH PROFOUND AND SURPRISING TO STAFF AND PATIENTS WHO REMEMBER THE OLD WAYS.

"BEFORE, WE WEREN'T EARNING THEIR RESPECT, IT WAS JUST FEAR," SAID OVERTON; THE BURLY AIDE WHO STILL WEARS A BELT THAT SAYS "BOSS"

"NOW I'M MORE OF A COUNSELOR OR BIG BROTHER THAN AN ENFORCER," OVERTON SAID; LIKE A COLD WAR RELIC, HE NOW USES SKILLS OTHER THAN JUST HIS BRAWN; SUCH AS HIS WOODWORKING KNOWLEDGE WHICH HE PASSES ON TO PATIENTS IN A NEW CLASS HE TEACHES.

"I USED TO GET SHUFFLED A WHOLE LOT OF TIMES WHEN I WOULD GO OFF AND HIT SOMEONE;" SAID DAVID HOLLAND, 24 WHO HAS BEEN AT THE JORDAN CENTER FOR 2 AND A HALF YEARS; "NOW, THEY GIVE US A LOT MORE TIME TO CHILL OUT AND CALM DOWN, IT'S GETTING BETTER EACH DAY."

END