New State Hospital Already Destined to be Closed

In an article, “New state hospital may close,” published in the Bulletin of the Salem’s Central Oregon region,  the Associated Press reported December 3, 2016, that Oregon’s Governor Kate Brown had suggested she had decided or was in the process of deciding to close a new state psychiatric hospital, in the Eugene, OR area, near Junction City. which is the new site of the original Oregon State Hospital.This hospital has a total capacity of 100 beds.

The hospital which has been open only 18 months and cost $130M to build, is slated for possible/probable closure in mid-2018. Its closure was heralded as necessary to save the economically beleaguered state much-needed monies. No real details are given by the state personnel’s’ announcement concerning this drastic move except there is a large budgetary “hole” in the state’s health care departments’ budgets and closing the hospital, which has 422 employees will save the state $34.5M a year.

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Is Privatization of State Hospitals A Viable Solution?

An article by Annie  Gilbertson KPCC news  of Califorma that appeared yesterday, “California counties look to private firm to run new state psychiatric hospital, again takes a look at a solution that has been lingering in the wings of state legislatures and policy wonks for several years now, and that is of getting out of the business of running and financing state psychiatric hospitals altogether by the good old mechanism of “outsourcing.” Outsourcing has a decidedly mixed track record, with some successes in various industries, massive job losses in others. In some industries such as major passenger airlines big and small, outsourcing has had disastrous results. Some readers may be able recall vital passenger airplane  maintenance duties being outsourced to private companies to avoid higher union wage costs. The outsourcing companies would save the airlines money by employing lower-paid and as it turned out less well-trained technicians and cut corners such as quality control, with mixed and sometimes catastrophic results. Even the ‘business’ of war in the George Bush years saw the use out “outsourcing” which is some military experts’ opinions and views were nothing more than employing American mercenaries to fight in questionable military operations in Iraq and Afghanistan. Remember the ill-fated romance with the firm Blackwater that turned out to be a mess?

The federal and state correctional systems have been utilizing corrections companies to run prisons for over two decades now. There are some very solid parallels between the prison “industry” and the state psychiatric hospital spheres. Both of these areas of operation of governmental entities have in the last several decades the huge costs of replacing dozens and dozens of aging, falling down, buildings and facilities built in the late 1800’s. I recall consulting at a state prison in my home state for several years. that prison was from the late 1800’s. Parchman prison in Louisiana is another very famous example of a prison from a different, not so ‘nice’ era.

Continue reading “Is Privatization of State Hospitals A Viable Solution?”

History of Osawatomie State Hospital in Kansas as National Metaphor

Ms. Megan Hart of the Kansas Public Radio Station KCUR and the group Heartland Health Monitor partner KHI News Service has been following and chronicling the long sad story of the Osawatomie State Hospital in Kansas for quite some time now, nearly two years or perhaps longer, that this writer has been aware. Ms. Hart’s latest article, “Osawatomie State Hospital: A Leading Light for Mental Health Care Slowly Dims.” published  July 25, 2016 documents very ably both the issues of this state hospital, its parent state, and the social vise that all too many such state hospitals more or less find themselves facing in this time of hoped for reform.This piece of American state hospital history is in many ways not unique to the fascinating and very checkered social history of the American state psychiatric hospital for public inpatient care of the seriously and chronically mentally ill.

Continue reading “History of Osawatomie State Hospital in Kansas as National Metaphor”

State Hospital Psychiatric National Bed Count Hits Historic Lows: Good or Bad?

A now slightly dated article published July 4, 2016 in many papers authored by Lateshia Beachum of the Washington Post that I came across in the Walla Walla Union Bulletin of Washington state recorded the magnitude of the cut backs nationally in public state hospital beds psychiatric beds. While this has long been known as a trend occurring over at least the last five decades, this article startled even this observer by how many beds have been cut by state governments in just the last several years. The article was entitled, “Psychiatric bed count hits record low in state hospitals.”

The first sentence of the article hints at two of the main themes: “The number of psychiatric beds in state hospital has dropped to a historic lows, and nearly half of the beds that are available are filled with patient from the criminal justice system.”

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Central State Hospital’s Failure to Report Patient Death Imbroglio

Just yesterday I wrote briefly of the contrasts between New Hampshire and Vermont who face difficult state wide mental health service care delivery tasks.

Today I feel I have to return to a story, or rather a sad saga, of Central State Hospital in Virginia. Virginia since the tragedy of State Senator Craige Deeds’ son Gus who was variously reported as bipolar or schizophrenia, committed suicide two years ago. The circumstances were unbelievably tragic, sad and preventable if, in my view, public and/or private psychiatric inpatient facilities had done their duty [more on that rant later below]. In brief summary, young Gus was in his very early 20’s and had been repetitively psychotically mentally ill for a few years illustrating the typical early adult onset of these illnesses, especially schizophrenia. He became psychotic again and stabbed his father. He was taken by his father to a nearby hospital ER, a hospital without a psychiatric inpatient unit. He was held in the ER for some period of time [the reports vary from hours to a few days]. He had to be released under less than clear circumstances because a bed could not be found for him in ANY psychiatric inpatient unit in the state, which to me is the first bad tip off in this saga. He very shortly thereafter, while apparently still quite symptomatic and actively ill, suicided. As is well known, his father Sen. Deeds has thrown his considerable talents, knowledge, energies and influence into crafting exemplary legislation in Virginia to correct many cracks and deficiencies in their combined state system of psychiatric care. Of note is the lingering issue that his bill is still not law in Virginia.

Now to the current unfolding tale of woe, and goodness knows what else that is week by week it seems, unfolding out of Virginia’s Central State Hospital. There have been a series of near damning articles in multiple minor and major newspapers in Virginia detailing the trial of failures it appears that resulted in the death of a woman named Valerie Anderson now buried on the campus of Central State Hospital since she died there.

Grave of Valerie Anderson
Grave of Valeria Anderson

The accounts from the various media, best summarized in the article, “State fails to notify family woman dies at Central State Hospital,” which appeared in the July 3, 2016 edition of the Culpepper Star-Exponent, shows that this woman was likely chronically mentally psychotic, a neighborhood recurring disturbing presence and was arrested for misdemeanor trespassing May 14, and was jailed as she was poor and could post a $1,000 bond. She was reportedly evaluated and cleared because of unspecified behavior in jail, and transferred May 24, 2016 to Central State Hospital. All without notifying her family but there were real issues with this part as she was out of follow up treatment and no one seemed to know where her family resided or how to contact them. She then died under unclear circumstances at Central State Hospital May 26th. The family as time went on, found they could not contact her. No one who knew her knew where to look. Meanwhile, the hospital for various and sundry reasons apparently did not do due diligence in following up and trying to establish more information about her and to contact the family. It finally took the Richmond Times-Dispatch in June bringing a Freedom of Information lawsuit to secure, confirm and establish that this lady had died in the hospital. This was prompted as described in the article thusly: “The search for answers in Valerie Anderson’s death was launched in earnest last month after the spokeswoman for the Department of Behavioral health and Developmental Services and other state officials declined to provide any details related to the transfer of an inmate from Hampton Roads Regional Jail to Central State Hospital.”

“Among the information officials initially would not provide about the Central State Hospital death: the patient’s name, gender, and age’ when he or she was transferred to the hospital; when exactly he or she died; and when and why the person had been incarcerated.”

Further, “Later, they to The Times-Dispatch that the patient was female, had been arrested for trespassing; was evaluated and medically cleared on May 24 for admission to a state hospital following mental health crisis at the Portsmouth jail; and was transported Central the following. she was found dead the morning of May 26 by a hospital worker.”

The intrepid reporters for the Times-Dispatch, then armed with the scant information they were able to gain from their Freedom of Information suit, did gumshoe, old-fashioned journalistic ‘detective work.’ and examined Newport News court records, found the record of a Valerie Anderson trespassing charge. And of things in the newspaper “morgue file,” as they used to be called, they found a sticky note marked “Important,” that gave the date of May 25 as her transfer/admission to Central State, and of May 26 as the date of her death.

An instance of denial by hospital officials June 8, to the Times-Dispatch team working the story, prompted them to only dig further [my characterization of what appeared to happen] and her grave was located on the grounds of the hospital. The Times-Dispatch also then were the ones–get this folks!- to locate her family and notify them of her death. Unbelievable…

As it turns out Virginia DOES have good state laws and mandatory procedures for handling patient deaths in state institutions of any kind and they are detailed quite objectively in the above-cited article.There are well-defined time frames in which certain steps must be taken in order and that the steps must go up the state government’s chain of command in a certain order to the highest levels. But the article’s description of the halting effort the hospital made in its description of the events and refusals and declinations to give information makes for sad but also infuriating reading. To make matters worse, the family was rebuffed initially in their efforts to gain information regarding the fate of their mother. This makes for tough reading as the article details the obfuscating and self-justifying responses of the officials that were contacted.

I will end this story with a final slightly lengthy quote which I think emodies the then attitude of the protective state functionaries [a kinder word than I think the families or reporters would use] who were in a position to help the family and reporters: “Anderson had a personal Facebook page and was online frieds with her four children. But social media sites and internet search engines are not part of the process state workers use to locate family members [I would ask WHY NOT?] when someone dies in custody, according to Maria Reppas, spokeswoman for the Virigina Department of Behavioral health and Developmental Serivces…The facility does not take steps such as conducting Google searches or looking through Facebook sites to locate next of kind nor is it required to do so,” Reppas said in a email.

After the family learned through the newspapers’ reporters that their mother was indeed deceased and had been buried in the hospital cemetery, the daughter Jacqueline asked to visit her mother’s gravesite. The article states at its end that she was told she would have to make an appointment to do so.

 

 

 

 

 

 

 

 

Bridgewater State Hospital and Its Problems

I became aware of Bridgewater State Hospital during my college and medical school years in Ann Arbor, Michigan through two events in my student life back then.

First, I was able to see the famous documentary movie, “Titicut Follies,” almost accidentally at a university sponsored film festival in 1970 or so. The film was all the rage since it had been “banned in Boston” by the Supreme Court of Massachusetts.  It was filmed in 1967 by the now acclaimed filmmaker Frederick Wiseman. I remember not knowing really anything about the movie, but going with friends to see this controversial movie. At that time, I had not settled on a future career in psychiatry. I was stunned at the content of the movie which showed deplorable conditions at a correctional center division of the state hospital located at Bridgewater Massachusted. After I finished medical school, I was

After I finished medical school, I was fortunate enough to land a six-month externship in forensic psychiatry at the Center for Forensic Psychiatry located on the grounds of Ypsilanti State Hospital south of Ann Arbor. This was a state hospital that had become famous in its own right. It was the subject and setting of a famous book, The Three Christs of Ypsilanti, by Milton Rokeach.

The Three Christs of Ypsilanti
The Three Christs of Ypsilanti

The book was ahead of  its time, portraying the irony of three psychotic inpatients who shared a unit as well as the common delusion that each was Christ. The book was hit for years and required reading almost in every university in first-year classes in psychology. I had read the book as well and was fascinated by the premise of how these patients handled the dilemma of their common and contradictory claims.

Little did I know that my externship would bring me into contact with the late forensic psychiatrist, Dr. Ames Robey. Dr. Robey astutely had realized and discovered the identity of the “Boston Strangler” as one of the psychiatric inpatients at Bridgewater, Albert DiSalvo.

Albert Desalvo
Albert Desalvo, The Boston Strangler

This brought Dr. Robey national fame and publicity though he had no interests in all media attention. As an aside, I also was able to work under Dr. Elissa Benedek MD, an early female forensic psychiatrist, who was also a child psychiatrist, and a few years later, became President of the American Academy of Child and Adolescent Psychiatry. She was a small bespectacled woman, calm, supportive and incredible teacher, and clinician.

So, these two experiences acquainted me serendipitously with Bridgewater State Hospital. Late last year, Bridgewater State hit the headlines again as stories of abuse, poor treatment, a group of deaths of three men in 2015 were reported in the Boston media.  Within months, three guards at the facility were indicted of involuntary manslaughter and the Boston Globe had a documentary series of articles on the all too familiar, decades-old tale of sandals and substandard levels of care. I had actually assumed that Bridgewater State, by this time, had long been closed. Silly me. Like so many state psychiatric facilities, it was very much needed and like an old battleship kept in service for decades. The news about the hospital by April of this year just kept getting worse. To me, it was like somehow seeing an eerie reprise of the movie “Titicut Follies.” That goofy and weird feeling kept me following the news stories that have emerged in the last two months in the Boston Globe newspaper.

How did this hideous story come to be repeated nearly 45 years later? The Boston Globe reported on the slowly evolving, yet almost inevitable conditions that brought this tragic replay back to life in an article in April 2016, this past month at the time of this writing. The usual culprits of legislative neglect through decades of inadequate funding, lack of oversight and installation of a poor level of care, and a herculean task demanded of an institution not properly fueled for its job.

A once famous historical psychiatric institution forced into repeating its own tragic failings because of legislative “neglect” forced into a Kafka-esque re-run reinforcing all the negative stereotypes of a psychiatric institution. This has almost a psychotic quality, all its own, in which the observer, cannot tell reality from unreality…

 

 

 

A Good Idea from a Texas Mental Health Leader

Texas, like many states, has been struggling for the better part of the last two decades with its public mental health system’s needs. Like almost all other states in the United States, it has seen its share of declining state funding for state-wide mental health services. Ageing state hospitals for the acutely mentally ill, chronically mentally ill and developmentally disabled have been closed or downsized. Short-falls have gradually appeared in the provision of outpatient services recommended and hoped for, to supplement or replace those reduced state hospital beds.

Texas for a number of years has begun to experience the enormous increase in jail populations of the mentally ill, mirroring many other states, especially New York with its travails at Rikers Island, perhaps the country’s most famous metropolitan jail facility, serving New York City. Rikers Island has lamentably been in the tragedy borne headlines in the last few years with repeated suicides of mentally ill inmates, and lawsuits by families and repeated efforts at reform and improvement, recently occurring again by necessity under the mayoralty of Bill DeBlasio.

Harris County Jail, of Houston Texas, has become known as one of the largest “psychiatric” facilities in the country. Several years ago I recall that the Harris County Jail had to increase its psychiatrist staff roster from three psychiatrists to fifteen and add a number of psychiatric physician extenders and other staff to serve the needs of this swelling psychiatric segment of the inmate population. What happened in Harris County, encompassing metropolitan Houston, was not unique to the country’s correctional systems at all, but became known readily nationwide as one of the first such settings recognized for this tell-tale barometer of the deficiencies in any area’s public mental health service system. Harris County, on a personal note, is known quite well to me, as that extended area was where my father came from and is where I have my only sibling living all our adult lives.

A very recent article online written by Stephen M. Glazier, one of the nation’s leading mental health care executives and head of UTHealth Harris County Psychiatric Center of Houston, outlined one of the best-written definitions of the concept of psychiatric “continuum of care,” that I have ever read. His article appearing at TribTalk.org, “Bridging the Mental Health Treatment Gap,” on May 9, 2016,  provided insight into Texas’ progressive efforts in just the last 1-2 years on improving the state’s mental health reform and care delivery efforts which have not received the recognition they deserve.

Mr. Glazier pointed out the common issue seen in many states who have had to face the need to close or replace aging state hospitals, and the multifaceted dilemmas of what to replace them with. He eloquently wrote of the concept of providing what he termed the middle range of less intensive residential and non-hospital based psychiatric services in the overall continuum from hospital to home or ultimate living placement for the mentally ill person. He delineated some key concepts and facts: 1) that Texas’ state psychiatric bed ratio has declined since 2001 from 13.4 beds per 100,000 persons to 10.9; and that, 2) even if Texas had ‘kept up’ with the growing mental health needs, the rapid growth population growth in the state of Texas, which has always been in the top five states in the US, the state’s level of services would still have fallen behind previous levels of beds per 100,000 population.

His idea is not a new one, that increased and nuanced provision of these middle ground “residential,” transitional psychiatric services, would to at least some degree, not only replace some state hospital beds, but reduce the spill-over, or “trans-institutionalizations,” (the new buzzword) that we are seeing as ever more rapidly increasing numbers of the seriously mentally ill, shift from non-existent state psychiatric hospital beds to jails, hospital ERs, and the streets and shelters, all never intended to serve this population. But Mr. Glazier’s description of what is needed in filling in the gaps in the continuum of care of the mentally ill is well worth reading.