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Monday 17th June 2019

Violence at California's mental hospitals

16th April 2012

An attempt by the U.S. Department of Justice to improve poor conditions and rights violations at California's state mental hospitals appears not to have worked.

Prison Wire

The state of California was sued by the department in 2006 for violating the rights of patients, who were heavily drugged and subjected to the improper use of restraints.

The state government was forced to agree to an improvement plan at four of its hospitals, which currently hold more than 4,000 patients, many of whom have pleaded not guilty by reason of insanity to violent offences.

But the plan, which was supervised by the court, has apparently failed to achieve its main goal, and patients are still not receiving appropriate care.

The plan was designed to cut the use of restraints and sedatives at the hospitals, but has resulted in a doubling of patient assaults at two of the hospitals concerned, Norwalk and Atascadero state hospitals in San Luis Obispo County.

Meanwhile, at a third hospital, Napa, the rate of assaults was more than three times higher over the course of two years. It fell after staff imposed a security lockdown following the death of a staff member at the hands of a patient.

Assaults only decreased -- by 15% -- at the Patton state hospital in San Bernardino county.

At all the hospitals subjected to the approval plan, patients have been confined for longer than before its inception. Those in hospital following a criminal trial were typically held for nine months longer last year than they were in 2006.

The Justice Department has applied for its oversight of two hospitals to be extended following concerns that patients there continued to be at "serious risk."

During the past six years, court officials have identified 12 cases in Metropolitan and Napa state hospitals in which a patient either died or was seriously injured because of lapses in care.

The state Department of Mental Health now has a new political leadership following the departure of Nirbhay Singh, and is now engaged in unravelling Singh's reliance on form-filling and written reports to ensure compliance with the plan.

Psychiatrists described the reform effort as an "idiotic experiment" that went badly wrong, saying that the plan had made staff nervous about restraining the most violent and unruly patients.

A huge increase in the burden of paperwork left staff little time to spend with patients, and less flexibility to tailor care packages to individuals, according to medical staff, care workers, patients and their relatives.

Singh's experience with Buddhist-inspired mindfulness treatments had worked well in other settings, but he had had little experience of potentially violent psychiatric patients with a criminal record.

He resigned in 2011 after being approached by journalists, and has since defended his tenure at the department, saying he had helped hospitals move from treating symptoms to providing individual care packages offering patients greater dignity and independence.

Government figures show Singh, a former consultant, made around US$4.4 million (£2.7 million) from the state.

His supporters say he implemented a rigorous treatment planning procedure, and helped lessen the use of high-risk medications, isolation rooms and restraints.

Staff have consistently complained about the reforms, saying they made the working environment more dangerous for them, and "made people sicker."

Under Singh's plan, group therapy replaced individual sessions, which were regarded as crucial to helping the patients to gain some insight into their condition.

Staff said they were routinely churning out up to 30 pages a month per patient to keep in step with Singh's approach to personalised treatment plans.

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