California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Improvement Plan for Calif. Mental Hospitals Fails, Investigation Finds

Efforts to improve conditions at public mental hospitals in California have failed to shorten periods of confinement and help patients curb violent tendencies, according to an investigation, the Los Angeles Times reports.


In 2006, the U.S. Department of Justice sued California on the grounds that it was violating patients' rights by using improper restraints, heavy sedatives and failing to provide adequate treatment.

The state settled the lawsuit and agreed to a court-supervised improvement plan for four public hospitals with more than 4,000 patients.

According to the Times, DOJ’s main objectives were to ensure that patients were not institutionalized longer than necessary and learned to control violent tendencies.

Times Analysis

According to a Times analysis of state data, mental hospitals used fewer restraints and limited their use of certain medications under the improvement plan. However, the rate of patient assaults on other patients and staff members had doubled at Atascadero State Hospital and Metropolitan State Hospital by the end of 2011, according to the Times. The assault rate at Napa State Hospital increased by more than 300% over two years, before decreasing after the killing of a psychiatric worker.

Assault rates decreased by 15% at Patton State Hospital under the improvement plan, according to the Times.

In addition, the Times analysis found that patients on average have been confined in mental hospitals for longer periods under the improvement plan.

According to the Times, DOJ has expressed overall satisfaction with the pace of improvements at state mental hospitals, despite the longer periods of confinement and rising rate of assaults at certain facilities. In November 2011, the agency allowed oversight of Atascadero and Patton to expire. However, DOJ in December 2011 asked a federal court to extend oversight of Metropolitan and Napa, saying in court documents that patients at the facilities remained "at serious risk of harm, even death."

Reversing Reforms

The state Department of Mental Health has started reversing many of the changes made at the mental hospitals as federal oversight expires.

According to the Times' analysis of state records -- as well as interviews with hospital officials, workers, patients and their families -- hospital workers were reluctant to take action against violent or unruly patients under the improvement plan because of pressure to place the fewest restrictions on patients as possible. In addition, hospital workers were charged with documenting progress on about 360 separate objectives under the reform effort, leaving them less time to care for patients and develop suitable treatments.

Mubashir Farooqi, a psychiatrist at Patton, said the improvement plan "was a huge, very expensive, very idiotic experiment that failed badly."

Mel Hunter, former executive director of Atascadero, said, "[I]n terms of reduction in cost, reduction in time served in treatment and reduction in violence," the plan was "a failure."

Federal Response

Assistant Attorney General Thomas Perez (D) -- head DOJ's Civil Rights Division â€" said that policies and procedures at the mental hospitals improved under court supervision but that the facilities did not pay enough attention to whether patient health also was improving.

A DOJ spokesperson said that hospitals must respect patients' constitutional rights and that state officials must determine the best course to do so (Romney/Hoeffel, Los Angeles Times, 4/15).

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