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The Family Partners

Volunteer Family Monitor Program at Trenton Psychiatric Hospital. The Family Partners. State Hospitals. Trenton (1848 - ) Greystone (1876 - ) Marlboro (1931 – 1999) Ancora (1955 - ) Hagedorn ( 1977 - 2012). Hospitals: One Minute History (Osborn, 2009).

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The Family Partners

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  1. Volunteer Family Monitor Program at Trenton Psychiatric Hospital The Family Partners

  2. State Hospitals • Trenton (1848 - ) • Greystone (1876 - ) • Marlboro (1931 – 1999) • Ancora (1955 - ) • Hagedorn ( 1977 - 2012)

  3. Hospitals: One Minute History (Osborn, 2009) • 1700s: Chains, cellars, prisons • 1773: Eastern Lunatic Asylum (first mental hospital) • 1790s: Moral treatment: Rush, Pinel, Tuke • 1841: Kirkbride at PA Hospital for Insane • 1848: Dix and NJ Asylum • 1890s Moral treatment  Cust .care  “Mental Hygiene” Asylums  Institutions 1920s ECT, hydrotherapy, insulin therapy, lobotomies, exodontia • 1950s: Thorazine, medical model, milieu therapy • 1960s: Deinstitutionalization • 1970s: Lawsuits • 1980s: Psychosocial model

  4. Asylum: “Exceptionalism” (Frank & Glied, 2006)

  5. Institution: Bedlam 1945

  6. Byberry “Neglect – even in progressive States. This picture was taken in an eastern hospital.”

  7. Byberry “Incontinent ward. A big Phila. State Hosp. 1945”

  8. Byberry “Man in restraints, B, violent ward. Phila. State Hosp.

  9. Byberry “Wasted writing. A, incontinent ward.”

  10. Byberry “Missing plaster”

  11. Byberry “Day room scene, B, violent ward. Phila. State Hosp.”

  12. Ten years later… “…the animals of nearby piggeries were better housed, fed, and treated than many of the patients on their wards.” --Albert Deutsch, testifying to U.S. Senate, 1955

  13. Legal Matters: Big themes • Civil commitment • Right to treatment • Jackson v. Indiana (1972) • Wyatt v. Stickley (1972) • Doe v. Klein (1979) • Right to refuse treatment • Community integration • Olmstead v. L.C. (1999) • NJPA v Davy (2005)

  14. NJPA v. Davy (2005) • “…Defendant has egregiously misused CEPP status to retain staggering numbers of individuals in locked and dangerous facilities when they have a right to reside in and receive mental health services in the community...“ • "CEPP patients residing on overcrowded and understaffed wards are routinely subject to abuse and neglect... • "... very limited therapy is offered in state psychiatric hospitals, even for conditions for which therapy, and not medication, is the recommended treatment..." • "... the Defendant has flagrantly failed to minimize the restrictions on the liberty of the individuals on CEPP status, as required by fundamental tenets of due process and human liberty."

  15. CEPP • http://www.drnj.org/litigation.htm

  16. State Hospitals • Trenton (1848 - ) • Greystone (1876 - ) • Marlboro (1931 – 1999) • Ancora (1955 - ) • Hagedorn ( 1977 - 2012)

  17. Greystone: Monitors (1979-2009) • Doe v. Klein (1979)

  18. 2008: U.S. DOJ  Ancora • Investigation about civil rights violations • “…patients at Ancora suffer an undue risk of harm, stemming from the facility's failure to treat aggressive and self-abusive behavior and its failure to implement systems to protect patients from harm.”

  19. 1996 Family members shall be actively encouraged to participate in various hospital advisory committees (e.g., grounds inspection, human rights, monitoring, boards). Each hospital shall develop orientation opportunities to help families participate effectively on internal committees (e.g., Training, buddy systems).

  20. 2003: “Transformation” Begins 2003: New Freedom Commission

  21. “Transformation” 2003: New Freedom Commission 2003: National Consensus Statement

  22. “Transformation” 2003: New Freedom Commission 2003: National Consensus Statement

  23. “Transformation” 2003: New Freedom Commission 2003: National Consensus Statement 2005: Federal Action Agenda

  24. “Transformation” 2003: New Freedom Commission 2003: National Consensus Statement 2005: Federal Action Agenda 2006: NJ Transformation Statement

  25. NJ Transformation Statement (Martone, 2006) • “…ensure that consumers and families receive a system of recovery-oriented services ...” • “… our system embraces evidenced-based and promising practices that promote recovery and wellness across our entire spectrum of hospital-based and community-based services.”

  26. Recovery-oriented Services • Illness Management and Recovery (IMR) • Integrated Dual Disorder Treatment (IDDT) • Assertive Community Treatment (PACT) • Family Psychoeducation • Supportive Employment • Supportive Housing

  27. BH: Risk vs. Service Intensity (Beacon Health Strategies, 2012)

  28. Office of State Hospital Management

  29. Trenton Psychiatric Hospital

  30. Monitoring

  31. Program Features • Visits ~1 x month 60-90 minutes Escorted. Scheduled but unannounced Submit evaluations • Team meetings (?) Discussions Presentations Team-building

  32. Program Benefits • Know the system • Work for improvement • Learn the practices • Support patients and staff • Help the management • Lead for change

  33. Process • Express interest • Interview • Paperwork (and fingerprinting) • Health check • Orientation • Visit

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