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) 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

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

Institution: Bedlam 1945

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

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

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

Byberry “Wasted writing. A, incontinent ward.”

Byberry “Missing plaster”

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

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

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)

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."

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

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

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

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.”

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).

2003: “Transformation” Begins New Freedom Commission

“Transformation” 2003: New Freedom Commission National Consensus Statement

“Transformation” 2003: New Freedom Commission National Consensus Statement

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

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

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.”

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

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

Office of State Hospital Management

Trenton Psychiatric Hospital

Monitoring

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

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

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