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

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

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

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

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
New Freedom Commission

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

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

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

24. “Transformation” 2003: New Freedom Commission
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