A Texas Mess

The Dallas Morning News reports of some heavy duty abuse and neglect within its 10 State Hospitals. What I believe it really comes down to is a combination of a few things. People with disabilities are not valued by the general community as much as their non disabled counter parts. There is also an ongoing issue around educating the general community regarding the systemic challenges faced by the disability community. I hope I'm changing that, if only slightly.

Reports show systemic abuse at Texas' psychiatric hospitals

By EMILY RAMSHAW / The Dallas Morning News

AUSTIN – Patients with severe mental illness are committed to Texas' state psychiatric hospitals to be protected from themselves. Instead, some are suffering vicious abuse from the very caregivers hired to look after them.

Last year, one state mental hospital employee tackled an adolescent patient who was sobbing for his mother, dragging him across the floor by his wrists and hair.

The year before, another brought a female patient into a hospital bathroom and sexually abused her.

And dozens more have participated in brutal beatings at the psychiatric hospitals since 2005, employee disciplinary reports show – using chokeholds, headlocks and threats of violence to restrain the patients under their watch.

In all, 72 employees across Texas' 10 state mental hospitals have been fired in the last three years for allegations of physical abuse, according to a Dallas Morning News analysis of state personnel records. Hundreds more have been terminated for other violations, the records show, from sleeping on the job to over-medicating mentally ill patients.

State officials say there will always be some reports of abuse and neglect in an institutional setting. And they say they take any allegations of mistreatment seriously. But the records show that as in other state-run facilities, abuse and neglect are systemic.

The state's juvenile prisons, group homes for the disabled, and state schools for people with mental disabilities all came under fire last year for reports of widespread physical and sexual abuse. The state psychiatric hospitals, like other systems for vulnerable Texans, are chronically starved for cash, advocates of more state funding say, and services at the local level can't keep up.

"You get what you pay for," said Rep. Garnet Coleman, D-Houston, who has bipolar disorder. "When you financially dumb something down, you make services cheap, something's got to give. Unfortunately, it usually ends up being a mentally ill or disabled Texan."

Officials with the Department of State Health Services, the agency that runs the psychiatric hospitals, say abuse and neglect are "absolutely not" pervasive – and verified cases are actually dropping.

In the last two years, they confirmed 15 "Class I" cases – the most serious abuse. On average, investigators substantiate 5 percent of the more than 2,000 allegations they examine annually. And nearly 90 percent of patient deaths since 2005 were attributed to natural causes, agency spokesman Doug McBride said. Five were suicides, and none were the result of abuse.

"Keep in mind there are about 7,400 employees, 18,000 patient admissions and probably hundreds of thousands of staff-patient interactions in a year," Mr. McBride said.

State officials acknowledge that the psychiatric hospitals are stressful environments; there are times, Mr. McBride said, when employees "do not handle a situation appropriately." But they say the rules for reporting abuse and neglect are stringent – and confirmed cases of physical and sexual abuse are reported to police.
And they balk at the suggestion that conditions bear a resemblance to the state schools for people with mental disabilities, where the U.S. Justice Department has intervened twice in recent years.

The state psychiatric hospitals, which have about 2,500 patients daily, had 137 confirmed abuse cases in 2007. The state schools for people with disabilities, which have twice as many residents, have an average of 300 confirmed abuse cases per year.
But some advocates fear the mentally ill patients may face greater risks. Patients of the psychiatric hospitals are largely indigent, transient and not connected to their families, so they have few allies as they bounce through the mental health system.

"It's a population that's easy to abuse because they're not on the radar in any way," said Richard Hansen, a Texas mental health advocate who was chemically restrained, shackled and beaten to the point of broken ribs years ago while suffering from bipolar disorder in a New York mental hospital.

But there are few alternatives, advocates say, because smaller community-based services are as strapped as the state system.

Fired hospital workers

Among the allegations of abuse and neglect state hospital workers have been fired for since 2005:

• A worker at the North Texas State Hospital slammed a clipboard on a patient's head, dragged her by her feet and kicked her in the legs and buttocks.

• An employee at the Big Spring State Hospital failed to notice a patient who knotted her sheet and strung it around her neck. The patient was blue by the time staff found her.

• At the Austin State Hospital, a male employee brought a female patient into a private room for her to carry out a sexual act on him.

• An employee at the Austin hospital tackled a juvenile patient and pinned the patient's neck and head to the floor, bloodying his lips and face and breaking his glasses.

Other employees were punished for offensive treatment, from using racial slurs on patients to making verbal threats and sexual advances. Some ignored patients' cries for help while they watched TV, played video games and wrote text messages. Others stole state property and sold tobacco products to patients.

Mr. McBride said employees are carefully screened and are terminated the moment they're found unfit for their jobs.

Mr. Hansen said many employees are conscientious, but conditions vary from hospital to hospital and ward to ward. Some are simply warehouses, where patients are often overmedicated and ignored. In others, patients frequently turn up with unexplained injuries, he said.

Unexplained death

Jason Evans called 911 in November during a bipolar meltdown and was admitted to the Terrell State Hospital. Days later, the 34-year-old was dead – and his parents still don't know why.

State officials told the Kaufman couple that their son, who was severely mentally ill but in good physical condition, had been disruptive that evening, and records obtained by the family indicate hospital workers medicated him before sending him to sleep. Mr. Evans was apparently found hours later in his bed, and was no longer breathing.

Lynn Evans, his mother, said psychiatric hospital workers attributed the death to natural causes, and doctors said her son had lost oxygen to the brain. But she and Mr. Evans' father, a pharmacist, have been unable to get specific details about their son's death. They believe Jason was effectively overdosed by hospital workers trying to restrain him.

"It was a disease. Jason couldn't help it," said Mrs. Evans, choking back sobs. "In my heart, I will go to my grave knowing that hospital killed him."

Mr. McBride said that the agency is prohibited from confirming the identities of anyone in their care – but that any unexpected deaths are investigated by the Department of Family and Protective Services or by local law enforcement.

"There were no deaths among Terrell State Hospital patients last fall from anything other than natural causes," he said.

Experts say the troubles at state psychiatric hospitals are the same ones facing any institutionalized care facility. Employees are overworked and underpaid. Many entry-level workers have little education and training. And upper level managers battle high turnover rates while struggling to find qualified staff.

The problems are compounded by the fact that many psychiatric hospital patients don't have support networks. They've frequently alienated their families through a cycle of homelessness and incarceration. They often are sent to the hospital by a judge. And their length of stay – just over a month, on average – gives employees little time to build personal relationships and empathy for the patients in their care.

Aaryce Hayes, a mental health policy specialist with Advocacy Inc., said the Department of State Health Services is working to improve the state hospital system, from incorporating trauma-informed treatment into care regimens to increasing employee empathy training. It is also trying to reduce reliance on restraint and seclusion to keep control of patients.

"They get it," she said. "They want to see a culture change."
But it's hard to improve when the state hospital system is so overburdened, Ms. Hayes said. Right now, the state funds just 27 percent of mental health needs in the community – meaning everyone else rotates in and out of crisis care. There are more than 450,000 adult Texans with serious and persistent mental illness, everything from schizophrenia to major depression, Ms. Hayes said.

"If we said we were serving just 27 percent of people who had cancer, or diabetes, nobody would be comfortable with that," Ms. Hayes said.

Money is a persistent problem. In 2003, lawmakers stripped $100 million from the state's mental health budget, Mr. Coleman said – funding that has only partially been replaced.

The Legislature approved $82 million last year to improve community mental health crisis services, said Robin Peyson, executive director of the National Alliance on Mental Illness' Texas chapter. But Texas ranks 48th in the country in per capita funding for people with mental illness, so that money only begins to address the shortfall.

"There are not services at the community level and there are not enough beds in the system," she said. "If you have inadequate funding, you're just supporting this cycle, this revolving wheel."

Staff writer John Jordan in Austin contributed to this report.