Thursday, December 04, 2008

Texas The "Institution Capital of America"

The U.S. Department of Justice has delivered a stinging rebuke to the Texas mental health care system, accusing it violating patients' constitutional rights to proper care:

Texas has more mentally disabled patients in institutions than any other state, and the federal government has concluded that the state's care system is stubbornly out of step with modern mental health practices. Critics allege that Texas remains stuck in an era when the mentally disabled were hidden away in large, impersonal facilities far from relatives and communities. "In Texas, it's like a time warp," said Jeff Garrison-Tate, an advocate who wants to close the 13 hospitals called "state schools" and move patients into group homes.

Investigators found that dozens of patients died in the last year from preventable conditions, and officials declared that the number of injuries was "disturbingly high." In addition, hundreds of documents reviewed by The Associated Press show that some patients have been neglected, beaten, sexually abused or even killed by caretakers. Inspection reports also describe filthy rooms and unsanitary kitchens.

The American Institution on Intellectual and Developmental Disabilities says large care facilities — usually those with at least 16 residents — "enforce an unnatural, isolated, and regimented lifestyle that is not appropriate or necessary."
Because of those concerns, eight states have abolished large institutions for the mentally disabled. Another 13 states closed most of their largest facilities, leaving just one open in each state. But Texas has remained "the institution capital of America," said Charlie Lakin, director of the Research and Training Center on Community Living at the University of Minnesota. The 13 facilities in Texas house nearly 5,000 residents — more than six times the national average. On a per-capita basis, Texas has 20.4 people per 100,000 in large institutions, Lakin said. The national average is 12.2 people.

critics allege that "warehousing" patients in large institutions invites abuse. Patients are isolated from their families and communities, making regular contact with loved ones more difficult. And caretakers often get overwhelmed by the large numbers of patients, Garrison-Tate said.

In Texas, officials verified 465 incidents of abuse or neglect against mentally disabled people in state care in fiscal year 2007. Over a three-month period this summer, the state opened at least 500 new cases with similar allegations, according to federal investigators.

An AP investigation earlier this year revealed that more than 800 state employees have been fired or suspended since the summer of 2003 because they abused, neglected or exploited mentally disabled residents.

And in the one-year period ending in September, as many as 53 deaths in the facilities were due to potentially avoidable conditions such as pneumonia, bowel obstructions or sepsis, the Justice Department said. Some families tell horror stories of their loved ones in the state facilities. For instance, Michelle Dooley said her son spent three months in the Austin State School, which she described as a place of "dingy yellow floors and patients running around without any clothes on."

The AP story also details the story of horrifying abuse suffered by one patient, Farhat Chisty, who was routinely beaten and abused, treatment that left him confined to a wheelchair unable to even feed himself. The circumstances behind Chisty's story are told in more detail in this Dallas Observer story from August, which also delves into the decrepit state of mental health care in Texas in general. To be fair, more Texas mental health patients have moved into community settings in recent years, but at a pace that's hardly sufficient and mental health authorities deny requests to move out of institutions at a far higher percentage. So far the Texas legislatures only response has been to increase funding for state institution employees, but the DOJ report makes it clear that this is simply throwing good money after bad, and that a revamp of the entire system is needed. The DOJ does not specifically require that Texas Dept of Aging and Disability Services move to a greater community approach, but the "recommendations" it does make leave it difficult to imagine how the problems they found could be fixed absent such a move.

No comments: