Concerns Arise over Mental Health Care in Texas and the District of Columbia

By Hafemeister, Thomas L. | Developments in Mental Health Law, January 2008 | Go to article overview

Concerns Arise over Mental Health Care in Texas and the District of Columbia


Hafemeister, Thomas L., Developments in Mental Health Law


A report that seventy-two employees in Texas' ten state mental health hospitals had been fired in the last three years for allegations of physically abusing patients generated considerable attention in Texas. Hundreds more had been terminated for other violations, ranging from sleeping on the job to overmedicating patients with a mental illness.

News accounts asserted that these records show that abuse and neglect are systemic in this system, while state officials responded that there will always be some reports of abuse and neglect in an institutional setting and that the number of verified reports had actually dropped. State psychiatric hospitals in Texas provide services to about 2,500 patients daily, admit 18,000 patients annually (with an average length of stay of just over a month), have 7,400 employees, and had 137 confirmed cases of abuse in 2007. About 2,000 allegations of patient abuse are examined annually, with investigators substantiating five percent of them.

The news accounts cited experts who claimed the troubles at state psychiatric hospitals are the same ones facing any institutionalized care facility, with employees overworked, underpaid, entering the system with little education, under-trained, and turning over quickly, leaving hospitals struggling to find qualified staff. Despite this criticism of institutional conditions, patient advocates noted that there are few alternatives because community-based services are as strapped for funding as the state hospital system. The state was purported to be funding just 27% of the mental health needs in the community, with more than 450,000 adult Texans experiencing serious and persistent mental illness and Texas ranking 48th in the country in per capita funding for people with mental illness. In addition, it was noted that state schools in Texas for people with mental disabilities have also raised concerns, with the United States Department of Justice intervening twice in recent years. Emily Ramshaw, Patients Neglected, Abused by Workers, Hundreds Fired Since '05 in Cash-Starved System; State Officials Say Cases Dropping, THE DALLAS MORNING NEWS, May 4, 2008, at 1A.

In 2007, similar concerns about the safety of a mental health facility led the Department of Justice and the District of Columbia to agree upon a settlement to improve conditions inside the District's psychiatric hospital, St. Elizabeths. The Department of Justice had demanded changes following a "spate of deadly violence" at the hospital, which resulted in a pair of patient deaths and an ensuing investigation. A news account that reported the settlement described St. Elizabeths as "long a troubled place" that "is the core of a troubled mental health system in the District" and that "has been the subject of periodic reform efforts" but where "as elsewhere, the needs of the mentally ill are often eclipsed by other demands, such as better schools or more police officers." Henri E. Cauvin, U.S., D.C. Reach Deal on St. E's; City Promises Improvements at Mental Hospital, WASH. POST, May 15, 2007, at B01.

The Department's Press Release regarding the settlement stated that the Department's investigation had "revealed numerous civil rights violations," which included "allegations of failure to protect patients from harm due to an excessive number of assaults, elopements and chemical restraints; failure to provide adequate psychological and psychiatric services; and failure to ensure adequate discharge planning and placement in the most appropriate, integrated setting."

The settlement establishes numerous requirements that must be met in creating a protocol to improve conditions for patients. Compliance will be monitored and supervised for five years by the federal government. The Department of Justice exercised its authority under the Civil Rights of Institutionalized Persons Act of 1980, which allows the agency to "identify and root out systemic abuses" in mental health facilities. …

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