The State of New Jersey’s Division of Mental Health and Addiction Services (through its Office of State Hospital Management) supervises the State’s public psychiatric hospitals. The Division has implemented a collaborative Family Monitor program in which it arranges for vetted family member volunteers independently to observe and objectively to report on conditions within these hospitals.
PsychOdyssey is engaged in the Family Monitor project at Trenton Psychiatric Hospital (“TPH”), New Jersey’s oldest state psychiatric hospital founded in 1848 by the legendary 19th century social reformer, Dorothea Lynde Dix. We will be working with members of a local volunteer team organized in part by NAMI Mercer that will periodically visit TPH to view its situation through the eyes of family members.
As preparation and support for its Family Monitor efforts, PsychOdyssey has researched some interesting literature relevant to the family monitor process as well as state psychiatric hospitals. Below are some publicly available selections for the benefit of all interested in this distinctive form of advocacy on behalf of patients at TPH and their family members.
Resources for Family Monitors
From the U.S. Mental Health and Substance Abuse Administration:
This Commission Report was a critical relaunching step to redirecting the mental health system to the concept of recovery.
SAMHSA. (2009). Transforming mental health care in American: The Federal action agenda: First steps. from http://www.samhsa.gov/Federalactionagenda/NFC_TOC.aspx
This manifesto is the Federal government’s action plan for implementing the declarations of the New Freedom Commission.
Substance Abuse and Mental Health Services Administration. (2003). National consensus statement on mental health recovery. Washington, DC. Retrieved from http://store.samhsa.gov/shin/content//SMA05-4129/SMA05-4129.pdf.
This statement of 10 principles set the philosophical basis for transforming the mental health system to focus on recovery.
From the New Jersey State Division of Mental Health Services:
Martone, Kevin (2006). New Jersey Division of Mental Health Services Wellness and Recovery Transformation Statement. Trenton, NJ: Division of Mental Health Services.
On February 10, 2006, NJ Division of Mental Health Services Assistant Commissioner Kevin Martone issued a groundbreaking statement. “Based upon the growing body of research and knowledge in the recovery field, as well as first-hand accounts from people recovering from mental illness, the Division of Mental Health Services believes that people with mental illness can achieve wellness and recovery. It is clear that consumers of mental health services are able to identify and articulate their individual service and support needs. A strong, responsive system can recognize and meet the varying needs of people as they experience the recovery process. To this end, it is the Division’s policy to ensure that consumers and families receive a system of recovery-oriented services and resources that promote wellness, an improved quality of life and true community inclusion.
“This fundamental shift to a recovery orientation challenges our entire system to consider our role in assisting consumers in their transition to wellness. As a result, the landscape of our services will need to adjust accordingly. Our responsibilities as state officials, providers, consumers and family members will evolve as our system embraces evidenced-based and promising practices that promote recovery and wellness across our entire spectrum of hospital-based and community-based services.”
This document provides a three-year action plan (2007-2010) for implementing the elements articullated in the Division’s Wellness and Recovery Transformation Statement (above).
The official birth of family involvement in the NJ state hospital system was with the adoption of the DMHS Administrative Bulletin 4:12, signed by Alan G. Kaufman, then Director of NJ’s Division of Mental Health Services. The document is called the “Professional Collaboration with Families of Adult Clients Hospitalized in New Jersey State Psychiatric Hospitals” in 1996, with the purpose “to ensure that hospital policies and procedures are uniformly supportive of families and encourage their active collaboration in addressing the needs of hospitalized relatives.”
This 39 page PowerPoint presentation, attributed to Mr. Greg Roberts, a previous Director of State Hospitals, provides interesting history and explanation of the NJ Family Monitors’ Program.
This document governs the supervision of individuals with psychiatric disabilities residing in state hospitals. Among other things, the document defines and describes the four levels of priviledges accorded to patients during their stays, depending on their conditions. It also describes procedures for involunatary transfers of patients from one state hospital to another.
About Recovery and Wellness:
Anthony, W.A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11-23.
The implementation of deinstitutionalization in the 1960s and 1970s, and the increasing ascendance of the community support system concept and the practice of psychiatric rehabilitation in the 1980s, laid the foundation for a new 1990s vision of service delivery for people who have mental illness. Recovery from mental illness became the vision that has guided the mental health system in the succeeding decades. This seminal article by Bill Anthony, one of the titans of psychiatric rehabilitation, outlines the fundamental services and assumptions of a recovery-oriented mental health system. As the recovery concept becomes better understood, it could have major implications for how future mental health systems are designed.
Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), 311-314.
There is a significant paradigm in the field of public mental health practice that encompasses a wellness approach. This paper by New Jersey’s own Peggy Swarbrick, a leading national advocate for wellness, presents a wellness approach by comparing it to the traditional medical model. A personal application of the wellness approach is be discussed.
Swarbrick, M. (1997). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1-4.
The President’s New Freedom Commission on Mental Health (2003). Achieving the promise: Transforming mental health care in America [Executive Summary]. Retrieved from: http://store.samhsa.gov/shin/content//SMA03-3831/SMA03-3831.pdf
This landmark commission report describes a strategy for mental health care transformation that ensures services and supports that actively facilitate recovery and build resilience. It identifies six goals of transformation and showcases model programs to illustrate goals in practice.
About State Hospitals in General:
Fisher. W. H., Geller, J. L., & Pandiani, J. A. (2009). The changing role of the state psychiatric hospital. Health Affairs, 28(3), 676-684.
State hospitals were once the most prominent components of U.S. public mental health systems. But a major focus of mental health policy over the past fifty years has been to close these facilities. These efforts led to a 95% reduction in the country’s state hospital population. However, more than 200 state hospitals remain open, serving a declining but challenging patient population. Using national and state-level data, this paper discusses the contemporary public mental hospital, the forces shaping its use, the challenges it faces, and its possible future role in the larger mental health system (Fisher et al., 2009).
Geller, J. L. (2000). The last half-century of psychiatric services as reflected in Psychiatric Services. Psychiatric Services 51(1): 41-67.
Commemorating the 50th anniversary of the journal Psychiatric Services, Geller provides a copious account of developments and trends in psychiatric services. The author organizes his review largely around the locus of care and treatment because the location of treatment–institution versus community–has been the battleground for the ideology of care and for the crystallization of policy and legal reform. He concludes that even after 50 years of moving patients out of state hospitals and putting them somewhere else, mental health policymakers and practitioners remain too myopically focused on the locus of care and treatment instead of on the humaneness, effectiveness, and quality of care. The article provides an excellent contextual background to the situation today in state psychiatric hospitals.
Osborn, Lawrence A. (2009). From beauty to despair–The rise and fall of the American state mental hospital. Psychiatric Quarterly, 80. 219-231.
The American State Hospital has survived over 200 years. Society once viewed state hospitals as an absolute necessity and each state constructed numerous hospitals. Over time, the image of the state hospital as a means to cure the mentally ill changed drastically. The public perceived state hospitals as snake pits that warehoused the mentally ill and the state hospital was nearly destroyed. Nevertheless, the state hospital remains today with purposes similar to its ancestors and some that are very different. This paper examines the many influences that created the state hospital. Additionally, this paper addresses the Kirkbride Model (by which Trenton Psychiatric Hospital was designed), treatment methods and practices over time, and how the state hospital fell into disfavor as a means to treat the mentally ill. The paper concludes with comments on the mental health system today, in relation to the state hospital’s role in treatment.
Reiter, M., & Plotkin, A. (1985). Family members as monitors in a state mental hospital. Hospital and Community Psychiatry, 36(4), 393-394.
In 1983 the cooperative efforts of the Western Massachusetts Alliance for Mentally Ill Citizens and the Massachusetts Department of Mental Health led to the development of a program in which family members of patients at Northampton State Hospital monitor conditions at the hospital. The authors describe the process that generated the program, the training and duties of the family monitors, the role of the hospital administration and staff in the monitoring process, and the program’s outcomes. They believe that the program gives families a much-needed role in the care of mentally ill relatives and that the staff-family collaboration it fosters strengthens the power of advocacy.
Smith, R. C., and Bartholomew, T. (2006). Will hospitals recover? The implications of a recovery-orientation. American Journal of Psychiatric Rehabilitation, 9(2), 85-100.
This is an excellent overview by Russell Smith and Tom Bartholomew, consultants to TPH from UMDNJ’s Psychiatric Rehabilitation Department, who detail the justification for and challenges of implementing a recovery oriented care regimen at state psychiatric hospitals. From the article’s conclusion: “The power of the recovery model is transforming the lives of many people with severe and persistent mental illness. Mental health systems are adopting these practices because they work and it’s what consumers say that they want. State psychiatric hospitals have the additional challenge of providing treatment to acutely ill individuals as well as promoting their recovery. We believe that the recovery model is a necessary addition to the hospital model.”
About New Jersey’s State Hospitals in general:
The State Hospital Evidence-based Practice Consultation Initiative is a project of Department of Psychiatric Rehabilitation and the Counseling Professions at UMDNJ-SHRP and is funded by the New Jersey Division of Mental Health Services (NJDMHS). It’s mission is to improve consumer outcomes in New Jersey’s five state hospitals by enhancing hospital staff workforce competencies and implementing evidence-based practices like Illness Management and Recovery into the hospital’s service delivery system.
In August 2010, WNBC-TV in New York ran these two news stories on its television news about allegations of forced medication at Hagedorn Psychiatric Hospital:
About the lawsuit:
In August 2010, the public interest law firm Disability Rights New Jersey, in collaboration with Kirkland & Ellis, filed a complaint in U.S. District Court in New Jersey against the NJ Departments of Human Services and Health and Senior Services regarding the involuntary administration of medication to psychiatric patients in New Jersey’s public and private hospitals.
The lawsuit challenged the implementation of procedures in NJ State psychiatric hospitals in response to the litigation in Rennie v Klein (1978-1983) and the lack of any formal procedures or oversight in the other hospitals.
The lawsuit alleged that the State’s procedures, which do not provide for an independent review in the event of a challenge to the need for involuntary medication, no longer conformed to current understanding of patient rights and good clinical practice.
Although the lawsuit ultimately failed, the legal documents provide helpful background for Family Monitors about certain controversial State hospital issues.
Click here to access a copy of the complaint.
Click here to access a copy of the opinion denying protective order.
Click here to access a copy of the opinion regarding motion to dismiss.
About Ancora Psychiatric Hospital:
About Greystone Park Psychiatric Hospital:
Website: Preserve Greystone
Preserve Greystone is a New Jersey-based organization dedicated to protecting the open space and historic buildings on the former Greystone Park Psychiatric Hospital property in Morris County, NJ. Their website provides a detailed history of Greystone: http://www.preservegreystone.org/history.html.
In November 2011, PsychOdyssey came across YouTube videos showing a stark contrast of Greystone as it was and, after public outcry finally brought action, as it sadly came to be. To see these videos (in PsychOdyssey’s “Remember…” section, click here.
About Trenton Psychiatric Hospital:
A one-page history from The Journal of American Psychiatry.
TPH Family Support and Education Program (Different than TPH Family Monitor Project)
Bartholomew, T., & Kensler, D. (2010). Illness management and recovery in state psychiatric hospitals. American Journal of Psychiatric Rehabilitation, 13, 105-125.
A TPH staffer (Kensler) teams up with a TPH consultant (Bartholomew) to report on the successful implementation of an Illness Management and Recovery program at TPH, with many insights into the problems and opportunities at state psychiatric hospitals. Illness Management and Recovery is one of the five accepted evidence-based practices in mental health.
Birkmann, J. C., Sperduto, J. S., Smith, R. C., & Gill, K. J. (2006). A collaborative rehabilitation approach to the improvement of inpatient treatment for persons with a psychiatric disability. Psychiatric Rehabilitation Journal, 29(3), 157-165.
This team of experts from University of Medicine and Dentistry of New Jersey report on a 3 year project at a550 bed New Jersey state hospital to implement new recovery principles. The report describes the partnership between the hospital and the university to improve staff competence, enhance services for the patients, and integrate psychiatric rehabilitation principles in a setting steeped in institutionalism and the custodial care model. This article is a very good overview for family members to see the many challenges state hospitals face–and how they can impact the care of their loved ones.
Caldwell, B. A., Gill, K. J., Fitzgerald, E., Sclafini, M., & Grandison, P. (2006). The association of ward atmosphere with burnout and attitudes of treatment team members in a state psychiatric hospital. American Journal of Psychiatric Rehabilitation, 9(2), 111-129.
This article, co-authored by Dr. Ken Gill, Chairman of the UMNDJ Department of Psychiatric Rehabilitation, describes some of the challenges facing treatment teams in state psychiatric hospitals like TPH and solutions to address them.
Morris, M. E., Caldwell, B., Mencher, K. J., Grogan, K., Judge-Gorney, M., Patterson, Z., Terrian, C., Smith, R. C., & McQuaide, T. A. (2010). Nurse-directed care model in a psychiatric hospital: a model for clinical accountability. Clinical Nurse Specialist, 24(3). 154-160.
This article, co-authored by current TPH CEO Teresa McQuaide, along with experts from UMDNJ’s Department of Psychiatric Rehabilitation, describes a newly implemented staff training approach, called the Nurse-Directed Care Model, which is helping another state hospital shift its care regimen for its patients from the traditional “custodial” model (with its focus on the primacy of providers, location, and organization in the treatment regimen) to the currently preferred recovery model (with its focus on the individual with psychiatric disability as primus inter pares in a team approach with providers to the determination and design of individualized recovery).
Swarbrick (Peggy), M., and Brice, G. H. (2006). Sharing the message of hope, wellness, and recovery with consumers in psychiatric hospitals. American Journal of Psychiatric Rehabilitation, 9(2), 101-109.
Leading health and wellness advocate Peggy Swarbrick, Ph.D., a professor at UMDNJ’s Department of Psychiatric Rehabilitation and director of the Wellness Institute of Collaborative Support Programs of New Jersey, along with her CSPNJ colleague and fellow consumer George Brice, M.S.W., report on their innovative project at TPH to establish a consumer led and directed program for health and wellness within a state psychiatric hospital.