Investigations by the U.S. Department of Justice has revealed that mental hospitals in San Bernardino and Atascadero are besetted with widespread problems, including inadequate diagnoses and treatment, improper and excessive medication, besides prolonged hospitalization.
In addition violence among patients, repeated suicide attempts by hanging, improper and inadequate care that has led to visible signs of irreversible side effects from psychotropic medications has been found at the San Bernardino's Patton State Hospital.
The investigations were made public two days following California's mental hospital system being sued by federal officials and a detailed consent decree which has been designed as a court-monitored road map for reform over the next five years.
State officials, to their credit have hired a former U.S. Justice Department consultant to help them convert the outdated system of mental health care in California to a new model of care which involves patients more actively in their recovery.
Most patients at Atascadero and Patton have entered through the criminal justice system, of which some are docile while others are violent or sociopathic, presenting a challenge to their individual treatment. In addition the system has also been struggling with staff shortages and forced overtime.
These investigative findings have shown just how far the hospitals are from meeting accepted standards of care.
These include initial assessments which are oft only 'cursory and not individualized' which in turn lead to inappropriate prescriptions and treatment planning. Reports of inappropriate sexual relations between patients and staff were also made.
Atascadero mainy focused on 'symptom reduction' that has contributed to 'a perpetual cycle of chronic disability and repeated hospitalization.'
The report also chided the medical and psychiatric departments for excluding professionals — such as psychologists and other therapists — from diagnoses and treatment decisions. The lack knowledge among nurses of mental health diagnoses and their frequent unit changes leading to unfamiliarity with individual patients was also a point of concern
Investigators were startled in December when they observed Patton patients with tardive dyskinesia, a generally irreversible side effect of long-term use of haloperidol and other psychotropic drugs. Symptoms can include grimacing, tongue protrusion, rapid blinking, and movements of arms and legs.
Hospital staff "failed to detect these symptoms and even consider prescribing other medications with less harmful side effects," they wrote.