Texas time warp? State criticized for mental care

[Guest guest]

http://www.newsweek.com/id/171923/output/print

Texas time warp? State criticized for mental care

Texas time warp? State keeps more mentally disabled patients in

institutions than any other

JEFF CARLTON Associated Press Writer

AP

For more than a century, thousands of mentally disabled Americans were

isolated from society, sometimes for life, by being confined to huge

state institutions.

In at least one place, they still are.

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 facilities called " state schools "

and move patients into group homes.

For the third time in three years, the criticism has attracted the

attention of the Justice Department, which on Tuesday accused Texas of

violating residents' constitutional rights to proper care.

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.

Many of the nation's mentally ill or disabled in the 1800s were housed

together in institutions, sometimes called insane asylums. But by the

1960s, most experts concluded that mentally disabled patients fared

better in smaller, community-based settings.

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.

Other states with large populations such as New York and California †"

which have rates of 11.2 and 7.5 people, respectively †" rely far less

on large institutions.

Federal law requires the mentally disabled to be treated in " the most

integrated setting " possible †" a factor that led to the Justice

Department rebuke of Texas.

Albrecht, a spokeswoman for the Texas Department of Aging and

Disability Services, said the agency is expanding community-based

services. Texas officials say keeping the facilities open is a matter

of preserving as many treatment options as possible.

But 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, 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. "

During his time there, he refused to leave his bed and often

languished in his own excrement, she said.

Dooley eventually moved her son into a group home in Denton where

treatment costs average about $50,000 per year †" roughly half as much

as the costs at state schools, Garrison-Tate said. Medicaid often

picks up most of those costs.

" It was just horrible, " Dooley said. " If he goes back to a state

facility, he will shut down and die. "

At the San Angelo State School, inspection reports from 2007 took note

of scuffed walls pocked with holes, rotting food, dirty kitchens,

broken furniture and missing shower curtains.

More seriously, two employees were fired after throwing a resident

into a pool while he was wearing a restraint jacket. The employees had

made a bet with the resident that he would be unable to dunk another

resident under water. When he lost the bet, the employees restrained

him and threw him in the water, according to the reports.

Other families say they are happy with the state care.

Neil son said his daughter , who has cerebral palsy and is

mentally retarded, has flourished during her 10 years at the Lubbock

State School.

" I'm very impressed with the level of care she has received, " son

said. " As far as I am concerned, it's Mr. ' neighborhood.

Everybody is looking out for everybody else. "

A visit to the Denton State School, the largest in Texas, reveals a

sprawling campus spread across well-kept lawns. Superintendent Randy

Spence described the place as a " happy, homelike atmosphere. "

" The vast majority of our employees love the people they work with, "

said Cecilia Fedorov, another spokeswoman for the Department of Aging

and Disability Services. " They think of them as extended family. "

But Denton is also the site of Texas' most notorious case of state

school abuse.

In 2002, a care worker repeatedly kicked and punched a resident in the

stomach and groin. Haseeb Chishty nearly died after that beating. He

is now confined to a wheelchair and unable to feed himself or use the

bathroom.

" It got to the point where it was fun beating him, torturing him, "

said former care worker , who is now serving 15 years for

aggravated assault.

In a statement videotaped by Chishty's lawyer, said he and many

of his fellow care workers used methamphetamines, cocaine and

Oxycontin on the job.

Chishty's mother filed a lawsuit against the facility, but it went

nowhere. In Texas, government entities are all but immune from lawsuits.

Some critics want to close the state schools. But because the Texas

Legislature created each one, only lawmakers can close them.

Many of the institutions are large employers in small towns, and they

often pay more than other jobs in rural areas. Lawmakers fear taking

action that would lead to layoffs, Garrison-Tate said.

" Even if we said we wanted to close all state schools, the community

resources aren't there at this time, " said state Rep. Larry ,

chairman of a legislative committee studying the facilities.

Reddell, the lawyer whose client's son was beaten nearly to

death, said the state is not doing right by its mentally disabled.

" The very nature of the institutional setting, I think, creates the

environment for the abuse to take place, " she said. " How in the world

can you think this system is the best and it makes sense? "

URL: http://www.newsweek.com/id/171923

© 2008