After a scathing federal probe in 2002, Metropolitan State Hospital set out to do more than just fix its failings -- it aspired to become a beacon in mental health treatment, a model for the other state hospitals to follow.
The locked Norwalk facility, state officials decided, would be first to shift its approach from relying on drugs and restraints -- which federal inspectors had found objectionable -- to helping patients develop the skills to live on the outside. It would encourage them to help plan their own recovery, to learn about their diseases, mimic normal daily routines and hone such basic skills as cooking.
Three years later, a Times review of state data and legal claims -- including four recent suicides -- indicates that Metropolitan's experiment has stumbled. Indeed, the facility is, in most respects, more dangerous for patients and staff today than it was in 2002. It is also more dangerous than any of California's three other long-established mental hospitals. (Coalinga State Hospital, which opened a few months ago, was not included in the review.)
More patients hurt themselves, attempt suicide, are caught with contraband, escape, allege physical abuse by staff and allege rape -- predominantly by other patients -- than at any of the other three state hospitals, state records show. This happens despite the fact that Metropolitan houses roughly 600 patients, about half as many as each of the other three hospitals.
The spate of suicides -- after more than five years without one -- prompted Metropolitan's president and chief of staff to suggest at a recent state Senate hearing that the so-called recovery model, adopted in 2002, might be imperiling patients.
"We're experimenting with our patients here with unproven treatments," Dr. Christopher Heh testified in September before a Senate committee. "I would say we need to revisit, re-look at the plan very carefully."
The soul-searching comes amid intensified federal scrutiny of California mental hospitals. Napa State Hospital is reeling from a critical report this summer, and federal investigators are investigating conditions at Atascadero State Hospital. A review of Patton State Hospital, near San Bernardino, began this week. And Metropolitan is still negotiating reforms with inspectors from the U.S. Department of Justice.
Despite Heh's concerns, state Department of Mental Health Director Stephen W. Mayberg and Metropolitan officials say their new approach has paid off, resulting in, for instance, shorter patient stays and fewer returns to the hospital.
They also say that Metropolitan has patients who are more difficult to handle than those at the other state hospitals.
Though most patients at Metropolitan and other state mental hospitals are committed by the criminal courts, Metropolitan houses the state's largest proportion of severely ill people committed by civil courts, many of whom have not succeeded in less secure settings. Although it may seem counterintuitive, hospital officials say these patients tend to be more consistently disruptive than those coming through the criminal justice system.
Former Metropolitan Executive Director William G. Silva, who handed the reins to a replacement last month after 18 years, recently suggested that problems had been mostly resolved, pointing to the hospital's recent accreditation by a national hospital review organization.
"Three weeks ago we met or exceeded national standards, so don't talk to me about three years ago," he told the hospital's advisory board Nov. 16, shortly before his departure.
But statistics, legal actions and interviews with patients' families and attorneys tell a different story. They suggest that the switch to a less restrictive environment in 2002 introduced a new set of problems:
* Patients harm themselves and attempt suicide considerably more often at Metropolitan than at other state hospitals. At Metropolitan, reports of self-harm, such as cutting and burning, were twice as high between January 2004 and last June as in the previous 18 months.
Although state officials say the recent suicides were in no way related, 20-year-old Cecilia Marie Russell, a gregarious patient with an impish smile who took her life in September, had found the hanging body of her roommate, Maria Garcia, 18, in May. Russell was distraught over the suicide, her parents and a former roommate said. Both women hanged themselves during the dinner hour, when patients could return to their rooms largely unsupervised.
Last week, a 36-year-old man was found hanging by a bedsheet in a bathroom. He died days later. Another patient committed suicide in 2004.
* Escapes are on the rise.
From January to June, there were 18 reported escapes from Metropolitan, double the number of the previous six months and by far the highest for any six-month period since mid-2002. Escapes from July 2002 through June of this year totaled nearly five dozen at Metropolitan, compared with eight from Napa, three from Patton and none from Atascadero.
