Cecilia Russell wasn't safe in her Central Valley home. The drive to hurt herself -- to cut, burn, swallow pills -- was too strong. Nightly, the teenager's parents locked up the kitchen knives. When a short-term care facility in Merced proved unable to monitor her, they gave up "Ceci" in order to save her.
State conservatorship was the best route to a locked facility that could watch the young woman around the clock. She entered Metropolitan State Hospital in March 2004.
Eighteen months later, at age 20, she was dead. A roommate found her hanging, just as Russell had found her previous roommate four months before.
The Norwalk facility houses some of the state's most troubled mental patients. Intent on harming themselves, some swallow toothbrushes or turn towels and sheets into suicide tools.
Others lash out at fellow patients or staff or fabricate dramatic tales of abuse, making real abuses tough to prove.
Inappropriate -- at times coerced -- sex is not uncommon in a patient population in which many act out sexually.
"When you stick a bunch of mentally ill people together, things are going to happen," said Joanna Gridley, a five-time Metropolitan patient who was released in October and found Russell, her friend, hanging by a sheet from a bedroom locker. "That hospital really does try. But there's only so much they can do with what they have."
Tragedies can occur in any mental hospital, no matter the precautions. But Metropolitan, state statistics, interviews and legal claims indicate, is less safe for patients and staff today than it was three years ago, when administrators began an overhaul of treatment policies meant to improve care.
Since 2002, the hospital has turned from stressing safety and security above all to an approach emphasizing patients' rights, including a measure of privacy, autonomy and preparation for life outside the hospital.
It is not clear how much the new model of treatment has contributed to Metropolitan's problems. What is clear is that the staff at times is stretched too thin, and, under the new approach, it relies less on restraints and medications to keep patients from harming themselves or others.
For some, the shift in philosophy has meant new hope and self-respect. Suzanne Serbin's schizophrenic son, James, 35, has been at Metropolitan for 17 years, unresponsive to medication. Of late, she's noticed an improvement in his mood. James mingles with other patients in exercise and music therapy classes now and is learning to interact with peers.
