The state is moving toward shutting down the last children's ward in the California mental hospital system, a unit at Metropolitan State Hospital seen by critics as a throwback to an old, broken paradigm of care that favored institutions over individualized treatment.
The ward has been the subject of contentious scrutiny from the start, and its potential closure has sparked vigorous debate though only a small number of patients are affected.
Some advocates argue against closure, calling the ward a catchall for severely ill children who haven't found a place elsewhere in the state's troubled mental health system.
Others call it a well-intentioned but failed enterprise; one pending lawsuit alleges that a 12-year-old boy sold sexual favors to his fellow patients there and another alleges that a patient was abducted and sold into prostitution.
Nancy Kincaid, a spokeswoman for the Department of Mental Health, said the state's "ultimate goal" is to move remaining patients out of the Child and Adolescent Treatment Center, which has been housed at the Norwalk hospital for 10 years.
Indeed, the state has quietly let the ward's population dwindle in recent years. Just 15 patients remain today -- down from roughly 100 shortly after it opened -- and four of those will "age out" in the next five months. The ward treats patients between the ages of 11 and 17.
"The best place for a child is not in a state institution," Kincaid said. "We know these children are better served in their community." Kincaid, however, stressed that the state has not made a final decision to close the ward for good. The pace of closure, she said, will be determined largely by the state's ability to place remaining patients in a safe and secure setting.
It could be a difficult task in some cases. The ward typically treats children with severe mental illness, most of whom landed at Metro only after failing -- or being failed -- at other facilities. Kincaid said that, until it is closed, the ward will continue to accept new patients if counties cannot place them elsewhere.
The unit opened in the summer of 1997 after the state closed Camarillo State Hospital, which had served as California's chief children's unit for more than six decades. The move was supposed to bring a new day for the state, and for some of its most troubled, vulnerable patients.
Officials pledged to distance themselves from the practices of the past -- excessive medication, children strapped to beds with leather restraints, open-ended, warehouse-style care -- and adopt more modern techniques.
"There was a lot of optimism," said Jim Preis, executive director of Mental Health Advocacy Services, a public interest law firm in Los Angeles County.
"There was a lot of thinking about the old, traditional way -- where you had to prove a kid was so bad he couldn't be treated anywhere else. Instead, they wanted to look at their strengths, develop the person with a long-term plan, with an eye toward integrating into the community."
There was some success; one reason the state was able to reduce the patient population in recent years is that the hospital began crafting each child's discharge plan "the day they walked in the door -- to get them back in their community," Kincaid said.
The ward has been dogged by allegations, however, that it has failed to shed some of the practices of the past. Metro's care of children and adolescents was the focus of a scathing U.S. Department of Justice investigation in 2002.
The probe concluded that many of the children and teenagers housed at that point were inadequately supervised, wrongly diagnosed and improperly medicated. The poor care had resulted in repeat suicide attempts and sexual coercion among the patients, the investigation found. And last year, a court monitor suggested that some patients were languishing without a sufficient discharge plan.
Since last year, all of the state's mental hospitals save its newest, in Coalinga, have been operating under a federal consent judgment, which calls for improvements to care, including for children and adolescents. Kincaid said that the state's desire to shut the ward is unrelated to Department of Justice oversight. A Justice Department spokeswoman declined detailed comment.
The hospital is also battling serious allegations of misconduct in court. One lawsuit filed last year in Los Angeles County Superior Court alleges that a then-12-year-old male patient, placed in Metro on an inpatient basis, performed sex acts on other male wards in exchange for money.
The acts took place in 2004 and 2005, according to the boy's attorney, Jack H. Anthony. They came to light, he said, when the boy was found carrying a sizable amount of cash. The boy had a history of being sexually abused, Anthony said, and the lawsuit brought on his behalf argues that Metro employees were negligent in failing to supervise him adequately.