America’s Psychiatric Facilities Are ‘Incubators’ for COVID-19
By Leah Harris
As the novel coronavirus continues to wreak havoc around the globe, whistleblowers at American psychiatric facilities paint a picture of mismanaged COVID-19 responses and lax safety protocols, putting patients, workers, and the surrounding communities in harm’s way. Some allege coverups of deaths.
News outlets nationwide report being contacted by fearful workers and family members, who insist on anonymity to avoid retaliation. Employees of Manhattan Psychiatric Center in New York told POLITICO that the hospital, which is run by the state’s Office of Mental Health, has “rejected workers’ requests to work from home and has threatened retaliation against those who do not come in.” Workers at a Milwaukee public psychiatric hospital told the Milwaukee Journal-Sentinel that supervisors threatened to write them up for wearing protective gear. And patients at St. Elizabeths, the District of Columbia’s only public hospital, have had enough of the unsafe conditions and are now suing the institution.
To make matters worse, there has been a dearth of information from psychiatric facilities, leading to chaos and confusion. A recent report by the Judge David L. Bazelon Center for Mental Health Law noted that “Psychiatric hospitals, like correctional facilities, are potential incubators for the virus. While the danger has been recognized, little information is available about the steps states, localities, and the hospitals themselves are taking to mitigate the danger.”
The Bazelon Center reported that the American Psychiatric Association’s guide to state actions in response to COVID-19 focused on risk mitigation in correctional facilities but not in psychiatric hospitals.
State-Run Facilities Decimated by the Virus
Psychiatric hospitals’ mismanagement of their response to COVID-19 has taken on a disturbingly similar pattern from coast to coast, with many state-run facilities that were underfunded prior to the pandemic being particularly hard hit. Hospital workers say they were being systematically prevented from wearing PPE until an outbreak or the death of a staff member or patient occurred, at which point such policies were reversed, but serious problems persist. Here is a sampling of just some of the news reports emerging from around the country.
On April 3, The Trentonian reported that the Trenton Psychiatric Hospital administration may have covered up the COVID-19 death of a 60-year old man, said to be the first such death within the walls of New Jersey’s four state psychiatric facilities. Further, staffers at TSP told The Trentonian that the hospital’s CEO, Robyn Wramage-Caporoso, “exploded and abruptly ended” a call with union officials regarding conditions at the hospital. Employees allege ongoing coverups of deaths.
Wramage-Caproso is also accused of “blatantly ignoring” social distancing mandates, forcing staff to attend meetings where they are sitting in close contact. PPE has not been provided, workers said. And someone connected with the hospital started a Change.org petition about the unsafe conditions directed to New Jersey Governor Phil Murphy, which reached nearly 1,000 signatures.
On April 10, a NJ Advance Media investigation found that the number of patients and employees testing positive for COVID-19 within the state’s psychiatric hospitals had tripled over the course of the previous week, to over 200 cases. Employees from Ancora and Greystone Park hospitals had sent letters to NJ Advance Media alleging that senior management had not been transparent with staff about the real-time numbers of infections.
According to the most recent data reported by the New Jersey Department of Health, 97 patients and 237 staff have tested positive for the virus, and 6 people living in the state’s four psychiatric facilities have died.
District of Columbia
A COVID-19 emergency has been steadily escalating at the District of Columbia’s only public psychiatric hospital, with advocates warning from the start of the pandemic that the institution was not prepared to practice the necessary precautions to contain the spread of the virus.
Civil rights groups had been fighting for better conditions at St. Elizabeths even before the pandemic. The American Civil Liberties Union (ACLU) of DC, the Washington Lawyers’ Committee, and others filed a federal class-action lawsuit against the hospital in October 2019 after it lacked clean, running water for 27 days last year, forcing residents to live in “disgusting” and “unsafe” conditions.
Beginning in mid-March, the activist network Black Lives Matter DC began to sound the alarm about the hospital’s lack of preparedness for a potential outbreak, urging residents of the District of Columbia to call Mayor Muriel Bowser.
Also in March, the Washington Lawyers’ Committee began writing a series of letters to the hospital’s administration, citing concerns about the speed at which patients were being evaluated for release, as well as the conditions within the hospital itself.
Initial reports about workers and patients testing positive for the virus began to surface on April 1. That day, Andrea Procaccino, a Disability Rights D.C. attorney who advocates for residents of St. Elizabeths, told The Washington Post that her agency had already been contacted several times by patients concerned for their safety. “St. Elizabeths does not have as robust of an infectious disease department as medical hospitals do,” she told the Post. “We are concerned that the infectious disease staff is not prepared for an outbreak and will not have adequate resources and personnel.”
In a letter dated April 2, the Washington Lawyers Committee wrote to the D.C. Department of Behavioral Health, pleading for the hospital to reduce the population: “We renew our request that you evaluate every patient for community placement and either release or make appropriate recommendations to the Court to place patients in community settings.”
The D.C. Public Defender Service filed an emergency motion in the D.C. Superior Court on April 3, requesting the release of people charged with misdemeanors undergoing competency proceedings in St. Elizabeths and the D.C. Jail.
That same week, D.C. health officials announced the death of the first patient at the hospital. By April 10, DC attorney James Ziegler Tweeted, “There is a crisis at St. Elizabeths, the District’s public psychiatric hospital.”
Other attorneys and activists took to Twitter to express their outrage:
In a striking new development reported by WAMU-FM on April 17, residents of St. Elizabeths are now suing the hospital. Represented by the same civil rights groups that filed last year’s class-action lawsuit on the water stoppage, the patients say it is impossible to practice social distancing, that they don’t have masks or PPE, and that the hospital was not quarantining those exposed, but not exhibiting symptoms. The Washington Post reports that most hospital residents are now under quarantine.
Four patients are known to have died from the virus as of this writing, and court documents say nearly 80 other patients and workers are positive for COVID-19.
Kaitlin Banner, deputy legal director at the Washington Lawyers’ Committee for Civil Rights and Urban Affairs, said in an April 16 statement that the facility serves a large population of people of color, many of whom live in poverty, and all of whom are disabled. “The lack of regard for their lives and safety is breathtaking,” Banner said.
Georgia
The notorious Central State Hospital in Milledgeville, Georgia began to make local headlines after a nurse died from COVID-19-related complications at the end of March. Local news station 13WMAZ Verify reported on April 1 that it had received over a dozen calls from hospital employees, who provided evidence that the administration had prevented them from using personal protective equipment (PPE), claiming that it violated the hospital dress code.
However, after a worker’s death, administrators began allowing staff to bring their own PPE into the hospital. In an April 6 statement, the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) said that it was lacking an adequate reserve of PPE, and announced the arrival of a mask shipment five days later. On April 9, the Georgia National Guard’s Infection Control Team was brought in to begin decontaminating the hospital.
13 WMAZ Verify reported that Governor Brian Kemp sent a memo on the evening of April 11 to all hospital staff notifying them that a second worker at the hospital had died from COVID-19 complications. As of that date, 12 patients and 24 employees had tested positive for the virus.
DBHDD Commissioner Judy Fitzgerald, who had visited the hospital during the second week in April, told the Oconee Radio Group that the hospital was “walking alongside” public health guidelines regarding testing.
On April 14, Governor Kemp announced that the state would be sending additional workers to relieve worker shortages in facilities across the state, with twenty additional employees heading to Milledgeville.
Most recent state data confirm 48 cases of the virus at the hospital as of April 17.
Washington
At Western State Hospital, the state’s largest psychiatric facility just outside of Tacoma, more than five staff members and two patients had tested positive for COVID-19 by the end of last month, prompting the Washington Federation of State Employees (WFSE), which represents the 2,700 workers at the hospital, to demand that administrators of the 850-bed facility improve safety measures. The union said that state agencies had waited three weeks to come to the table and had not presented any tangible safety plans as of the end of March.
Behavioral Health assistant secretary Sean Murphy told the Northwest News Network last month that the thermometers being used to screen employees at the door were not taking accurate readings. Murphy said that by the time the hospital realized that the batch of thermometers was faulty, supply shortages indefinitely delayed a further shipment. Hospital employees were then required to attest verbally to being symptom-free upon entrance.
Like other hospital employees around the country, the staff at Western State complained that they were initially restricted from wearing PPE, even as the virus steadily spread throughout the sprawling complex. After the union went to the Department of Social and Health Services (DSHS) management, the hospital reversed its policy and began allowing employees to wear their own PPE “at their own risk.”
Following the first COVID-19 patient death, on April 3 the hospital announced plans to discharge sixty civilly-committed patients to community placements. Murphy told The Associated Press on April 3 that Western State had already faced staffing shortages prior to the pandemic and, following the outbreak, had released some of the high-risk staff for their own safety, which further exacerbated the shortage.
A recent report on the hospital in The Seattle Times cited an “entanglement of challenges” including “aging buildings ill-adapted for 21st-century psychiatric care” and “a lack of beds elsewhere in Washington for patients ready to be discharged.”
Tensions between employees and the hospital’s management remain ongoing.
Oregon
Early on, Oregon State Hospital, which primarily houses people found “not guilty by reason of insanity” (NGRI) and people undergoing competency restoration to participate in court proceedings, severely restricted new admissions to prevent the virus from entering the hospital.
In a March 14 memo, hospital CEO Dolly Matteucci announced a new policy that resulted in a halt in admissions of people deemed unable to “aid and assist” their attorneys in their own defense, leaving them stranded in jail during a pandemic. This policy put the hospital in violation of a 2002 judge’s order requiring that criminal defendants court-ordered into psychiatric care be moved from jails to the hospital within one week.
“The implication of the policy is that the vast majority of people deemed unable to aid and assist their attorneys would not be admitted to the state hospital, but would instead remain incarcerated at a local county jail,” Disability Rights Oregon wrote in a letter to state officials on March 19. “There is no definite end to how long this prolonged confinement would last, and no one is currently in a position to make predictions.”
Even before the pandemic, the hospital had been out of compliance with the judge’s admissions order for nine months in 2019.
By mid-April, the hospital suddenly reversed course and announced that it would resume the admissions process for “aid and assist” defendants.
Panic on Social Media
While multiple news reports and investigations have rightly focused on the spread of COVID-19 in U.S. jails, prisons, and nursing homes, much less media attention has been paid to what is happening in psychiatric facilities, where individuals are often not free to leave. Media coverage has typically begins only in the wake of a patient or staff death from the virus. Current and former patients, hospital workers, and loved ones have been taking to social media to express their dismay and to attract the attention of policymakers and the media.
Here is just one of their frantic Tweets:
My husband works in a hospital psych unit. All he has is a cloth mask they gave him a few days ago. Before that he wasn’t allowed to wear one at all. There is no decon between his wing and the ICU and ER. Betrayed is exactly how we feel. #coronavirus #covid19 https://t.co/rGUMRxwJ4l
- Trinity (@Trinitydraco1) April 11, 2020
Some psychiatric hospital staff have simply decided not to come back to work, citing unsafe conditions. As this former worker Tweeted, “Yeah, I’m good.”
Putting Profit Over Patients
Reports of poor management of the COVID-19 crisis extend beyond the state-run facilities to for-profit hospitals, including the poshest of private psychiatric hospitals.
Employees at the StoneCrest Center, a private 162-bed facility in Detroit, accuse the company of cutting corners when it comes to safety. “You’re putting profit over your personnel, you’re putting profit over your patients. And that’s really what the environment, that’s what we feel,” workers told WXYZ Detroit. Only last week did the hospital enact proper social distancing protocols. Prior to that time, employees told the news station, group therapy was being conducted with as many as fifteen patients sitting close to one another. At least five staff have tested positive for the virus, but employees still do not have proper PPE and are using cloth masks.
And at CenterPointe, a small private psychiatric hospital in St. Charles, Missouri, employees went to the media with allegations of mismanagement similar to those at the state-run facilities. A veteran staff member at the hospital complained to NBC 5 On Your Side about the hospital’s new corporate management, citing “many irregularities in the last year especially, but now with COVID-19, this is life or death.”
Employees told the news station that the hospital was not conducting proper sanitation or decontamination protocols and that they were told to bring their own cleaning supplies. Employees recount having to beg for masks, not receiving them until March 25, four days after the first patient tested positive for the virus. As of the most recent reports, more than 20 staff and three patients have tested positive for COVID-19.
Families of patients also contacted the news station to say that the hospital had lied to them about the outbreak and didn’t provide them with information about loved ones who had been exposed to the virus prior to discharge. “Think about the lives you’re affecting. Be honest with people. We can handle the truth and we deserve to know the truth,” family members told the station.
After whistleblowers went to the media, the hospital halted admissions temporarily to begin the decontamination process, and reopened on April 10.
Amidst a Pandemic, Familiar Policy Debates Arise
For decades, there has been a longstanding conflict between those advocates who call for abolishing the asylum and those who argue that it should be rebuilt. But as COVID-19 spreads through psychiatric institutions, pre-existing policy debates have taken on a new urgency.
Disability rights organizations and legal advocates had been fighting abuse and neglect in institutional settings long before the pandemic hit. They have argued consistently for fully-funded community supports and housing, which would reduce the demand for institutional care. These advocates were among the first to come forward when the nature and seriousness of the virus were coming to light.
In a blog for the National Health Law Program last month, attorneys Abigail Coursolle and Jennifer Lav argued that psychiatric hospitals face a “unique challenge” in mitigating the spread of the virus. “Like other health care settings, people in these settings often eat and bathe in shared facilities. An added challenge that is unique to behavioral health facilities is that many facilities still rely on restraint, seclusion, and involuntary medication-interventions which, while already dangerous, now have increased risk due to close contact,” they wrote.
Amidst a clear and troubling pattern of COVID-19 mismanagement within congregate care facilities resulting in employee and patient deaths, advocates continue to call for ongoing access to institutional care. Some are upset about new regulations from the Trump administration allowing the use of inpatient psychiatric beds for COVID-19 cases, according to the blog of journalist Pete Earley.
Others continue to advocate for a repeal of what is known as the “Institutions of Mental Disease (IMD) Exclusion.” This rule was enacted at the beginning of the Medicaid program in 1965 to de-incentivize states from overreliance on institutional settings and limits Medicaid funding to psychiatric institutions with more than 16 beds that are not attached to a general hospital. The IMD Exclusion has been a continued flashpoint between civil rights groups, disabled people, and ex-psychiatric patients on one hand and caregivers, law enforcement, and medical advocates on the other.
On March 25, pro-involuntary treatment advocate DJ Jaffe, writing in the National Review, called for a “swift suspension” of the IMD rule during the COVID-19 crisis: “The prohibitions on using Medicaid for the incarcerated and hospitalized mentally ill should be waived during the pandemic so that they can be treated appropriately.”
An Oregon State Hospital worker who chose to remain anonymous for fear of retaliation told Mad in America that he finds such proposals disturbing. “My life experience tells me that these people know ‘when the sun is out, it’s time to make hay.’ It’s an opportunity to continue to move forward an agenda that they have been promoting for decades.”
Policy proposals to increase access to institutional care during a pandemic run directly counter to guidance put forth by the Substance Abuse and Mental Health Services Administration (SAMHSA). A SAMHSA document from March 20 said: “Because of the substantial risk of coronavirus spread with congregation of individuals in a limited space such as in an inpatient or residential facility, SAMHSA is advising that outpatient treatment options be used to the greatest extent possible. Inpatient facilities should be reserved for those for whom outpatient measures are not considered an adequate clinical option.”
On April 9, President Donald Trump held a call about mental health and coronavirus with 177 “invitation only” listeners, according to Earley’s blog. Earley said that the purpose of the call was to “thank mental health workers who are risking their lives to serve individuals in need, and to tout what the administration is doing to help Americans with opioid addictions and mental illnesses.”
Both President Trump and Vice President Mike Pence referred to the mental health call during that day’s Coronavirus Task Force press briefing. An insider familiar with the contents of the call told Mad in America that while the use of psychiatric beds for COVID-19 patients was discussed, outbreaks in psychiatric facilities were not.
Still Waiting on the Promise of Olmstead
Kathy Flaherty, executive director of the Connecticut Legal Rights Project, recently documented her own experience trying to obtain a test for COVID-19 while navigating debilitating symptoms.
Flaherty told Mad in America that she has been frustrated by the lack of media coverage as the number of COVID-19 cases rises across facilities run by the Department of Mental Health and Addiction Services (DMHAS). “What will it take before the spread of COVID-19 within congregate settings for people with disabilities is deemed a higher priority?” she asks. “Will it take someone dying?”
Flaherty has been reaching out regularly to reporters and posting on social media about the situation at the state hospitals. According to the latest state data, 16 patients and 29 staff have tested positive, with the majority at Connecticut Valley Hospital and Whiting Forensic Hospital. The CT News Junkie reported last week on a doctor who contracted the virus in a DMHAS facility, who alleges the state is not doing enough to protect workers and residents.
In a Twitter thread on April 11, Flaherty shared a set of policy recommendations from the Connecticut Legal Rights Project. In the thread, Flaherty called for the state of Connecticut “to do what it can to prevent new involuntary admissions to congregate settings through the process of civil commitment,” “to discharge people to community settings with services and supports,” and to “ensure that people are receiving treatment in the least restrictive environment,” among other proposals. Flaherty also advocates for competency restoration in pending criminal cases to proceed “in the community rather than in a hospital setting.”
In an April 16 statement, the Bazelon Center for Mental Health Law called for “serious efforts to be made” to discharge people from psychiatric hospitals to community supports:
Access to housing must be increased, including to meet the needs of people with serious mental illness who in other circumstances would be hospitalized. Newly available housing subsidies made available through the CARES Act should be used. Vacant hotel rooms and college dorms should be used. Trailers including those provided by the Federal Emergency Management Agency (FEMA) and even recreational vehicles should be deployed as needed.
In many cases, families will offer to temporarily house and care for relatives being discharged from or not admitted to hospitals. More will do so if support is available from community providers. Many nursing home residents are being discharged to live with families. The same can happen with psychiatric patients.
Last month, advocates in Oregon advanced a similar proposal for expanding care capacity outside of dangerous congregate settings. Disability Rights Oregon encouraged the state to use its emergency powers to lease or purchase rooms, with contracted staff on hand to provide care, so that those trapped in jail could have a safer place to go. The state declined this recommendation, saying that “establishing a hospital level of care in a non-hospital setting (such as a hotel) is simply impossible during the current surge.”
“The Supreme Court ruled in Olmstead v. L.C. in 1999 that people have the constitutional right to receive services in the least restrictive setting,” Flaherty added. “Unfortunately, our states have never fulfilled the promise of Olmstead by adequately funding a community-based system of voluntary services and supports. We need to end a system that relies far too much on coercion and treatment over objection.”
Flaherty continued, “It has never been more clear that a bed in a psychiatric hospital or any other congregate environment (jail, prison) is a danger to someone’s health and safety. We are showing that it is possible to provide shelter to the unhoused in ways that support their dignity and privacy. We can and must do better.”
MIA Reports are supported, in part, by a grant from the Open Society Foundations
Leah Harris
Leah is Mad in America’s political correspondent. She has previously been a blogger for MIA; her writings have also been published in the Huffington Post, Psychology Today, Medium, and other forums. A longtime activist, she writes about mental health, trauma, addiction, and suicide as matters of social justice.
Originally published at https://www.madinamerica.com on April 19, 2020.
