Allegations of overcrowding and unsafe conditions are so serious at the state-run Greystone Psychiatric facility that New Jersey should reopen a Hunterdon County psychiatric hospital that closed five years ago to help relieve the situation, according to Sen. Richard Codey (D-Essex), a long time mental health advocate.
Codey, who has gone undercover several times to investigate concerns about psychiatric care and other social services, called on Gov. Chris Christie Monday to reopen the former Hagedorn Psychiatric Hospital to help reduce population pressure at Greystone, the largest remaining state facility for patients with severe mental illness. If there is no response, Codey said he would push for the reopening under a new governor, after Christie, a two-term Republican, leaves office in January.
According to state data, there were two dozen violent patient incidents — half involving staff, the other half involving other patients — and one sudden, unexpected death at Greystone during the first quarter of 2017, double or more the number of incidents reported at any of the other three state psychiatric hospitals. Several of the attacks at Greystone, which is located in Parsippany, involved the same two patients, officials said.
And reports from March showed that Greystone had 560 residential patients, the highest population since it reopened in 2008 in a new facility that replaced a historic 132-year-old facility under the same name. The old building was dogged by extensive media coverage, legislative investigations, and repeated efforts at reform. The census has trended upward in recent years at the new Greystone complex, which was built to house 450 people in the main building with another 60 living in cottages.
(Hagedorn, in Glenn Gardner, held around 300 patients at its peak; the facility now houses a transitional program for homeless veterans, run by the state’s Department of Military and Veterans Affairs.)
These conditions have raised concerns for members of Greystone’s board of trustees, some mental health advocates and officials at the state Office of the Public Defender, who described the conditions as “prison-like” with the most violent patients “running things” in a story published Wednesday by NJ.com. They blamed a lack of leadership and need for more and better-trained staff, according to the article.
“The hospital is supposed to provide a safe and supportive environment for patients, and instead has our most vulnerable residents living like prisoners and professional staff too afraid to properly do their jobs. This is a deplorable situation and the fact that it exists at a state-run facility should be cause for concern at the highest levels of government,” Codey, who served as governor between 2004 and 2006, said Thursday in response to the story. “I am personally sickened by the conditions patients are living in at Greystone.”
The governor’s office declined to respond to a request for public comment and a spokesperson for the state Department of Human Services, which oversees the psychiatric hospitals, said they did not comment on legislative proposals. All together, the four facilities now hold nearly 1,600 — down from more than ten thousand in decades past — and the vast majority of patients now receive care in local settings.
The other currently operating sites include Ancora Psychiatric Hospital, in Winslow Township, Camden County; Trenton Psychiatric Hospital, in West Trenton, Mercer County; and Ann Klein Forensic Center, a psychiatric hospital for patients who have been referred by the criminal court system, also in Trenton.
Some advocates, like Carolyn Beauchamp, president and CEO of the Mental Health Association of New Jersey, would like to see that trend continue. MHA has encouraged the state to focus on beefing up smaller, regional psychiatric facilities and strengthening the community providers that form the safety net for many with metal illness. Large, public psychiatric institutions generally reflect outdated models of care that are not ideal for many patients, Beauchamp said, and they frequently struggle with limited resources.
In addition, the troubles at Greystone are complex and involve other factors beyond overcrowding. Beauchamp said state hospitals are faced with more challenging and violent patients than in the past, many with dual diagnoses of mental illness and substance-use disorders, and both leadership and staff need better cross-training to properly treat these complex cases. (Christie has called for adding as many as 900 beds for dual-diagnoses patients in private healthcare facilities.)
The patients’ “needs are very different and we’re trying to shove them into a psychiatric hospital” unprepared to treat them, “and we don’t have the resources to deal with this,” Beauchamp said, noting that more patients are ending up in traditional hospital emergency rooms as a result, places that are unprepared to address their needs. “The whole system is underfunded,” she said.
Further complications have resulted from internal disputes between some Greystone staff and DHS officials. An August 3 letter from Acting Commissioner Elizabeth Connelly to Eric Marcy, the Greystone board chairman, stressed that state officials are working in several ways to recruit and add clinical staff, improve safety at the facility, and reduce overcrowding by discharging patients that are ready to re-enter the community.
Several leadership positions have recently been filled and the department is working with Rutgers University Behavioral Health to recruit and retain other critical providers, Connelly said. Teresa McQuaide, an assistant director at the Division of Mental Health and Addiction Services and the former CEO at Trenton Psychiatric Hospital, is serving as an interim CEO while the state searches for a permanent replacement.
“It is unfortunate that these actions are not being effectively communicated to and/or supported by some staff,” Connelly wrote, noting that a delay in settling a union contract has also impacted discussions over compensation for staff psychiatrists.
But Codey wasn’t keen on the steps outlined by Connelly in her letter, in particular her focus on the need to ensure efficient discharges. “There are a number of issues that must be fixed immediately, but there is no doubt that the fundamental problem is the overcrowding and can be traced to the closure of Hagedorn and other facilities,” he said. “The issue is that we need more beds for those who require care.”