New Jersey officials are looking to move forward with new oversight, more robust staffing, and expert recommendations on how to reduce overcrowding and violence — and improve treatment — at the state’s largest psychiatric hospital.
These promises follow months if not years of dysfunction at Greystone Park Psychiatric Hospital, in Morris County, which former board members and advocates have said is beyond capacity and lacks proper caregivers and security — putting patients, staff, and even visitors at risk, and reducing the chances for clinical success.
This group cites a pattern of violent assaults, lack of transparency and proper oversight by the administration of former Gov. Chris Christie, and continual strife between the state and the board. Christie replaced seven members of the Greystone board five days before he left office. Last week, at the first meeting since the shakeup, hospital officials outlined their plans to address those concerns.
Reforms will involve a strategic plan that state leaders are developing to benefit New Jersey’s network of four state psychiatric hospitals, including Greystone, due to be completed later this year. The state will also rely on an audit from an outside consultant that was hired last fall, which should be finished soon, according to health officials.
“Our main focus is on enhancing the quality of care in all of the psychiatric hospitals,” said Dr. Shereef Elnahal, acting commissioner of the Department of Health, which now oversees these facilities. “We are optimistic that the new board will work well with the management team at Greystone, and look forward to the candid feedback and consultation with all of the board members.”
Moving away from hospitals
There has been a continuous effort in recent decades to treat individuals with mental illness in less restrictive, community settings — instead of state hospitals and other institutions. This process was hastened by Christie, who closed a fifth psychiatric hospital, Hunterdon County’s Hagedorn Psychiatric Hospital, in 2012, and shut down several state-operated facilities for adults with developmental disabilities during his two terms in office.
But the state continues to care for approximately 1,350 patients in these institutions, including nearly 560 at Greystone. State officials have insisted that Greystone — which was reopened in a new building nearly a decade ago — is not beyond its safe capacity and efforts to build a permanent, sustainable executive team and fill the clinical ranks are ongoing.
Critics, including former board members, contend that it is not just the numbers but the complexity of care required that is stressing the system. Greystone now serves a mix of mentally ill patients, some who also suffer from drug addiction, or are elderly, or were committed by the court — designations that demand slightly different care.
“The current population presents complex medical issues that did not exist at the time the hospital was initially opened,” former board chairman Eric Marcy, one of the most vocal critics, wrote to state officials in December. But nursing staff has remained at approximately the same level since the facility reopened in 2009, he said, and “There continues to be a shortage of psychiatrists and the recent efforts by the State to hire psychiatrists remains inadequate.”
To help reduce overcrowding, Sens. Richard Codey (D-Essex) and Joseph Vitale (D-Middlesex) have introduced a bill calling on the administration to re-open Hagedorn — something Marcy and many others support. Gov. Phil Murphy, who took office just over eight weeks ago, has not spoken publicly on the issue, but Elnahal, whom he picked to head the DOH, said state psychiatric hospitals are a priority for his team.
Earlier this month, Elnahal said officials had reviewed a “near final” draft of a report produced by New Solutions Inc., a New Brunswick-based consultant hired late last year by Christie — at a cost of $740,500 — to review the entire psychiatric hospital system. According to the request for proposals, the goals include improving patient care and “supporting congruency between hospital staff and administration.”
“The Department will be using the report to continue to improve quality care across the state hospital system with a more patient-centered focus and measures to better optimize the work environment,” Elnahal said, noting that they are not waiting for the final draft to take action. “We are continuing to fill critical vacancies.”
But Marcy and other observers, including attorneys and mental health providers who frequently work with Greystone patients and families, continue to raise concerns. Wards are overfilled and understaffed, violence is underreported, and the public is left in the dark, they insist.
One key question is assaults. State reports for January through June 2017 show there were 39 assaults at Greystone, out of a total 79 statewide. But Marcy and others said those numbers only include incidents that required medical attention; when all violence is recorded these numbers can reach as high as 100 incidents a month, they have found.
“Staff have stated in the clearest of terms that they are fearful for the safety of patients, for their own safety, and that they are unable to ensure the safety of patients. Significantly, the staff has confirmed that their ability to provide therapeutic treatment is seriously compromised due to the lack of security,” Marcy wrote in December.
Marcy was among the five members of the former board who were not reappointed to their role as Greystone trustees; the group was extremely critical of the Christie administration’s oversight and frequently clashed with state representatives. In January, just five days before he left office, Christie nominated seven new leaders — including his friend and former colleague at the U.S. Attorney’s office, Michele Brown, and his chief counsel Jim DiGiulio — to oversee the facility. (Two positions were vacant.)
Meetings initially scheduled for January and February were cancelled, raising concerns among some observers, but six of the seven new members gathered for their first session last week. The public portion of the meeting was also attended by Marcy and the former vice-chair, Kimberly Donnenberg, various mental health advocates, and several staff members who were eager for updates on the reforms.
The new board members were sworn in and led through an orientation by acting Greystone CEO Teresa McQuaide, who also serves the DOH as assistant division director for the state psychiatric hospital system. McQuaide briefly discussed some of the changes underway and noted that she is working on a strategic plan for all state hospitals that will address census issues, treatment, violence reduction, and workforce development.
The meeting also included a historic overview of the facility, which dates back to 1876, and a video on the importance of hand washing featuring a garage-type band that included some Greystone staff members.
“We’re pretty open and transparent. I want to assure you of that,” McQuaide told the incoming board, who remained quiet for much of the meeting. “We are looking forward to having a supportive advisory board,” she added.
In addition to Brown and DiGiulio, who was elected chairman, the new members include Morris Township Committeeman Bruce Sisler, an aide to Assemblyman Anthony Bucco (R-Morris); Morristown attorney Louis Modugno; Peter Simon, a chief of staff at the Port Authority of New York and New Jersey; and Wayne Hasenbalg, former president and CEO of the New Jersey Sports & Exposition Authority, who did not attend Thursday’s session.
But tempers flared fairly quickly, when Marcy spoke up to question the board’s planned meeting schedule (10 times a year) and its compliance with the state’s Open Public Meetings Act. He warned the new board members to ensure they were getting full reports from the administration on violence, lawsuits, and other sensitive matters, and urged them to remain independent in their oversight role.
“This is a serious board. It is not a rubber stamp,” Marcy insisted.
His questions clearly irritated McQuaide, who at one point early on rose and left the meeting for several minutes, leaving an awkward silence in her wake. Marcy said out loud he suspected she would have him removed from the meeting.
That didn’t happen; in fact, several minutes later McQuaide presented Marcy and Donnenberg with certificates to thank them for their service.