State Shares Good News About Reforms at Psychiatric Hospitals

Lilo H. Stainton | May 21, 2019 | Health Care
DOH is putting its back — and its budget — into making facilities more responsive to patients, safer for staff

Credit: nj.gov
Ancora Psychiatric Hospital
Progress has continued at New Jersey’s four state-run psychiatric hospitals, with violence and patient numbers declining, staffing levels increasing, new safety protocols in place, and a growing focus on quality patient outcomes.

Those are among the findings in a new report by the state Department of Health, a draft of which was obtained by NJ Spotlight. It provides an interim update on progress on goals identified in an 18-month reform plan released in August by Commissioner Dr. Shereef Elnahal.

The 18-month plan was developed after a consultant hired by the previous administration found the four troubled hospitals were plagued by problems like overcrowding and staff shortages, which created unsafe conditions for psychiatric patients and employees and serious clinical challenges.

To address these shortcomings, the DOH — which was granted oversight of the system at the end of Gov. Chris Christie’s tenure — sought to better integrate standards and policies, improve staff recruiting practices, and create a culture where safety was standard and real treatment was possible.

‘Continuum of recovery’

“The state psychiatric hospital system plays a major role in the continuum of recovery services for the residents of New Jersey,” the interim report noted. “The role of New Jersey’s psychiatric facilities continues to evolve as they transition into a single system of care.”

The state’s system of psychiatric hospitals — Ancora Psychiatric Hospital, Greystone Park Psychiatric Hospital, Trenton Psychiatric Hospital, and Ann Klein Forensic Center, which serves individuals placed by the courts — has gained attention in recent years after some board members and elected officials called for greater investment in the facilities.

The hospitals became increasingly crowded and violent over the past decade after Christie closed a fifth facility and the remaining sites were left to treat more patients with increasingly complex issues, often involving addictions. One location nearly lost its federal accreditation as a result of safety concerns.

According to the draft interim report, scheduled to be released today, the population in the four facilities is down nearly 11 percent since January 2018, for a total of 1,344 patients in April 2019. Violent incidents that result in moderate or major injuries were also almost 30 percent lower, or 10 fewer attacks, in the first quarter, when compared with the same period last year.

Continuing to staff up

In addition, the state has hired another 135 clinicians since July, including a dozen psychiatrists and four advanced practice nurses; this comes on top of 220 employees added in the first half of 2018. The DOH has also expanded its pool of short-term physicians, standardized its credentialing for certain specialists, and has implemented quality-assurance training programs, the report notes.

The DOH is also working to create a “culture of safety” throughout the system, using surveys and focus groups to assess the current status and create a plan for improvements. It has formed a central violence-prevention committee, which has met monthly since February. The department has also standardized emergency responses, trained staff in these protocols, and ensured all facilities have the proper first aid equipment on hand, it said.

On the clinical side, the state is working with Rutgers University experts to create treatments that take into account patients’ past traumas, which can impact health outcomes over a lifetime, a method called trauma-informed care. It is providing clinicians access to textbooks, journals, and online resources to support their work and has implemented several training programs for patients, designed to help them better manage their own issues and care.

In addition, the DOH has launched a technology pilot program at Ancora that enables staff to track admissions, transfers, discharges, medical decisions, and even pharmaceuticals through a single system. Much of the work at these facilities involved paper charts and records as of last summer, officials said.

When it comes to capital investments, the state has committed an additional $4.8 million to various improvements at the four facilities, many related to safety. More than half of the money went to reduce strangulation or hanging risks at Trenton Psychiatric Hospital. Other funding went to upgrade fire alarms and door systems at Anne Klein and to replace the roof at Ancora, the report notes.