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Wednesday, September 14, 2016

Dr. Nirbhay Singh: The Consultant Who Helped Make Mental Hospitals in California More Dangerous

      If you live in California, are seriously mentally ill, and have been accused of a violent crime, do not plead not guilty by reason of insanity. If you do, and succeed, you'll end up in a state mental hospital. It's a lot safer in prison, and you'll get better treatment.

     In 2002, in an effort to improve services in California's mental hospitals that treat the criminally insane, the state hired a private consultant to reform the system. The reformer, a professor of psychiatry at Virginia Commonwealth University named Dr. Nirbhay Singh, had come to the United States in 1987 from New Zealand. Having specialized in research on the developmentally disabled, Dr. Singh had no experience treating seriously mentally ill patients with sociopathic and predatory tendencies. He had published articles about Buddhist-inspired mindfulness (whatever that means), and alternative treatments such as the herb kava as a calming agent. Dr. Singh, in reforming California's state mental institutions, among other things, replaced individual therapy with group classes on anger management.

     Notwithstanding Dr. Singh's "reforms," the U.S. Department of Justice stuck it's long nose into the problem by suing California on the grounds the state was violating patients' rights by heavily drugging and improperly restraining these extremely violent and dangerous people. The state, rather than fight the case, agreed to a court-supervised improvement plan at four hospitals with more than 4,000 criminally insane patients. (State hospitals in Norwalk, San Luis Obispo County, San Bernadino, and Napa.)

     According to the plan, overseen by Dr. Singh, these four hospitals reduced the use of restraints, isolation rooms, and heavy drugs. The reformer dismantled several behavioral programs, and placed greater importance on bureaucracy, and the production of documentation in support of compliance with the federal mandate. Many health care workers complained that the red tape came at the expense of patient care. Much of the paperwork, according to Dr. Singh's critics, was redundant, and clinically useless. Employees, under Dr. Singh's system, had to fill out 300 new forms every month. Staff members said they no longer had time to play cards and chat with patients, activities that the patients missed.

     While he worked as the chief consultant in California, Dr. Singh also worked with mental health systems in Connecticut, Georgia, Kentucky, Louisiana, and Tennessee. In January 2011, two weeks after the Los Angeles Times published an interview with a top State Department of Mental Health official about the effects of Dr. Singh's reforms, Dr. Singh abruptly resigned. Dr. Stuart Bussey, president of the Union of American Physicians and Dentists which represents California's mental hospital's psychiatrists and medical doctors, complained that Dr. Singh's reforms did "very little to create a healthy and safe environment for patients and staff." In fact, according to studies conducted in the four hospitals involved in the federally mandated reforms, three of them had become much more dangerous places for patients and mental health workers. The ban of heavy drugs, restraints, and isolation rooms had tripled the incidents of patient-on-patient and patient-on worker assaults in three of the institutions.

     While, according to his critics, Dr. Singh didn't know beans about how to run a place for the criminally insane, he did know how to make a buck. During his nine year tenure as a California mental health consultant, he charged the state $2,500 a day. His total bill came to $4.4 million. No wonder California was broke.

     Dr. Mubashir Farooqi, a psychiatrist at one of the pilot hospitals, called the reform program a "huge, very expensive, very idiotic experiment that failed badly." But in December 2011, notwithstanding the increased violence in the three California mental hospitals, the Department of Justice asked a federal court to extend the oversight, and continue along the same reform path. According to an assistant in the Department of Justice Civil Rights Division, California's reforms had not succeeded in improving mental health "outcomes" (bureaucrats love that word) at the four institutions. "Are we where we need to be? Absolutely not," he said in an interview. In the meantime, while the federal government dabbled in the care and treatment of California's criminally insane, mental hospitals in the state were dangerous places for patients, and the people trying to help them.  

1 comment:

  1. Why was the 4th hospital, with the lower rate of violence, different?

    ReplyDelete