Hospitals’ preventable patient deaths add to big concerns in mental health care

lacasamhrc-300x200With mental health services stretched thin and failing to fill significant need, it may be more distressing still for the public to confront growing evidence of big problems in existing facilities that try to treat those with serious psychiatric ills.

The Los Angeles Times, based on its investigation, has found “nearly 100 preventable deaths over the last decade at California psychiatric facilities, including at La Casa Mental Health Rehabilition Center  (shown here). It marks the first public count of deaths at California’s mental health facilities and highlights breakdowns in care at these hospitals as well as the struggles of regulators to reduce the number of deaths.”

The newspaper said it “submitted more than 100 public record requests to nearly 50 county and state agencies to obtain death certificates, coroner’s reports and hospital inspection records with information about these deaths.” Reporter Soumya Karlamangla said she had to look far and wide for data on problems in psychiatric facilities because, “No single agency keeps tabs on the number of deaths at psychiatric facilities in California, or elsewhere in the nation.”

The total, she reported, “includes deaths for which state investigators determined that hospital negligence or malpractice was responsible, as well as all suicides and homicides, which experts say should not occur among patients on a psychiatric ward. It does not include people who died of natural causes or other health problems while admitted for a psychiatric illness.”

The newspaper’s latest reporting followed up on its published account on how one patient is suspected in the killing of another at Kedren Community Health Center, a psychiatric hospital that the Los Angeles Times said had shown “serious failures of oversight in the care of patients.”

Axios, the news and information online site, has reported that problems are cropping up nationwide in psychiatric facilities:

“In September, the Tampa Bay Times published an investigation of North Tampa Behavioral Health, a psychiatric hospital that ‘makes huge profits by exploiting patients held under Florida’s mental health law.’ [In October],the Seattle Times reported on 10 private psychiatric hospitals in Washington state that have been approved or expanded since 2012. The paper found a series of safety issues, bad record-keeping and instances of hospitals trying to keep voluntary patients from leaving.”

Axios also quoted Morgan Shields, a Ph.D. candidate researching psychiatric inpatient care at Brandeis University, and noted that:

“Psychiatric hospitals, like nursing homes, by definition care for a vulnerable population who often struggle to advocate for themselves. Facilities may then exploit patients’ vulnerability in order to drive profits higher. ‘Patients often are not able to choose where they go … and, even if they could choose a hospital, patients and family often do not have any information on the quality of care provided,’ Shields said. Further complicating the issue is that the U.S. has a shortage of mental health care to begin with; there aren’t enough beds for all of the patients who need treatment.”

Indeed, the Los Angeles Times, reporting on the preventable deaths in California facilities said:

“Like mental illness itself, these tragedies cut across age groups, races and social classes. Among those who died in California’s psychiatric wards were a 15-year-old high schooler in marching band, a 27-year-old who spent his free time volunteering at church and a Ph. D. student in criminology. [One] was the child of a celebrity couple: [Another was] a champion boxer and [yet another] starred for more than two decades on [a] soap opera … Although the number of inpatient deaths in California does not appear to be higher than national averages, the deaths reveal serious lapses … Mental health experts say that while there are rare cases in which a hospital staff cannot prevent the death of a patient on the psychiatric ward, most people admitted can be kept safe. State officials who investigated these deaths largely attributed them to low staffing levels, staff errors, lack of training, or facilities that were deemed unsafe.”

The newspaper, finding that the number of available psychiatric bed keeps plunging, reported that regulators try to work with facilities and their operators to keep services flowing. Penalties, even when flaws and wrongdoing are found, can be relatively light. In California, efforts to deal with deaths in psychiatric facilities are complicated further by strict privacy laws intended to protect patients but that end up shielding institutions, their staff, and operators.

The New York Times, meanwhile, has quoted Jean M. Twenge, a research psychologist at San Diego State University and author of the book “iGen,” about mental health trends among those born since 1995, as saying: “We’re in the middle of a full-blown mental health crisis for adolescents and young adults. The evidence is strong and consistent both for symptoms and behavior.”

Jane E. Brody, the newspaper’s respected health journalist, talked to Twenge and others for a column on the “crisis” in youth suicide, which grown-ups, in misguided fashion, may be frightened but stigmatized by — enough so they are trying to keep it quiet to the detriment of people who desperately need help. As she reported:

“In October, the Centers for Disease Control and Prevention reported that after a stable period from 2000 to 2007, the rate of suicide among those aged 10 to 24 increased dramatically — by 56% — between 2007 and 2017, making suicide the second leading cause of death in this age group, following accidents like car crashes … Along with suicides, since 2011, there’s been nearly a 400% increase nationally in suicide attempts by self-poisoning among young people. “Suicide attempts by the young have quadrupled over six years, and that is likely an under count,” said Henry A. Spiller, director of the Central Ohio Poison Center, who called the trend “devastating.” “These are just the ones that show up in the E.R.”

Brody reported that grownups need to step up to help young folks get unhooked from electronic devices, notably smart phones that cause big problems with anxiety, bullying, and unhelpful comparisons among kids about their looks, intellect, social and economic standing, and accomplishments. They also can keep young people from getting the exercise and sleep they need during a time when their brains and bodies undergo rapid change.

If you are in crisis or know someone who may be, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text HOME to 741741. Both work 24/7. More resources are available at SpeakingOfSuicide.com/resources.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to afford and access safe, efficient, and excellent medical care, especially mental health care. The Obama Administration, with bipartisan support, passed important legislation that finally aimed to put mental health services on a more equal standing with other medical services in funding, filling dire needs, and in seeking to eliminate stigma and unequal treatment of those with mental disorders.

That promise is going unfilled, and the consequences, particularly for the vulnerable young, are almost too painful to see. We need to eliminate the silence, shame, and fear in dealing with mental illness and the rising challenges of suicide.These deaths take a terrible toll, especially on survivors.

The battle against them may need to include dealing with gun violence as a public health issue, learning more how we can help those in mental distress at the highest moment of need, so they do not take their lives. New research confirms that just a slice of suicide attempts (<8%) end in death. But, among that low percentage, the even smaller number of incidents involving guns (again 8+%) results in 75+% of fatalities.

We’ve got a lot of work to do to ensure that those who need mental health assistance get the services they need, so tragic consequences do not follow.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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