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DROVE TO THE FRONT OF THIS BUILDING.AND SOMEONE WAS IN THE WINDOW.NOT SURE WHAT IT WAS...

A couple more examples of how charges of "neglect" are more often related to noncompliance with regulations than with actual patient harm:

I had secured a home to become the community residence of four adults who were virtual lifetime residents of an institution slated to close. Funding was in place to make needed structural modifications, purchase appliances and furniture, a van for their transportation in the community, etc.

Although they had significant orthopedic and medical problems in addition to sensory deficits and severe/profound mental retardation, we wanted to have an open kitchen so that the residents could participate in some meal preparation commensurate with their abilities. The fire marshall and one state licensing board came in and said that we had to close the kitchen off from the rest of the house due to the residents' disabilities.

Because each of the people used a custom wheelchair and had a 24-hour positioning schedule with side-lyers and other devices, we chose to furnish the living room with mat tables and the positioning devices. Then we were cited by another group for having "institutional" furniture and floor plan. None of the residents could sit in a regular sofa or chair, and we did have some chairs for visitors, but they said we needed a typical living room sofa, coffee table, etc. We eventually prevailed on that as the regulators got to know the people better, but were cited for the kitchen's enclosure on every review. There would have been no community residence at all had we not enclosed the kitchen. As it was, the residents were being driven down the interstate on the last day the institution had been open while the fire marshall was making his final inspection of the new home, and we were all on pins and needles, just praying that he would issue our certificate of occupancy before they arrived and found themselves homeless. The fire marshall also required that in addition to the standard two exits, each of the two bedrooms have a direct exit to the outside. This was so that if there was a nighttime fire, the residents could be safely evacuated in their beds rather than having to take the time to position them into their wheelchairs. Of course we also had sprinklers, exit signs, emergency lights, an alarm wired directly to the fire department, etc. We were not allowed to refer to the exit ramps as "porches" or "decks"--they were purely "egress ramps." On this, we were cited for not having any swings or planters or other "homelike" furnishings for the people to enjoy (but had we put such items there, we would have been in violation of the fire code and therefore "neglectful" of our residents). So it's not even just that there are multiple standards with which to comply; it's that one regulator requires one thing and other regulators demand different, mutually exclusive things.

On another review at a different home, we received a very serious citation because a bottle of medication was stored improperly. It was a controlled substance (Schedule IV) but was inaccessible to any of the residents, so no "harm" was done. But the citation, on its face, sounds like the bottle was open on the dining room table and being passed around during dinner.

We also had conflicts regarding use of antidepressants. A lady who had been with us for years had been diagnosed with depression and treated by one of our psychiatrists. When her case was reviewed, the reviewed concluded that we did not have baseline data that warranted the use of "behavior-controlling/altering drugs." We argued that the medicine was not to control her behavior, that depression was a medical condition, and that the medication was to treat the illness, just like a blood pressure pill or thyroid pill. We lost, and had to taper her medication, document symptoms of depression as they re-emerged, and then re-start her medication. Even our argument of "ok, we agree, we messed up, but don't make her go through this" did not help us. We did monitor her mood very closely, to document the tiniest observable change, so hopefully we got her back on her antidepressant before she suffered too much.

i too was pulled over by a cop right in front of that building, lol

now that's eerie

son hermosas, te llevan a un viaje la raja. saludos gataloca,santiago de chile

Wow! I love this pic!

brownie is not the owner he is the ground keeper ,three men from new york own it , they come out to check on it once in a while it is for sale,and definately strange stuff going on there. Also if you are cauht in the bond room you could face imprisonment even though it has been closed for many years.

Looking for a 1950 Commander Automatic Transmission that fit onto a stude 245 motor. Please email me royvaldez@wildblue.ne

I've looked at so many pictures of abandoned hospital auditoriums recently that when I went to vote at my neighborhood school today, I thought *it* looked oddly different, with all its signs of active use by a bunch of active children.

When those of us who work/worked in the mental health field talk about patients and signs like this, we are not in any way intending any disrespect to the patients or to their memory, if they are now deceased. We are sharing what it is like, how things have changed, how things still need to change, trying to cut through some of the sensationalism around mental health care and discuss the reality of it. It is in NO WAY intended to be demeaning to the person. We do not "blame" the patients or resent the care we provide. We know that we would not have jobs if people didn't have problems, and if people didn't need help with daily living, they wouldn't be in our care. We know better than most people that it is the illness, not the person, causing problems. We want to help. There are always more needs than we can meet, so it is not in our interest to "force" treatment on someone who doesn't need it or to keep someone in treatment any longer than necessary (and today, with managed care, the problem is usually being able to keep someone in treatment long enough to really make a difference as opposed to just getting through a short-term crisis).

In addition to what BigEd (thanks, BTW, "impulse control problems" is what I was trying to say in my post on another picture and couldn't manage to remember it) and Lynne said about "extreme precautions," for me they would also include no rings, watches, or bracelets, long hair tied back, keeping an "escape" route between the patient and myself, and having a means for requesting assistance if I needed it. Sometimes we had to assign two staff to work with one patient in especially extreme cases.

I would imagine that "violent" wards used to see much more violence than today because there was so much overcrowding and there were no medications to help reduce aggressive behavior.

Most patients in a state hospital, especially in a "violent" ward, were not "fine" and just in need of "a little help." I care very deeply about each person I have worked with, and try to always focus on his/her strengths. But that doesn't mean I can ignore the symptoms of paranoia, delusions, extreme irritability, lack of coping skills, lack of ability to foresee consequences of their actions, etc. that require closer supervision and more intensive treatment. This sometimes requires involuntary commitment to a locked psychiatric facility.

When I worked with facilities that were closing, the closure took a number of years, with intermediate targets to be met on the way to final closure. The institution's population was gradually reduced, first by ceasing new admissions of children (under age 18), then by ending all new admissions, then by setting up community placements for the current residents. The residents with the fewest and least complicated needs would be placed first. Population also declined due to patient deaths--many of the patients had very complex physical needs in addition to their mental health/developmental needs. As people moved to their new community homes, the remaining units would be consolidated, with more and more of the campus being closed, until finally the very last patients moved to the community (in some cases it is part of a closure plan to move some patients from the institution closing to another state institution that is still open). There were court orders involved, so there was regular oversight by a court monitor as well as by various state agencies and the legislature. The last, and most difficult-to-place group, became part of a special legal "class" that provided additional funding due to the cost of their care in the community. At the very end, it really was a case of "Will the last person here please turn out the lights."

I love the perspective of this shot! When I start at the bottom of the photo and scroll upward, I feel like I'm walking down the hall (or conversely, backing away from something if I start at the top and scroll down).

so many questions go through my mind as I look at this

Personal items weren't taken from patients to be mean or to make them feel bad. It was done for safety reasons, to prevent access to anything that could be used as a weapon against oneself or another (belts, drawstrings, shoe strings, razors, glass containers, pocket knives, any mouthwash or perfume that contained alcohol--yes, many people do drink mouthwash if that is the only alcohol available).

Many, perhaps most, patients came to the hospital with next to nothing in the way of personal possessions. Often they had nothing other than the clothes on their backs. A person ends up in a state psychiatric hospital because s/he is unable to live in the community and has no other place to go.

On several occasions I have responded to crisis referrals and gone to the individual's home to obtain needed personal items for a hospital stay. Usually I ended up at a local store to buy what s/he needed for a few days because there was nothing remotely clean or wearable in the person's home. The rest could be provided by the residential site or obtained from thrift stores, but I wanted him/her to have some new things, things that had never belonged to anyone else before. It came out of my own pocket, even winter coats and shoes if that's what was needed. No one asked me to do it, it wasn't part of my job, no one expected it, but it needed to be done, one human being to another. If it was within my ability to do, then it was my responsibility to do. I think most staff feel this way.