Abuse and Coverups in Mental, Developmentally Disabled Care

It seems like the world will always be full of people who are charged with the responsibility of taking care of others but who just don’t seem to much care about how they do their job. Or whether they do it at all.

When it comes to mopping up after unruly children, whether you care about your job probably isn’t very important. When it comes to ensuring the safety, health and proper treatment of people who rely on you for helping maintain their own health or their very life, it probably is. When a person needs you in order to live — and needs you to give a damn about your job — that is a very serious and real responsibility.

Today I write about two stories in recent headlines that demonstrate the depths of indifference that some people have toward people who are the most vulnerable in our society, and the ones who need our greatest care and protection.

First up, Eastern Health’s Maroondah Hospital in Victoria, Australia. In a heart-breaking story about a young woman’s rape while spending her first night in the hospital’s psychiatric ward, we hear not of the hospital’s sincere concern and apology for the events that occurred. Instead, we hear the hospital mumbling “blame the victim” mentality, that all policies were properly followed, and the police need not be bothered.

In response to her rape complaint, Eastern Health staff provided Alexandra with the morning-after pill and a leaflet on ”inappropriate relationships” between patients.

The hospital apparently didn’t administer a rape kit, apparently didn’t call the police, and apparently didn’t think to refer the patient to sexual assault counseling services. The victim had just turned 21 and was previously a virgin. She was apparently heavily drugged at the time with psychiatric medications: ”I was in a catatonic state when it happened,” she said.

Her door, which was supposed to be locked at night, was apparently left open unintentionally by a staffer after he came into the room to check on her; another patient is accused of perpetrating the rape.

The rape surfaced after the newspaper, The Age, conducted an investigative report about unexplained deaths in the system:

Both cases raise serious questions about the handling of sexual assault allegations made by patients of Victoria’s mental health system and come after The Age recently exposed 34 deaths in psychiatric wards that were deemed unnatural, unexpected or to have occurred in violent circumstances.

According to the newspaper report, some changes have been made at the hospital as a result of the incident. “Eastern Health is understood to have made a series of policy changes in relation to matters raised by Alexandra’s case, including establishing a women-only corridor with a swipe-card entry system.” Gee, wouldn’t have that been a good idea years ago?

The second story, perhaps even sadder because of its breadth, is the unexplained and unexamined death of hundreds of developmentally disabled individuals in the care of operators of group homes for them in New York state, reported in The New York Times.

The Times reviewed the case files of all the deaths not resulting from natural causes that the commission investigated over the past decade and found there had been concerns about the quality of care in nearly half of the 222 cases. […]

At homes operated by nonprofit organizations, low-level employees were often fired or disciplined, but repercussions for executives were rare. At state-run homes, it is also difficult to take action against caregivers, who are represented by unions that contest disciplinary measures.

New York relies heavily on the operators of the homes to investigate and determine how a person in their care died and, in a vast majority of cases, accepts that determination. And the state has no uniform training for the nearly 100,000 workers at thousands of state and privately run homes and institutions.

People die from neglect or simply a very lackadaisical attitude toward their work — one man died after drowning in his own bath because the worker failed to turn off the water in time. After all, Facebook calls.

This comes on the heels of the Times’ report earlier this year on how New York state-run homes operated with impunity and abusing their residents without fear of retribution or firing. The commissioners who ran the agencies charged with overseeing how these homes are run weren’t fired — they were allowed to resign. Meanwhile, little has changed.

Worse, the state doesn’t want to know how developmentally disabled residents die:

Outside experts said they were particularly puzzled that records maintained by the state would list the cause as “unknown” in more than 700 deaths over the past decade, and wondered how hard state officials had tried to determine what happened.

If we leave it as “unknown,” the thinking may go, then nobody can be held responsible for the death. Great for the home operators and even for the agency overseeing them. Not so great for the individuals in their care:

Bruce Simmons was one of the many people the state had listed as dead of unknown causes. But a review of the records from the state’s own investigation reveals what occurred. He lived in a group home in Cortland, N.Y., which kept him under tight supervision around food because of his history of stealing food and choking. But the nonprofit group that took care of him during the day decided that was not necessary, and he choked to death in November 2008. He was 52.

The idea behind group homes was to remove people from large hospital-like buildings that had little connection to their local communities. It was thought if you put people in a more “normal” environment — like a regular home — residents will be happier and lead better lives.

The downside to this philosophy is that it is prone to significant problems if such disparate group homes and their staff aren’t carefully and closely monitored by an oversight agency. With so many different organizations responsible for running the group homes, there’s little consistency in care, training or standards. Well, there is in other states like Connecticut and Massachusetts. Not so much in New York.

In the abuse article, the Times notes:

Most of the state-operated homes are in economically depressed areas upstate, and the jobs they provide — paying from $29,000 to nearly $62,000 with generous benefits — are sometimes among the few decent employment opportunities. The state has no educational requirements for the positions, which involve duties like administering drugs, driving residents to day activities, feeding them and preventing them from choking. Some of those hired have shown no previous interest or skill in caring for difficult populations.

And that’s the problem. If you hire people who have little interest in their job outside of the monthly paycheck, don’t be surprised when they do their job poorly or without regard to the human lives they hold in their hands.

The solution is just as simple. Increase oversight, training and standards. Stop hiring people who only care about the paycheck. Institute standardized continuing training administered not by the organizations themselves, but by state employees who take their jobs seriously.

And stop renewing contracts for the organizations who continually perform below standards or have higher rates of unexplained deaths (or abuse) in their homes. Once an organization’s budget is threatened, you’ll suddenly see them motivated to start caring more about how the people whose lives they are charged with caring for.

Read The Age article: Mental health service accused of rape cover-up

Read the Times story: In State Care, 1,200 Deaths and Few Answers