Psychiatric cuts at ASH raise alarms

January 23, 2012


Deep budget cuts at Atascadero State Hospital have prompted administrators to slash positions of more than a dozen contract psychiatrists during the past three months, just as the hospital initiates a unique pilot program for collectively treating the system’s most dangerous patients.

But attacks by patients on four ASH employees last week were not associated with the facility’s new “enhanced treatment unit,” said hospital spokesman Craig Dacus.

“None of the incidents from the past Friday had anything to do with (that),” Dacus told CalCoastNews in an email.  “The level of aggression in January is consistent with the months preceding.”

He added, “It is important to note that the nursing staff-to-patient ratio has not changed, and they are the line staff responsible for the management and safety of the unit.”

As to the recent reduction (13) in contract psychiatrists, Dacus wrote, “(ASH has) enough psychiatrists on staff to meet the patients’ needs. We now have 30 active treatment units and one psychiatrist for each unit, plus a floating pool of ten psychiatrists to supplement each unit. This is improving patient treatment and care because it is providing consistency. The psychiatrist in the unit knows each patient and knows how they interact with staff members and the other patients.”

The administrative moves at ASH are in keeping with a cost-cutting effort by the California Department of Mental Health, one element of which will pump more of the department’s diminishing resources toward the mental health and prison systems’ most urgent patients.

The ASH program will provide a prototype for the state’s other mental health facilities, according to the plan.

A major reorganization plan was unveiled by the Brown Administration last week, calling for formation of a new Department of State Hospitals. Now, 6,300 high-risk patients will become the state’s primary focus. And to deal with the same system’s less dangerous patients, the state will ask county governments to pick up the slack.

More than 600 of the department’s 11,000 state hospital positions are being eliminated in an effort to stanch a current $133.6 million deficit in the department’s $1.3 billion general fund budget. ASH’s current budget is $200 million.

The moves at the state level accentuated a recent announcement by the U.S. Department of Justice that ASH “has been released from federal court jurisdiction.” The state’s mental health hospitals have been under federal microscopes over the past five years because of allegations of poor treatment, care, and of dangers to patients and staff. The November announcement said  ASH “is in substantial compliance” with a 2006 agreement between federal and state officials.

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This stuff just makes me crazy.