Brisbane Report Table of Contents

The Brisbane Report, Nancy D. Feldman, J.D., for New Jersey Protection and Advocacy, Inc.

CONCLUSION

THE FUTURE OF BRISBANE?

Future of Adolescents in New Jersey’s Mental Health System Dependent on Replacing Brisbane’s Role as "Place to Wait"

In August 1990, Dr. Friedman recommended that Brisbane be closed as of January 1, 1992. This recommendation was not followed by the State. Brisbane has remained open, but the compelling, fundamental flaws identified by Dr. Friedman, Dr. Nurcombe and the Mental Health Association of Monmouth County almost a decade ago remain.

The State’s untiring dedication to Brisbane is surprising not only because of its sweeping ineffectiveness, but also because of the small number of adolescents who actually need extended psychiatric hospitalization. In mid-October 1998, for example, the total hospital population was only 28, and of those patients, 23 or 82% were on CEPP status, waiting for placement. Only five adolescents were actually committed to Brisbane.

This handful of adolescents who require extended psychiatric hospitalization could be served on a regional basis, closer to home, rather than at Brisbane, a central statewide institution with persistent problems. Once stabilized and no longer in need of commitment, however, where would they go? Without Brisbane, where would they wait until an appropriate, less restrictive placement was found?

Behind the questions of whether Brisbane should be closed, or whether Brisbane can be "fixed" to continue to serve the handful of severely mentally ill adolescents who need long-term psychiatric inpatient care, hides the fundamental issue of the de facto or real role of Brisbane -- To house the much larger group of adolescents who no longer need commitment but have no where else to go.

Using Brisbane in this role denies the critical needs of the adolescent patients, especially their need to be re-integrated quickly into a less restrictive setting once they no longer meet the standard for civil commitment. CEO Grimaldi acknowledged that the wait for placement in this confined setting exacerbates their feelings of neglect and abandonment and precipitates the deterioration of their mental health. New Jersey is failing its hardest-to-place adolescents by not providing appropriate residential placement options for them and promptly moving them out of Brisbane.

Keeping Brisbane as a "place to wait" serves as a safety valve for the depleted mental health system. By keeping adolescents at Brisbane beyond the time they need inpatient treatment, until a placement can be found, Brisbane is a cover for the huge gaps in the State’s mental health services for adolescents. Brisbane is a leaky lifeboat being used to keep an overwhelmed mental health system for adolescents afloat. Continued reliance on Brisbane should not be accepted by the State or tolerated by the advocacy community.

As stated in the Introduction, this Report has not attempted to recreate the list of problems and recommendations for Brisbane because they have already been identified so clearly and repeatedly. This Report supports the conclusion that instead of continuing to try to "fix" Brisbane, the State should address the glaring need for appropriate services for the adolescents who are waiting there.

Brisbane’s role as a place to wait must be replaced with appropriate mental health services for adolescents. The State must mandate, develop and fund the full range of services that adolescents waiting at Brisbane require, including intermediate care facilities. Development of intensive residential programs for adolescents is also essential.

Discussions about the conditions at Brisbane quickly and inevitably lead to the issue of the future of Brisbane: Should Brisbane be Closed? But the more compelling question is: What of the Future of the Adolescents that it Serves? As long as Brisbane continues in its role as a "place to wait," the futures of the waiting adolescents are imperiled. Only if the State addresses the profound gaps in children’s mental health services that Brisbane serves to mask or cover will these adolescents have hope for the future.

ACKNOWLEDGMENTS

The author would like to acknowledge the invaluable help in preparing this report generously provided by state officials, advocates for children and adolescents with mental illness, parents, and staff at New Jersey Protection and Advocacy.

Footnotes:

Stroul, B., Pires, S., Armstrong, M., and Meyers, J., "The Impact of Managed Care on Mental Health Services for Children and Their Families," The Future of Children: Children and Managed Health Care, Vol. 8, No. 2, Summer/Fall 1998, pp. 120 -21.

² See description of Phoebe's Place below.

³ This summary is based completely on sources that described the incident, and not an independent investigation, including: Division of Mental Health Services, Administrative Incident report (February 1998); Asbury Park Press, "Hospital aide not charged in teen death," June 25, 1998, "Rift at Brisbane," January 18, 1998, at A1, "Why Brisbane patient died still not determined," January 7, 1998, at A1; Star Ledger, "Mental hospital where teen died has been focus of complaints," January 8, 1998, at 25; The Times, "Abuse reported before patient died," January 14, 1998.

⁴ New York Times, "Hospital and Employee Are Cited in Death of Boy," May 8, 1998, at B5.

⁵ Asbury Park Press, "Rift at Brisbane," January 18, 1998, at A2, A3.

⁶ Arthur Brisbane Child Treatment Center Action Plan, May 1998.