The Brisbane Report, Nancy D. Feldman, J.D. for New Jersey Protection and Advocacy, Inc.
PREFACE
New Jersey Protection & Advocacy, Inc. is part of a nationwide network of agencies and programs established by Congress to protect the legal, civil and human rights of persons with disabilities. NJP&A was designated as New Jersey’s protection and advocacy system by Governor Whitman in 1994, succeeding the Department of the Public Advocate. Through its Protection and Advocacy for Individuals with Mental Illness program, authorized by 42 U.S.C. §§ 10801-10807, NJP&A is responsible for monitoring the care and treatment of persons receiving services in mental health facilities, particularly state-operated institutions.
NJP&A is a consumer-directed, private, non-profit organization. The majority of NJP&A’s Broad of Directors are persons with disabilities or family members of persons with disabilities. NJP&A’s priorities and policies are developed also with the assistance of consumer-lead advisory committees. NJP&A’s staff of attorneys and advocates provides legal representation, advocacy, education and training, and technical assistance for, and on behalf of, persons with disabilities, their families, and advocacy organizations.
Nancy D. Feldman is a consultant specializing in legal and policy issues affecting children and juveniles. A graduate of Wesleyan University and New York University School of Law, she has served as Director of the Office of Inmate Advocacy in the Department of the Public Advocate. In that capacity, she challenged living conditions and care in county youth facilities and jails. Ms. Feldman also worked as a staff attorney at the Association for Children of New Jersey, where she performed legislative, policy and budgetary analysis on a series of issues regarding the child welfare system and children in poverty.
INTRODUCTION
Prompted by concerns about the care and treatment adolescent patients receive at the Arthur Brisbane Child Treatment Center (Brisbane), New Jersey Protection and Advocacy, Inc., began the Brisbane Project in April 1998, to review the care and treatment Brisbane provides and to assess the hospital's role within the system of mental health services for children and adolescents in New Jersey. The Project started at a time when Brisbane was receiving heightened scrutiny. The first death of a patient, Kelly Young, had recently occurred. In its aftermath, advocates and families were voicing criticism of Brisbane and its policies, and the State was preparing its May 1998 Action Plan.
As the Project proceeded, it became clear that the current list of complaints and recommendations for improvements were almost indistinguishable from the deficiencies and proposed remedial actions identified eight to ten years earlier. Although there were strong efforts to bring improvements to Brisbane, many of the most critical problems, including the abusive relationships between staff and patients and the problems with restraint, have persisted. Some of these problems defy permanent correction through policy changes because they flow from intrinsic features of the hospital’s setting. The physical isolation of Brisbane discourages family involvement and limits the recruitment of staff, while the layout of the buildings restricts the hospital’s ability to classify the adolescents and leads to continuing supervision and safety concerns.
In spite of these intractable problems and in spite of a shrinking number of patients who are committed to the hospital, the State has remained steadfast in its commitment to the institution. The key to understanding the State’s continuing commitment to this beleaguered institution lies in recognizing the de facto or real role of Brisbane. Brisbane has changed, or evolved, from providing acute psychiatric services to providing a place to wait for the majority of the adolescents residing at the hospital who no longer meet the standard for civil commitment, but who are waiting at Brisbane for appropriate services in a less restrictive placement. The State’s use of Brisbane to provide a place for ready-for-discharge adolescents to wait for months pending appropriate placement may not only be a violation of state and federal law but, more importantly, is detrimental to the mental health of the adolescents who are retained there.
Moreover, while the State justifies its commitment to Brisbane because it provides a "safety net" for the most seriously mentally ill adolescents, the reality is that Brisbane functions instead as a "safety valve" for the entire mental health system for adolescents. By providing this place to wait for the hardest-to-place adolescents, Brisbane serves as a cover for the State’s failure to provide for adolescents appropriate services along the full continuum of need.
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This Report places Brisbane in the framework of the overall system of mental health care for children and adolescents, provides historical background, and gives an overview of the hospital and the patients. The death of Kelly Young is discussed and evaluated in the context of Brisbane’s long-standing problems and its impact on the present situation at the hospital. The Report reviews, but does not attempt 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.
Mental Health Services for Children and Adolescents:
On the Brink of Change?
There are clear cycles to New Jersey's planning and implementation of its system of care for mentally ill children and adolescents. The first cycle began in 1978. Before then, New Jersey maintained children's units at each of the four state psychiatric hospitals and at Brisbane, serving a daily population of between 300-350 children and adolescents. In 1978, concerns arose about the quality of care in these units, the physical plants, and the programming for the juvenile patients. A new State Plan was released in 1978, and implemented between 1979 and 1980. This Plan called for the creation of the Children’s Crisis Intervention Services (CCIS) units and put in place alternatives to inpatient care. The Trenton Psychiatric Hospital Adolescent Unit was designated for adolescents in need of extended inpatient psychiatric care and Brisbane was designated for the treatment of younger children.
However, by the mid-1980's, this system broke down and the mental health system for children and adolescents was in crisis again. Following the death of a patient in the Trenton Psychiatric Hospital Adolescent Unit, the New Jersey Department of the Public Advocate filed a lawsuit, Slocum v. Perselay, to address overcrowding and life-threatening conditions in the Adolescent Unit. In 1987, this litigation led to the release of a new Plan to establish regional psychiatric programs. A new system of care was put into place that included the closing of the Adolescent Unit at Trenton Psychiatric Hospital, the designation of Brisbane as the "Statewide Back-Up Unit" for mentally ill adolescents, the implementation of the Youth Incentive Program, and the expansion of the CCIS units.
Currently, there appears to be growing recognition that New Jersey is again facing the end of a cycle and that the system of care for mentally ill children and adolescents put into place a decade ago is no longer meeting their needs. On April 22, 1999, Governor Whitman announced the development of a Children’s Mental Health System of Care initiative, intended to be a major reform of the State’s system for dealing with children with serious emotional disturbance. While this proposal promises systemic reform, it does not appear to address the role of Brisbane in the children’s mental health system.