Jul 17, 2012

We have good reason to fear the asylum

Human beings seldom get captivity right. Guards dominate. Prisoners suffer. We’ve seen it time and again throughout history. It’s part of human nature. A famous 1971 Stanford University psychology experiment grouped students into roles as “prisoners” or “guards” in a mock institution. The “guards” became brutal and abusive. After six days, horrified researchers shut the exercise down.

This sad truth is that it takes a special effort to keep captives safe. We must put our minds to it. So we design our facilities to promote safety. We screen applicants for employment. We restrict staff power. We design grievance procedures, bring in inspectors, and develop quality improvement processes. Ethical leadership pervades safe institutions. Safe institutions let information pass through them to all levels of leadership, as well as to governing bodies like boards of directors, accreditation agencies and regulators – as well as to people on the outside. Openness to families also promotes safety. Anyone who has ever visited a nursing home knows that the residents who are visited by family members get the best care.

We can write all the procedures we want, but if good management does not prevail within the institution, residents inevitably suffer. We can write our core spiritual beliefs and values into mission statements all we want, but for people to be safe, the facility must exemplify these values every day in its ordinary operations. This is an especially tough challenge when residents are dangerous or disagreeable. Imagine what it’s like to work with our toughest mental health populations. Violent, out of control adults. Children who are not safe enough to live in their own homes.

I’ve been reviewing news reports and other material about one situation at a children’s residential treatment facility in northern Kentucky, Campbell Lodge Boys’ Home. The 24-bed treatment center closed in June when Kentucky officials removed all of the state-funded residents. Whistleblowing staff members reported medication abuse and other problems to state officials, prompting an investigation. A school resource officer reported other issues to local police months earlier.

The nonprofit group operating the center is reorganizing, in an effort to prove to authorities that it can fix its operations and reopen. The group looks pretty good on paper. It’s accredited by the Council on Accreditation, has substantial community support and a multi-million dollar endowment, not to mention an organizational history that goes back more than 50 years. It was founded in 1958 as a Catholic orphanage on the Boys’ Town model.

Situations like this make me worry about other facilities in Kentucky. Kentucky does not seem to have much in the way of routine oversight of mental health treatment facilities. Very few incidents must be reported to state regulators – only “serious” occurrences like a resident’s death, a serious injury to the resident, or a resident’s suicide attempt. In Ohio, a facility must report every use of force and any incident or allegation of physical, sexual, or verbal neglect or abuse. 

In my experience, when regulators are not routinely interacting with facilities, people suffer. There’s an illusion of safe operations, nothing more. Management by assigning blame protects no one.


News articles about the Campbell Lodge Boys Home investigation

The Campbell Lodge Boys Home website is http://www.clbh.org/

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