undreds of patients released from state
psychiatric hospitals in New York in recent years are being
locked away on isolated floors of nursing homes, where they
are barred from going outside on their own, have almost no
contact with others and have little ability to contest their
confinement, according to interviews with workers and experts
and visits to the homes.
The Pataki administration approved the creation of the
special units for the mentally ill in 1996, but has otherwise
left them unregulated. The nursing homes generally lack mental
health expertise, and have not sought licenses to operate
locked floors.
As a result, some experts said, the administration was
allowing the homes to violate state regulations governing the
care of the mentally ill and in the process was depriving them
of their civil rights.
The conditions in the locked units, which the
administration authorized with no public notice, were
uncovered in a four-month investigation by The New York Times.
The investigation was based on multiple visits to the homes -
many are in New York City - as well as more than 50 interviews
with residents, relatives, workers and officials.
The units are in nursing homes that mainly care for the
elderly. They are not part of the separate system of adult
homes for the mentally ill, which were the focus of a series
of articles in The Times earlier this year that detailed
extensive neglect and malfeasance.
The units are just the latest development in the troubled
evolution of New York's mental health network over the last
half-century. As the state continues to empty out its costly
psychiatric hospitals, it appears to be moving even further
from what it says had been a fundamental goal: helping the
mentally ill gain independence and self-sufficiency to live
within a community.
The investigation of the nursing home units shows that the
mentally ill residents - many in their 30's and 40's and
physically healthy - often receive little in the way of
rehabilitative therapy and are chiefly left to wander the
halls or languish in their rooms. The residents are not
violent and have not been involuntarily committed by a court.
Yet on the fourth floor of the New Surfside nursing home in
Far Rockaway, Queens, about 50 mentally ill people are
prevented from going outside by locked elevators and fire
doors with alarms. Residents at the nearby Haven Manor nursing
home are outfitted with electronic bracelets that trigger an
alarm should they try to leave. And at the Woodmere nursing
home in Nassau County, residents have broken windows in a
desperate bid for freedom, workers said.
Gov. George E. Pataki would not comment for this article.
Administration officials and a main operator of the homes
disputed that the floors are technically locked. They said the
units are merely secured, and thus do not legally require a
special license. The officials said the units provided quality
care and did not confine residents against their will.
Visits to the homes and interviews with workers and
residents like Leonard Holloway indicated otherwise. Mr.
Holloway, who is 48 and has schizophrenia, was not allowed
outside Haven Manor until late last month, three months after
arriving at the home and only after being visited by a
reporter. ``You feel like you're in a - like you're a prisoner
in here,'' said Mr. Holloway, once a clerk at the main branch
of the New York Public Library.
Tacked on the wall over his bed is evidence of what he has
accomplished during his stay: three children's jigsaw puzzles
that he put together during recreation time.
Many mental health advocates and lawyers were unaware of
the units and voiced dismay when told of the restrictions.
``I have never heard of this type of facility in the
12-plus years that I have been doing this,'' said Tim Clune,
managing attorney for Disability Advocates, a nonprofit legal
office in Albany. ``I am very surprised that this exists, and
that the state would allow this to exist. This is de facto
involuntary commitment. These people's civil rights are being
violated.''
Administration officials said they did not know exactly how
many units were operating. The State Office of Mental Health
estimated that at least a dozen existed, suggesting that as
many as 1,000 mentally ill people lived in them. Yet the
office, which was responsible for discharging the patients
from the state psychiatric hospitals to the units, has chosen
not to take a role in overseeing them or ensuring that
residents receive proper care.
The administration's chief nursing home regulators, Dr.
Antonia C. Novello, the state health commissioner, and Wayne
Osten, a senior health official, said the units were
appropriate and had been examined by officials during routine
inspections of the homes. They said the units, which the
department refers to as ``neurobiological units,'' did not
need additional regulations.
``The residents can leave the units if they want,'' Mr.
Osten said. ``From our standpoint, there are means of egress
for the residents.''
Mr. Osten said it would be incorrect to call the units
locked, explaining that while elevators were often ``keyed,''
as he described them, the fire doors were only alarmed.
But workers said in interviews that residents are told that
under no circumstances are they permitted outside on their
own. The workers said the floors were confined to prevent the
mentally ill residents from mixing with elderly residents on
other floors. The restrictions also allow the homes to avoid
hiring more staff to keep track of the mentally ill residents,
the workers said.
An aide to Benjamin Landa, who is a partner in four homes
with units, said state officials knew about the restrictions
imposed on residents, adding that health and mental health
officials had repeatedly visited the homes. The aide, Frank
Iannucci, said the residents agreed to the conditions before
they were admitted.
``This is a voluntary program,'' Mr. Iannucci said. ``All
the clients are told exactly what is on the unit.''
Legal experts like Mr. Clune dismissed that assertion,
saying that psychiatric wards are sending the patients
directly to the units and the patients have little say in the
matter.