Missouri Mental Health Commission report calls for changes

JEFFERSON CITY, Mo. -- The state Mental Health Commission recommended ways to better protect patients in a report Tuesday, including providing for more independent investigations and making some information on abuse and neglect reports public.

A panel appointed by the governor also has been looking at changes to the mental health system. Both groups have called for reporting all deaths at state health facilities to the coroner or medical examiner.

The scrutiny comes after two deaths at the Northwest Habilitation Center in suburban St. Louis in the past year. One resident choked on a pen after being left unattended, and another suffered severe burns after being placed in very hot water.

"While some folks may feel the system may be under a microscope, I think that's a good thing and the outcome will be a better mental health system," Department of Mental Health spokesman Bob Bax said Tuesday.

The department already has made some changes. For example, it said it's now notifying the Missouri State Highway Patrol if patients die or assault is suspected in private or state-run centers -- another recommendation from the governor's task force. It also has created a centralized unit to investigate abuse and neglect cases and has implemented random drug screening of employees. The department may implement other ideas on its own, but some will need extra funding or a change in state law.

The Mental Health Commission's report said investigations should have internal and external components, to provide expertise while also offering independence, along with having people both within and outside the department accept and look into complaints. It also called for filing reports both at the facility and to the department's central office, so problems aren't ignored, and for better tracking of abuse and neglect data to spot concerns or trends. The commission said video surveillance should be "strongly considered" for all state mental health centers.

"The commission feels these recommendations are critical to achieving a mental health system that prioritizes safety and accountability as its primary responsibilities," commission chairman John Constantino said in a statement.

The commission also called for changing state law to make some information in abuse reports public, an idea the governor's task force also is studying.

Under current state law, reports of abuse at mental health institutions and the subsequent investigation reports are closed to the public. That means they also are kept secret from the employees against whom the allegations are made and from other families with relatives at the institutions. Some say the secrecy stirs anger among accused employees and could hamper efforts to prevent abuse.

A recurring element of the debate over mental health services has focused on state-run facilities. Supporters, including many with family members staying at such facilities, say their loved ones can't be served well in a private setting or with in-home assistance. But Gov. Matt Blunt has called for closing the Bellefontaine Habilitation Center in the St. Louis area, citing questions about patient mistreatment and excessive cost.

The commission said people should continue to have the options of state-run facilities or community services.

"There are clients with specific profiles of disability ... who may be better served in dedicated centers than in community settings," the report said.

Citing long waiting lists for mental health services, the commission also said the Department of Mental Health needs more funding to provide adequate services.