Atascadero State Hospital

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Atascadero State Hospital
Location Atascadero, California, United States
Care system Psychiatric ward
Hospital type Forensic psychiatry
Emergency department None
Beds 1239
Founded 1954
Website Official website
Lists Hospitals in California

Atascadero State Hospital (ASH) is located on the Central Coast of California, in San Luis Obispo County, halfway between Los Angeles and San Francisco. It is an all-male, maximum-security facility, that houses mentally ill convicts who have been committed to psychiatric facilities by California's courts.[1] Located in the city of Atascadero, California, it is the largest employer in that town.[2]


ASH opened in 1954, as a state-run, self-contained public sector forensic psychiatric facility. It is enclosed within a security perimeter, and accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Patients are referred to the hospital by the Superior Court, Board of Prison Terms, or the Department of Corrections.

Its treatment programs have reflected the psychiatric assumptions of the times.[3][4] Initially constructed to treat mentally disordered sex offenders (MDSOs), initial programs focused on separation from society, albeit in an environment which provided freedom of movement. This was restricted after patient escapes. Initial research and treatment programs aimed at understanding and reducing the risk of reoffense in sexual offenders.[5][6][7][8][9][10][11][12] In the early 1980s, the focus of the hospital's treatment programs shifted to patients found not guilty by reason of insanity (NGRI) and incompetent to stand trial; ASH was a pioneer in developing effective treatment programs for the latter.[13] In the 1990s, California passed sexually violent predator (SVP) laws, imposing civil commitment upon prisoners meeting criteria upon the expiration of their determinate prison term. SVPs were housed in ASH until the new state hospital in Coalinga opened around 2004.

In the mid-1980s, a US Department of Justice investigation under the Civil Rights of Institutionalized Persons Act (CRIPA) led to important and positive clinical reforms at ASH. Sidney F. Herndon was the Executive Director throughout the 1980s and brought in a strong clinical and administrative team and built up the medical staff under Gordon Gritter MD as Clinical Director. David Saunders MD led the development of a forensic psychiatry fellowship, affiliated with UCSF-Fresno and UCLA. Harold Carmel MD and Mel Hunter JD MPA established the Atascadero Clinical Safety Project (ACSP) which conducted groundbreaking research into staff injuries from patient aggression [14][15] and, after Carmel left to become CEO of the Colorado Mental Health Institute at Pueblo in 1991, under Hunter and Colleen Love developed important programs to improve staff safety,[16][17][18] which won awards from the American Psychiatric Association[19] and, in 1998, JCAHO's Ernest A. Codman Award in the Hospital Category.[20] In this era, ASH was an important center of research and teaching.[21][22][23][24][25][26][27]

Many clinical staff left ASH in the late 1990s with the advent of the SVPs, which was believed by many clinicians to compromise the hospital's mission of providing excellent care for persons with serious mental illness, as opposed to containment of sexually dangerous offenders.

When salaries for California prison mental health staff, especially psychiatrists, increased dramatically as a result of federal litigation, ASH lost many of its psychiatrists and other clinical staff.[citation needed][28] Psychiatrist salaries have been increased to levels just under the prison psychiatrist salaries, and ASH's psychiatrist staffing is now (2014) being rebuilt.[citation needed]

Another traumatic period came with another US DOJ CRIPA investigation in the mid-2000s. Mel Hunter, by this time ASH Executive Director, was removed from his position as a result of his refusal to alter the clinical operations of the hospital at the behest of the DOJ consultants. He was replaced by new hospital leadership. In the event, the imposition of the atypical views of consultants with no experience in forensic psychiatry led to a degradation of clinical operations and safety, with great spikes in patient violence that came to an end when the consultants left the hospital following exposes by the LA Times into apparent cronyism.[29][30][31]

Patient-on-patient homicides[edit]

On May 28, 2014, a patient was killed and an employee was severely injured during an alleged attack by a patient.[1]

On March 30, 2008, 44-year-old inmate Earl McKee strangled a fellow inmate, 37-year-old Lawrence Rael, to death with a knotted towel. McKee was originally institutionalized as a "Mentally Disordered Offender". Last year, after making abusive threats to other inmates, he was reclassified as a "Sexually Violent Predator". The murder came in the wake of federal court-mandated changes that reduced the usage of medication and restraints on patients, as well as a large turnover in staffing resulting in less experienced personnel working at the hospital.[32]

Drastic changes since appointment of court monitors[edit]

In recent years, the hospital, under the threat of a lawsuit by the United States Justice Department alleging violations of the Civil Rights of Institutionalized Persons Act, has been implementing a court-approved Enhancement Plan to bring the hospital into compliance with CRIPA. The Enhancement Plan was proposed and implemented by the "Human Potential Consulting Group" out of Alexandria, Virginia. This consulting group consists of various clinical professionals who have been contracted by other states to ensure compliance with CRIPA. In some states the consultants serve as court monitors while others serve as consultants. They regularly switch roles from Justice Department monitors to consultants, depending on the state.

Notable patients[edit]

Employees, staff and officers[edit]

ASH employs a staff of over 1800, with on-site training programs for a variety of schools, including nurse practitioner programs, clinical psychology internship programs, and psychiatric technician training.

Popular culture[edit]

In the film Terminator 2: Judgment Day, Sarah Connor is institutionalised at "Pescadero State Hospital" - a mental institute heavily based on Atascadero State Hospital[citation needed].

One of radio host Phil Hendrie's recurring fictional characters is Herb Sewell, a former sex offender who was remanded for eight years at Atascadero State Hospital.

It also is referred to in the film The Grifters as the place where 'Cole' is sent after his mental breakdown.

In James Ellroy's "The Black Dahlia" (1987), set in the late 1940s, there are several anachronistic references to characters having been committed to Atascadero State Hospital – which did not open until 1954. This includes a woman committed there at the end of the novel (ch. 35) – ASH has never admitted a woman patient.


  1. ^ a b "Atascadero State Hospital patient killed in attack". U-T San Diego. May 29, 2014. 
  2. ^ "Atascadero Chamber of Commerce - Economic Profile". Retrieved April 2, 2016. 
  3. ^ "Teaching the nonverbal components of assertive training". Journal of Behavior Therapy and Experimental Psychiatry. 3: 179–183. doi:10.1016/0005-7916(72)90070-5. 
  4. ^ "The ineffectiveness of systematic desensitization and assertive training in hospitalized schizophrenics". Journal of Behavior Therapy and Experimental Psychiatry. 2: 107–109. doi:10.1016/0005-7916(71)90022-X. 
  5. ^ "Report of a Five-Year Follow-Up Study of Mentally Disordered Sex Offenders Released from Atascadero State Hospital in 1973 Symposium: Differential Treatment of the Sex Offender in California 4 Criminal Justice Journal 1980-1981". HeinOnline. Retrieved 10 July 2016. 
  6. ^ "Plasma Testosterone Levels in the Rapist. : Psychosomatic Medicine". Lippincott Williams & Wilkins. Retrieved 10 July 2016. 
  7. ^ "Shame aversion therapy". Journal of Behavior Therapy and Experimental Psychiatry. 1: 213–215. doi:10.1016/0005-7916(70)90005-4. 
  8. ^ "Effects of a Relapse Prevention Program on Sexual Recidivism: Final Results From California?s Sex Offender Treatment and Evaluation Project (SOTEP)". Sexual Abuse: A Journal of Research and Treatment. 17: 79–107. doi:10.1007/s11194-005-1212-x. 
  9. ^ "A comparison of the measurement characteristics of two circumferential penile transducers". Archives of Sexual Behavior. 6: 45–51. doi:10.1007/BF01579247. 
  10. ^ Melnyk, John; Derencsenyi, Anna; Vanasek, Frank; Rucci, Alfred J.; Thompson, Havelock (25 October 1969). "XYY Survey in an Institution for Sex Offenders and the Mentally III". Nature. 224 (5217): 369–370. doi:10.1038/224369a0. Retrieved 10 July 2016 – via 
  11. ^ "Failure of a Token Economy, The 38 Federal Probation 1974". Retrieved 10 July 2016. 
  12. ^ Haynes, Robert L.; Marques, Janice K. (1 June 1984). "Patterns of Suicide among Hospitalized Mentally Disordered Offenders". 14 (2): 113–125. doi:10.1111/j.1943-278X.1984.tb00342.x. Retrieved 10 July 2016 – via Wiley Online Library. 
  13. ^ Noffsinger, Stephen G. (1 June 2001). "Restoration to Competency Practice Guidelines". Int J Offender Ther Comp Criminol. 45 (3): 356–362. doi:10.1177/0306624X01453007. Retrieved 10 July 2016 – via 
  14. ^ Carmel, Harold; Hunter, Mel (1 December 1993). "Staff Injuries from Patient Attack: Five Years' Data". J Am Acad Psychiatry Law. 21 (4): 485–493. Retrieved 10 July 2016 – via 
  15. ^ Carmel, Harold; Hunter, Mel (1 September 1991). "Psychiatrists Injured by Patient Attack". J Am Acad Psychiatry Law. 19 (3): 309–315. Retrieved 10 July 2016 – via 
  16. ^ Love, CC; Hunter, M (1999). "The Atascadero State Hospital experience. Engaging patients in violence prevention". J Psychosoc Nurs Ment Health Serv. 37: 32–6. PMID 10486772. 
  17. ^ "Total quality management and the reduction of inpatient violence and costs in a forensic psychiatric hospital". Psychiatric Services. 47: 751–754. doi:10.1176/ps.47.7.751. 
  18. ^ "Intractability is relative: Behaviour therapy in the elimination of violence in psychotic forensic patients". Legal and Criminological Psychology. 2: 89–101. doi:10.1111/j.2044-8333.1997.tb00335.x. 
  19. ^ "Significant Achievement Awards". Psychiatric Services. 50: 1481–1485. doi:10.1176/ps.50.11.1481. 
  20. ^ "Atascadero State Hospital". The Joint Commission. Archived from the original on September 27, 2007. Retrieved August 1, 2007. 
  21. ^ "Forensic treatment in the United States: A survey of selected forensic hospitals". International Journal of Law and Psychiatry. 16: 57–70. doi:10.1016/0160-2527(93)90015-7. 
  22. ^ Klinge, Valerie (1 February 1994). "Staff Opinions About Seclusion and Restraint at a State Forensic Hospital". PS. 45 (2): 138–141. doi:10.1176/ps.45.2.138. Retrieved 10 July 2016 – via (Atypon). 
  23. ^ Marques, Janice K. (1 April 1999). "How to Answer the Question "Does Sex Offender Treatment Work?"". J Interpers Violence. 14 (4): 437–451. doi:10.1177/088626099014004006. Retrieved 10 July 2016 – via 
  24. ^ "Suggestions for the clinical and forensic use of the hare psychopathy checklist-revised (PCL-R)". International Journal of Law and Psychiatry. 17: 303–317. doi:10.1016/0160-2527(94)90032-9. 
  25. ^ Reed, Karen J. (1 January 2002). "Music Therapy Treatment Croups for Mentally Disordered Offenders (MDO) in a State Hospital Setting". Music Ther Perspect. 20 (2): 98–104. doi:10.1093/mtp/20.2.98. Retrieved 10 July 2016 – via 
  26. ^ Gacono, Carl B.; Meloy, J. Reid; Sheppard, Karen; Speth, Eric; Roske, Allan (1 September 1995). "A Clinical Investigation of Malingering and Psychopathy in Hospitalized Insanity Acquittees". J Am Acad Psychiatry Law. Journal of the American Academy of Psychiatry and the Law. 23 (3): 387–397. Retrieved 10 July 2016 – via 
  27. ^ Gibler, Brian; Hayes, Grace; Raleigh, Fred; Levenson, Barbara; Heber, Sheryl; Tham, Ann (1 August 1996). "Forensic Psychiatric Pharmacy Practice at Atascadero State Hospital". Journal of Pharmacy Practice. 9 (4): 222–228. doi:10.1177/089719009600900403. Retrieved 10 July 2016 – via 
  28. ^ Archived December 29, 2014, at the Wayback Machine.
  29. ^ Romney, Lee; Hoeffel, John (17 June 2012). "Ex-consultant to California mental hospitals criticized elsewhere". Retrieved 10 July 2016. 
  30. ^ Hoeffel, John; Romney, Lee (14 April 2012). "California hires relatives of hospital reform effort's leader". Retrieved 10 July 2016 – via LA Times. 
  31. ^ Romney, Lee; Hoeffel, John (28 January 2011). "Consultant to California mental hospitals abruptly resigns". Retrieved 10 July 2016. 
  32. ^ Romney, Lee (April 4, 2008). "Patient's slaying rattles hospital". Los Angeles Times. p. B1. 
  33. ^ "Judge refuses to release killer". Retrieved 10 July 2016. 
  34. ^ LYNCH, RENE (17 December 1992). "Slayer of Seven Is Sent Back to Atascadero : Treatment: Ex-janitor who shot nine people at CSUF in 1976 is found 'not appropriate' for Napa State Hospital". Retrieved 10 July 2016 – via LA Times. 
  35. ^ Editors (January 9, 2017). "Edmund Kemper Biography". A&E Television Networks. Retrieved 2017-02-15. 

External links[edit]

Coordinates: 35°27′49″N 120°38′06″W / 35.46361°N 120.63500°W / 35.46361; -120.63500