Atascadero State Hospital

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Atascadero State Hospital
Location Atascadero, California, United States
Care system Psychiatric Ward
Hospital type Forensic psychiatry
Emergency department None
Beds 1239
Founded 1954
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 and disordered convicts who have been committed to psychiatric facilities by California's courts.[1] Located in Atascadero, California, it is the largest employer in that town.[citation needed]


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.[2][3] 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.[4][5][6][7][8][9][10][11] 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.[12] 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 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 [13][14] 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,[15][16][17] which won awards from the American Psychiatric Association[18] and, in 1998, the Ernest A. Codman Award in the Hospital Category.[19] In this era, ASH was an important center of research and teaching.[20][21][22][23][24][25][26]

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.[27] Psychiatrist salaries have been increased to levels just under the prison psychiatrist salaries, and ASH's psychiatrist staffing is now (2014) being rebuilt.

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 compromise the clinical operations of the hospital at the behest of the DOJ consultants. He was replaced by hospital leadership whose understandable priority was to expedite the CRIPA process by obeying all diktats by the consultants. 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.[28][29][30]

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.[31]

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.

The enhancement plan is now generally regarded by the vast majority of clinical staff at ASH as a failure. The amount of paperwork has increased astronomically and the time spent with patients building trust and rapport has dropped. The cost for caring for patients at ASH has gone from $130,000 per patient per year to over $200,000. (source?) This is a direct result of the changes mandated by the court monitors. The institution is now considered a much more dangerous place to work, again from changes mandated by the court monitors. Assaults on staff and on other patients has increased dramatically, both in numbers and in severity. This is also considered by staff to be attributed to the Enhancement Plan, which put severe restrictions on the ability of psychiatrists to medicate violent patients and the discretion of staff to place violent, assaultive patients in restraints or seclusion.

Many staff believe that the treatment of the patients at ASH has become less humane since the court monitors have directed so many radical changes in the way that these forensic psychiatric patients are treated.

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.

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". The San Diego Union-Tribune. May 29, 2014. 
  2. ^ "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. 
  3. ^ "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. 
  4. ^
  5. ^
  6. ^ "Shame aversion therapy". Journal of Behavior Therapy and Experimental Psychiatry 1: 213–215. doi:10.1016/0005-7916(70)90005-4. 
  7. ^
  8. ^
  9. ^
  10. ^
  11. ^
  12. ^
  13. ^
  14. ^
  15. ^
  16. ^
  17. ^
  18. ^
  19. ^ "Atascadero State Hospital". The Joint Commission. Archived from the original on 2007-09-27. Retrieved 2007-08-01. 
  20. ^ "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. 
  21. ^
  22. ^
  23. ^ "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. 
  24. ^
  25. ^
  26. ^
  27. ^
  28. ^
  29. ^
  30. ^
  31. ^ Romney, Lee (April 4, 2008). "Patient's slaying rattles hospital". Los Angeles Times. p. B1. 

External links[edit]

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