When Garth Webb was sent to Napa State Hospital, his parents were relieved.
The bellboy and amateur composer from Sebastopol had been in the throes of bipolar disorder when he was charged with threatening the lives of co-workers. His family encouraged him to plead not guilty by reason of insanity, thinking that in a mental hospital he would get the treatment he needed.
Instead, Webb and his parents say, he was repeatedly brutalized. His main tormentor, a patient in the room next door, assaulted him several times, wrapping him in a headlock and sexually abusing him.
Soon after, the same man strangled a psychiatric worker on the hospital grounds.
"Since I've been here, that's what I've witnessed ... these random acts of violence," Webb, now 31, said in an interview from the hospital. "It was a rude awakening."
Webb's ordeal offers a window on the failings of a six-year effort to improve conditions in California's public mental hospitals at a cost of hundreds of millions of dollars.
Under pressure from higher-ups to place the fewest possible restrictions on patients, hospital staff members grew reluctant to take assertive action against violent or unruly ones, according to state records and interviews with hospital officials, employees, patients and their families.
Paperwork intended to document progress toward about 360 separate objectives left staff members with far less time for patients and less flexibility to craft suitable treatments.
"They have succeeded in putting in all these measures and employing people to count their forms," said Mel Hunter, former executive director of Atascadero, who left the hospital in 2007 because of his objections to the changes. "But in terms of reduction in cost, reduction in time served in treatment and reduction in violence, it's a failure."
The architect of the reforms was Nirbhay Singh, a Virginia-based consultant.
Singh came to the United States in 1987 from New Zealand, where he had served as psychology director at an institution for the mentally retarded. He became a professor of psychiatry at Virginia Commonwealth University and developed specialties in "person-centered" care — designed to build on a patient's strengths — and "positive behavior support."
Singh had scant experience treating psychiatric patients, let alone the sort of dangerous offenders who fill the state hospitals. He specialized in research on the developmentally disabled, particularly children, and published articles about Buddhist-inspired mindfulness and alternative treatments, such as using the herb kava as a calming agent.
Yet Singh had at least one qualification that appealed to California officials: He was well-acquainted with the Justice Department lawyers who were scrutinizing the state hospitals. They had hired him 21 times over the years, mostly to advise them on problems with care at centers for the developmentally disabled.
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California State Mental Hospitals Plagued by Peril