Since psychologist Simona Bujorneau and BCH Child Protection Team Head Dr. Alice Newton performed their "parent-ectomy" (
http://www.bostonglobe.com/metro/2013/12/15/justina/vnwzbbNdiodSD7WDTh6xZI/story.html), Justina had been held by BCH in the Bader 5 unit until her transfer to the Wayside Youth and Family Support Network in Framingham (
http://westhartford.patch.com/group...-justina-pelletier-transfered-to-new-facility). During that time, the BCH CPT with DCF have, through what seems to be incomplete informing of the courts, usurped responsibility for Justina's medical and life decisions. Justina, therefore, IMO, became a de facto foster child of BCH B5staff for over a year. BCH continues to influence her treatment by staff at the new facility and by the court. I would have expected that in such circumstances, the treatment of Justina would have met the high ethical and medical standards which would be expected of any unit of BCH. I would also expect that after a year of such treatment, Justina would have had visible improvement if SB's diagnosis of somatoform disorder was accurate. Admittedly there are problems in considering this because reports have been one-sided. As well, Dr. David DeMaso, BCH psychiatrist-in-chief, told the Boston Globe that the mental health field has moved away from using somatoform disorder as a diagnostic tool. (
http://www.bostonglobe.com/metro/20...l-uncertain/Y7qvYTGsq8QklkxUZvuUgP/story.html) It should also be noted that the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is replacing somatoform disorders with somatic symptom and related disorders. (
http://www.dsm5.org/Documents/Somatic Symptom Disorder Fact Sheet.pdf) IMO, DeMaso's comments weaken Bujorneau's position.
IMO, Justina, as a citizen of the United States, has rights protected by the U.S. Constitution, and those rights extend to people who live in psychiatric facilities. Places like Bader 5 do not exist in a bubble above and apart from influence from the body of American laws. I also believe that if she has become a de facto foster child, Justina deserves to be given every benefit accorded to every other foster child in the state of Massachusetts. IMO, this provides a framework with which it's possible to evaluate just a little bit, the care that's been given to Justina. I've come across three documents which, I think, are relevant. I'm selecting at a few items from each document, and following each with a comment regarding the way it applies in Justina's case. The first document is a flyer,
Basic Rights at Inpatient Mental Health Facilities in Massachusetts, prepared by the Mental Health Legal Advisors Committee, October 2012. (
http://www.mhlac.org/Docs/basic_rights_at_inpatient_mental_health_facilities.pdf)
(This flyer describes important rights under the U.S. Constitution and Section 23.)
Among the rights listed are the following:
(Excerpted by me. Comments are my own, and jmo.)
" * The right to send and receive 'sealed, unopened, uncensored mail'. If you are present, staff may open and check mail for contraband, but may not read it. The superintendent, director, or designee of the superintendent or director must document with specific facts the reason for opening the mail." This was violated in Justina's case by Bader 5 staff when Justina felt compelled to hide notes to her family, and when the B5s, according to Justina's father, used "behaviour modification" to either correct her or to punish her according to personal interpretation. (
http://www.theblaze.com/stories/201...lk-to-us-i-want-to-have-all-my-guns-blazing/#)
" * The right to receive visitors of your "own choosing daily and in private, at reasonable times.' …The facility's superintendent, director, acting superintendent or acting director may temporarily suspend the right to have visitors if there is a substantial risk of serious harm to you or others and less restrictive alternatives would be futile. Any suspension must be documented in your record, and may last no longer than the time necessary to prevent harm." The phrase "substantial risk of serious harm" implies, IMO, that B5s should have had compelling proof that the actions taken by Justina's parents in her previous care, and their requests upon arrival at BCH, had been undertaken without due consideration for Justina's continued health. BCH CPT and B5s went along with the hunches of BCH staff, such as the request for a feeding tube which CPT and B5s used as proof of child abuse to the court. It is doubtful, IMO, that the court was ever informed that BCH finally reached the conclusion that Justina did need a feeding tube. The presence of a guard makes private conversation impossible, especially if B5s felt the need to apply behaviour modification following visits. In addition, B5s implied that Justina's parents were not taking her mental health into account. In fact, Justina had been regularly seeing a mental health professional. As well, the B5s noted that the parents should be restricted in their dealings with Justina because they were "insolent", because they disagreed with the way B5s proposed to treat Justina and wanted to take her to her original doctors. JMO, but the Pelletiers had every reason to distrust SB.
" * The right to a humane environment including living space which ensures "privacy and security in resting, sleeping, dressing, bathing and personal hygiene, reading, writing and toileting." This right does not mean you have the right to a private bedroom." I don't know how that's possible to be honest, however having a roommate means that your access to privacy will be limited. Having two roommates would make any privacy very difficult to come by. In addition, from at least the time Justina was confined to Bader 5 against her will, she has had to ask permission to use the bathroom and may have been monitored at those times whether she had to change a tampon or simply urinate. No privacy for a year. At least.
" * You enjoy a Constitutional right to reasonable access to the outdoors." According to Justina's lawyer, she has not had any access to the outdoors. Great to know Bader 5 has windows, but windows filter light. Many buildings with internal temperature controls and air-conditioning do not have windows which can readily open to allow fresh air into the rooms. My fear is that with safety a concern in Bader 5, and locked double doors, open windows might not be part of the suite's design. So, Justina's access to fresh air may have been severely limited for the year she was locked up in BCH.
The second document is the
Massachusetts Foster Child Bill of Rights, developed by the Youth Advisory Board of the Mass. Dept. of Children and Families.
(
http://www.mass.gov/eohhs/gov/depar...en-and-youth/foster-child-bill-of-rights.html)
Among many rights listed are the following:
(Excerpted by me. Comments are jmo.)
"Every foster child shall live with a family and in placement setting that provide a safe and nurturing environment while supporting permanency, and well being, including encouraging youth's goals, interests. social and school activities." According to comments up-thread, Bader 5 is a very stressful place which was designed for short term residency which, by definition, does not support permanency. No matter the intentions of those placing Justina in this environment, the unintended consequence has been to deny her a nurturing environment for an extended period of time. She has been denied the right to follow her interests, to be involved in social or school activities for a year.
"Every foster child shall receive support from social worker, foster family/provider in maintaining positive contact with significant people (relatives, teachers, friends, and community supports) including assistance with contact information and visitation." B5s has not, according to the family's comments, done this. Instead B5s has continued to separate Justina from the people she loves. She was denied consultation with the entire team of doctors who had looked after her before her incarceration. IMO this lack of consultation by B5s underscores their unwillingness to even consider what had helped Justina in the past while planning her future. IMO, DCF similarly denied her this element of her care when they condemned Justina's family without ever once visiting their home to see what the conditions really were.
"Every foster child shall have access to personal possession, personal space and privacy with allowance for safety. Shall receive assistance in acquiring life skills, education, training and career guidance to accomplish personal goals and prepare for the future and be informed of the post-secondary and employment supports available to youth in care through the Department." From the comments of Justina's family, it would appear that her academic skills went into decline during her time in the Bader 5 unit. It would also appear that little personal space, and little privacy, was available within that suite of rooms for Justina for a year. The need for privacy has been noted in the first document as well.
BCH publishes a helpful online document for those about to become familiar with Bader 5:
Helping With Your Child's Psychiatric Hospitalization: A Practical Guide for Parents. (
http://www.childrenshospital.org/~/...Psychiatry Inpatient Service/parentguide.ashx). This is the third document to which I refer. On Page 1 of the guide, BCH tells parents to
"Remember that you are an essential part of your child's treatment team. You know your child better than anyone else." Judging from what happened in this case, you may know your child better than anyone else, just don't tell the psychiatric team or you may be thought to be "too active" in seeking medical help for your child.
From this guide i learned that the Bader 5 Unit has 18 beds, treats children for a variety of psychiatric conditions, and has patients ranging from 2 - 18 years of age. There are two teachers to provide education for all those children. I learned that single rooms are used in special circumstances, and that children and adolescents have one or two roommates. I learned that the unit has a double door which is kept locked at all times . Bathroom doors are kept locked which "allows staff to monitor children closely and provide observation or assistance if necessary." Meals are family style with staff, and one menu only, however, according to the guide "It's important that parents make staff aware of any special dietary requirements your child may have…" The guide explains passes in which parents are allowed to take their children out of Bader 5 for 15 minutes or more, since "time off the unit is important in helping you and your child develop skills and comfort in being together outside the unit". For parents concerned about finances, the guide offers reassurance. "Insurance is usually the primary method of payment for an inpatient hospitalization…If you do not have insurance or if your child's mental health benefits run out, you may be eligible for …MassHealth. Your child's clinician can help you begin this process."
According to the model provided under the heading "How will my child spend his/her day?" we learn that wakeup and monitoring of vital signs begins at 6:30 am, and the day concludes at 9:30 pm for adolescents. Breakfast at 8:00 is followed by a community meeting to "review goals and plan for the day." Three hours is allotted to School in the morning (9:00 - 12:00). An hour for lunch. Therapy groups then for four hours (1:00 - 5:00). Dinner for an hour. Free time from 6:00 to bed, unless there are visitors. Relaxing evening group sessions are also held in this time. Groups are scheduled throughout the weekend, although children may "choose to spend time with family instead of attending groups." A very regimented format which is probably necessary to do short term diagnostic work, but seems to me to be inadequate for meeting the needs of anyone in the long term.
In light of the situation with Justina, this statement is particularly poignant.
"Your child is on Bader 5 for a limited time, and most likely will return home to live. Family meetings are a critical piece of your child's treatment for a smooth transition home." As is this one:
"The people on Bader 5 recognize that they are not working with an individual, but with a family." A little more honest is "The average hospital stay is approximately two weeks, but this is highly variable depending on your child's needs…Avoid promising when your child can leave the hospital."
For more than a year, Justina has been forced to ask permission to go to the toilet, to change a tampon, to throw up, to wash her hands and face. How humiliating is that, especially when all these normally private activities may be observed. This goes against the FCBoR and BRIMHF. She has had no privacy. This goes against the FCBoR and BRIMHF. She was forced to sneak out notes to her family. This goes against the BRIMHF. She has had her education curtailed. This goes against the FCBoR . She has been denied a family environment. Sorry, but movie night or pizza night just don't cut it as a substitute for genuine love even if there is professional concern from staff. This goes against the FCBoR. Her telephone calls are monitored and interfered with as well (
http://www.bostonglobe.com/metro/2013/12/15/justina/vnwzbbNdiodSD7WDTh6xZI/story.html). This goes against the BRIMHF. Justina has had no time with her parents without a guard sitting between them, and the time is severely limited. This goes against principles stated in all three documents.
From the information posted up-thread, we know that life in Bader 5 is stressful. Very stressful--lockdowns happen without warning. Upset children are crying when their parents leave. Other patients are yelling at staff or their parents. Stressed parents are yelling at staff. This goes against the FCBoR. Although proof has not been made public, the claim by her attorney that Justina has not been in direct sunlight or breathed fresh air since she was first locked up in Bader 5 could very well be true. This definitely goes against the BRIMHF and every recommendation for a healthy lifestyle for an adolescent that I've read.
For over a year, BCH has been "institutionalizing" Justina, subjecting her to a rigorous program of medication and talk therapy and behaviour modification. From the actions of BCH staff and DCF, IMO, Justina has been learning that her family does not really have her best interests at heart since B5s are protecting her from them. She's learned that she cannot trust that she's feeling pain because it's probably all in her head and she's really not sick at all. She's learned that courts cannot be trusted to help her or listen to her. She's learned that her opinions and needs do not matter to the people in charge of her future. Imo, she's probably learned to hide whatever she's feeling because the only place she can be truly private is inside her thoughts.
Justina's sister Jennifer has visited her sister and spoken to media about what Justina told her. " 'Justina says psychiatric staff have told her she is never coming home. ..I don't know exactly when or how many times she has been told this but Justina believes she is going to die in there." (
http://www.dailymail.co.uk/news/art...lletier-kidnapped-doctors-use-guinea-pig.html). If Jennifer is remembering correctly what her sister said and how she looked, and the article is an accurate portrayal of her words, then this is a tragic example of unintended consequences. While B5s may not have used those exact words to Justina, that is what Justina perceived to be the meaning of their words and actions. In many ways, IMO, it doesn't matter what words were used. All that matters is Justina's perception. That she has such a bleak outlook speaks volumes. And if such depression was simply a side effect of prescribed medication, which we all know is possible thanks to TV ads for anti-depressants, it makes the B5s even more culpable for requiring that she take such medication. JMO, but living under those restrictions with constant supervision, constant therapeutic sessions, fewer contacts, and being medicated against one's will for a year would depress the most healthy and normal of adults let alone fragile adolescents.
Justina's situation could be an anomaly among the many successful stories that may have come out of Bader 5. Or, her situation could be typical of children who are made wards of the state of Massachusetts, but who do not have a family still fighting on their behalf. Or whose families have been told they won't be allowed to see their children if they speak to the media. IMO, BCH CPT and the Bader 5 director of Justina's case have failed to meet the standards of care set out not only by the Mental Health Legal Advisors Committee of Massachusetts and the Youth Advisory Board of the Mass. Dept. of Children and Families, but also of standard of excellence in child care set out by BCH itself in its own manual.
