In response to a story Inside Investigator ran regarding Disability Rights Connecticut’s (DRCT) investigation into the Connecticut Mental Health Center (CMHC), a group of anonymous CMHC staff sent a letter highlighting their own concerns over CMHC’s management, as well as their frustration with what they perceive as a lack of management response upon their raising of these concerns internally.
“We are tired of seeing our patients set up for failure, of our complaints to the right people go[ing] wrong, of being told we can not talk to people, to have to step back because we see no way forward,” read the letter. “Your collective involvement has allowed a sliver of hope that our voices will finally be heard and patients will get the care they deserve.”
In May, DRCT released the findings of a three-year investigation into CMHC, a 32-bed facility in New Haven staffed by Department of Mental Health and Addiction Services (DMHAS) and Yale School of Psychiatry professionals. The investigation found CMHC to be afflicted by unsafe conditions, improper treatment, frequent and unchecked sexual abuse, lack of oversight and violations of patients’ rights. The anonymous letter outlined a laundry list of issues that staff identified as responsible for CMHC’s poor outcomes, pointing a finger at the ways in which the facility is managed and named individuals in particular whose practices they deemed questionable.
After Inside Investigator made these individuals aware of the concerns raised against them and requested comment, Krystin DeLucia, Communications and Legislative Program Manager for DMHAS, sent an email in their defense.
Chief among the staff’s concerns were the practices of doctors Erika Carr and Dale Sebastian, Associate and Assistant Professors of Psychiatry at Yale, respectively. Specific practices of Carr’s and Sebastian’s that the letter brings into question are the taking of patients off of their psychiatric medications, a reliance on patient-led treatment planning to the detriment of patient’s health, and the citation by Carr and Sebastian of their own published research articles to validate future practices.
“The staff have long questioned that since Dr. Sebastian started on the inpatient unit there has been an increase in patients that are regularly taken off their medications,” read the letter. “The question is asked, if they do not require medication, why are they in our care and not released in a timely manner?”
The staff asserted that patients located on CMHC’s fourth-floor, acute inpatient unit are there because they “need stabilization and inpatient care.” Staff said they are “disturbed” by the number of patients taken off their medication because it often causes a pharmaceutical and treatment outcome rollercoaster for the patients. The letter claimed that patients become unstable when taken off their meds, then restabilize as they’re brought back on them, which typically only occurs after a court order, then spiral yet again once they’re subsequently retaken off their meds.
“This results in extended lengths of stay and institutionalization of patients,” read the letter. “It also leads to increased seclusions, staff injury, and patients accusing staff during their delusional state. Staff have brought these concerns up, but are told we are not doctors and administration is aware and supports this.”
Perhaps the most concerning scenario detailed in the letter was attributed to the insistence on Dr. Carr and “several other doctors” to engage in patient-led treatment, “which on paper may sound good, but we feel had massive detrimental effects to the patients.” The staff believed that the reliance on patient-led treatment models in patients who display “maladaptive thought processes and unhealthy coping styles,” leads to behavior plans that simply encourage the patients’ poor behavior and thought processes, instead of correcting them.
“One of the more upsetting examples of this was when the doctors let a patient have shards of glass so they could cut themselves as part of their behavioral plan because the patient felt it was helpful,” read the letter.
DeLucia said that CMHC’s in-patient treatment is based on “recovery-oriented principles and shared decision-making, emphasizing client autonomy and recovery goals.” DeLucia described medication changes and discontinuations as “collaborative decisions” made between clients and care teams, which are only made after “thorough risk assessments, ensuring alignment with evidence-based practices and ethical standards.” She also said that “while challenges arise,” data does not reflect an increase in adverse patient outcomes, and assured that CMHC, “continuously reviews incidents and seeks improvements.”
In addition to the above practices, staff wrote that a shortening of Yale Residency rotations at the inpatient unit from 3-6 months to “much shorter ones,” has led to an inconsistency in the care of patients, as new staff often bring with them new modalities for treatment of their patients, “leaving the patients with inconsistent and unconventional treatment.” Staff also believe that the Center has transitioned from a “comprehensive interdisciplinary effort” that was primarily led by nurses, to one that is now primarily under the lead of social workers, which they believe to be out of touch with direct care workers and too bogged down by bureaucracy to actualize meaningful change.
“What once was an effective lead team that worked to solve problems swiftly is now mired in excessive administrative personnel and a nonstop string of ineffective meetings,” read the letter. “The social work leaders are out of touch with the daily working of all the direct care staff and often do not have the clinical experience to effectively address issues.”
The letter contained links to various studies published by Carr and Sebastian, the first of which mirrors what DeLucia described as CMHC’s treatment philosophy; the belief in reducing patients’ reliance on medication and in providing patients suffering from psychosis greater agency in the treatment of their mental illness. In the abstract of this study, which was published in July 2024, the two questioned the psychiatric field’s focus on treating psychosis through medication adherence, and claim that “approaches that incorporate recovery-oriented care and shared decision-making (SDM) could provide a more holistic and effective approach to serving individuals experiencing psychosis.”
“The article advocates for collaborative approaches in antipsychotic prescribing, such as SDM and recovery-oriented care, to support those experiencing psychosis in constructing a life of meaning as they define it, including in how they choose to take medications,” reads the article’s summarized findings.
The staff questioned the way in which Sebastian and Carr utilize their own studies to legitimize their practices. The letter contained a link to another study, which chronicles the responses that CMHC had to situations in which a patient having a psychiatric break accused a staff member of sexually assaulting them. The staff were concerned because, “the situations referenced in this article are associated with situations that had very poor outcomes, proving this treatment suggestion is not good at all.” Staff said that these studies are typically done without long-term follow up, to with “no ongoing assessment of the situation to see if it, indeed, is beneficial in the long term.”
“They reiterate how they handled a situation and pose it as the standard for treatment,” read the letter. “Then they use these articles that they wrote themselves as a justification for their future practice.”
Staff also wrote that they have questioned the ethical ramifications of these studies from the patient’s perspective, as they are unaware whether Sebastian or Carr have notified the patients or their families/conservators of their involvement in such studies.
In response to Carr’s and Sebastian’s alleged use of their own research, DeLucia said that “faculty led research focuses on improving these areas [patient outcomes and staff experiences] while ensuring continuous evaluation and adjustment.” DeLucia said that all research follows ethical standards, and that clients, families and conservators are made aware of their involvement in such studies.
“Transparent communication and informed consent are key components of our approach to maintaining trust and protecting client rights,” said DeLucia.
Throughout the letter, the staff stressed their own persistence in raising these concerns with CMHC’s doctors and administrators to no avail. The letter highlights another study, this one published by Dr. Allison Ponce, Yale Professor of Psychiatry, and Kyle Pederson, CMHC Foundation Director, as an example of administrators touting their own responsiveness to staff concerns while simultaneously discarding them. The study highlights a pilot leadership program implemented by CMHC during COVID, supposedly with the goal of helping “middle management with burnout and to be better leaders.”
“This article says that Kyle Pederson and Allison Ponce, created a group of middle management representing inpatient and outpatient nursing, social work, and rehab, and did seminars, classes and providing meals with them to show support and teach how to lead,” read the letter. “While this program sounds good on paper, no inpatient nursing middle management was involved in this program despite them saying they were represented and despite inpatient middle management having the most burnout actively working on COVID units.”
DeLucia said that this team contained nine team leaders, some of whom worked in outpatient settings while others worked in inpatient care. She said, “If specific voices felt underrepresented, that feedback is valuable and will be considered for any future iterations of the project.”
Staff also said they were “very upset” with the use of CMHC Foundation funding for the creation of the program, as it is traditionally reserved for the patients. They also noted it as another example of “a management written article published without any long-term follow up of how well it worked,” and noted that the group is no longer in use and that staff morale “has never been lower.”
“Improving morale and fostering collaboration remains a top priority,” said DeLucia. “CMHC demonstrates its commitment to staff support through initiatives aimed at addressing organizational challenges, promoting innovation, and enhancing employee well-being and workplace satisfaction.”
The letter paints a picture of resignation among the staff, who listed out the various methods in which they claim to have tried and failed to get their voices heard in CMHC’s decision-making process. Staff wrote that they have spoken out in staff and committee meetings, individually posed suggestions to administrators, and raised concerns through anonymous staff surveys. They also claimed that they tried to create an inpatient committee to help strengthen their voices, but were met with a “chastising email” by the Director of Nursing after submitting this proposal.
They also accused CMHC’s current patient advocate, who they said is responsible for staff complaints, of being non-responsive to their complaints, and said that “she is regularly described as ‘abrasive and ‘overly opinionated.'” They also accused her of using CMHC resources during patient care hours to punish an off-duty staff member who made “comments that were concerning,” in a way that they thought was excessive and overbearing.
“The reception received is usually one of surprise followed by comments along the lines of “of course we want your feedback” just to have no follow up or change,” read the letter. “In the meantime, we have to watch as patients who had housing and a community end up losing it because of length of stay or the fact that when they return home, the behaviors that got them in our care have not changed, so they get kicked out of their housing and loose whatever natural supports they had in place.”
Despite the sordid picture painted by the letter, DeLucia said that “CMHC is committed to delivering quality care, maintaining ethical standards, and fostering a supportive environment for staff and clients.”
Topics on this page
Republish our articles for free, online or in print, under a Creative Commons license.
The CNRU at CMHC fires good nurses who speak up. Patient subjects are fasting for well over 12 hours, and when a nurse cannot find an adequate vein, he/she is claimed. They recently discharged a patient from the Rest program who was gravely disabled, when they knew he would be homeless at least one night. He stated he was afraid of the dark. They take advantage of substance use disorder subjects. And don’t have any rehabilitation follow up for them. They get them clean in 7 days, then say “goodbye”. It is sick. On the fourth floor, patients are suffering because they are not medicated. I am a nurse of 34 years Wrongfully terminated because I needed more time to learn blood draws an IV’S. Management condones hazing of new employees. I was called Autistic by my manager . It is a sick system, and allowed to continue with Patient and staff abuse if you come in from the private sector. Please investigate.
Editors note: the above comment was submitted using the name and email of a CMHC employee who reached out to inform us that the comment was made by an imposter.
We have changed the name to “Comment A” and would be interested in speaking with the individual who commented to gather evidence of these claims. Additionally, we encourage anyone with information about abuse and corruption to reach out to us tips@insideinvestigator.org
Thank you,
Conner Drigotas
Managing Editor
A few things to consider:
1. A plurality of antipsychotic medications is not a guarantee of symptom abatement. If a regimen of multiple medications have not reduced symptoms, it might be the best thing to either trial untried medications or other treatment modalities. Stated simply, thoughtful medication trials under the guidance of a psychiatrist are a core part of treatment in any setting.
2. A common clinical journey of patients who are admitted to inpatient units is having travailed through multiple other settings including emergency rooms with varying lengths of stay. In an inpatient admission, it can be life-changing for patients to have their medication regimens re-assessed.
3. The sentiment that recovery-oriented treatment “on paper may sound good, but we feel had massive detrimental effects to patients” is simply wrong. Perhaps consider if you had a relative in inpatient treatment, how you would like their treatment team to care for them. Patient-led does not mean patient-only. It does not mean psychiatrists relinquish their own expertise; to suggest otherwise is simply false.
4. The letter claimed that “patients become unstable when taken off their meds, then restabilize as they’re brought back on them, which typically only occurs after a court order, then spiral yet again once they’re subsequently retaken off their meds.” So you’re saying the same psychiatrists who are being accused of getting people off their meds are also going to the courts to get people on their meds?
5. The letter also notes a reduction in residency rotations to “much shorter ones,” (a duration that the investigative journalist could have but did not ascertain) has led to inconsistency in the care of patients because new residents bring new modalities for treatment of their patients. It is important to point out that residents are not inventing treatment modalities so it is unclear what is meant by “unconventional treatment”. Additionally, it is important to note that although a resident newly joining a treatment team might have different (not unconventional) treatment ideas, they are supervised by the Attending physician and are not themselves implementing these treatments willy nilly whenever they arrive. As the supervising physician is consistent, it is again unclear where the idea of inconsistent care emanates.
6. There are also multiple comments about the use of their articles to justify their approach. Recovery-oriented care is an established approach to psychiatry and is not something dreamed up by those mentioned in the article or some product they benefit from personally if they use. Is the issue with the approach as a whole? Or with those mentioned being people who have contributed to the literature? I would be interested in learning how that is different from this writer using their own prior publication in the very first line of this article to set this stage for this article.
7. The information in this article does not seem to have been verified in any way – not by any staff member identified by the writer (on or off record) or by any current or former patients. Even consulting other psychiatrists about the possible appropriateness or otherwise of the approaches used might have gotten you to a different endpoint. The decision to leave a comment posted by someone – not just anonymously but by someone who impersonated a different staff member – is concerning.
8. The closest to a silver lining is that there was a time, perhaps not too long ago, when psychiatrists were accused of overmedicating and being overly paternalistic towards patients and so this is as huge a sign as can be of how far we’ve come in psychiatry.
Natural means SHOULD be incorporated. No one ever got mentally ill from a nutritional deficiency of a psych med. I found black cumin seed oil helpful, and Dr. Sebastián supported me in that. There are plenty of books on this topic, as well. I agree, irresponsible isn’t good, but a natural approach in a comprehensive way does not meet that description. Both patient and doctor must want the patient to be completely well.