On Sept. 4, the residents of the College-owned Country Club Apartments woke to find a detailed description of Dexter Moses posted on their apartment doors.
Moses, a patient from Trenton Psychiatric Hospital, had been reported missing. The fliers were posted before 8 a.m., residents of the apartments said. A chain link fence separates the hospital campus from the apartments.
The fliers gave the patient's name, age, height, weight, hairstyle and the outfit he was last seen wearing. In bold letters it said, "This individual may become violent to himself and others as he is in need of his medication."
The fliers asked students to call Campus Police if they saw anyone fitting the description, and reminded students to lock their doors, not let in strangers and call 911 if they saw anything suspicious.
At 9:46 a.m., Campus Police sent a campus-wide e-mail with similar information and additional details: Moses was last seen at 7:30 a.m. that morning and was reported to have a scar on his face.
Human Services Police - the Department of Human Services is in charge of the hospital - said it never indicated Dexter Moses was dangerous. Rather, it just notified neighboring police forces to be on the lookout.
Sgt. Greg Smith of the Ewing Police Department said that because the patient was not considered a threat the police just acted as "an extra set of eyes" for Human Services.
If the patient had been considered dangerous, Ewing Police would have notified nearby residents with a recorded telephone message. Smith, who has been with the department for 21 years, said it's very rare for a dangerous patient to escape.
The missing patient had been living at the hospital for more than two years, had permission to walk the grounds unattended and had been waiting for placement in community housing, a spokeswoman for the hospital said, according to an article in The Times of Trenton.
"We notify the campus community whenever there is a potential threat to safety, and this takes just a few minutes from the time we are informed of a walk-away," Matt Golden, director of the College's Office of Communications and Media Relations, said. "As to the Sept. 4 notification, we shared all the information that we received."
"We didn't used to notify the community so often," Gregory Roberts, assistant director of Mental Health Services, a division of Human Services, and a former chief executive officer of the hospital, said.
The hospital's notification systems have definitely improved, Golden said via e-mail. Last year there were two incidents involving patients with violent tendencies who walked away from the hospital "without any timely notification from the hospital to the neighboring police agencies," Golden said.
Kathryn Leverton, who is in charge of Campus Police as the associate vice president of Administrative and Environmental Services, represented the College in meetings with Human Services employees to talk about the hospital's need to improve its notification system, Golden said.
On Sept. 29, 2005, the College and Ewing Township mutually expressed that communications and internal processes at the hospital needed to change so that members of the College and township could be adequately notified, Golden said.
"Deputy Commissioner Theresa Wilson was receptive to these concerns and indicated that procedures should have been handled differently," Golden said. "She also agreed to work together on a notification process that would keep all agencies informed."
"If we are not aware of an incident involving a violent walk-away, then we are not able to issue a timely warning to our campus community. Due to the agreement between Human Services, Trenton Police, Ewing Police and (Campus) Police, we receive both verbal and faxed copy information regarding walk-aways who may pose a threat to themselves or others," Golden said.
The College would gladly participate with Trenton Psychiatric Hospital, Ewing Township and the state in further discussions related to security, Golden said.
The Effects of Overcrowding
The hospital's 100-acre campus is about three miles from the College. It is set up like a small town complete with houses, basketball courts, administrative offices and kitchens. Small groups of patients walk accompanied by staff members to a convenience store called the Trading Post to purchase cigarettes.
Five hundred adult men and women, most of them diagnosed with schizophrenia, receive treatment there. Seventy percent of those diagnosed with schizophrenia also have a problem with substance abuse. Half of them would be discharged if they had a place to go for the next step in their recovery, but many were homeless when they came in for treatment and don't have families to return to. Many patients have been "waiting for months to get housing," Teresa McQuaide, the chief executive officer of the hospital since August, said.
A lack of community housing has led to overcrowding. Some patients sleep seven to a room in rooms designed for four. The Governor's Task Force on Mental Health documented the overcrowding in its March 2005 Final Report, calling the situation "unacceptable."
"State hospitals (especially Trenton and Ancora) are severely overcrowded due to population growth, increased forensic population and inability to discharge due to lack of appropriate housing," the report said, adding that "overcrowding at the state hospitals impacts on all aspects of patient well-being, care and treatment."
Today, it is "still a problem," Roberts said.
"Overcrowding is the root of all evil," Roberts said. Patients can lose their personal locker, possibly diminishing their sense of privacy and dignity, he said.
Some get frustrated with waiting and leave, McQuaide said.
"Truthfully, if a patient wanted to walk out that entrance, they could do that," Roberts said.
There were 85 patient escapes in 2005 and about 32 so far in 2006, Roberts said.
The hospital entrance on Sullivan Way - one of four entrances to the campus - is three-tenths of a mile down the road from the entrance to the Country Club Apartments. About 60 upperclassmen live in the apartments, which were acquired by the College from Human Services to meet student housing needs in 1997, Golden said.
A black chain-link fence, about seven-feet tall, separates the apartments' backyard from the hospital campus. A supervised, fenced-in recreation yard for patients is a few hundred feet away, though not visible because it's on the other side of a building.
"I could climb that if I really wanted to get away," Monica DeFalco, junior chemistry major and a resident of the apartments, said of the fence in her backyard.
The vast majority of escaped patients should not be considered dangerous, Roberts said, and those that could be considered dangerous are often primarily a danger to themselves.
Sometimes, though, patients with violent pasts do escape, including Edgar Rene del Cid-Perez, who is accused of kidnapping a woman at gunpoint last year. He escaped from the hospital on Aug. 7.
Del Cid-Perez was apprehended in Irvington the next day.
Now, hospital officials are trying to notify neighboring Trenton, Ewing and College police departments about missing patients without reinforcing what Roberts calls a media-perpetuated stereotype that escaped, mentally ill patients are going to try to kill people.
"It's not true," Roberts said. "It's extremely not true."
The mentally ill are more likely to be victims than to commit a crime, he said. McQuaide said that most mentally ill patients have symptoms that cause withdrawal, so they won't get out of bed or take care of themselves. When the hospital sends out an alert that a patient escaped, officials are usually more worried the patient is going to hurt himself, she said.
"We have a responsibility to be secure, but within a clinical setting," Roberts said. They don't want the hospital to feel like a prison, but at the same time they want to be good neighbors and have the local community feeling safe, he said.
Inside the Hospital
The Signal was given a tour of the facilities on Sept. 21. Roberts pointed out the ongoing measures to increase security and explained aspects of the mental health system. The Signal was also able to meet at nearby Ancora Psychiatric Hospital with the new acting commissioner of Human Services, Clarke Bruno, who stepped in on Sept. 18.
Oak trees line the Ancora campus and there is a sprawling spruce planted by Dorothea Dix, the humanitarian who founded the hospital in 1848 as the New Jersey Lunatic Asylum.
In the Travers Cottages cluster of patient homes, four men played cards in a gazebo and another patient relaxed on a bench, apparently asleep. Another walked alone and smoked a cigarette on the sunny Thursday afternoon.
In these homes the patients learn to cook, to manage money and to understand and treat their physical and mental medical needs, Roberts said.
All of them are on level three or level four supervision, meaning they can walk the grounds unsupervised at certain times, and, in level four cases, leave the grounds by themselves at designated times. Some take the bus to Quaker Bridge Mall, for example, he said.
"Everything is based on individual situations," Roberts said.
Patients with violent histories are mixed in. Currently there are 35 Krol patients and 29 sex offenders that must be publicly listed under Megan's Law. "Krol" is the term used in New Jersey for patients found not guilty by reason of insanity. There are seven patients currently incompetent to stand trial, but who will stand trial when they stabilize.
"These patients are subject to additional procedures," Roberts said. If a criminally violent patient's treatment team suggests a change in the level of supervision, the change has to be approved by the Special Status Patient Review Committee at the hospital, formerly known as the Dangerous Patient Review Committee, and then an additional committee based in Trenton, Roberts said.
"That assessment process goes on at all times," McQuaide said.
For some patients, like Howard B. Unruh, there is a hearing each year to see if doctors and a judge agree to decrease the level of supervision. Unruh, 85, is considered one of the first modern American mass murderers. The World War II veteran killed 13 of his Camden neighbors in a 20-minute shooting spree in 1949.
If a Krol or Megan's Law patient escapes, "I would encourage you to be careful," Roberts said. "Know how to interpret that information."
Roberts is interested in explaining patient classifications to members of the College community, perhaps in psychology classes, he said.
In the case of Janicki, the 22-year-old was at level three supervision for a time, able to walk around unsupervised, but his treatment team decided he should be changed to level two, an increased level of supervision.
"He lost those privileges, but it wasn't communicated well," Roberts said. Staff did not realize his supervision had been changed, so they mistakenly gave him a pass to walk the campus, allowing him to slip away.
Half of the 500 patients are classified as CEPP, meaning their stay has been conditionally extended pending placement. They're ready to be discharged to a community home, but there isn't one available, Roberts said.
These CEPP patients make up the "overwhelming majority" of escapes, McQuaide said.
There were 29 patients that escaped in 2006 up until Aug. 15, Roberts said. Of those, 21 were level three CEPP patients, meaning they were allowed to walk the grounds alone and were ready to move out. Fifteen of the 29 were back in 90 minutes or less, he said. Seventy-one percent of patients are located the same day and another eight percent are found within 24 hours.
Three of the 29 patients that left the grounds unauthorized were under level one supervision. Only one - del Cid-Perez - had been there because of a criminal case, Roberts said.
When patients do escape, it's not unusual for them to be found enjoying soda or cups of coffee from the QuikChek at the Sunoco down the street, Roberts said. That is popular because caffeine is not allowed at the hospital, he said.
Sometimes patients go to a train station in Trenton to score drugs, Roberts said. Ten percent of escaped patients are found at their homes, McQuaide said, citing a hospital press release from October 2005.
"Very, very often the patient is found on grounds," he said.
Robert noted that with only about three months left in 2006 there is an apparent decrease in the rate of escapes, but that the hospital is not satisfied. "If we can get it down to 10, we want to do that," he said.
At Drake, housing for patients with level one or two supervision, there is a recreation yard with basketball hoops, tables and benches. Patients go to the yard for exercise and smoke breaks, Roberts said.
Recent Security Changes
The recreation area is supervised and fenced in, but a couple of patients get over the fence each year, Roberts said. In light of the recent escapes and efforts to bolster security, the hospital plans to augment the fence up to about 15 feet, Roberts said.
Other changes have also been implemented since last year.
Before, when staff realized a patient was missing, they would check the recreation yard again first, and then call Human Services Police. Now, the policy is to call police immediately, he said.
Del Cid-Perez knocked out tamper-proof screws and broke a part designed to keep his window closed when he escaped. Now, additional strips of metal have been screwed along the point where the windows swing out. "Those metal bars were put in place to prevent that from re-occurring," Roberts said.
Another idea is to close two of the four entrances and staff security guards at the other two entrances around the clock, Roberts said.
The hospital has also implemented a callback system, so staff members know if a level three or four patient has arrived on time after they've walked across the campus on their own, he said.
Alarms and extra locks were installed on doors in Drake after some escapes from there, he said.
"Some doors didn't lock," he said. If a staff member loses his keys, he changes the locks right away, a process made easier by the ongoing switch to electronic locks and key cards, he said.
Another new policy is to update patient photos with a digital camera every six months, in part to identify patients when distributing medication.
The hospital is in the process of fencing in some recreation areas from the roof down. The extra fencing acts as a cage, but it looks like an awning. Patients used to hop right over, Roberts said. One recreation yard is complete, and materials are on the way for the other recreation yards of the same design.
None of the County Club residents expressed serious concerns about escaped patients, although they said they were a bit shaken up the first day when they saw the fliers.
Their parents, however, are a different story.
Caitlain Adriance, junior finance major, said her mom told her, "Call me as soon as you find out that they catch them."
Monica DeFalco, junior chemistry major, said her father asked if she wanted pepper spray.
"I'm not concerned," Adriance said, noting that police "were good about letting us know."
Bianca Williams, junior psychology major, said she doesn't feel threatened by the patients and thinks most of them wouldn't be violent.
"I'm not really worried," Leah Axelrod, junior graphic design major, said. "I'm more annoyed by the lack of air conditioning than the fact that there's a psych hospital next door."
