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Consultant to California mental hospitals abruptly resigns

A Virginia psychologist who earned millions of dollars as a consultant to California's mental hospitals over nearly nine years has abruptly announced his resignation at a time when the facilities are struggling with increasing violence and staff dissent.

Nirbhay Singh was a key architect of the state's plan to transform care at the hospitals, which mostly treat severely mentally ill patients accused or convicted of crimes, to give patients more control of their treatment.

His resignation, which is effective Tuesday, comes less than two weeks after The Times interviewed a top state Department of Mental Health official about his performance and role.

Reached Thursday, Singh said, "Basically, my job is done," noting that the hospitals have reached compliance with many of the demands spelled out in a 2006 U.S. Justice Department lawsuit settlement. "I've been with them for nine years. That's long enough. I have a life," he said.

Singh declined to comment on whether inquiries by The Times played a role in his decision.

The psychologist is stepping down a month after the retirement of Stephen Mayberg, longtime director of the Department of Mental Health. Cindy Radavsky, who oversees the hospitals as deputy director of long-term care, was not available for comment Thursday.

Department spokeswoman Jennifer Turner said in a written statement that the hospitals have made "significant progress over recent years" to implement the court-ordered reform plan and will maintain and improve on the changes. She did not mention Singh.

Singh drew criticism from many hospital employees who disagreed with his approach. In an interview this month, Radavsky said that Singh often had to play the role of the heavy.

"Sometimes people didn't want to hear the message," she said. "And sometimes I think Nirb carried the message so that it didn't come back on us. Sometimes you've got to do that good cop-bad cop. And he was willing to do that, knowing he's going to walk away. We're going to stay here and maintain the system."

While he was the chief consultant in California, Singh also worked in other states with troubled mental health systems, including Connecticut, Georgia, Kentucky, Louisiana and Tennessee.

Though California's hospitals are complying with many of the federal requirements, most facilities have experienced increases in violence since the consent judgment was imposed, and many staff members contend that patient care has worsened. Some became more vocal after the recent slaying of a Napa State Hospital psychiatric technician, allegedly by a patient.

Singh's departure was welcomed by his critics, including employee unions and staff members who say his changes were inappropriate for the types of patients housed there and led to deteriorating safety.

His background is in working with developmentally disabled people, not the severely mentally ill that dominate California's hospitals, some with sociopathic and predatory tendencies.

"According to most of our members, he did very little to create a healthy and safe environment for [patients] and staff, and he did a great deal to create a morass of paper and a waste of professional time," said Dr. Stuart Bussey, president of the Union of American Physicians and Dentists, which represents the hospitals' psychiatrists and medical doctors.

The federally mandated reforms shifted the hospitals toward a "recovery model" intended to involve patients more in their own care and promote their rights by reducing the reliance on complex medication cocktails, restraints and other restrictions.

But critics including Ken Lakritz, a former Napa State Hospital behavioral psychologist who headed a team to deal with problematic and violent patients that was disbanded by Singh, contend the reforms were implemented in a "cookie cutter" manner without strong safety mechanisms.

"He created an environment that was much less safe than it was before."

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