For 25 years, a quiet but powerful transformation has been taking place in New Jersey’s state psychiatric hospitals.
A Rutgers-based team has been steadily changing the way inpatient psychiatric hospitals treat those with serious and persistent mental illness, replacing outdated custodial care through evidence-based psychiatric rehabilitation and modern, recovery-oriented approaches.
Launched as a partnership between Rutgers School of Health Professions (SHP) and the New Jersey Division of Mental Health and Addiction Services, the initiative’s goal is not just to stabilize those with mental illnesses, but to help them rebuild their lives and reenter the community.
The program began with the idea that people with even the most complex mental health challenges—many of whom had been confined to state hospitals for years—can recover, if given the right support.
For over two decades, the SHP team had offices inside the state’s psychiatric hospitals, including Greystone Park, Trenton, Ancora, Ann Klein Forensic Center, and the now-closed Hagedorn facilities.
Being embedded allowed them to observe clinical practice firsthand, train staff, design innovative person-centered care approaches involving patients in treatment decisions, assess how closely program models were followed through fidelity assessments, and conduct research to measure outcomes.
We weren’t just advising from the sidelines—we were fully integrated.
“We were flying under the radar for years,” said Program Director Thomas Bartholomew. “Because we were in the hospitals, not on campus, few people at Rutgers even knew we existed.”
But our mission was clear: bring the goals, values, principles, and practices of psychiatric rehabilitation to settings that have traditionally delivered outdated, sometimes even harmful, care.Â
Instead of the traditional medical model—where professionals diagnose, prescribe, and treat with little input from the patient—psychiatric rehabilitation emphasizes collaboration, asking patients what their goals are and what is meaningful to them. It gears treatment toward that vision.
It’s a fundamentally different philosophy, the director said. “And, as we’ve shown, a more effective one.
—Thomas Bartholomew, Program Director
One of the most innovative models introduced by the team has been the inpatient treatment mall.
In the traditional ward-based model, patients spend most of their day in a single unit, dependent on staff who are often overwhelmed and unable to meet the wide range of individual needs. The result is high levels of boredom, limited engagement, and missed opportunities for recovery, Bartholomew said.
Treatment malls change that.
“In a mall model, programming is centralized. Patients leave their units and attend a range of structured, specialized groups elsewhere in the hospital—like classes on symptom management, coping skills, diabetes care, or communication skills,” Bartholomew said. “It creates an economy of scale, allows for greater personalization, and addresses one of the most insidious problems in inpatient care: therapeutic inactivity.”
The team is now leading a national study on inpatient malls, making them among the foremost experts in the country on this increasingly adopted model.
The program’s early work focused on implementing a treatment called Illness Management and Recovery (IMR)—a group-based, evidence-supported model designed to help individuals understand and manage their symptoms, set goals, and prevent relapse.
Their research, published in a peer-reviewed medical journal, showed that for every hour a patient participated in IMR, the risk of psychiatric readmission decreased.
“But the key is doing it well,” Bartholomew said. “Hospitals are often so chaotic that we’d walk into an IMR group and find someone running it without training, without the manual, without fidelity.
Quality is an ongoing challenge.”
To address this, the team developed training protocols, fidelity assessments, and long-term implementation strategies—all while navigating the enormous difficulty of changing entrenched systems.
“Good treatment can change the trajectory of a person’s illness,” the director said. “Recovery isn’t just possible—it’s likely, with the right support.”
Behind the data are compelling stories that show what’s possible when treatment shifts from maintenance to recovery.
One woman had lived in a hospital for 21 years with complex issues including being unable to read.
In addition to social skills training, a nurse taught her diabetes management using pictures. She left the hospital and now lives in the community, said Bartholomew.
Another woman who struggled with emotion regulation issues and was frequently restrained completed a type of behavioral therapy that teaches people to manage intense emotions. After her discharge, she became a peer advocate, helping others navigate their recovery.
“There are hundreds of stories I could tell,” said Bartholomew. “They’re the result of intentional, evidence-based, person-centered work. And they’re proof that good treatment changes lives.”
When COVID-19 hit in 2020, inpatient hospital treatment programs were suspended and group activities much reduced.
In response, the Rutgers team pivoted, moving their training models online.
The team established the Institute for Inpatient Psychiatric Rehabilitation, a virtual hub located on the Rutgers Health website, for research, training, and collaboration with other hospitals nationwide.
They’ve conducted multiple national studies on topics ranging from competency restoration to reducing the use of restraints.
Their free trainings and webinars dedicated to improving inpatient psychiatric rehabilitation have been viewed more than 250,000 times since 2021.
Users have logged in from around the world—including India, Pakistan, Africa, and the Netherlands.
“Psych rehab was born in the U.S., and we’re one of the only programs in the country focused exclusively on inpatient psychiatric treatment for serious mental illness,” said the director.
“Now we’re training people globally.”
As the program celebrates its 25th anniversary, recent funding cutbacks have whittled the team down from five to just three people, running multiple centers, managing state and federal grants, and continuing to build a national evidence base for inpatient rehab.
SHP doctoral student Jake Mariani is working with Bartholomew on further research into recovery strategies that will reduce readmission rates to state hospitals. “There is a lot of room for this type of treatment to grow,” said Mariani, who is working on his Ph.D. in Psychiatric Rehabilitation. “The long-term goal is to help people leave institutions if they are capable rather than letting them languish.”
The mission remains urgent.
“We’re fighting a tide of disempowering treatment,” said Bartholomew. “But every day, we see how much more is possible.”
After 25 years, the message is clear: treatment works.
And with the help of this groundbreaking program, some of society’s most marginalized individuals are reclaiming their lives.
