Proposals aim to improve safety in state mental hospitals

Reposted at darkestcloset.blogspot.com

A worsening safety trend at California's mental health facilities has spurred legislation to better screen and separate violent patients, increase surveillance and improve workers' disability insurance.

 

By Lee Romney, Los Angeles Times  May 16, 2011 Posted in LA Times, Reporting from San Francisco—

Nearly eight months after a Napa State Hospital patient strangled a psychiatric technician, lawmakers and employee groups are pushing proposals aimed at reversing a worsening safety trend at California's mental health facilities.

Among them are bills that would enable officials to better assess patients' potential for violence, speed up the process to involuntarily medicate certain individuals and punish those who funnel contraband — such as tobacco and cash — to patients, feeding a black market that goes hand-in-hand with assault and extortion.

FOR THE RECORD:
Mental hospital safety: In the March 16 LATExtra section, an article about efforts to curb violence in state mental hospitals erred in stating that Atascadero State Hospital psychologist Henry Ahlstrom said excessive paperwork demands from a federal monitor had pulled staff away from direct care to focus on patient records. Many of the paperwork demands are not imposed directly by the monitor, who oversees federal reforms, but by state hospital administrators seeking to satisfy the monitor. —

Legislators are working closely with California Health and Human Services Secretary Diana Dooley, who lifted a hiring freeze at the state's psychiatric hospitals last month. In a long-awaited report, the Department of Mental Health, which Dooley oversees, recently called for better alarm and surveillance systems at the facilities.

"We are maybe for the first time in a long time approaching critical mass for driving reform," said state Sen. Sam Blakeslee (R-San Luis Obispo), who wrote the contraband bill and whose district includes Atascadero State Hospital.

Meanwhile, the Select Committee on State Hospital Safety chaired by Assemblyman Michael Allen (D-Santa Rosa) is expected to convene in about a month to propose longer-term solutions. And a coalition of employee groups formed at Napa in the wake of Donna Gross' death has expanded statewide to demand safer conditions for staff and the more than 5,500 patients they treat.

"We're very close here to coming to a boiling point," said Eric Soto, a psychiatric technician at Metropolitan State Hospital who heads the Norwalk facility's chapter of the California Assn. of Psychiatric Technicians.

Soto said he understands that "there is an element of risk" in working with state hospital patients, most of whom have been accused or convicted of crimes related to their mental illnesses. However, he said, "We all expect our employer to take steps to minimize that as much as possible."

Violence is among the issues the U.S. Department of Justice sought to address when it filed suit in 2006 and imposed court-ordered reforms at four of the state's five mental hospitals. Yet data show that assaults against patients and staff have increased at most of the facilities.

A study obtained by Allen's committee shows that in 2010 there were 6,700 victims of aggressive incidents and 5,100 injuries at the state's mental hospitals — 1,000 of those to staff. That's a rate of 14 injuries a day.

On Wednesday night, a 49-year-old Napa patient described by staff as "frail" and "shy" was found unconscious and bloodied beyond recognition. Charged with attempted murder in the assault was 31-year-old Victor Hugo Mandujano. Mandujano was not responding to medication, often complained of hearing voices and suffered frequent bouts of violence, a fellow patient said.

"People would lend him headphones and radios just to drown out the voices so he could get some rest," said Tim Breckenridge, 35.

A psychiatric technician who responded to the attack said the hospital houses patients of various ages and violence levels in close quarters, with insufficient supervision.

The fears run systemwide. At Metropolitan last week, three female patients adorned their shirts with the slogans "Stop the Violence" and "Be Kind," said Denise Nicks, a rehabilitation therapist who is that hospital's union steward for AFSCME Local 2620.

Nicks, whose nose was broken by a patient last year, said it is upsetting that employees cannot keep patients safe, attributing the problem to inadequate staffing and excessive and redundant paperwork.

Yet consensus is building to place greater restrictions on the most violent patients. A bill by state Sen. Noreen Evans (D-Santa Rosa) would require thorough violence assessments, place the most aggressive patients in specialized units and, if secure housing cannot be found, send them to prison or jail. Patients who commit serious assaults would also be transferred.

Allen has also moved two bills through committee — one that makes it easier to involuntarily medicate certain patients deemed incompetent to stand trial, and another that enhances the disability insurance policies for all hospital staff.

Labor groups contend the Department of Mental Health has not moved with sufficient urgency to address the violence. But department spokeswoman Jennifer Turner said 50 employees have been hired since Dooley lifted the freeze and officials are working to expedite the process of sending violent patients to prison.

The department's recent safety report endorses the creation of special units to hold the most aggressive patients. They would have extra staff and on-site police officers, the rooms would have high-security doors and patients would be restrained when moved.

The most extensive reviews were conducted at Napa and Metropolitan, which have open campuses not designed for patients with violent criminal histories. Recommendations include more fencing and outside lighting and teams of psychiatric technicians and police officers to monitor the grounds as they do at Patton State Hospital in San Bernardino. The department's call for new video monitoring and upgraded alarm systems applies to all state hospitals.

While the price tag of these reforms would be high, the cost of doing nothing could be steeper. In 2010, Napa recorded 384 staff injuries resulting in 289 workers compensation claims and 10,724 missed work days, according to an analysis accompanying one of the bills. Systemwide, overtime costs in the last fiscal year ran up to $100 million, Allen said, in part due to injuries.

Psychologist Henry Ahlstrom, Atascadero's chief steward for AFSCME Local 2620, said he and other members of the statewide safety coalition applaud the legislation. But he stressed that underlying problems that feed the violence also need to be addressed.

The federal government's lawsuit brought about some positive changes, he said, including documentation and, to some extent, accountability through stricter protocols and audits. But excessive paperwork demands from the federal monitor have pulled staff away from direct care to focus on grooming patient records. The result is eroded therapeutic relationships, which are key to de-escalating violent situations, he said.

"We don't have sufficient time to help our patients develop healthy attachments and regulate their emotions better," Ahlstrom said.

Patient advocates say fear only worsens the equation. At Napa in particular, interactions with patients have become "guarded, tense, conveying orders or instructions, leaving patients feeling disrespected and disregarded," said Barbara Duncan, spokeswoman for Disability Rights California, which advocates on the patients' behalf. That atmosphere can cause patients to "back away, apologize for every request, avoid eye contact, close down," she said.

"When you have little positive human interaction, the result is hopelessness," she said, adding that the response "can be withdrawal and depression, but can also be anger and violence."

http://www.latimes.com/news/local/la-me-hospital-violence-20110516,0,7831085.story