California’s state mental hospitals care for the most seriously mentally ill patients who, increasingly, have committed serious crimes and acts of violence. Meeting the needs of these very ill and often dangerous patients, while protecting hospital staff, poses complex and challenging questions involving treatment, medication and patient rights.
Annually, the Department of State Hospitals serves more than 12,000 patients – more than any other state – in five state hospitals and three psychiatric facilities. Decades ago there were roughly equal numbers of civil and criminal commitments, but now more than 90 percent have committed serious crimes (“Violence rife in state hospitals for convicts,” Forum, Feb. 8).
With this shift, violence has become a key issue in managing a forensic mental health system. Preventing aggressive acts against patients and staff is our top priority. By the end of 2013, our hospital system recorded reductions in aggressive incidents that translated into 180 fewer patient assaults and 30 fewer staff assaults per month from the peak of violence in 2010.
To reduce violence, the department has implemented violence risk assessments of patients and developed the California State Hospital Violence Assessment and Treatment guidelines, Cal-VAT, a unique resource for clinicians. A team of experts in psychopharmacology advises doctors on medications for the most difficult patients. In addition, a personal alarm system device unlike any other in the nation is worn by all of the employees at three state hospitals and is being implemented at the two others.
Also, new laws approved last year will increase safety. Assemblyman Henry Perea’s AB 1960 will improve safety and security by allowing department clinicians to access the criminal history of all patients. AB 1340 by Assemblyman Katcho Achadjian allows for building enhanced treatment facilities where the most aggressive patients will receive specialized treatment. And AB 2186 by Assemblywoman Bonnie Lowenthal and AB 2625 by Achadjian streamline involuntary medication orders and court procedures to help staff treat the fastest-growing segment of our population, those who are incompetent to stand trial.
In caring for the most aggressive and mentally ill patients – and caring for more of them – California is at the forefront of efforts to find solutions to the national problem of violence in mental health facilities. We are working with our partners to develop new approaches to enhance safety, treatment and the environment in which the patients reside. Although these patients are difficult to treat, we are dedicated to serving them and ensuring our hospital staff stays safe.
Pam Ahlin is the director of the California Department of State Hospitals.