Like all five California state forensic mental hospitals, Napa State Hospital, where I work, suffers from a plague of violence. Top administrators who oversee the system, however, are slow to respond.
The vast majority of patients don’t pose a risk. But the fraction who do make it unsafe for the patients who hope to get better, and for the doctors, nurses and medical technicians who want to help.
I was exposed to the violence at Napa on my first day when a brawl occurred on the unit. A patient was badly injured, and my head got banged into a wall. And it simply has continued on that way. I fear for myself, the staff and the patients. And that’s why I stay.
Their stories need to be heard. The violence they endure cannot go unnoticed any longer.
Napa State has roughly 3,000 assaults a year. Patients most often are the victims, though staff members have been attacked, too. Staff and patients have been murdered.
During a three-day period last year, a collection of hospital “incident reports” showed 30 assaults had occurred. Here is some of what the reports say:
“(Patient) came out of the restroom with her left forearm dripping with blood.”
“(Patient) sustained a possibly broken nose.”
“(Patient) found in his room assaulting his roommate.”
“(Patient) Help! Mr. X just punched me. … (Patient) hit (patient) on the left cheek while standing in the hallway.”
“(Patient) attempted to assault nurse.”
“(Patient) placed in 5-point restraints after injuring two staff.”
“Staff reported two patients swinging at each other with closed fists.”
“Staff witness(ed) patient stabbing female peer in the head with a pencil.”
Nine incidents were simply reported as “aggressive acts toward staff,” or “aggressive act toward another individual.”
In July 2011, psychiatrist Laura Dardashti said in an NPR radio report that when she started working at Metropolitan State Hospital near Los Angeles, she was told that it’s not if you get assaulted, but when.
Dardashti’s turn soon came when a psychotic patient grabbed her by her hair. It took four staff members to get the patient off. That wasn’t the worst part. “I remember driving to work the next day with a wave of panic coming over me and tears welling in my eyes, thinking, ‘I don’t know if I can do this,’” Dardashti said.
At Atascadero State Hospital, The San Luis Obispo Tribune reported in 2012: “The number of assaults resulting in injury to staff at Atascadero State Hospital has more than doubled in the past seven years.”
At Napa State, the powers that be at least admit the problem.
Last June, an email to staff read: “This message is being sent in recognition of the recent increase in serious acts of aggression resulting in injuries to both patients and staff. It is most unfortunate and disturbing that violence remains a part of our hospital experience.”
The California Department of State Hospitals, which oversees the state psychiatric hospitals, convened a two-day “Violence Risk Steering Committee Summit” at Coalinga State Hospital in November.
An executive summary stated that that the department should strengthen data collection, “consider allocating more data management” and switch to “modified and updated methods of reporting violence.”
This is nonsense.
Three thousand assaults per year at Napa State is data enough. The problems at Napa and other state mental hospitals are easily identifiable and most are eminently fixable. A survey of persons who work at Napa State produced this list of reasonable changes:
▪ Move staff members’ offices away from inpatient units. One reason for assaults on the staff is people getting hit either entering or leaving their office.
▪ There are no guards on the units. We freely walk the hospital corridors among the criminally insane. For people intent upon using violence, close contact breeds opportunity. Guards should escort staff on and off the units.
▪ Patients are frequently assaulted in common day halls or when intruders enter their rooms at night. Hall monitors and permanent day hall guards would help this.
▪ We need segregation for the worst offenders. Construction of a psychiatric Intensive Care Unit or Containment Unit which would house the 10 percent of patients responsible for the lion’s share of beatings would help a great deal. At Napa, a five-year pilot program has tentatively been approved for one such unit, if the funds are available.
▪ Most importantly, every patient sent to a state forensic hospital should come with a court order for administration of anti-psychotic medications. Our patients are the mentally ill who have successfully employed the “insanity defense” being found either not guilty by reason of insanity or incompetent to stand trial. They are remanded for care in lieu of serving prison time for their crimes.
And yet, owing to Superior Court decisions, unless specifically ordered by a judge, these people may refuse that treatment. Too many violent mentally ill persons remain unmedicated.
If a criminal avoids jail to get treatment, he or she should have to receive that treatment. How can patients get better if they’re getting beaten up all the time? How can the staff help if they work in fear for their safety?
I hope Pam Ahlin, Gov. Jerry Brown’s newly appointed director of the Department of State Hospitals, will see this. Maybe state legislators will take notice. Maybe the governor himself will make something happen. They are, after all, ultimately responsible for how the state hospital system operates, and for the safety of the patients and staff.
Dr. Stephen Seager, a staff psychiatrist at Napa State Hospital, is the author of “Behind the Gates of Gomorrah: A Year with the Criminally Insane.”