A single clinician is often left to supervise a unit of more than 50 patients. Mandatory overtime is routine, as is burnout, according to staff members.
"It's a miserable place to walk into," said one psychiatric technician. "Morale is horrible."
A growing sense among patients that they have been effectively railroaded into a life prison term formed the seed of discontent during the summer and fall.
Administrators have since challenged the patients' account of the "strike," saying the percentage of people participating has been far lower than patients and some staff members contended. They said, however, that they did not have attendance figures for educational and improvement programs.
But both patients and staff acknowledged that in the highly charged environment at Coalinga, even the most trivial of disagreements had ballooned into full-fledged disputes over civil rights.
In August, for instance, according to staff members, a group of patients taped small protest fliers to their hospital-issued identification tags. Most read: "When injustice becomes law, resistance becomes duty." Hospital officials ordered patients to remove them.
"They said they were defacing government property," a clinician said. "But they were just making this up as they go."
It did not end well; officers eventually hauled away one patient who refused to take off his protest flier.
"They made a martyr out of him," the clinician said. "The next day, patients had bigger pieces of paper taped to them that said: 'Please don't hit me because I'm wearing this piece of paper.' "
Patients, meanwhile, have developed a list of complaints and concerns. They say, for example, that the hospital drags its feet before allowing them outside the walls for specialized medical care.
The hospital denies having a problem, though a former employee familiar with the hospital's medical operation acknowledged that patients weren't seeing necessary specialists. The employee said the issue was complicated by the fact that physicians in nearby communities refuse to contract with the facility.
"Nobody can decide what we are," said Niles Carr, 38, who was routed into the mental hospital system in 1998 after serving time for molestation. "But as long as we're stuck here, we need to be treated properly."
Some of the patients' demands -- such as Internet access -- aren't likely to gain much traction with the public.
Others, however, have gained the attention of a congressionally charged, federally funded group that advocates on behalf of people with physical and mental health disabilities. Protection & Advocacy Inc. attorney Sean Rashkis said the group was investigating patients' concerns.
"They have done their time and have moved into a civil commitment which is based on treatment," he said. "Some of the patients argue that that's not what they are getting. It may be the case. We'll have to see."
One in a series of occasional articles on California's troubled mental health system.