Napa State Hospital is one of the five state mental health facilities in California charged with treating severely mentally ill, often violent, patients. Statistics and news reports suggest that living and working at the 1,100-bed facility in the last several years have been an ordeal for all. Documented incidents of violence by patients against staff in the second quarter of 2010 totaled 200 — double the total in the same period in 2009. Reports of patients assaulting one another increased sixfold, to 692, in the same year-over-year comparison. In fall 2010, a psychiatric technician, Donna Gross, was killed by a patient on the grounds of the secured treatment area.
It was the first killing of a staff worker in 20 years at any of the California state hospitals, but clearly the system had a problem with violence. Patient assaults against staff and other patients in total doubled at Metropolitan State Hospital from 2006 to the end of 2011. At Napa, they tripled between 2008 and 2010, declining only after Gross' death led to a prohibition on patients walking the grounds by themselves.
Part of the problem at Napa has been the effort to comply with a 2006 federal court order to stop violating patients' rights by overmedicating and excessively restraining them, and to focus on a recovery-oriented treatment program that involves getting patients out of their rooms and into group therapy sessions. Doing that, particularly on the fenced-in yet rambling grounds of Napa's secured treatment area, has proved troublesome. In the 1990s, a minority of patients were there for criminal reasons. Today, more than 90% of patients are hospitalized because their illnesses led to some criminal violence. And after state budget cuts, there are fewer staff members per patient.
Napa already has some new security measures. Hospital police now patrol the secured treatment area. Last week, some of the staff began testing an alarm device worn on a lanyard around the neck that can be activated by an employee under threat or attack. A day after it was rolled out, however, a patient grabbed a lanyard and tried to strangle a worker. The next day, employees were told they will be allowed to wear the device on a belt loop.
It's good that state hospital officials demonstrated that they are willing to listen to staff and make adjustments in security measures. But they have more work to do to figure out how to effectively and safely carry out treatment.
Better therapy would reduce violence and would fulfill the institution's most basic duty to its patients. As doctors, nurses, social workers and technicians seek ways to reach these patients, administrators must look for rules and innovations that protect the safety of staff without compromising that duty.