Letters to the Editor: I am an L.A. General psychiatrist who has been assaulted at work. This is why we use restraints or seclusion
To the editor: I am an attending psychiatrist at the Los Angeles General Medical Center’s acute psychiatric ward. I chose this career because I wanted to help the most vulnerable. Most days, I love my job. Other days, I question my ability to stay in this field. (“Psychiatric patients are restrained at sky-high rates at this L.A. hospital,” Oct. 19)
I have been assaulted by patients on multiple occasions. In a recent instance, I was brutally attacked by a patient coming down from meth. She looked me in the eye, said she was going to “terminate” me, then punched me in the head, grabbed my hair and held me to the ground.
As healthcare workers, we shouldn’t have to expect, or even accept, that we will be assaulted at work.
Many people with mental illness are not violent. However, most of the psychiatric patients we see at L.A. General have a history of violence. Restraint or seclusion is used when absolutely necessary to protect ourselves and other patients.
Laura Kendall, M.D., Los Angeles
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To the editor: The use of restraints in mental healthcare begins and ends with psychiatric nurses. As many as 1 in 3 nurses report experiencing violence or aggression from patients, and among psychiatric nurses, nearly twice as many (65%) have experienced patient aggression.
As a psychiatric nurse, I understand why violent healthcare scenarios end in interventions like seclusion and restraints, which are often initiated by nurses. But restraints are the wrong solution to hospital violence.
After all, nurse injuries and assaults continue to be high even when these restrictive interventions are used.
A healthy psychiatric nursing workforce is necessary if we want to end the dehumanizing use of seclusion and restraints. Studies suggest that adequate nurse staffing, leadership support and interprofessional communication in psychiatric settings can reduce adverse outcomes like nurse injuries and assaults.
However, in the aftermath of the COVID-19 pandemic, the psychiatric nursing workforce is in a staffing shortage and burnout crisis, just as it is among intensive care unit nurses.
Psychiatric nurses play a critical role in preventing the need for restraints. We must ensure adequate nurse staffing, supportive work environments and training on trauma-informed care so that it is possible for psychiatric nurses to partner with patients in their care and treat them with the dignity they deserve.
Kristen Choi, Los Angeles
The writer, a psychiatric nurse practitioner, is an assistant professor of nursing and public health at UCLA.
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To the editor: L.A. General’s use of restraint is higher than other hospitals because a higher volume of our patients is violent. Many have endured years of homelessness, incarceration and substance abuse, classic markers of decades of failed mental health resourcing at the state level.
A safety-net hospital, L.A. General does not turn away such patients, as others often do. Our staff and other patients are subject to assault at higher rates than those at most facilities.
Our mission is to provide excellent, critically needed care in a safe environment — for patients and staff alike. Our team does its absolute best in an imperfect system. It is unfair to ask nurses, doctors and medical staff to do this job without being able to protect themselves and other patients from violence.
The Times missed an opportunity to expose the societal breakdowns and lack of resources in our mental health system.
Brad Spellberg, M.D., Los Angeles
The writer is chief medical officer at L.A. General Medical Center.
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To the editor: In 1968 I was admitted to the Westwood Hospital. I was not a danger to myself or others, but I was psychotic.
One evening, I was hustled into a room and placed in restraints. It was one of the most frightening experiences of my life.
My sympathy is with anyone who’s had to endure this horrible procedure.
Joseph Gius, Los Angeles
