Soon after a patient was arrested in connection with the homicide of a Napa State Hospital worker, another patient is in jail, accused of seriously injuring a hospital employee.
Lawmakers are already grappling with what can be done to remedy what’s emerged as a serious problem with the death of psychiatric technician Donna Gross. It's almost inevitable that a raft of legislative proposals will also spark debate between mental health experts calling for therapy and workers calling for security.
The degree and amount of violence seem to beg the question: What is going on at Napa State Hospital?
Here are some questions that journalists, including myself, have been asking about the recent incidents and their implications.
Is there an upswing in patient attacks on workers?
Reading the Los Angeles Times headline “Patient aggression intensifies at Napa State Hospital," the answer seems to be a resounding “yes.”
However, that article also quotes an authority who said patient aggression only appears to be spiking because hospital authorities recently began including verbal assaults and thrown objects in the data.
The trend at Napa State Hospital isn’t quite as clear when you look only at figures tracking patient attacks on workers that resulted in medical treatment between May 2006 and May 2010. The data, provided by the Department of Mental Health, suggest more of a persistent problem than a recent uproar:
The trend line, however, looks far more dramatic at Patton State Hospital, another state-run facility in the Inland Empire:
Recent news reports do little, though, to shed light on what's going on at the hospital near San Bernardino.
What types of patients are coming into the hospitals?
The state mental hospitals house a variety of patients, mostly those wending their way through the state criminal justice system or bypassing it altogether. A tiny fraction are criminally insane and many are state prison inmates undergoing assessments for psychiatric problems.
Department of Mental Health spokeswoman Jennifer Turner noted that allegedly violent patients who are found incompetent to stand trial tend to be more aggressive when they’re first acclimating to a state hospital.
Here is some data provided by the department showing the number of those patients admitted each year to Napa State Hospital:
Again, there's a trend but not an incredible spike.
The numbers for Atascadero (in blue) and Metropolitan State (red) Hospitals, though, do signify a recent and marked change in the number of incoming patients deemed incompetent to stand trial. This is from data provided by the Department of Mental Health:
Authorities can explain the influx of such patients at Atascadero State Prison. The patients who are found ill fit to face charges are typically assessed and evaluated in state hospitals and often returned to local courts to face their accusations.
New Times San Luis Obispo reporter Colin Rigley reported about a 2009 court decision that expedites the movement of such patients from local jails to state hospitals, causing a stir:
The wave of new patients includes many who are much more aggressive than ASH staff are used to handling en masse. Having come from a non-treatment environment like a county jail, the new patients are entering ASH prepared to fight. 'These people come to us in a very unstable state,' ASH Public Information Officer Craig Dacus said.
Jennifer Turner, a spokeswoman for the California Department of Mental Health, said the Mille decision patients 'tend to arrive exhibiting unpredictable behaviors, including aggressive actions or violent outbursts. While clinicians work quickly to develop an effective treatment plan for the patient, it does take time to identify aggressive or violent behavior triggers.'
The Bay Citizen also took a look at violence at Napa State Hospital, taking ten steps back to note that the state mental hospitals were not always so interconnected with violent crime:
In many ways, the brutality at Napa State Hospital reflects changes that have occurred at mental institutions statewide. Since the early 1990s, thousands of mentally ill patients have been moved from state hospitals to community settings, opening up beds for patients who have been ordered there by criminal courts.
The Department of Mental Health reports that 92 percent of patients in state mental hospitals were referred by the criminal justice system; 15 years ago it was just 20 percent.
All of this, and hopefully more, will likely be on the table when lawmakers decide how to make the system safer.
Rigley reports that the process has already begun:
Sen. Sam Blakeslee plans to roll out up to four bills to address worker safety concerns at Atascadero State Hospital. …
For a second time, he said he plans to run a bill that would make 'gassing' a more serious offense. The term is used to describe patients filling bags with bodily fluids and then throwing them at staffers. Blakeslee authored a similar bill before, but it never made it out of committee.
And he has plans to address a litany of other safety concerns. Though his other bills are more tentative, Blakeslee said he wants to push legislation that would create a process whereby staff could administer medication more easily to dangerous patients. He also plans to 'fast track' violent patients back into the state prison system, noting that violent patients who were transferred from a prison to ASH would be more likely to modify their behavior if they knew going back was a consequence.
'That’s a common misperception that, because the population is mentally ill … traditional incentives and disincentives don’t work,' he said.
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