Western State Hospital’s psychiatric patients must be physically restrained as little as possible. Its staff must be protected from violent patients as much as possible. The two imperatives have created a serious dilemma.
The dilemma is laid out in the recent series by The News Tribune’s Alexander Otto. Western State’s administration has been pushing hard to reduce the use of straps and seclusion (locking a patient in a room) since 1998.
With one exception – the forensics admissions section, where criminal suspects are evaluated – the hospital has been largely successful. Outside forensics, Western State straps down patients less than half as often as it did in before 1998.
That is humane and important, but the staff has paid the price. Since 1999, patient attacks on workers have risen 19 percent. Severe assaults – those that result in medical claims – have risen 80 percent. The medical bills for these attacks are expected to run about $3.6 million for 2006. That’s a lot of injury.
According to the state Department of Labor and Industries, a good part of the blame belongs to the hospital administration. In October, the department issued a report saying that Western State’s safety culture was almost “nonexistent.”
That’s easy to believe, judging by hospital workers’ complaints that the “panic buttons” they are issued to call for backup sometimes just don’t work.
Labor and Industries found, among other things, that a comprehensive 1999 plan to cut violence at the hospital had “essentially disappeared.” It told the administrators to find the missing plan and start using it.
Western State’s current administration appears to be serious about staff safety. Among other measures, it is giving workers far more training in subduing and calming aggressive patients. And it has clarified that restraints can still be used when necessary to prevent injuries.
Many of the attacks occur in the hospital’s three forensics admissions wards. That’s not surprising: The “patients” here are men and women accused of violent crimes whose competency to stand trial is being evaluated. Inevitably, some of these are simply criminals, and those are who genuinely mentally ill are obviously capable of violence.
One forensics unit in Alabama, the Taylor Hardin Secure Medical Facility has succeeded in cutting its use of restraints without a corresponding rise in attacks, an impressive performance.
One of its strategies is doing more competency evaluations in jail, not at the hospital. Western State could benefit from that practice.
The pioneer in humane treatment is Pennsylvania. It began phasing out restraints and seclusion in the mid-1990s. By 2000, it had cut its use of them 74 percent – without an increase of attacks. Clearly this can be done; Western State just has to find the formula.
