There’s a crisis of violence at Western State Hospital. I know. I used to work there
In a hospital marginalized by scandals, loss of federal accreditation, intermittent failures in public safety and preventable deaths, the mundane statistical data steadily accumulating to tell the story of Western State Hospital’s worsening violence captures no attention in its own right. It just doesn’t compare to those intermittent peaks in controversy and drama, so I wouldn’t be surprised if this opinion goes unpublished.
In 2005 there were about 2,300 assaults at Western State Hospital in Lakewood, according to data obtained by a public information request. Over the course of the next three years, the assault rates dropped, and by 2008 they had fallen to 1,300, 56% of what they were three years earlier. Assaults stayed at this lower rate for six years, until 2014 when they began to rise. By 2017 the assault rates at the hospital were back to 2005 levels, and have remained at this higher level since that time.
In August of 2021 there were 8.86 assaults per 1,000 patient days at Western State — which translates to over 200 assaults in one month. That’s a lot.
Despite the significant increase in spending to address the problem of violence — and the creation of high profile initiatives like PERT (Psychiatric Emergency Response Team), PICU (Psychiatric Intensive Care Unit) and the STAR ward (Specialized Treatment and Recovery) — the problem just keeps getting worse. Last year, Western State ranked 10th out of 12 state psychiatric hospitals who surveyed patients and asked if they agreed with the statement, “I felt safe while I was in the hospital.” This survey question — and the responses — have particular significance in a hospital where patient histories of developmental and adult trauma led to their incarceration in such a violent institution.
In 2005 the culture of Western State was not conducive to a reduction in violence. I was a new attending psychiatrist at that time, assigned to the hospital’s “male assaultive” ward. That’s a term that has since been banned from use and replaced with the more uplifting acronym “STAR” ward. I was not a popular psychiatric attending back then. But the number of assaults, injuries, incidents of seclusion and restraints significantly decreased.
It wasn’t easy for me personally. I encountered an overwhelming number of hostile staff and executives in the pursuit of a change in the dominant hospital culture. I like to tell myself I had something to do with the dramatic decrease in overall violence at the hospital, but — to be honest — what really improved the hospital’s violence was the unflattering, not very pretty, often ugly interactions between the many genuinely caring, experienced and clinically knowledgeable hospital leaders and genuinely caring and experienced direct care staff. Assaults dropped from about 2,300 in 2005 to about 1,300 in 2008 due to these uninhibited and heartfelt discussions between caring staff and leaders.
By contrast, in 2015, I found myself sitting in a management meeting listening to the clinical director talk about how they would deal with a problematic patient. He explained the therapeutic benefits of transferring the patient to a ward where he would get beaten up for his behavior. As the managers sat around the table, all in cheerful reassuring agreement with the clinical director, I recognized the return of that previous culture I had fought against ten years earlier.
In 2014 there was a dramatic shift in the hospital’s executive leadership. Pretend politics — bolstered by over zealous sycophantic lieutenants — replaced clinically experienced and clinically dedicated leadership. In lieu of clinical experience and dedication, leadership honed its use of artful subterfuge, retaliation and intimidation. Predictably, this shift in leadership was and continues to be ineffective in reducing the hospital’s ongoing crisis of violence. Likewise, its ongoing use of highly paid outside “experts” has also failed to reduce the violence.
I no longer work for Western State Hospital. A week after my last critical opinion of the hospital’s leadership was published in The News Tribune I was placed under investigation and forced to leave. I subsequently spent a year and a half working at the King County jail in Seattle, where — unfortunately — many of the former patients lay languishing on the concrete floors of their cells waiting to get back into Western.
The tragic history of violence at Western State is readily apparent in the hospital’s own data. The humility that such data should evoke in hospital and state executives simply doesn’t exist anymore. Political rhetoric like declaring “Even one assault is too many!” passes for acceptable government performance rather than looking at, admitting and addressing its own ongoing failures.
The mundane statistical data accumulating month after month, year after year at Western State is unflattering.
It also appears to be of little interest or use to a leadership void of clinical experience and the wisdom to respond to it.
Dr. Joseph Wainer is a psychiatrist with over 20 years of experience working with patients struggling with severe mental illness and trauma. He has spent half of those years working at Western State Hospital.