State mental hospital grapples with rise in patient violence
LAKEWOOD, Wash. (AP) - Over the last decade, mental hospitals across the country have been working under a federal mandate to phase out use of restraints and seclusion, tools psychiatric workers once relied on to prevent and control violence among patients.
At Western State Hospital, fewer patients are getting strapped to beds or locked in empty rooms than the past, but incidences and severity of assaults on staff are on the rise.
Since 1999, the hospital has recorded a 19 percent increase in the number of patient attacks on workers, and the number of severe assaults - those resulting in medical claims to the state - have risen almost 80 percent, according to Department of Labor and Industries data.
To deal with the rising tide of patient violence, Western's staff is getting trained on techniques to slip away from enraged patients, duck blows and call for backup. Those maneuvers make restraints or seclusion a last resort.
Many at Western believe the increase in violence has more to do with inadequate training on how to calm overwrought patients.
Andy Phillips, Western's chief administrator since 2004, and his boss, Richard Kellogg, head of the state's Mental Health Division, told The News Tribune of Tacoma they aren't sure what's behind the increase in violence.
They're studying other states to see how hospitals elsewhere phased out restraints and seclusion without an increase in staff assaults. Both say reducing violence and reducing restraints and seclusion go hand in hand.
"The goal at Western is to make the hospital a safer place. As that happens," Phillips said, "the need for restraints and seclusion will just melt away."
Two things prompted Western to change its tactics.
In November 1998, federal regulators cited the hospital for keeping patients in restraints and seclusion too long. That jeopardized Western's Medicare and other federal funding - about 30 percent of its $156 million budget.
The threat of lost funding led to a quick, steep decline in restraints and seclusion in 1999.
Then, in 1999 and 2000, every other mental institution in the country was told to start eliminating most restraints and seclusion or risk losing federal funding. The order reflected a consensus among mental health experts that such techniques traumatize the mentally ill and make recovery more difficult.
Washington was one of eight state mental health systems to receive a three-year federal grant in 2004 to pay for efforts to limit use of restraints and seclusion. About $45,000 of the $237,000 the state gets each year goes to Western, where it's used to improve staff members' patient-handling skills and to furnish comfort rooms where patients can unwind.
To gauge the hospital's track record, The News Tribune compared restraint and seclusion data from January 1996 through October 1998 with data from January 2003 through September 2006, the most recent available.
In seven wards for people 55 or older, restraint use has dropped 56 percent and seclusion use 95 percent since the mid-1990s. In 12 wards for adults under age 55, restraint use was down 58 percent and seclusion use was down 79 percent.
Yet during the same period, Western's forensic center, which evaluates jail inmates for competency to stand trial and houses criminals found not guilty by reason of insanity, has seen restraint use climb 15 percent and seclusion use go up 47 percent.
Western administrators say they aren't sure why that's happened.
Violence is also a source of friction between Western staff members and administrators, because of declines in assaults at other hospitals around the country.
Administrators say it will take a couple more years for the nonviolence initiative to work, "but meanwhile we have to hear about people getting their jaws broken," said counselor Jim Sprague.
Sprague is president of the hospital's chapter of the Washington Federation of State Employees, a union that represents Western workers except nurses.
In an October report, the state Department of Labor and Industries called Western's organizational structure "dysfunctional" and characterized communication between staff and managers as hostile.
There were also lapses in worker safety, the report said, including electronic panic buttons workers carry to summon help that sometimes don't work properly.
Phillips acknowledged the findings.
Several workers said they've even given up filing unsafe work conditions petitions with supervisors because, they say, they're largely ignored.
Labor and Industries' report noted that Phillips, Kellogg and others in charge are "clearly committed to both worker and patient health and well-being, and they inherited many problems that have existed for years."
Phillips has implemented some of the changes recommended, including circulating training teams to teach workers how to handle patients more safely.
In the meantime, union representatives say the hospital has not done enough to teach workers how to deal with patients in ways less likely to trigger aggression.
Kellogg suggested Western might be too big to run effectively. With more than 1,700 total workers, about 900 involuntarily admitted patients on any given day and more than 2,000 inpatients treated per year, Western is larger than many of the country's state mental institutions.
Kellogg expects research on how things are done elsewhere to be completed soon, and hopes soon to have a plan to fix Western's problems.
At Western State Hospital, fewer patients are getting strapped to beds or locked in empty rooms than the past, but incidences and severity of assaults on staff are on the rise.
Since 1999, the hospital has recorded a 19 percent increase in the number of patient attacks on workers, and the number of severe assaults - those resulting in medical claims to the state - have risen almost 80 percent, according to Department of Labor and Industries data.
To deal with the rising tide of patient violence, Western's staff is getting trained on techniques to slip away from enraged patients, duck blows and call for backup. Those maneuvers make restraints or seclusion a last resort.
Many at Western believe the increase in violence has more to do with inadequate training on how to calm overwrought patients.
Andy Phillips, Western's chief administrator since 2004, and his boss, Richard Kellogg, head of the state's Mental Health Division, told The News Tribune of Tacoma they aren't sure what's behind the increase in violence.
They're studying other states to see how hospitals elsewhere phased out restraints and seclusion without an increase in staff assaults. Both say reducing violence and reducing restraints and seclusion go hand in hand.
"The goal at Western is to make the hospital a safer place. As that happens," Phillips said, "the need for restraints and seclusion will just melt away."
Two things prompted Western to change its tactics.
In November 1998, federal regulators cited the hospital for keeping patients in restraints and seclusion too long. That jeopardized Western's Medicare and other federal funding - about 30 percent of its $156 million budget.
The threat of lost funding led to a quick, steep decline in restraints and seclusion in 1999.
Then, in 1999 and 2000, every other mental institution in the country was told to start eliminating most restraints and seclusion or risk losing federal funding. The order reflected a consensus among mental health experts that such techniques traumatize the mentally ill and make recovery more difficult.
Washington was one of eight state mental health systems to receive a three-year federal grant in 2004 to pay for efforts to limit use of restraints and seclusion. About $45,000 of the $237,000 the state gets each year goes to Western, where it's used to improve staff members' patient-handling skills and to furnish comfort rooms where patients can unwind.
To gauge the hospital's track record, The News Tribune compared restraint and seclusion data from January 1996 through October 1998 with data from January 2003 through September 2006, the most recent available.
In seven wards for people 55 or older, restraint use has dropped 56 percent and seclusion use 95 percent since the mid-1990s. In 12 wards for adults under age 55, restraint use was down 58 percent and seclusion use was down 79 percent.
Yet during the same period, Western's forensic center, which evaluates jail inmates for competency to stand trial and houses criminals found not guilty by reason of insanity, has seen restraint use climb 15 percent and seclusion use go up 47 percent.
Western administrators say they aren't sure why that's happened.
Violence is also a source of friction between Western staff members and administrators, because of declines in assaults at other hospitals around the country.
Administrators say it will take a couple more years for the nonviolence initiative to work, "but meanwhile we have to hear about people getting their jaws broken," said counselor Jim Sprague.
Sprague is president of the hospital's chapter of the Washington Federation of State Employees, a union that represents Western workers except nurses.
In an October report, the state Department of Labor and Industries called Western's organizational structure "dysfunctional" and characterized communication between staff and managers as hostile.
There were also lapses in worker safety, the report said, including electronic panic buttons workers carry to summon help that sometimes don't work properly.
Phillips acknowledged the findings.
Several workers said they've even given up filing unsafe work conditions petitions with supervisors because, they say, they're largely ignored.
Labor and Industries' report noted that Phillips, Kellogg and others in charge are "clearly committed to both worker and patient health and well-being, and they inherited many problems that have existed for years."
Phillips has implemented some of the changes recommended, including circulating training teams to teach workers how to handle patients more safely.
In the meantime, union representatives say the hospital has not done enough to teach workers how to deal with patients in ways less likely to trigger aggression.
Kellogg suggested Western might be too big to run effectively. With more than 1,700 total workers, about 900 involuntarily admitted patients on any given day and more than 2,000 inpatients treated per year, Western is larger than many of the country's state mental institutions.
Kellogg expects research on how things are done elsewhere to be completed soon, and hopes soon to have a plan to fix Western's problems.