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Reducing Risk Of Assaults In Psychiatric Hospitals A Challenge


We've been reporting on the Napa State Hospital in California. Five years ago this week, an employee there was killed by a psychiatric patient. It's still a dangerous place. Steve Seager is a psychiatrist there.

STEVE SEAGER: Every time I leave the unit or go on the unit, it's like a little military exercise where I decide where I'm going to go, I watch every step, I look under my door before I open it.

CORNISH: Last year, 1,800 assaults took place on the campus of Napa State Hospital. So what can psychiatric hospitals do to make their facilities safer for patients and employees? And what's been successful? For an answer, we turn to Joel Dvoskin. He's a clinical psychologist. He consults with psychiatric hospitals around the country.

Welcome to the program.

JOEL DVOSKIN: Thank you for having me.

CORNISH: So I know you've also served as a monitor of federal court settlement agreements over psychiatric hospitals so you've seen a lot. What are some of the factors that the most troubled hospitals have in common?

DVOSKIN: Some of the common factors are either low staffing or not enough money to train people adequately, the type of patients who are in the hospital and the mix of patients - mixing predatory patients with vulnerable patients - whether or not they have security staff on the wards, the nature of the physical plant - do they have blind spots?

CORNISH: And when we say blind spots, we mean blind from cameras or just literally being able to see around the corner?

DVOSKIN: No, where staff can't see all of the common space from one spot, it means they have to walk around a lot of corners. And the staff spend a lot more time watching to keep people safe and not as much time interacting and providing treatment.

CORNISH: Can you give us an example of a state hospital, state facility, that was able to bring down the number of assaults? What are things that they did differently?

DVOSKIN: Well, one hospital, the Fulton State Hospital, did some innovative programs that helped them reduce their violence. One of the things they did is they didn't like the training that their direct care staff were getting so they scrapped it and made up their own training program, which is outstanding. And it was developed by the most skilled direct care staff. They also have brought in several different targeted kinds of treatment such as behavioral treatment that systematically rewards appropriate behavior. Additional programs is another thing that's done, when people are busy they tend to cause less trouble than when they're idle.

CORNISH: So what are those programs? Do you mean therapy or painting classes? What does that mean?

DVOSKIN: Well, it's both things. So many of the programs are specifically aimed at skills, and those vary from skills that a person's going to need in the community to life skills like conflict resolution or how to communicate better, how to make friends.

CORNISH: But can you get to skills teaching if you're still worried about assaults?

DVOSKIN: Well, it's certainly - the more fearful that the staff are, the more fearful the patients are and vice versa. And fear does interfere with people's ability to teach and their ability to learn. So creating a safe environment is absolutely important to allowing people to profit from these treatment programs. But I also, if I may just add, some of the other programs that people sometimes make fun of, you know, of painting and stuff, it's just the idea that anything that's done that's either interesting or fun is better for people than sitting around.

CORNISH: People hearing about these high numbers of assaults at this hospital or any other - is there a question that we should be asking that we're not, something that's kind of an elephant in the room for the industry that you know if you've been watching it, but that people may not realize when they hear these high figures?

DVOSKIN: We - in the United States, the budgets for public mental health have been drastically reduced over the last 15 years. I mean, to the tune of tens of billions of dollars. And because of that, not everybody gets the kind of treatment that they need as early as they need it, and so sometimes people are allowed to get worse before they get the help that they need. The other thing that's my own personal opinion is that a lot of violence in America - and it also means the violence in psychiatric hospitals - is more the result of fear and anger and despair than it is the result of mental illness. And that we have to be about building hope in people because when you're hopeless, you're much less likely to choose healthy ways to deal with your problems. And building hope, it's a hokey thing to talk about and we don't talk about it enough, but I think it is incredibly important if we're trying to make hospitals safer.

CORNISH: Joel Dvoskin, he's a clinical psychologist.

Thank you so much for speaking with us.

DVOSKIN: Thank you so much. Transcript provided by NPR, Copyright NPR.