At California Mental Hospitals, Fear Is Part Of The Job

The tipping point for major change is often tragedy. That may be the case in California at the state psychiatric hospital in Napa, where an employee was killed last October, allegedly by a patient — one of thousands of violent acts committed at the hospital that year.

Donna Gross, a psychiatric technician who had been working at Napa State Hospital for 14 years, was walking on hospital grounds late in the afternoon when she ran into a patient named Jess Massey.

Like many patients at Napa, Massey had a pass that allowed him to wander on the grounds unsupervised. He allegedly cornered Gross between a couple of buildings, attacked her, stuffed dirt into her mouth — which kept her from screaming — and strangled her.

Massey, who has pleaded not guilty, had a criminal history that included aggravated sexual assault, armed robbery and attempted murder. These days, that's not so unusual at Napa.

More than 80 percent of the patients arrive by way of the criminal justice system, considered incompetent to stand trial, not guilty by reason of insanity, or just too dangerous and mentally ill to be paroled to the community.

But 20 years ago, hardly any of Napa's patients were criminal commitments. And staffers complain that this hospital wasn't designed to deal with the patients it's now serving.

A Sharp Rise In Assaults

At a recent demonstration held by Napa employees demanding better safety measures, finding people who had been attacked by patients wasn't difficult.

There's Chris Cullen, a psychiatric technician who says he was punched in the face; and Zach Hatton, a recreation therapist who recounted two injuries. "I was punched in the face about a year and a half ago," Hatton says, "and then my wrist was twisted up pretty badly and just has never healed."

Dr. Richard Frishman, a psychiatrist, was attacked while interviewing a new patient. "He came flying across the table, fists flying," Frishman says. "He was able to hurl me against the wall where I struck my head and fractured my wrist."

There are statistics to support these stories. According to a report mandated by the federal government, patients at Napa committed 75 physically aggressive acts against staff in a single six-month period ending in early 2009. In the same period one year later, there were nearly four times as many assaults. The report also shows that patient-on-patient aggression more than doubled during that same time.

Asked what it's like to be afraid of the people he's tasked with helping, Frishman says: "You have to be able to separate your own traumas from the moment, and if you can walk away at the end of the day and feel that you've helped those truly in need of help, that seems to outweigh the risks that we currently take."

'I Have No Desire To Be Violent'

One Napa patient, whose name is not being used because he says he fears retaliation, says a relatively small percentage of predatory patients make violence and intimidation part of daily life.

"There is nothing therapeutic about what's going on here, nothing at all," he says. NPR wasn't allowed to enter the secured area or speak to any patients at the hospital, so the patient was reached by phone.

"So what do I do? Stay in my room," he says. "Because other than that, I have no desire to be out in the unit fighting. I have no desire to be violent. I'm not a violent person, you know, I'm just not."

At least, he's not when he's on his meds. This patient was sent to the hospital after being arrested for assault and found incompetent to stand trial. But as he describes it, violence is almost inescapable at Napa — like the night he heard an alarm go off in the hall outside his room.

"So I got up and got out of my bed," the patient says, "and this guy was around here throwing garbage cans, you know. He looked at me and told me I needed to take my old ass back to bed and blah blah blah, and he attacked me, and I put 11 stitches in his hand, but I broke my hand doing it."

An 'Inherent' Risk

That's the view from inside the security fence. In her office outside of the fence, the hospital's executive director, Dolly Matteucci, says that she wants nothing more than for her staff to be safe on the job. But "there's an inherent kind of risk in treating and working with individuals that are severely mentally ill," she says, "and I think all of our staff recognize that when they come to work here."

Matteucci first came to work at Napa 20 years ago as a dietician and rose through the ranks. She got her current job after Napa's previous chief executive was arrested on child molestation charges. He has since been convicted.

Matteucci says she welcomes the staff's renewed focus on safety. "I think that that is wonderful, in terms of us all talking more pointedly about what the concerns are, what the recommendations are and taking action," she says.

Among the actions taken since Gross' murder is the elimination of grounds passes like the one that Gross' alleged killer had. The campus-like layout of the hospital, with foliage and walled courtyards between buildings, provides too many places to hide.

A Plea For Help

But staffers want more, and they're hoping state lawmakers can help.

State Assemblyman Mike Allen, a Democrat, represents the Napa area. The hospital's employees are his constituents and a couple of hundred were at a hearing he convened at a local community college. Allen said he was there to listen — and he did, to a two-hour saga of injury, anger and grief.

Brad Leggs, a psychiatric technician at Napa and a union representative, created an image to go with the words. "If I may, I would respectfully like to ask those in the audience to briefly stand up if you've been injured or assaulted, or your co-worker has been assaulted."

Nearly everyone stood.

That sight motivated the acting head of the state Department of Mental Health to call a summit meeting to deal with safety issues at all of California's psychiatric hospitals. The meeting, held last week at Napa State Hospital, was picketed by staff who say they don't need more meetings — they need action.

Part 2, airing tomorrow on Morning Edition, examines whether the current treatment plan at California's psychiatric hospitals has contributed to making the hospitals more dangerous. Copyright 2011 National Public Radio. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, host:

The tipping point for major change is often tragedy. That may be the case here in California at the state psychiatric hospital in Napa. That's where an employee named Donna Gross was murdered by a patient last fall. Her killing was one of thousands of violent acts at the hospital that year.

We're going to be talking about rising violence in California's psychiatric hospitals this morning, and tomorrow with NPR's Ina Jaffe, who joins us here at NPR West. Good morning, Ina.

INA JAFFE: Good morning, Renee.

MONTAGNE: Let's begin with that murder of Donna Gross. Tell us who she was and how she died.

JAFFE: She was a psychiatric technician at Napa Hospital. She'd been working there for 14 years. And she was coming back from a break late one afternoon, walking on the hospital grounds, and she ran into a patient named Jess Massey.

You know, you have to understand, Napa's not a prison, it's a hospital. It's got a series of low-rise buildings on a sort of campus-like setting. And like a lot of patients at Napa, Jess Massey had a pass that allowed him to walk around on the grounds behind the security fence unsupervised. So allegedly he cornered Donna Gross between a couple of buildings, attacked her, stuffed dirt in her mouth, which kept her from screaming, and strangled her. And he's pleaded not guilty.

MONTAGNE: And was there no warning that he was dangerous?

JAFFE: Oh sure. He had a criminal history, included aggravated sexual assault, armed robbery and attempted murder. But you know, these days that's not unusual at Napa. More than 80 percent of the patients come there by way of the criminal justice system. They're considered incompetent to stand trial, not guilty by reason of insanity, or just too dangerous and mentally ill to be paroled to the community.

You know, 20 years ago, hardly any of Napa's patients were criminal commitments. And staffers complain that this hospital just wasn't designed to deal with the patients it's now serving.

So since Donna Gross's death, Napa employees have staged demonstrations in front of the hospital.

Unidentified People: What do we want? Safety! When do we want it? Now!

JAFFE: Finding people in this crowd who'd been attacked by patients turned out to be easy.

Chris Cullen is a psychiatric technician.

Mr. CHRIS CULLEN (Psychiatric Technician, Napa Hospital): Yeah, I just got punched in the face by an individual. I was protecting him from an assault when he punched me.

JAFFE: Zach Hatton is a recreation therapist.

Mr. ZACH HATTON (Recreation Therapist, Napa Hospital): I was punched in the face about a year and a half ago, and then my wrist was twisted up pretty badly and just has never healed.

JAFFE: Dr. Richard Frishman is a psychiatrist who had been interviewing a new patient.

Dr. RICHARD FRISHMAN (Psychiatrist, Napa Hospital): And he came flying across the table, fists flying. He was able to hurl me against the wall, where I struck my head and fractured my wrist.

JAFFE: As someone who is there to help make people better, what's it like when you're also afraid of those people?

Dr. FRISHMAN: You have to be able to separate your own traumas from the moment. And if you can walk away at the end of the day and feel that you've helped those truly in need of help, that seems to outweigh the risks that we currently take.

JAFFE: So you're able to just put that out of your mind?

Dr. FRISHMAN: My girlfriend would say no.

JAFFE: There are statistics to support these stories. Here's just one example: In a six-month period ending in early 2009, patients at Napa committed 75 physically aggressive acts against staff. In the same period one year later, there were nearly four times as many assaults. These figures are from a report mandated by the Department of Justice. It also shows that patient-on-patient aggression more than doubled during that same time.

JAFFE: That's the voice of a Napa patient. We weren't allowed to speak to any patients when we visited the hospital, so we reached him by phone. He fears retaliation, so we're not going to use his name. He says a relatively small percentage of predatory patients make violence and intimidation part of daily life.

Unidentified Man: So what do I do? Stay in my room. Because other than that, I don't, you know, I have no desire to be out in the unit fighting. I have no desire to be violent. I'm not a violent person, you know, I'm just not.

JAFFE: At least he's not when he's on his meds. This patient was sent to the hospital after being arrested for assault and found incompetent to stand trial. But as he describes it, violence is almost inescapable at Napa - like the night he heard an alarm go off in the hall outside his room.

Unidentified Man: So I got up, got out of my bed and this guy was sitting around here throwing garbage cans. And you know, he looked at me and told me I needed to take my old ass back to bed and blah, blah, blah. And he attacked me, and I put 11 stitches in his hand, but I broke my hand doing it.

JAFFE: That's the view from inside the security fence. In her office outside of the fence, Napa's executive director, Dolly Matteucci, says that she wants nothing more than for her staff to be safe on the job. However...

Ms. DOLLY MATTEUCCI (Executive Director, Napa Hospital): There's an inherent kind of risk in treating and working with individuals that are severely mentally ill, and I think all of our staff recognize that when they come to work here.

JAFFE: Matteucci first came to work at Napa 20 years ago as a dietician and rose through the ranks. She got her current job after Napa's previous chief executive was arrested on child molestation charges. He has since been convicted.

Matteucci says she welcomes the staff's renewed focus on safety.

Ms. MATTEUCCI: I think that that is wonderful, in terms of us all talking more pointedly about what the concerns are, what the recommendations are, and taking action.

JAFFE: Among the actions taken since Donna Gross's murder is the elimination of grounds passes like the one that Gross's alleged killer had. The campus-like layout of the hospital, with foliage and walled courtyards between buildings, provides too many places to hide.

But staffers want more, and they're hoping state lawmakers can help.

Assemblyman MIKE ALLEN (Democrat, California): First of all, just welcome all of you here. I'm just really glad that we have lots of staff from Napa State Hospital.

JAFFE: Assemblyman Mike Allen, a Democrat, represents the Napa area. The hospital's employees are his constituents and a couple of hundred were at a hearing he convened at a local community college. Allen said he was there to listen - and he did - to a two-hour saga of injury, anger and grief.

Brad Leggs, a psychiatric technician at Napa and a union rep, created an image to go with the words.

Mr. BRAD LEGGS (Psychiatric Technician, Napa State Hospital): If I may, I would respectfully like to ask those in the audience to briefly stand up if you've been injured or assaulted, or your co-worker has been assaulted.

JAFFE: Nearly everyone stood. And that sight motivated the acting head of the state Department of Mental Health to call a summit meeting to deal with safety issues at all of California's psychiatric hospitals. It was held last week at Napa, and it was picketed by staff, who say they don't need more meetings -they need action.

MONTAGNE: And Ina Jaffe's back with us. Now, Ina, what actions do they think need to be taken?

JAFFE: Renee, they want more security measures. Here's just one example: right now hospital police are stationed outside of the security fence. So if something goes wrong on one of the units, it takes them a while to get there. Employees want that to change.

They also say that the current treatment plan is actually making things more dangerous. It came about as a result of a consent decree with the federal government and it applies to four of California's five psychiatric hospitals. And that's one of the issues we're going to look at tomorrow.