A California state psychiatric hospital has improved the personal security systems for its staff members and revamped how it assesses potentially violent patients, with the changes coming five years after a technician was killed on the hospital grounds by a patient.
Napa State Hospital is a psychiatric facility managed by California’s Department of State Hospitals, and the destination for many of the state’s mentally ill patients referred by the criminal justice system. More than 80% of the hospital’s patients were ordered to the hospital by a court after being found incompetent to stand trial or not guilty by reason of insanity. Napa State reports that its patients committed more than 1,800 physical assaults at the 1,197-bed hospital in the past year.
The hospital has had elevated security for many years, with an extensive system of locked gates and doors as well as metal detectors and personal alarm systems for the staff. But it wasn’t enough on Oct. 23, 2010, when a patient dragged psychiatric technician Donna Gross to a secluded spot outside and strangled her to death. Like all staff members then, Gross had a personal alarm she could activate for help. The alarm, however, did not function fully outside the hospital building.
The employee’s death was devastating to the hospital staff and prompted a thorough assessment of how security could be improved, says Ken August, assistant director of the Office of Communications at the Department of State Hospitals (DSH) in Sacramento. The first major improvement was to introduce a new personal alarm system with GPS capabilities that works on the entire hospital campus and can direct hospital police to the precise location of the emergency.
New staff teams also were organized to create a consistent physical presence around the grounds and at special events, August says. This move was intended to address the scenario in which Gross was killed: supervising a patient outdoors and in transition from one place to another.
Another improvement at Napa State is an increase in communications with staff regarding incidents. When staff members are off work due to injuries as a result of patient aggression, hospital-wide notification is made and posted at the two main entrances to treatment sites. This process is intended to alert staff members to the current risk level of treatment units before reporting to duty, he explains.
Physical violence is also a frequent occurrence in acute community hospital psychiatry units worldwide, researchers reported.1 “Violent acts by patients cause many direct injuries and significantly degrade quality of care,” the authors warned. “The most accurate tools for predicting near-term violence on acute units rely on current clinical features rather than demographic risk factors.”
The efficacy of risk assessment strategies to lower incidence of violence on acute units is unknown, but a range of behavioral and psychopharmacologic treatments have been shown to reduce violence among psychiatric inpatients, they concluded.
REFERENCE
- Szabo KA, White CL, Cummings SE, et al. Inpatient aggression in community hospitals. CNS Spectr 2015 20(3):223-30.
A California state psychiatric hospital improved the personal security systems for its staff members and revamped how it assesses potentially violent patients, five years after a technician was killed on the hospital grounds by a patient.
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