Safety first at the Oregon State Hospital

By The Oregonian editorial board, January 27, 2009

It’s a sad commentary on America’s mental health system that employee safety has become an explosive issue at psychiatric hospitals from coast to coast.

Last year, a patient severely beat a nurse at a state institution in North Carolina. A counselor in Texas was similarly assaulted. So was an orderly in Kentucky, a physician in New York, and untold numbers of other employees of U.S. mental hospitals.

Two years ago in California, hundreds of employees of the state mental hospital packed a meeting room in Sacramento, many breaking down in tears as they shared stories of beatings by patients, nightmares and stressed personal relationships stemming from their jobs.

It’s a problem that has ballooned under a pair of conflicting pressures on the mental health system. Cash-strapped states are finding it increasingly difficult to provide adequate hospital staffing and training; at the same time, the U.S. Justice Department is cracking down on abusive treatment of patients.

Inevitably, this vise has closed on Oregon.

As The Oregonian’s Michelle Cole reported last Saturday, 323 injuries to staff members were reported at the state hospital in Salem during the first 10 months of last year possibly the highest number of such injuries in the hospitals history.

Cole told the stories of employees who feel increasingly vulnerable at the hospital. Such an atmosphere is unacceptable, so its reassuring to see the institution taking steps to address it.

Dr. Bruce Goldberg, state human services director, says nine people most of them women accounted for 45 percent of the violence last year. The hospital will open its first maximum-security ward for women next month, and that should considerably enhance staff safety.

Goldberg says hospital administrators are also addressing the problem by working more closely with occupational safety and law enforcement officials, and by stepping up training to improve behavioral management. And, of course, they’re pleading with state budgeters for more staffing a plea that echoes in the halls of mental hospitals from Maine to California.

No one should seek to diminish the fact that reported attacks on employees have increased at Oregon’s institution. Its worth noting, however, that these unacceptable statistics may be the downside of some things that are improving at the hospital.

One may be that the place is doing a better job of record-keeping. Another likelihood, one thats much more far-reaching, is that the hospital is responding to federal pressure to improve the treatment of patients.

Goldberg says such efforts led last year to an 83 percent reduction in hours of patient seclusion and a 60 percent decrease in hours of patient restraint.

Those are welcome reforms. They do, however, increase the opportunity for a handful of patients to engage in violence.

Hospital staff and patient safety are equally important. For once Oregon lawmakers must fund the staffing and training such safety requires.