Western State: Human cost of cut-rate mental care

The News Tribune The News TribuneOctober 13, 2013 

Western State Hospital in Lakewood


By many accounts, Western State Hospital is the state’s most violent workplace. The problem demands remedies both inside and outside the hospital.

The Lakewood psychiatric hospital has always been a place where nurses, counselors and attendants get beaten up regularly by out-of-control patients. The violence itself is not surprising, given that the hospital houses criminal defendants being evaluated for competency prior to trial and people confined for posing an imminent threat to others.

Still, the numbers are astonishing.

According to a new review by the state Department of Social and Health Services, which runs the hospital, the annual rate of assaults on counselors (full-time equivalents) approaches 50 per 100 employees. Nurses do somewhat better, with rates running from about 20 to 25 per 100.

DSHS succeeded in bringing the violence down in 2006 from a high in 2001, but it’s steadily creeping back upward.

One nurse recounted how, walking with a patient, “He hit me so hard I flew six feet through the air and broke my arm. We called for help, and no one came.”

The problem is bad enough, according to the report, that Western State’s administration actually pays violent patients not to attack the staff. Bribes presumably are cheaper than broken bones and concussions, assuming they don’t encourage more patients to get in on the action.

DSHS gets credit for commissioning this study by Jonathan Rosen, a respected national authority on occupational violence. It’s easier to keep such shocking things undocumented.

Thin staffing appears to be the biggest factor behind the high rate of assaults. Western State suffers from a high rate of absenteeism; some employees are scared of their own workplace, and some are out recovering from trauma at any given time. Rosen is blunt about the larger problem. He noted that both Western State and its Spokane-area counterpart “operate with a ‘lean staffing’ model, driven by state budget cuts . . .”

“The ‘lean staffing model’ is in conflict with the mission, vision (and) values of the hospitals . . .”

Lean staffing is merely one symptom of Washington’s general tendency to deal with the mentally ill on the cheap.

Western State’s capacity has been cut in recent years. Washington ranks dead last in the nation – or close to it – in the number of hospital beds per capita.

Lawmakers talk about the state’s effort to move severely sick patients out into community-based treatment, which is also in short supply. Optimism is easy on the pocketbook.

The shortage of psychiatric beds and other options means that people suffering psychotic episodes often wander the streets without care, land in jail or wind up parked for days in regular hospitals.

When Western State finds beds for them, they may be terrified or explosive, creating dangers that might have been prevented outside the hospital.

The biggest problem of all is that too many state leaders and citizens are willing to accept all this as a status quo. Nurses, counselors and other Western State employees are paying the price.

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