He’s a tall man, about 6’2”, black, looks younger than his 46 years. One of the doctors here told me that ‘many people with schizophrenia oftentimes will look younger in their face'. It’s their stoic look. They don’t show a lot of emotion, they won’t use a lot of muscles to frown, or to smile. This guy, he’s been in and out of locked facilities most of his life.
As a young boy, he witnessed his father commit suicide. When he was in his teens, he watched his brother kill himself. We don’t know where his mother is, or was. He won’t talk about it and the records are sketchy.
He doesn’t come out of his room much. Paranoia, say the experts. Fear, says I. He’s been assaulted more than once by patients in the hospital. Before coming to the hospital, he had many, many fights out in the world. It’s difficult for him not to retaliate. “I like it in here, I’m staying in my room. Will you tell me when it’s dinner?”
We all share two long hallways, med room, treatment room, two day halls with windows floor to ceiling. Steel screens outside of them and a small balcony overlooking the shrubs, lawn, picnic tables, basketball hoops and trees. Windows that don’t open. Years ago, when we were fully staffed and often took the guys outside, one of them scaled the outside fence faster than anyone had ever seen him move. He jumped to his death while patients and staff watched in horror, scrambling to stop him.
Courtyard isn’t used much these days. Not enough staff to secure the unit and take people outside at the same time. We have a dining room and 12 sleeping rooms. 34 patients, 6-8 staff work each of three shifts. Administrators survey the unit, walking through quickly, keys in hand. Saving grace for staff is going home each day after one, or possibly two shifts. Overtime is often mandated, as there are such low staffing thresholds.
Of our 34 patients, some will leave. Some never. Maybe when they age out, no longer a threat to society, they're transferred to a lower level of care facility, lower level of security. Where doors are sometimes left unlocked. Patients are often transferred, only to return after another incident weeks or months or years later. We get to know the guys. They think they know us.
This is one of many state mental hospitals around the country. I thought the one I worked in was unusual for the number of assaults on patients and staff. I blogged about it a while back and was amazed at the responses from other nurses across the country. “It’s just like that here, too.”
Three years ago, one of our hospital staff was killed by a patient. She was strangled to death in the corner behind a building. We think it was because she didn’t have a cigarette on her to give to the guy. We really don’t know. After this incident, there were speeches, letter-writing campaigns, meetings with unions and management. Rallies were held in the state capitol and in front of the hospital. Newspaper reporters requesting to talk with anyone who had information and/or would stand up to be heard. Many of us spoke out and felt the brunt of it from our supervisors. There was a lot of crying and hand-holding.
Our colleague was buried, we heard her family settled in a lawsuit with the State, though never confirmed by anyone I know. Millions of dollars were spent on new state of the art alarms for the staff. Staff alarms to be used at the time of attack, or in some other emergency, to call for help. No prevention here at all. Very little doctor-patient interaction. Physicians, social workers, psychologists come and go. Hospital administration preaches ‘continuity of care’. We don’t see it.
Last week, two staff on my unit were assaulted. The patient I mentioned was nowhere near the incident. He was safe in his room. One of the staff members was treating the attacker for a medical condition he has. She’s a Registered Nurse, a short little Filipina who has worked here for many years. She had other staff in the room with her. That didn’t stop the attack. The other staff member, also a little woman, an RN, has worked for years on the unit. She was unlocking an office door when she was punched along the side of her head, falling to the floor. Both of them are off work on workers comp. The patient continues to walk the halls. Medicated and watched.
Security is just an eight letter word here. Officers appear on the units once or twice in an 8 hour period. They respond after an assault. Staff carry alarms and keys and watch each others’ backs, always on vigilant alert, reading the patients and any change in their behavior. Families worry for our safety. Every staff person on my unit has been assaulted at least once, including myself. Former colleagues will never work again from the injuries they suffered. Physical and psychological damage. PTSD is rampant.
When I talk to outsiders about this work environment, they can’t understand how it can continue to happen. Why doesn’t someone do something about it? Mental health advocates and administration claim the patients are patients, not inmates, and won’t allow ‘guards’ to patrol the units. Staff is trained to restrain patients when necessary, not trained in self defense. Staff here are professionally trained to provide excellent patient care. And they do.
There is no security here. Until we walk out the door to come home. Later, we cry in our pillows. We worry in anticipation of the next incident. We’re care-givers, that’s why we took this job. To be of service to patients who require care, who need support, encouragement, understanding and love. We pull together at holidays to give the guys special treats and entertainment that they otherwise wouldn’t get. Most of the men here have been abandoned by their families, don’t really have any friends outside.
The patient I first mentioned, he’s still in his room. He comes out to toilet, to shower, for meds, and anytime he can eat. Three days a week, he goes to the hospital’s version of a classroom/school where he watches TV, plays video games, listens to music and gets his hands on more food. You can always find a little bag of chips in his pocket.
If you want to push it and ask him.