In an effort to quell surging levels of violence and workplace injuries at Minnesota’s largest psychiatric hospital, state authorities are preparing steps to segregate the most aggressive patients in more secure facilities.
Under a plan unveiled to lawmakers Tuesday, patients at the Minnesota Security Hospital in St. Peter with a history of violent outbursts will be transferred to separate homes with staff specially trained in de-escalating violent confrontations. The plan also calls for protecting new patients by admitting them to a separate unit isolated from the rest of the hospital population.
The efforts are designed to address an alarming increase in assaults on staff at the troubled security hospital, which houses about 225 of the state’s most dangerous and mentally ill patients. Currently, patients who are undergoing severe mental crises, and may be prone to violence, are housed together with other patients who are more stable, creating a combustible atmosphere that disrupts therapy, say state officials.
Last year, staff suffered a record number of injuries, 101, mostly from assaults by patients. The number of patient-on-staff assaults has more than doubled, from 32 in 2011 to 71 in 2014, and last year federal occupational safety authorities levied a fine of $4,900, which was later reduced to $2,450. The violations were identified as “serious” because they could have resulted in death or serious injury to employees, OSHA found.
The state mental hospital has long struggled to balance its dual mission of treating people with severe mental illnesses and preventing them from hurting themselves and others.
“There has to be a way to quickly and with a great sense of urgency move people when they are so disruptive that they are assaulting and hurting others,” Deputy Human Services Commissioner Anne Barry said in an interview. “Because they can change the entire therapeutic environment.”
The state’s plan would isolate highly aggressive patients in secure homes removed from the core hospital building at St. Peter.
The sites have yet to be determined, but the state estimates that fewer than six patients would need such strict isolation at any time, as most assaults are caused by just a handful of patients. For instance, last year, just one patient accounted for nearly 30 of the assaults on hospital staff, the state found.
But some mental health advocates worry that patients will be placed in prisonlike environments without adequate access to treatment.
In addition, advocates fear that hospital staff will be less inclined to treat difficult patients if they know they can be quickly isolated.
“It seems cruel,” said Rep. Jack Considine, DFL-Mankato, who worked at the hospital for six years. He noted that the hospital already has a special unit, known as “Unit 800,” for its most volatile patients.
“Why not allow staff to put them in [seclusion] until they quit screaming and shouting than to put them in isolation for 24 hours a day?” Considine said.
The idea, however, is supported by the union representing about 500 employees at the hospital. In recent months, AFSCME members have become increasingly vocal about workplace injuries, and held a protest outside the hospital in September. After the OSHA citation, the union participated in negotiations with the state to develop a safety plan.
Tim Headlee, a security counselor at the hospital and president of AFSCME Local 404, said violence against staff increased as the hospital and state have reduced the use of seclusion and restraint. In the past, security counselors could use their own judgment about when to place patients in seclusion rooms; now, Headlee said, they must get approval from a medical practitioner, which can take hours. Between June and October of last year, the hospital reduced its use of seclusion and restraint from 100 hours a month to just 45 hours, according to state data.
In other cases, patients are being released from seclusion rooms and restraints too soon, before they have calmed down and while they are still making verbal threats to staff, Headlee said.
“We run into way too many cases where it’s a premature release,” Headlee said. “We’ll have another altercation before the door even swings shut.”
Hospital and state officials are committed to the idea that they can reduce violence and the use of punitive restraints by engaging with patients more directly. In November, the hospital hired a new medical director, Dr. KyleeAnn Stevens, who oversaw a dramatic reduction in the use of restraints and seclusion at a troubled mental hospital in Washington, D.C.
In addition, about a dozen members of the hospital staff last fall visited a similar-sized mental hospital in Fulton, Miss., that has virtually eliminated the use of restraints and seclusion while also reducing violent incidents.
“The staff who went [to Fulton] came back and said, ‘Wow, we can make this work,’ ” Barry said. “I think it takes some time for people to really believe it.”