Plan laid out for ASH violent patient unit

Seventeen Atascadero State Hospital employees plus six ASH police officers will be assigned to a new treatment unit for its most violent patients.

Those were among the details outlined at a news conference Monday on the new program, called the Enhanced Treatment Unit, which has been in the works for about a year.

The pilot program, which opened Monday with 12 patients already at ASH, is designed specifically for patients who are not responding to regular care by instead treating them in small, specialized groups.

The unit’s employees did two weeks of training on safety protocols and exercises for keeping patients calm, among other things. The program could expand to include 27 ASH patients in three months if its methods help lower aggression. If it proves successful in six months, the program could expand to all of the state’s mental health hospitals, officials said.

About 5 percent of patients at the state’s mental hospitals are “chronically aggressive,” officials said, and the unit is a tool meant to deal with that behavior.

ASH has one of the highest security levels among California’s five state hospitals. It treats men who are referred from other state hospitals, superior courts and the state Department of Corrections and Rehabilitation. ASH’s patients range from prison inmates on psychotic breaks to those deemed mentally unstable while waiting for trial. But not everyone there is an inmate — some violent patients serve their parole at ASH or stay there indefinitely after their parole has ended.

The majority of patients are discharged, on average, within six months, and sent back for trial or to prison.

The objective within the new unit is to stabilize patients psychiatrically and then develop new “communication pathways” to help them verbalize what they want, instead of acting out violently to get it, said Marie Bell, the ASH psychologist who will be working in the new unit.

Violence at state hospitals has been an ongoing issue that was given fresh focus when psychiatric technician Donna Gross was strangled at Napa State Hospital in October 2010.

Detailed statistics on whether violent acts have risen at ASH are not available, but the facility has experienced numerous patient-on-staff attacks this year. Recent cases include a female employee who suffered a broken facial bone after being beaten in August and a male employee who was stabbed in the face in September when a patient tried to puncture his eye with a pen.

The unit will be run with a ratio of one staff member to four patients, which administrators say is more cost-effective than observing the hospital’s most violent patients in one-on-one settings in regular treatment.

The new unit will take 23 shifts to cover patient care in a 24-hour period, rather than the 36 shifts required in routine care, officials said. A shift involves one employee on eight-hour duty.

The change is part of a slew of reforms planned for all of the state’s hospitals, as well as psychiatric programs at Vacaville and Salinas Valley state prisons, to cut costs while improving treatments.

ASH was selected for the pilot program in part because it could already give each patient his own room, which is among the new treatment methods. Other tools include the use of medication, incorporating the patient’s family members in therapy and other small-group approaches.

The employees chosen for the new unit opted to be a part of the program, officials said.

Adding new alarms to ASH is also on the list of future improvements the state is planning.