WHAT ONE PATIENT CAN DO - Rhonda Bedow, PEF member and
nurse at the Buffalo Psychiatric Center, was brutally
beaten by a patient at the center in 1997, suffering
massive bruising, a concussion and dislocation of her
jaw. Bedow continues to suffer long-term effects from the
injuries, both psychological and physical. The patient
remains at the center.
Federal grant
to study psychiatric-center violence
Danger
stalks world of mental-health workers
A first-of-its-kind study about to begin in state psychiatric facilities could produce a national model for the reduction of violence against mental-health workers.
Funded by a $680,000 grant from the National Institute for Occupational Safety and Health, the study was proposed by PEF and other state-employee unions in partnership with the University of Maryland School of Nursing and the New York State Office of Mental Health (OMH).
"Preventing violence in mental-health institutions is a major priority for PEF," says PEF President Roger Benson. "We're pleased and proud to have won this grant to conduct cutting-edge research into this very serious problem."
PEF priority
PEF has long spoken out
about the need to provide its 15,000 members who work in
the health-care field with safe working conditions.
The death of PEF member Judith Scanlon in November 1998
while conducting a home-visit with an OMH client led to a
statewide outcry against unsafe working conditions for
mental-health workers, and underscored the need for
standards that will reduce the incidents of violence
against them.
Studies conducted by various research organizations have
discovered an alarmingly high rate of physical abuse at
the hands of patients among mental-health workers.
In the state of Washington, for instance, a recent study
found that every mental-health worker experienced as many
as four assaults a year by patients.
In New York state, the
numbers are just as disconcerting. (See chart.)
Barry Markman, a supervisor of rehabilitation services at
South Beach Psychiatric Center, has been working in the
field of mental health for more than 29 years and has
watched the number and severity of assaults on workers
steadily rise.
"The state workers in OMH facilities have the
highest occurrence of attacks in any state agency, higher
than the state Department of Correctional Services or the
Office of Mental Retardation and Developmental
Disabilities," says Markman, who served for several
years as PEF chair of the statewide OMH Labor-Management
Committee.
Because this is such a significant problem, since 1989
PEF has had an attack-insurance plan from Lloyd's of
London that pays $2,000 to any worker who is assaulted,
files a police report, receives medical attention and is
off from work for five or more days. Since its inception,
700 claims have been filed, and 430 of them have involved
staff working in OMH facilities.
Focus on OMH facilities
The intervention study
will be conducted at OMH sites - adult psychiatric
centers, children's psychiatric facilities and forensic
facilities. All 28 OMH-operated facilities were invited
to apply for consideration as study sites; as of press
time six had. The project team is evaluating whether all
six can be included in the study.
"The hardest thing in an OMH facility is getting the
time to do the work for this intervention study because
they are so short-staffed. They're barely treading water
with the kind of staffing they have," says Jonathan
Rosen, director of PEF's Department of Health and Safety.
Rosen will serve as a co-investigator of the study.
The three-year assessment is the first formal evaluation
of how effective guidelines issued in 1996 by the
national Occupational Safety and Health Administration
have been in preventing violence in mental-health
settings.
Those guidelines formed the basis of the current OMH
policy - the Safe and Therapeutic Environment Plan,
established in September 1999.
The study also will examine the cost of lost time on the
job and worker's compensation expenses resulting from
work-place assaults.
What makes the study so unique is that, in addition to
clinical elements, it also will examine the physical
environment and administrative policies that might serve
as predictors of attacks.
"It has always been a problem - one that people
thought they couldn't do anything about," says
Rosen. "But to some degree, violent behavior is
predictable."
Markman is hopeful the study may also help PEF workers in
psychiatric facilities improve the quality of care they
provide patients.
"If this study comes up with possible ways to reduce
the violence, it would be a tremendously positive step
and a huge benefit to our members, all the workers in the
psychiatric centers and the people we provide services
to.
Reducing violence would provide a much more therapeutic environment," Markman says.
Attacked at work
The psychological and physical toll these attacks take on workers is extensive. PEF member Rhonda Bedow, a nurse at the Buffalo Psychiatric Center, endured a brutal beating by a patient in September 1997.
The injuries she sustained included a serious concussion, massive bruising and such severe dislocation of her jaw that two separate surgeries were required to fix it.
The man who assaulted her was moved to the Mid-Hudson Psychiatric Center for a year, but is again back at Buffalo Psychiatric Center.
"He continues to threaten me now," says Bedow.
She has an order of protection and is not required to work on the wards where he is assigned, but when the patient is granted "privileges" at the center he moves about fairly freely.
"He could be on the elevator at any time. It is very trying, very unsettling," says Bedow, who suffers from continual jaw and ear pain, and sometimes experiences confusion when she is overtired.
While Bedow continues to deal with the consequences of her traumatic experience, assaults on her co-workers continue. She cited the recent case of a psychologist at the Buffalo center who was attacked by a patient as she was leaving the bathroom.
The psychologist suffered a broken nose and broken pelvic bones.
Bedow suggests that one reason these assaults are becoming more severe is because of the increasing number of admissions from the criminal justice system for whom no special accommodation is made.
"They are young, strong males being cared for by an aging work force. I think about 75 percent of our workers are more than 40 years old," Bedow says.
Another issue is staffing.
Some late-night shifts in psychiatric wards with 20 to 25 patients are staffed by only one nurse and one mental-health aide, she says.
- Mary Caroline Powers