Over the past month, Michael Rezendes of the Boston Globe has written several articles about the death of a man at Bridgewater State Hospital 4-5 year ago and the alleged mistreatment of a current patient there. One of the major points of his articles is related to DMH staff pressing charges against patients who assault them. Violence in mental health settings occurs, but it is not the norm and is viewed as a crisis on an inpatient unit. The underlying message in what he is written strongly implies that those of us who work in MH should just suck it up when a patient assaults us. There is an erroneous assumption that every person hospitalized on a psych unit is not criminally responsible for their behavior. This is simply not the case. Much violence on inpatient units occurs because someone said no, someone said wait, or someone felt disrespected.
The larger question is what should we do and how should we fashion our mental health system to meet the needs of those who are violent and dangerous, whether criminally charged or not? Currently, the staffing levels in DMH preclude having a safe environment with people who assault. We have too few beds and our community system is fragmented, and we often see people rehospitalized quickly after discharge. We need more beds, better staffing, and a coherent system of care that promotes stability in the community, especially among those who tend to be violent. Many of our patients are dually diagnosed. In addition to mental health issues, they struggle with substance abuse. Persons off of their meds who drink and drug are at most risk for behaving violently.
There is much to do, but I do not see the political will to do anything except to have a knee jerk reaction to the front page of the Boston Globe. The legislature, the Mental health and Substance Abuse Committee, needs to be holding hearing to address these concerns. They need to listen and reach out to those of us who work with patients everyday and stop listening to the ideologues, who have a vision, but do not see.