A law to protect Washington health care workers keeps patients in crisis
A law to protect Washington health care workers keeps patients in crisis
If someone is in psychiatric crisis, a state law could take them away from mental health help — and land them in jail, a Seattle Times and Marshall Project investigation found.
Under Washington state law, any assault on a health care worker can be a felony — including spitting, slapping or other actions that might otherwise be treated as minor offenses with fewer consequences for the accused. The decades-old statute was meant to protect providers, who are increasingly harmed in violent attacks.
But an investigation by The Seattle Times and The Marshall Project found the majority of the people charged by King County prosecutors under that law showed signs of serious mental illness, with dozens of patients in severe crisis punished for behavior that landed them in the hospital in the first place.
From 2018 through 2022, county prosecutors filed 151 cases for felony assault on a health care worker. Court records show that 76% of these cases were filed against people with signs of serious mental illness. That included people who were involuntarily committed to a psychiatric facility, were in an emergency room for a mental health evaluation or had EMTs respond to their mental health crisis.
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Oh hey! I'm one of the Healthcare workers getting hit! Well they try a lot anyway, but that's psych nurse reflexes for you (which we'll talk a bit more about below). There's a lot of things contributing to this, but the biggest is just that they don't pay enough or for enough people to take care of people properly while we're simultaneously trying to prop up the housing crisis with arguably the worst possible solutions.
And the psych hospitals are probably going to fail first (they're currently in the process) due to both staff burnout caused by the above but also because most of our population is homeless, meaning they can't pay (medicaid is a joke) AND they actually often seek out psychiatric hospitalization to avoid injury or death from exposure (although mental illness is also common), so not only are we dealing with increased mental illness with little reimbursement due to the stresses of abject poverty and homelessness, but now we have to do the homeless shelter's job too! Psych hospitals failing means less and less facilities which means these patients are backing up into the Emergency department and General medical-surgical units. This is one of the worst possible scenarios.
There's two problems with this situation:
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Emergency and medical nurses did not sign up to get swung on and have little to no training and experience doing so. Remember those psych nurse reflexes? I can almost physically feel someone walking behind me even like 50 feet back, I get a twinge of anxiety when I don't hear a door latch behind me, and I can make shifting around so that I'm always facing the patient and always between them and the door look completely natural and smooth (realistically I probably have PTSD, by it keeps me alive). Medical-surgical nurses have 0% of any of that. Emergency nurses have slightly more experience than medical-surgical nurses, but they're also simultaneously having to line stretchers up in the hall just to hold all the people using the ER as their primary care physician for their wildly uncontrolled diabetes and hypertension, so joe-bob sullivan from buttfuck county who's tweaking on an entire disability check laundered as baby formula worth of meth and thinks all the ER nurses are the aliens from the titular movie but can otherwise walk and breathe just fine is going to be taking a Haldol nap while the nurse goes back to checking on way more patients than an ER nurse should EVER be assigned (because they're using the ER for primary care) between jumping on people's chests and plugging bullet holes.
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The ER and med-surg units are fundamentally not designed to manage ANY psych patient, god forbid a violent one. My unit is a trashpile full of leaks and mold in a building built in the 70s. I am not pleased with either the interior design or the feng shui. That said, every hook or similar ourcropping my patient could hang themselves on is removed (shelves only), all the plastic bags and strings they could choke or suffocate themselves or someone else with are replaced with stiff paper bags, and, pretty much all furniture is 80 pounds or more with no easy handholds. There are no IV poles to swing at me, no hard plastic meal tray to bludgeon me with, no metal silverware or glass to sharpen or break and stab me with. There are no long corded ball bells or remotes like in other units to use as a flail (happened all the time when I worked medsurg), and the hall phones have 10-inch cords (I measured them after a patient tried to hit me over the head with one but couldn't reach). I can afford to take things slow and talk things out because I'm holding all the cards; those med surg and ER nurses are just going to get clubbed over the head and stabbed.
A significant number of patients also have types of mental disorders that aren't treatable with medication, and will actually likely worsen in a hospital environment, particularly personality disorders (like mine!). I needed 3 years of outpatient therapy twice a week in 1h individual and 1.5h group sessions. I can't even find people who do that kind of therapy anymore, and I was just lucky my parents felt bad enough about fucking me up to pay for it. So even if you can find that kind of therapy, it's a long-term commitment both financially and in terms of willpower. And we hardly do talk therapy inpatient because no one has the time to sit down and do it!
Also people with certain presentations of personality and other behavioral disorders need consequences like jail time to face up to the fact that the way they are treating others is unacceptable (our current correctional system also needs a looooot of reform, but that's a different subject). These patients aren't vividly hallucinating or detached from reality like a manic or psychotic patient, they've just learned a bunch of shitty behaviors over the course of their life that they would have to commit a ton of time and effort to unlearning. Throwing a patient like that into a psych hospital is often dangerous to the staff members AND other patients, and sometimes a sentence can lead to personal growth (I will eternally envy the Norwegian prison system for doing this regularly).
Even when people DO have mental illnesses that are treatable, the drug crisis means doctors are super stingy with... well everything actually, but narcs especially and when someone's been using ativan as a bandaid solution for their anxiety and insomnia for a decade, they're going to feel some type of way when you rip that bandaid off. The doctors are willing to control the withdrawal (they better; it can be fatal), but as nurses we still catch shit for making the decision to give the as-needed meds "too much" because they've got it in their head that the patient is drug seeking and I'm drug pushing when the patient is just trying to stop hallucinating my face warping and I'm trying not to get punched.
I'm getting tired and need to go call my insurance company so there's probably more to say or better ways to say some of this but I'm gonna tap out for now.
TLDR; the issue is mentally ill people are poor so they get fucked.
I wish I could upvote you more than once for this. I appreciate the view from the front lines, as it were. Everywhere I look poeple are being asked to do more with less and for less. I don't know how much longer these systems are going to hold out at the rate we're going.
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