My Life working in a State Psychiatric Facility!

My name is Michael Pantalone. I am a Mental Health Therapy Coordinator at Oregon State Hospital (OSH). I have been working at OSH for the past 29 years in many different programs including Forensic maximum security and medium security, Gero-psychiatric, Medical, Children’s and Adult Civil commit units.  Clientele I have worked with has ranged from acute psychosis to chronic psychosis, sociopathic and antisocial personality types, borderline personality disorder and different types of depressive disorders. Each psychiatric type takes a particular intervention skill set and has inherent risk of injury to patients and staff.

 In each of the areas I have worked I have suffered physical and mental traumas that I continue to bear the brunt of to this day. I have suffered numerous patient attacks over the years and have suffered injuries while intervening in order to keep patients from being injured by the person that was acting violently. I have had patients grab my face with their hands, one with the vocalized intent of wanting to gouge my eyes out. That same patient was known to stick his fingers in his anus often and had gotten a finger inside my upper lip. I have had a hepatitis C patient spit in my face and have been bled on and covered in patient feces which was used by a patient as a lubricant to make it hard for staff to subdue him when he “went off”.

Let me start at the beginning. I started at OSH in December, 1986 as a 24 year old man that had the desire to help people with psychiatric and behavioral issues. At the time I worked in a program known as MaPL which housed two civil commitment units for Marion, Polk, Linn and Benton counties. Both of these units took clients that were called POH (Peace Officer Holds). These patients would come to OSH by police escort with handcuffs and, sometimes, leg shackles on. The on call Physician would interview them and then admit them based on certain criteria for psychosis and dangerousness to self and others. I was working night shift at the time, along with numerous overtime shifts, and we would often get from 1 to 4 admits based on who the admitting Psychiatrist was for that night. The fear of violence to myself, and the clients in my care, was constant as the instability of many patients left staff wondering if they would be attacked or need to protect other clients that were attacked. On many occasions I stepped between a violent patient and his/her victim, taking the brunt of the attack to keep the victim from being hurt. Many times the fears were realized with patients hitting, scratching, biting and throwing objects, such as chairs and tables, at other patients and staff. Taking clients down was not only a daily occurrence but was, at times, something that happened more than one time on a shift. I spent a great deal of time going down onto my knees on concrete floors, as well as landing on my hips and back to physically control persons that were “out of control” and out to hurt others. We would place them in a restraint bed while they were trying to spit, hit, kick and bite staff. Many times they succeeded in tearing flesh, breaking facial bones and noses, causing concussions and hematomas to the staff attempting to help them.

In July of 1987 I was offered a position in the Forensic Evaluation and Treatment Services, otherwise known as Forensics, in the Maximum Security Wards, 48B and 48C. We were to provide treatment for patients that had been found Unable to Aid and Assist in their own defense in court or found Guilty except for Insanity in the commission of a crime. Ward 48C also had 5 beds that were allocated for corrections clients that would come from the Special Management Unit at the Penitentiary when the inmates had become unstable after refusing medications. Patient crimes range from small property crimes to domestic violence, menacing, murder, rape, arson, child molestation and so many others. We were, to best of our abilities, expected to set aside personal prejudices and provide treatment with the goal to have these clients ready to return to the community with a reduced risk of danger to self and others. It was on these units that I received numerous blows and the aforementioned eye gouge experience. This is also where I dealt with patients that were adept at making weapons out of things such as chicken bones, pieces of plastic, tooth brushes and the like and received numerous threats to myself and my family if I did not do as the patients demanded. Across the hall from 48B was the sex offender unit, 47B, which was part of the Corrections Treatment Program. Staff were sometimes floated to this unit and became familiar with the Penile Plethysmograph and its use in aversion therapy as well as the grotesque photos and films that were used during “Therapy” sessions. I don’t believe a person works with this type of clientele with any regularity in that they do not themselves become affected.

There was always a sense of tension in the air as staff waited for something to happen. 48B and 48C often ran with 4 staff minimum on each unit, not including suicide and behavior constants, while dealing with approximately 25 patients. The word ‘sucker punch’ was a common phrase as it happened often when the opportunity presented itself to clients. Patients on these units were “locked down” at 2200 hrs and doors opened at 0700 hrs. If the Unit began to go out of control it could be locked down with a Doctors order.

As the Psychiatric Security Aide 2, I was once informed of a planned escape attempt in which patients had been digging through the 4 layers of bricks in one of the outer walls in order to escape during an upcoming evening. When I found the hole in the wall, they had already dug through 3 layers of bricks. I called the Physician on duty and asked to lock down the unit because of the possibility of makeshift weapons and threatening behaviors from the patients. Upon locking down the unit the patients tore porcelain sinks and toilets out and tore holes through walls between rooms. The halls of the unit were flooded and the threat of potential weapons was extremely high with pieces missing out of the walls and shards of porcelain all over the place. It took 30 days to restore this ward to working order by replacing all of the broken walls with cinder block and replacing the broken toilets and sinks. The unit was searched repeatedly looking for sharp items that might still be available from this riot. During this lock down it was not uncommon to have urine or feces thrown at the staff that were trying to serve meals and meds, and meet patient needs. Besides being degrading there was a continuous concern of contracting hepatitis or some other disease from the excrement that was being flung at staff as they performed their duties.

When I promoted into the position of Psychiatric Security Aide 3, later Mental Health Therapy Coordinator, I became more aware of the need for security in order to have a therapeutic environment. It is impossible to provide an environment that allows clients to thrive and grow if they are in constant fear of unprovoked attacks from other patients. This is even truer if you consider that staff has not been feeling safe in this environment since I had started working in Forensics. Firm boundaries come with the price of heightened vigilance of staff and continual testing of the boundaries by patients that want to control the environment. Threats of violence and attacks on staff continued, sometimes with drastic results. Being in a continuous pressure cooker takes its toll on a person both mentally and physically, and can only be endured for so long before the results become destructive. Different people have different thresholds but the fact is this type of environment is one that wears everyone out over time. For me personally, I have had a laminectomy of my lower back and bilateral hip replacements. I’m told I am very young to have this happening to me already.

While working in maximum security I interviewed for and was blessed to be accepted into the Marion County Sheriff’s Office Reserve Academy. I graduated in June of 1992. I decided I wanted to go into the law enforcement direction because I really saw the job I did in maximum security closely resembling police work. I was constantly breaking up fights, stayed wary of the concern of assault and had to continuously scan the area and search for possible weapons materials.

I transferred to the medium security drug and alcohol unit in approximately 1990 in the Position of Psychiatric Security Aide 3. The Position title changed to Mental Health Therapy Coordinator but the job, otherwise, stayed the same. On this unit there was a focus on treatment for substance abuse.  For every serious client there were 3 or 4 that were trying to play the system. Though the violence did not happen as often it still happened and was still just as devastating. There was, during this time, an incident in which a patient had taken some pieces from the wall ventilation system and had fashioned some talons for his hands. It was with this weapon that he attacked a seasoned staff member’s face during a psychotic episode. This left the staff member off duty and on medical leave for quite a few weeks to recover. It is a constant reminder that security and safety are needed in order to maintain a therapeutic environment.

I was soon bumped from this position due to Hospital downsizing and took a position on the medical ward, 34B, of the Gero-psychiatric/Child and Adolescent Program. I became an instructor of Prevention and Management of Aggressive Behavior (PMAB) and worked to teach employees about ways to prevent and manage aggressive behavior. How to implement verbal intervention techniques to exerting physical control and the restraining of dangerous and out of control patients. It was also on the medical unit that I learned how easy it is to get punched in the face or bitten while trying to feed someone or covered in feces while attempting to clean up a patient that was being violent. No matter what program I ventured to, the prospect of being assaulted and degraded remained an inherent risk. No matter how hard we work to mitigate the risk involved with our client base the fact was, and remains to this day, that this job comes with risks that are not common in daily private sector jobs. Even the elderly clients that are sent to OSH from the community usually come because they are too dangerous to deal with in Nursing homes, adult foster care or group homes.

While working on the medical unit, 34B, for my regular shift I often worked overtime in the children’s unit, 40C in particular, since it was considered part of the same program. In this program I had chairs thrown at me and large teenagers rush me while I was trying to perform the duties assigned to me. There were threats of violence and wishing for me to get in a car wreck on the way home from work. There were allegations of inappropriate behavior and overtly suggestive statements by the patients. I had 4 year olds that pinched and bit at me and yelled obscenities I never thought I would ever hear from a little child. This program, too, showed that no matter how hard you attempt to mitigate risk there continues to be an inherent danger to doing this job.

During this time I was also on loan to the program that became Adult Treatment Services. These were the units that were relocating from Damasch State Hospital as it was closing and I was there to help with the transition. On 35A there was a staff that was working an overtime shift and he was watching a patient that was on a constant watch. While he was doing so another patient came up behind him and started beating him until he went to the floor and then the patient kept beating and kicking him. I never saw this staff person again but was told that he had brain trauma from the injuries and was unable to think clearly anymore and, so, was unable to make a living working at the State Hospital anymore. Quite a high price to pay for an income to take care of yourself and your family and really something that no person in a public service industry should have to endure without the support of the division.

In approximately 1996 I was moved into the position of Mental Health Therapy Coordinator for Ward 50E. Ward 50E was a medium security unit that specialized in MR/DD services. I worked on this unit until the new hospital was opened in 2010. I enjoyed working with MR/DD clients but it still came with the same unpredictability and risks. When I first started on 50E patient fights were a daily occurrence and patients would throw property, throw pool cue balls and outright assault staff when they did not receive the answer they wanted. While on this unit I was kicked, attacked from the front while sitting in a chair, had a chair slammed on top of my head (I received 5 staples in the top of my head and a slight concussion for this). 

I also had a patient break a plastic garbage can and threaten to stab me with the sharp shard that remained. We had to use the shield to enter and remove the shard from him (something that would not be done in corrections, they would spray or taze the client before entering into the area to remove the dangerous object). Staff are placed on 1:1 constant watch, on a regular basis, with patients that are known to act out aggressively toward themselves or others with the knowledge that we are not to physically intervene unless there are 2 staff present. At the same time we risk discipline if we allow the patient to hurt themselves or others. It is a catch 22 that is highly stress inducing.

I could continue on with numerous examples of staff injury and loss of livelihood. I have seen far too many people lose their health due to the violence of patients and the limited rules of engagement for staff. I myself have had a laminectomy for an extruded disc, bilateral hip replacements and bilateral injections and physical therapy on my knees and shoulders. This does not include the numerous hits, bites and scratches that occur quite frequently as well.

I stand committed to providing the best care possible to the clients we serve and to protect the public as we are called to do. I would ask the great State of Oregon to look at the duties we perform and realize that our roles fall under that of Police and Fire.

I spent 5 years as a Solo Reserve Deputy Sheriff for Marion County Oregon. I have sworn to uphold the Constitution of the United States and the Constitution and laws of this great State. I have been first in on drug busts and responded to domestic violence situations in which I wasn’t sure if the significant other would turn on me or not. I have also been involved in high risk stops of drive by shooters and searched residents for burglars while the alarms were blaring. I tell you this to emphasize that while a Police Officer faces real risks daily it is not far from the constant stressors and possibility of assault that faces all of the direct care staff that work at OSH. Daily we come to work not knowing what the day will bring and not knowing who is going to be assaulted today.

In my personal life today I stay aware of my surroundings. I have run into past clients at the 7-Eleven, the Doctor’s office, immediately after a sinus surgery at McDonalds and at the shopping mall while carrying my baby girl in my arms, as well as numerous other public settings. When I have these interactions I am never sure how things will go. I have had past clients threaten to harm me, I have had clients ignore me and I have had them thank me. The point is that not knowing how things will go is a big portion of my experience away from work and it leaves me in a position of being constantly on guard. When I go to restaurants I always sit in a seat that allows me to see the door because I have a fear of ex-clients sneaking up on me or my family, and accosting us. This concern in real and is not something that leaves or that I can just turn off.

Injuries I have suffered have ranged from black eyes and bruised face, torn lips, scratched face, pulled shoulder muscles, bursitis, swollen and painful knees, back injuries, hip injuries, sliced open scalp, neck aches, bites on my arms, numerous torn clothing, busted nose, numerous cuts, abrasions and exposures to possible lifelong diseases from being spit on and patients grabbing my face and getting their finger in my mouth while covered in feces.

The stories I have told in this article are but a small portion of the things that have happened to me over the past 29 years. Along the way there were other injuries and accusations of wrong doing that were absolutely ludicrous. I have given a simple glimpse into the life of a person that dedicates themselves to a lifetime of working in this environment. These patients are the forgotten of Society and we, the staff that care for them, are the forgotten of the Law Enforcement and Medical Fields. Please give us the dignity we deserve for doing the job that many others cringe at the thought of doing.

I ask that you consider that tasks we are given and the limited tools we have at our disposal to use with this protected class of people. We are, indeed, here to help people but it does come at a high cost to our own personal well being physically, mentally, emotionally and financially.

Sincerely,

Michael Pantalone