Tuesday, June 5, 2007

Law aims to make mental health calls safer


A safety law taking effect this week lets community mental health workers bring a second worker with them on calls to consider detaining seriously disturbed patients.
The "Marty Smith law" grew out of the death of a case worker in Bremerton in November 2005. Smith was killed when visiting a client to evaluate him for involuntary commitment, which is the kind of situation the new law is aimed at.

The Service Employees International Union 1199NW and private nonprofit providers like Behavioral Health Resources in Olympia and Shelton were among the bill's backers.

The new requirements take effect this week, a month after Gov. Chris Gregoire signed House Bill 1456 into law, said Rep. Tami Green, the Lakewood Democrat who sponsored the bill. In a related move, lawmakers authorized $3.7 million in new funding after July 1 that will help agencies with training and making other changes to the system.

"I think it needs to happen,'' said counselor Micki Dextre, who works for Behavioral Health Resources in Olympia and lobbied for the legislation. "When you are driving around with a psychotic person in your car, it can get a little scary … because they can go off.

"We are seeing it more and more where clients become psychotic. We are the front-line people and we go out to their homes, and we step into the situation,'' Dextre added.

"Just last week I was dealing with a client who is schizophrenic and doesn't open the door to anyone.''

BHR is a nonprofit group that provides state-paid mental-health care to the public through state-funded contracts, and it has about 300 workers with face-to-face dealings with clients. The organization already has trained its workers, partly because the agency saw incidents that were worrisome.

Incidents in recent years included a client pulling a knife on an employee.

"A lot of it has to do with being prepared … in case someone does get violent to have an escape route,'' BHR chief executive John Masterson said.

Who it covers

The new law does not affect workers directly employed by the state, but some state employees in the mental-health arena are carefully watching the state's progress in putting the new statute into effect.

"Anything to do with mental health we're watching," said Tim Welch, spokesman for the Washington Federation of State Employees, which has members at the Western and Eastern state hospitals in Steilacoom and Cheney. Welch said recent reports of increasing numbers of assaults at Western State have drawn particular interest, and the union is interested in other legislation from Green that failed but would have set minimum staffing levels at state hospitals.

"A lot was done to fund safety at the mental-health hospitals this year but more needs to be done,'' Welch said. "We clearly believe we need extra staffing. The administration at Western State Hospital believes otherwise and wanted to use training before asking for more staffing.''

The Service Employees International Union Local 1199NW, which represents some nurses at Western State and community mental-health counselors at organizations such as BHR, also is watching closely. Assaults on staff have increased by 19 percent since 1999 and several assaults have increased by 80 percent, according to state Department of Labor and Industries data cited in recent news accounts by the Tacoma News Tribune.

Out in the field, mental-health workers such as Dextre say they will have more protections.

"It took a lot of these incidents that occurred" to spur action, she said. "We had three or four incidents in one year. That's when people got concerned and the training got in place."

Dextre, a member of SEIU 1199NW, said she hasn't yet seen employees go out in pairs on involuntary detention calls. But Masterson said it has been an approved procedure at BHR and he doesn't expect any problems putting the Marty Smith protections in place.

"I support it," Masterson said of the changes. "The main provisions include making sure there is appropriate training for staff so they can protect themselves, ensuring they have access to a cell phone, and making sure they have access to enough medical records so they can assess the risk.''

"I think the question is statewide. Part of the problem is there is not always good information about how frequently that policy is followed. … It's different in an urban setting than a rural setting - if you have to travel 50 miles on back roads to get to someone,'' Masterson said.

Worker safety report

The Department of Social and Health Services released a report on mental-health outreach workers' safety late last month that details the incidence of assaults and also is based on a safety summit convened last fall. The agency now is developing a plan for outreach and education to help prepare mental-health workers to deal with dangerous clients.

Details on that effort still are in the works, according to David Kludt, a program administrator with DSHS's mental-health division.

The legislation makes Washington No. 1 in the country for this particular aspect of mental-health worker safety, Green said. But she added, "the Marty Smith bill is sort of bittersweet. It is frustrating that it can take someone to die before you can do something with worker safety.''

Because Smith had to travel from Bremerton to Poulsbo within the half-hour required by his employer in an emergency, he did not have time to adequately review medical files on the violent client. Even then, Green said, the files were inadequate.

In 2006, Green had sought legislation to require at least two employees to respond in such difficult situations, but she compromised this year and believes the law as written gives more control of situations to employees; the legislation also requires training.

"Most of the mental-health centers have already started moving that way. The handwriting was on the wall," Green said, adding that most of her concern is for smaller mental-health clinics located outside urban centers.

Green also is looking at the related safety of state employees in state mental hospitals and has a second bill that would set mandatory staffing levels, increasing the number of employees who have direct care contact with patients. That bill and its Senate companion both died without hearings in the 2007 Legislature, but Green is optimistic.

"Any time we make improvements in worker safety it buoys the spirit of all mental-health workers. It gives you some hope that you can fix the mental-health system,'' Green said. "I think the Marty Smith bill is kind of the first step for how we can make more improvements. I'm going to keep working on it.''

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