Work con­di­tions un­safe at Md. psy­chi­atric hos­pi­tal

Baltimore Sun - - COMMENTARY - By Miriam Doyle

I lov­ingly fist-bumped two mur­der­ers, and then I walked out of work to protest the Ho­gan ad­min­is­tra­tion. I am a foren­sic so­cial worker at Clifton T. Perkins Hos­pi­tal Cen­ter, Mary­land’s max­i­mum se­cu­rity state psy­chi­atric hos­pi­tal. I pro­vide ther­apy and case man­age­ment ser­vices to the crim­i­nally in­sane, and I am strug­gling to do this job sat­is­fac­to­rily or even safely un­der cur­rent work­ing con­di­tions.

Stand­ing in the rain and chant­ing slo­gans out­side of fundraiser events isn’t the only way that I’ve tried to ad­dress the prob­lems at my un­der­staffed hos­pi­tal. I’ve also made nu­mer­ous calls and writ­ten let­ters to the Mary­land Gen­eral As­sem­bly, trav­eled to An­napo­lis to meet with del­e­gates and state sen­a­tors, and tes­ti­fied at a la­bor man­age­ment staffing meet­ing, giv­ing ex­plicit tes­ti­mony about the preva­lence of vi­o­lence in my work­place, the dele­te­ri­ous im­pact on pa­tient care caused by not hav­ing enough so­cial work­ers and the dif­fi­culty we’ve had hir­ing new em­ploy­ees.

I went back to An­napo­lis in Oc­to­ber, and from a few feet away I watched Sec­re­tary Robert Neall from the Mary­land Depart­ment of Health dis­cuss my work­ing con­di­tions with the leg­is­la­ture. When they asked him why so­cial work­ers at Clifton T. Perkins Hos­pi­tal don’t re­ceive haz­ard pay for work­ing with a dan­ger­ous pop­u­la­tion, Sec­re­tary Neall said that the so­cial work­ers are only at risk “to a de­gree” be­cause “they have of­fices, and the pa­tients are brought to them.”

I thought about Sec­re­tary Neall’s re­sponse a lot on Nov. 13th, af­ter I asked one of my pa­tients to meet with me and he threat­ened to crack a chair over my head.

I want so des­per­ately for my pa­tients to get the treat­ment that they need and de­serve. They should have am­ple op­por­tu­ni­ties to go off the ward for gy­mac­tiv­i­ties, art ther­apy, anger man­age­ment, what­ever. The dis­tant lure of get­ting dis­charged years down the line isn’t enough, they need chances to get pos­i­tive stim­u­la­tion ev­ery sin­gle week. Without hav­ing groups can­celed be­cause there isn’t enough se­cu­rity cov­er­age, or be­cause there aren’t enough nurses to dis­pense med­i­ca­tion as sched­uled. They should be able to get in­di­vid­ual ther­apy without go­ing to the bot­tom of a 35-pa­tient wait­list be­cause there aren’t enough ther­a­pists to go around. And hell, my wish for suf­fi­cient time to run psy­choe­d­u­ca­tional groups is also self­ish, be­cause that’s the best part of my job.

I rel­ish chances to con­nect and learn from my pa­tients, es­pe­cially when I get to fa­cil­i­tate ther­a­peu­tic op­por­tu­ni­ties. One of my groups uses Touch­stones ma­te­ri­als for struc­tured dis­cus­sions, dur­ing which the pa­tients re­flect on writ­ings and en­gage in a care­ful ex­plo­ration of each other’s per­spec­tives. I call pa­tients in and pass out ma­te­ri­als in hopes of help­ing them to grow their ca­pac­ity for cog­ni­tion, lead­er­ship and com­mu­ni­ca­tion, and of­ten feel that I am the one ed­i­fied by the en­su­ing con­ver­sa­tion.

Ear­lier this month I had them read an ex­cerpt from Homer’s epic “The Odyssey” about the re­union be­tween Pene­lope and Odysseus af­ter he spent 20 years away fight­ing at war — the test that Pene­lope gave him to make sure that the hag­gard stranger she be­held was truly her hus­band. I was blown away by the en­su­ing dis­cus­sion, as my pa­tients pre­sented sound ra­tio­nales for Pene­lope’s cau­tion, voiced com­pas­sion and un­der­stand­ing, and also drew par­al­lels about the in­ter­per­sonal dif­fi­cul­ties peo­ple in their sit­u­a­tion might face, re­turn­ing home to loved ones af­ter be­ing hos­pi­tal­ized for years.

Some peo­ple might look at this group of pa­tients and see Mary­land’s “Most Wanted,” but any­one will­ing to lis­ten will per­ceive par­tic­i­pants and guardians of a thought­ful and nur­tur­ing space, whoare fully ca­pa­ble of en­gag­ing in bril­liant, beau­ti­ful, and mean­ing­ful anal­y­sis.

As a side note, I can­celed the Touch­stones group ses­sion last week, an un­for­tu­nate re­sponse to the mul­ti­tude of is­sues that arose on the unit. I used to have an ide­al­is­tic ex­cite­ment over this job, telling my­self that my abil­ity to do amaz­ing work was only lim­ited by my­own­abil­ity to be cre­ative. Now I re­al­ize how many other lim­i­ta­tions I face — how­ever cre­atively I dream of ways to do ther­apy, my abil­ity to pro­vide that ther­apy is con­stantly chipped away as de­mands on my time mount in a dys­func­tional en­vi­ron­ment.

I need time to do the work that I love. And for that I need my hos­pi­tal to have enough staff to pro­vide the ther­a­peu­tic en­vi­ron­ment that our pa­tients de­serve and that the state of Mary­land has man­dated for them.

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