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RENEE MONTAGNE, host:

This morning, we're continuing our report on the increase in violence at some of California's state psychiatric hospitals. In a moment, we take you to Atascadero State Hospital on the central coast. It was designed to treat mentally ill criminal offenders.

NPR's Ina Jaffe has been reporting this story, and she joins us in our studio here at NPR West.

Good morning.

INA JAFFE: Good morning.

MONTAGNE: And yesterday, we talked about the psychiatric hospital in Napa. The problem there is that the hospital wasn't designed to handle all the patients from the criminal justice system that it now treats. But that's not the story of Atascadero. Why is the violence going up there, too?

JAFFE: Well, considering the patients they treat at Atascadero, it's always going to be dangerous. But according to state and federal documents, it's gotten worse since 2006. Now, that's the same year that the state signed an agreement with the federal government to put in a detailed new treatment plan. It's 92 pages long. It covers everything - psychiatry, dentistry, nutrition, the works.

MONTAGNE: And why is the federal government getting involved in its psychiatric care?

JAFFE: Well, they're not exactly. The treatment plan came out of a civil rights investigation. It's something the Justice Department has done at a lot of public hospitals around the country. In California, they found some serious problems: abuse and neglect of patients, substandard care, lousy record-keeping. Their investigation actually turned up some pretty disturbing stories.

MONTAGNE: So, the new treatment plan was supposed to make things better.

JAFFE: And it did, according to Justice Department documents and some of our conversations with hospital staffers. But violence has gotten worse at three of the four hospitals covered by the treatment plan. At Atascadero, it's gone up 36 percent. And that's what brought Republican State Senator Sam Blakeslee there recently, and not for the first time.

State Senator SAM BLAKESLEE (Republican, California): I have constituents who live here and work in the facility that are just distraught about their sense of threat and risk and potential injury. And it's just an inherently dangerous population.

JAFFE: But as we walk through the hospital, it appears more blandly institutional than dangerous. The halls seem endlessly long. The patients wear identical khaki pants and shirts. They tend to ignore us as we walk by, and no one looks up from the television when we enter the day room.

State Sen. BLAKESLEE: You know, that's how things are most of the time. And when things change, it changes very quickly.

JAFFE: A former psychiatric technician named Ramona Goodman found that out the hard way. It was September 2008. A patient made a routine request: He wanted some clean socks from the laundry room.

Ms. RAMONA GOODMAN (Former Psychiatric Technician, Atascadero): Which was down the hallway. So he and I walked down the hall, and as we were walking together, I had asked him about a - you know, so, you had a really hard time this weekend. And do you want to talk about that later with me? Maybe we can help you get things worked out. Yeah. I don't want to talk about it right now. OK.

JAFFE: And then they reached the laundry room door.

Ms. GOODMAN: I got my key in the lock, and I felt his arm come around underneath my chin. And I dropped my chin down as far as I could into my neck so he couldn't choke me out. So, we began to struggle. And he was hitting me alongside the head as I was biting him. And after a, I don't know, couple of minutes, I realized I was not going to win this fight.

JAFFE: Eventually, she managed to scream and a co-worker came to her rescue. Goodman now has two artificial discs in her neck held in place by a titanium plate. Her surgeon told her she can't work at Atascadero anymore.

Ms. GOODMAN: Because I could get knocked down, or whatever, and be paralyzed.

JAFFE: The attack was one of more than 1,000 violent incidents at Atascadero that year. Goodman blames the treatment plan the hospital was forced to adopt after the Justice Department's investigation. She says it drove a wedge between the staff and the patients by requiring massive amounts of documentation.

Ms. GOODMAN: Spending more time on paperwork than you are treating the patient, that's really the security problem right there.

JAFFE: She's not exaggerating, says psychiatrist William Walters.

Dr. WILLIAM WALTERS (Psychiatrist): I spent three or four hours a day typing, maybe sometimes six hours a day typing.

JAFFE: Walters left Atascadero about a year and a half ago after working there for nearly two decades. He says something else changed when the hospital went to the new treatment plan: Their safety program was disbanded. It had won awards and been cited as a national model.

Dr. WALTERS: They made it a hospital-wide mantra that safety was the first consideration. And they did a really fine job of it.

JAFFE: In 2008, the hospital started a new committee to deal with violence after a patient was murdered by a fellow patient.

We spoke with a number of current staffers at Atascadero. We aren't using their names because they've been warned not to speak to reporters without going through hospital administration. But they mostly share William Walters' skepticism about the plan calling for patients to identify their own goals and interests in choosing treatment options.

Dr. WALTERS: Which was, I thought, really poorly adapted to a mental hospital for felons and people who had committed severely violent crimes.

JAFFE: California is the only state where the Justice Department has imposed this regimen on hospitals that exclusively treat mentally ill criminals. California's second such hospital, Patton in San Bernardino, has also seen violent incidents rise by 36 percent.

The Justice Department declined our requests for an interview. We also tried to speak with a court-appointed monitor who tracks California's compliance with the treatment plan, but he's barred from speaking with the media.

The treatment plan does have a champion, though, in Jon DeMorales, the executive director of Atascadero. He welcomes the demands it's made on the hospital:

Mr. JON DEMORALES (Executive Director, Atascadero): That we establish reason for commitment, discharge goals, obstacles to discharge, and be geared to the strengths and weakness of an individual, to provide the individual with a realistic opportunity to recover from the reasons that led to their commitment here.

JAFFE: Which is not to say that the plan can't be improved. California's agreement with the federal government expires later this year, and DeMorales is already cutting down on those paperwork requirements.

Mr. DEMORALES: To reduce the workload on the staff, to give them more time to spend with their patients.

JAFFE: Walking through the hospital, State Senator Sam Blakeslee says there are things that have nothing to do with the treatment plan that can make this place safer, like new furniture.

State Sen. BLAKESLEE: You notice the chairs are intentionally so heavy, they're almost impossible to pick up and throw.

JAFFE: But ultimately, Blakeslee thinks it'll take new laws to make the hospital less dangerous. Other lawmakers agree. There are now at least half a dozen measures pending in the state legislature, all focused on hospital safety. One of Blakeslee's would make it easier to medicate patients against their will.

State Sen. BLAKESLEE: Those that are acting out and behaving in a way that could pose a risk to themselves, to the staff and other patients.

JAFFE: In the end, says Blakeslee, it's a matter of keeping faith with the taxpayers who are spending more than $500 for each day a patient stays in the hospital.

State Sen. BLAKESLEE: And the public has a right to expect that these individuals will get the treatment to make them less dangerous, because ultimately, many of these people will be back on the streets. They'll be our neighbors. They will be at our grocery stores. Our kids will walk by their homes.

JAFFE: And they won't be less dangerous on the streets, he says, if they're trying to get well in a violent place.

Ina Jaffe, NPR News.

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