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Over this past year, we've been reporting on escalating violence in California's state psychiatric hospitals. Thousands of assaults occur annually, but only a tiny fraction result in criminal charges. NPR's Ina Jaffe reports that mental-health and law-enforcement officials are trying to figure out how to hold aggressive patients accountable without punishing people for being sick.
INA JAFFE, BYLINE: It's been four months since psychiatric technician Jill Francis was attacked by one of her patients at Atascadero State Hospital on California's central coast. There's still a bruise under her left eye from reconstructive surgery.
JILL FRANCIS: I received a laceration above my eye which took seven stitches to close. My eye was actually pushed back and down; I had fractures in the bone below my eye; and I got a concussion - from one punch.
JAFFE: The patient who allegedly hit her is Desmond Watkins. According to law-enforcement officials, Watkins had previously been in prison for assault with a deadly weapon. And when Jill Francis met him, he was in Atascadero for the second time.
FRANCIS: He just got fixated, all of a sudden, that he wanted to go back to prison and that by hitting someone, that would enable him to go back.
JAFFE: Watkins may get his wish. He's been charged with three felonies, including aggravated battery. He's one of thousands of Californians caught in the revolving door between the state's prisons and mental hospitals.
Many of these people make that back-and-forth trip because of a law unique to California. It's known as the Mentally Disordered Offender law. It says that prison inmates who've committed serious crimes and been diagnosed with a major mental illness can be forced to serve their parole in a state hospital. And each year that they're in the hospital, they get a trial to determine if they're still mentally disordered.
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DR. PHYLISSA KWARTNER: He has symptoms such as auditory hallucinations; he hears voices that sometimes call him bad names, or tell him what to do.
JAFFE: Psychiatrist Phylissa Kwartner testified recently in the case of Atascadero State Hospital patient Christopher Matzick. He sat quietly next to his attorney, dressed in a canary yellow jumpsuit, wrist restraints and shackles.
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KWARTNER: He attacked one inmate and two correctional officers, based on the paranoid belief that they were talking badly about him.
JAFFE: The judge sent Matzick back to Atascadero State Hospital for another year of treatment. There are more than 600 mentally disordered offenders there, as many as at all the other state hospitals combined. In fact, they make up a majority of Atascadero's patients.
JON DEMORALES: As a group, the mentally disordered offenders are the most aggressive.
JAFFE: Hospital director Jon DeMorales explains that's why the toughest ones are housed on a special unit with tiny, private bedrooms, and windows that allow staffers to see inside.
DEMORALES: Kind of a stark environment - the beds are bolted to the floor; there are no lockers.
JAFFE: DeMorales has worked at Atascadero for decades. And he's developed a theory about his patients.
DEMORALES: There are criminals who happen to exhibit symptoms of a mental disorder, and there are mentally ill people who happen to have committed crimes. They all end up in the same place.
JAFFE: And they all get treated the same. But they shouldn't, says County District Attorney Gerald Shea. He believes that mentally disordered offenders should be subject to the same laws in the hospital that they were in prison - where any violent act against a staff member, no matter how slight, is treated as a felony.
GERALD SHEA: And can result in additional incarceration time on top of the time you're already serving.
JAFFE: Shea says that extending this law to parolees in the hospitals is only fair.
SHEA: We just feel that the employees at Atascadero State Hospital shouldn't be subjected to lesser protection than their counterparts at the state prisons.
JAFFE: So Shea sent a memo with his legal arguments for the change to his state senator, Sam Blakeslee. Blakeslee now plans to introduce a bill that would turn Shea's idea into law. But the senator says that the increased penalties would not apply to every patient.
STATE SEN. SAM BLAKESLEE: You've got people who are so mentally compromised that they either are not guilty by reason of insanity, or just unfit to stand trial. And this legislation would not apply to those individuals.
JAFFE: But some of those individuals are chronically aggressive. So even if Blakelee's bill passed - and similar bills have failed before - it would not solve the violence problem. That's why the Department of Mental Health is now experimenting with what they call an enhanced treatment unit.
The first one, a pilot project, just opened at Atascadero. Again, Jon DeMorales.
DEMORALES: Some of our own staff and the public, and perhaps the media in general, think of the enhanced treatment unit as a bad-boy unit or a secure unit. It is not.
JAFFE: It will have more intensive treatments, says DeMorales, and more staff, all of whom have volunteered for the job.
DEMORALES: If it's successful, we may then export the program to other hospitals and/or take referrals from other hospitals to treat here.
JAFFE: But at full strength, the enhanced treatment unit can only take 27 patients, meaning California's psychiatric hospitals will still be searching for ways to keep staff and patients safe.
Ina Jaffe, NPR News.
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