Napa State Hospital, a 135-year-old facility for the mentally ill, sprawls over hundreds of acres in wine country, its grounds dotted with palm, oak and redwood trees.
But in this pastoral setting, an epidemic of violence has scared staff members and patients, leading state legislators to call for emergency financing to help make the hospital safe.
In October, a psychiatric technician was strangled inside the hospital’s “secured treatment area,” where the criminally insane live. Last Saturday, a rehabilitation therapist sustained four skull fractures when he was assaulted, allegedly by a patient who, days earlier, was accused of attacking a custodian.
In interviews, staff members describe an environment in which predatory patients prey upon the more vulnerable. The secured treatment area, which is surrounded by a fence topped by razor wire, is rife with gang activity, methamphetamine use, pimping and extortion, staff members say. Yet, hospital police officers are prohibited from carrying firearms or Tasers.
“Every single unit is contaminated in its atmosphere with a culture of violence,” said Patricia Tyler, a psychiatrist at the hospital since 2006.
In many ways, the brutality at Napa State Hospital reflects changes that have occurred at mental institutions statewide. Since the early 1990s, thousands of mentally ill patients have been moved from state hospitals to community settings, opening up beds for patients who have been ordered there by criminal courts.
The Department of Mental Health reports that 92 percent of patients in state mental hospitals were referred by the criminal justice system; 15 years ago it was just 20 percent.
“Our mental health hospitals, basically, in the state are an extension of the criminal justice system,” said Ken Murch , the chief negotiator for the California Association of Psychiatric Technicians.
In Napa, 86 percent of approximately 1,150 patients were committed by the criminal courts; many were deemed incompetent to stand trial or not guilty by reason of insanity.
“Now we get people who have committed murders, and they are housed in facilities that were designed for perhaps depressed grandmas,” Dr. Tyler said.
Over the past two years, there were 224 instances when injuries inflicted by patient assaults caused Napa hospital staff members to miss at least one day of work, Deborah Moore, the hospital’s public information officer, wrote in an e-mail.
Last year, 1,580 crimes — including 1,275 batteries and 103 felonies — were reported at the hospital, according to the police officers’ union and the hospital administration. The vast majority of those cases never led to prosecution.
“You have really vulnerable patients who are severely mentally ill who get victimized by these manipulating individuals who have a prison mentality,” said Crystal Johnson, a psychiatric technician. “We really don’t have any way to protect them.”
Johnson said she was choked by a patient in 2008 but escaped when she fought back and managed to hit her alarm, causing the patient to flee. She suffered a black eye and a sore neck and back and missed work for three weeks.
Staff members say the recent attacks underscore the need to overhaul security that is still designed for dealing with a less volatile population.
Napa State Hospital’s stated therapeutic approach is a model that emphasizes “wellness and recovery.” Since 2006, the mental hospital and others in California have operated under a federal court order to improve conditions for patients. Napa accepts patients deemed a low- or medium-security risk, but that designation refers to the risk of flight, not a propensity to harm others.
In addition, staff members say, some patients have faked mental illnesses to avoid long prison terms and win transfers into the more comfortable hospital environment. As a result, violent patients — some of whom are mentally ill — are mixed in with more vulnerable patients and staff members.
Sean M. Bouchie , a 24-year-old patient charged in last weekend’s assault on George Anderson, a rehabilitation therapist, had a reputation for violent behavior, including a recent attack on a custodian, staff members say. Mr. Bouchie has pleaded not guilty.
Dolly Matteucci , the hospital’s interim executive director, said she made an urgent request to the Department of Mental Health for 20 more police officers after a patient strangled Donna Gross, a psychiatric technician, last October. Jess W. Massey , 37, has been charged in the killing but has not entered a plea, pending an examination.
“I want nothing more than for our staff to be safe,” Matteucci said in an interview in the administration building, which sits well outside the secured treatment area.
Matteucci took over in February, when Claude E. Foulk was fired as the executive director after he was arrested on charges of child molestation. Foulk has pleaded not guilty.
After last weekend, two Napa legislators, State Senator Noreen Evans and Assemblyman Michael Allen , called on Gov. Arnold Schwarzenegger and Gov.-Elect Jerry Brown to “use the power of the governor’s office to immediately allocate the necessary resources to secure the hospital.”
With California facing a $28 billion budget deficit, Department of Mental Health officials say they have taken action with the resources at their disposal, prohibiting patients from walking the grounds unescorted and establishing a shuttle service for employees.
“The department is in the process of reviewing the recommendations offered by employees and the unions, and has conducted a security audit” of hospital grounds, Jennifer Turner, a department spokeswoman, wrote in an e-mail.
The Union of American Physicians and Dentists, which represents psychiatrists in the Napa hospital, has recommended that patients who have displayed very aggressive behavior be housed and treated in their own heavily secured unit.
“Everyone knows the bad actors in the state hospitals,” said Sue Tredennick, 66, a nurse who said she had been attacked by patients four times in her 19 years at Napa. “They should be put on another unit where there are police officers and taken out of the mix.”
Strategy documents and meeting notes from the hospital show that such a plan was extensively explored at Napa in 2006, but it foundered on the question of how to provide security for the specialized unit.
The hospital is due for a visit from the Joint Commission, a nonprofit organization that accredits hospitals, in 2011. Ken Powers, a spokesman for the commission, said that it did not announce its accreditation visits, but that Napa last had a full on-site survey in October 2008 and that the surveys typically occurred every 18 to 36 months. Safety will be reviewed as part of its accreditation.
For now, though, Napa State Hospital remains in a virtual lockdown, administrators and staff members say. Staff members can no longer escort patients on the grounds alone, and patients are more frequently confined to their units.
Escorting patients can leave those units understaffed, creating additional security problems, said Mindy Musch , an organizer for Service Employees International Union Local 1000, which represents 1,100 workers at Napa, including registered nurses.
“There’s more tension in the units, because there’s less activities and more staying inside,” said Odell Phipps, a 53-year-old patient. “So, at some point, there’s going to be a combustion of violence somewhere. It’s inevitable.”
This article also appears in the Bay Area edition of the New York Times.