By Dan Linehan
Free Press Staff Writer
ST PETER — Most of the patients who live at the Minnesota Security Hospital in St. Peter are committed by the courts as mentally ill and dangerous, often after committing a violent crime.
The people employed to watch over them have little more than their wits to protect them — no batons, certainly no guns.
“There’s been a mentality that it’s our job to get hurt,” said John Collins, union steward for AFSCME Local 404.
Injuries among security staff quadrupled during a nine-month period in 2009 compared to the same dates four years earlier. There were 117 security counselors attacked in a recent year, meaning any given person had more than a 50 percent chance of being assaulted that year.
The issue illustrates the dual role of the Minnesota Security Hospital, the only facility of its kind in the state. Its 250 residents are not here by choice, but the hospital is focused on treatment, not punishment. Unlike the separate Minnesota Sex Offender Program, patients at the hospital are sometimes released after they improve.
The 232 people who provide security here are called “security counselors.” It’s not entirely a misnomer — they are assigned patients to informally counsel.
“For years, it’s (the security hospital) struggled with its identity,” said Chuck Carlson, president of AFSCME Local 404 and a security counselor for 22 years. Because of rules about staff speaking to the media, Carlson and Collins, a security counselor for three years, emphasize they are talking from their perspective in the union.
Carlson said he had surgery on his elbow twice, needed stitches twice and has had a few concussions.
Drew Campbell, a retired security counselor with 28 years of experience, said he is still bothered by back pain.
Bruce Hunt, a security counselor at the Minnesota Sex Offender Program, was injured in 2003 when a patient threw a cup of scalding grease on his face and arms, according to a March 20, 2003, story in The Free Press. The man needed skin grafts to repair the damage to his arms.
Why is violence rising?
Take your pick: The layoff in 2008 of 56 security counselors. State laws that restrict punishment of patients in hospitals. A change in treatment philosophy that frowns on putting patients in isolation. A spike in particularly violent patients.
That last explanation was the response of Dr. Read Sulik, assistant commissioner of the state Department of Human Services, to a letter from state Sen. Kathy Sheran, DFL-Mankato, about her concerns on employee injuries.
“Over the past several months, MSH (Minnesota Security Hospital) has experienced an unusually large number of complex patient cases who have exhibited violent behavior, and unfortunately the number of staff injuries has increased during that time,” according to the letter.
The union members have more complicated explanations.
They cite Rule 36, state law that governs how the mentally ill can be treated. “From our point of view, it’s too restrictive,” said Carlson, the union president. The security hospital is the only maximum-security psychiatric hospital in the state, he said, but its staff have to follow the same rules as people working in the psych ward of a regular hospital.
“It helps create a cultural mindset of not holding patients responsible,” Carlson said.
The security counselors don’t have any tools or weapons besides a radio.
“We’re sent out with our wits, basically,” said Collins, the union steward.
They also say there’s been a change in treatment philosophy that de-emphasizes the use of isolation and restraints.
Keeping a patient isolated requires the in-person assessment of a psychiatrist, which rarely happens. Rep. Terry Morrow, DFL-St. Peter, raises this issue in a letter to DHS Commissioner Cal Ludeman, whose response gives a glimpse into the reason for the rule.
“Protective isolation may not be used for the convenience of staff or as a substitute for programming,” Ludeman writes.
The union members also note the layoff of 56 security counselors in 2008.
What was once considered the minimum number of security counselors on one shift is now the maximum, Collins said. “Our only safety is numbers,” he said.
Campbell, the retired 28-year veteran, said patients will be less violent if they’re treated more humanely.
“You don’t need to run the place like a correctional facility,” he said. “The clients are going to respond if they’re being treated as criminals.”He said security counselors should develop relationships with the patients and listen to them.
Response coming
Collins and Carlson, the union members, say they got legislators involved because of a slow response from administration.
“Management’s response so far has been a lot of task forces and think tanks,” Carlson said.
Sulik, the DHS official, said the “high risk” patients have been getting extra attention from staff, who have been getting special training on how to deal with complex cases. Temporary employees also have been hired to provide additional care.
Sulik said those efforts are starting to bear fruit in the last few months.
One bright spot was a March meeting between Sulik and union members, wherein Sulik agreed not to cut more security counselors to help balance the state’s short-term budget woes.
He also said there’s been a nationwide movement away from the use of seclusion and restraints to manage patients, though it’s still necessary during emergencies.
“In a therapeutic venue, we can’t solely rely on seclusion and restraint to manage the outbursts,” he said.
