Former hospital staffer: Why I quit social work at Umstead

Violence, staffing vacancies took toll

Sheila Read is a graduate student at the UNC-Chapel Hill School of Journalism and Mass Communication. This story is about her time working as a social worker at John Umstead Hospital.

In the end, the decision to leave was easy. Three staff members injured that week. A psychiatrist's bashed head. Puddles of blood on the floor.

After 17 months as a social worker at a North Carolina state psychiatric hospital, I resigned.

I had taken the job at John Umstead Hospital because I needed it. My husband and I had just moved to North Carolina and bought a house. I had a master's degree in social work but did not yet have a clinical license, which limited my job options.

Also, for personal reasons, I felt called to help people who were suicidal. I saw myself counseling patients and families, helping them through crisis and despair.

Although I didn't know it then, the fall of 2003 was a bad time to start work at a state psychiatric hospital. North Carolina had started implementing mental health reform, cutting funds for hospitals to focus on serving the mentally ill in their communities.

I left John Umstead Hospital in April 2005, more than three years ago. But the intertwined problems that led me to resign appear to remain today at the state psychiatric hospitals: understaffing, overcrowding, violence and demoralizing working conditions.

Since the new Central Regional Hospital opened in July, staff members have complained about unsafe working conditions. The hospital was intended to treat patients from the former Umstead and Dorothea Dix hospitals. But some Dix mental health workers are protesting the move, citing concerns that include inadequate safety measures at the new hospital.

Record admissions

A few months after I started work, the adult admissions unit achieved a record. The unit had admitted more than 400 patients that month.

In a staff meeting, we were handed red stars cut out of construction paper. The number of admissions was marked in the star's center. This was something to celebrate? I looked at a colleague and rolled my eyes.

Before mental health reform, even 300 admissions per month were rare, veteran employees said.

The state's four psychiatric hospitals saw the number of patients admitted increase by more than 82 percent between 2001 and 2005, The News & Observer reported in its series on mental health reform. During that five-year period, the state cut $15 million from hospital budgets.

The state badly botched the implementation of reform, cutting funding for psychiatric hospitals and community mental health centers before ensuring that new private treatment centers were available in communities.

As a result, many mentally ill people lost the therapists or psychiatrists they trusted and found it difficult to schedule appointments. When they couldn't get therapy or medications, more patients ended up being admitted to psychiatric hospitals.

The wards were always full. Walking onto one of the locked wards was like running a gantlet through patients, often angry, who waited by the door or in the narrow halls. "Where is my doctor?" "Are you my social worker?" "I need to use the phone!"

Fights broke out almost constantly.

Throughout the day, the overhead pager went off, summoning all staff members to Ward 232 or 234 or 236. Feet pounded through the halls as male staff and the few larger women who were capable of restraining patients raced to help.

Although suicidally depressed patients rarely cause trouble, patients admitted for mania often provoke others by nonstop loud talking, aggressiveness and a tendency to violate others' personal space. Psychotic patients sometimes hit someone without warning.