Laurie Coker: Focus on culture of care

Regarding the July 23 Point of View “Felony for assaulting health workers an outrage for NC mentally ill”: If we consider violence by mental health patients, we must accept that much has to do with the culture of the service environment. If a setting seems to be more oriented toward helping a person heal (reportedly 90 percent of people in psychiatric hospitals have significant histories of trauma – often by abuse) and less on simply managing or controlling behavior, we would see less fear and violence.

I worked many years as a psychiatric nurse, and I have seen the difference in overall patient behavior relative to the culture of care. It would be much better in the long run for our state to focus on problem-solving in meaningful, proactive ways rather than attempting punitive action. Hospital staff members need emotional CPR training (one of our state hospitals, fortunately, is undertaking this). Inpatient clinical and nonclinical staff need trauma-informed care training.

Further, a growing number of hospitals, even some here in North Carolina, are finding that using peer support specialists in emergency intake areas and on the patient units promotes a more effective and supportive culture, minimizing triggers for violent activity. This is because the presence of people who understand what illness truly is like from personal experience can help promote the shift in attitude about what helps a person being treated.

We also need to look at how we intervene with people before we get to the hospital. Are we using enforcers or trained mental health professionals, including peer specialists? While working with people in distress, we need highly effective people whisperers – inpatient and outpatient. Competent mobile crisis teams could save us tax dollars and a lot of unnecessary activity in our communities. This is important because the way in which people are engaged when they need help sets the tone for all else that follows in service settings.

Have lawmakers truly studied the repercussions of having a felony on one’s record? Do they realize that having a mental illness does not always mean that a person’s case will be tried in light of the fact he/she had been symptomatic? More people are not given this consideration than are. I know many fine people who have had acute mental health challenges who have difficulty finding employment now that they have recovered – because of a felony on their record. My own son lost hope and died in part because of stigma-driven lapses in justice and enforcement. He never recovered. But many people can and do.

This is a real problem, and we have made it much worse by pushing through a damaging and superficial solution rather than finding and applying solutions that have broader and more lasting consequences for all involved.

The length limit was waived to permit a fuller response to the POV.

This story was originally published July 28, 2015 at 5:28 PM with the headline "Laurie Coker: Focus on culture of care."