Patients as Felons; Workplace Violence for Providers
Today, I testified on legislation in Colorado related to workplace safety for our mental health workforce
Hello,
It’s Tuesday, February 27th, and this is Bipolar and Bipartisan.
Today, I testified on legislation in Colorado on legislation related to workplace safety for mental healthcare workers. Nurses and other providers are frequently exposed to physical, verbal, and sexual abuse during their workday, and it is totally unacceptable. I heard nurses today testify that they have been punched in the nose, peed on, and stabbed with a fork. One pregnant nurse once locked themselves in a storage closet to protect themselves.
Public policy debates across the country are playing out on this issue, with two big picture questions. First, what should we do about workplace safety for mental healthcare providers? Second, should mental health patients experiencing psychosis, mania, or other symptoms of their disorder be charged with felonies if they engage in abuse?
In Colorado, this debate is showing up as bill HB24-1066, titled “Prevent Workplace Violence in Health-Care Settings,” which I testified in favor of today. My live testimony was limited to only two minutes, but with an opportunity to say more, the below remarks are what I would have said.
Thank you for reading.
Sincerely,
Tyler
My Experience
Thank you:
To the Committee Members and Chair for the opportunity to testify;
To Representatives Hamrick and Garcia, and Senators Michaelson Jenet and Gonzales for sponsoring this legislation;
To The Colorado Nurses Association, Mental Health Colorado, and other advocacy organizations working on this bill.
My name is Tyler Fisher and I live in Edgewater, Colorado. I live with type one bipolar disorder and have twice been placed on M1 Holds in in-patient hospitals in our state. My experience, both times, has been inhumane. I have been denied rights, dignity, and proper care. My lived experience gives me a unique perspective on this piece of legislation, which I wholeheartedly support.
Last year, when I was admitted at Cedar Springs Hospital in Colorado Springs:
I showed up, the words Nazi and KKK were written on the public white board;
I was unable to access the medication that I had been taking for three years;
I slept on an extremely uncomfortable cot and showered in cold water that routinely went out;
I asked to see an attorney, and was constantly denied;
I was only able to see two family members, every other day, for only for 30 minutes;
I only saw a psychiatrist for 15 minutes over an eight day stay, and my only 20 minute therapy session was in a public space;
There was no ability to exercise, and no time in the day for it; fruits and vegetables were not served;
There was no quiet time, no reprieve from yelling in the middle of the night, and much more;
I was not read or given the patient's bill of rights upon arrival, as legally required by Colorado law.
I could go on. You get the point. In-patient facilities in this state, and country, are failing. There are many problems, and many solutions to those problems. Today, this committee is considering two problems.
First, we have an overworked, under-resourced, exhausted mental health workforce — and yes, a workforce that faces physical safety risks.
Second, we have a patient to prison pipeline problem — a vicious cycle that turns patients into prisoners, and prisoners into patients, with little intentionality in how we break the cycle, or even an acknowledgment that the cycle is even there.
The Mental Health Workforce
On the workforce, consider that in a recent poll of mental healthcare workers across the United States:
83% said they do not believe current providers will be able to meet growing demand for mental health and substance abuse services, absent public policy changes;
65% of the workforce reports an increased caseload since the onset of the Covid pandemic, and 72% say the severity of illnesses has increased since the onset of the pandemic;
48% of the workforce says they have considered other career opportunities because of the workforce shortage.
At least part of these data can be explained by exposure to workplace violence. When patients are experiencing psychosis, mania, or other symptoms of their disorder, they can turn violent. In 2023, an Oregon mental health provider, Haley Rogers, died providing care to the mentally ill. Health Care Workers (HCWs) are five times more likely to experience workplace violence than other workers. A 2017 literature review of 17 academic studies that verbal assaults affected 46–79% of HCWs, physical threats affected 43–79% of HCWs, and sexual harassment impacted 10–37% of HCWs.
These experiences can enable the onset of post-traumatic stress disorder, anxiety, and depression among mental healthcare providers — worsening our country’s crisis in two ways: increasing the number of people needing care, while simultaneously decreasing the number of people who want to provide it.
This is not surprising to me. I have seen it first hand. I saw an ex-Marine physically intimidate workers at Cedar Springs Hospital. I saw a woman constantly scream, for days, at mental health providers.
Not only have I seen it, I have felt it. I was physically scared being around the ex-Marine while trying to exercise. I was yelled at by the same woman, as I peacefully sat doing a puzzle. And when I refused to take a medication the doctors refused to educate me about, I was tackled so they could inject the shot into me. I was tackled by six providers. And I kicked back. It was violent. For both patient and provider.
The Patient to Prison Pipeline
On the patient to prison pipeline, the data are equally alarming:
The three largest mental health facilities in our country are jails;
A Colorado citizen can be brought to, and held in, a jail following an episode of substance abuse, even if they have not committed a crime;
According to the Bureau of Justice Statistics, 56 percent of state prisoners and 45 percent of federal prisoners have symptoms or a recent history of mental health problems.
Mental health patients in jails rarely receive the type of care that they should, and they are regularly held in solitary confinement. If they are held for more than 23 hours per day in a location with no social interaction for 14 straight days, that meets the United Nation’s definition of torture. This happens in Colorado.
The Human Rights Watch says that Section Seven of the International Covenant on Civil and Political Rights is violated when “[P]risoners' mental health deteriorates and they endure serious psychological suffering because they have not been provided the mental health treatment that is needed, their right to be free of cruel or inhuman treatment may have been violated.”
The Public Policy Puzzle and Just One Solution
The legislation before this committee addresses a root cause of the mental health crisis we face. This proposal acknowledges that mental health providers, especially nurses on the front lines, are under physical, emotional, and sexual threat. The law requires hospitals and the state to get smart, and to create plans — plans that will need to comply with standards and be distributed to workers. The bill will grant mental health workers training, so they can keep themselves safe. The legislation will provide workers resources for when they are inevitably assaulted again.
Here’s the public policy puzzle on mental health that keeps me up at night.
First, we know more about mental health than ever before.
There is more research, more training, and more effective medications.
Second, mental health is destigmatized more than ever before, even if we are not where we need to be.
More people are speaking up, the issue is on the public’s consciousness, and it’s commonly accepted our country is facing a mental health crisis.
And, yet, despite those two things, we are worse off than ever before.
Suicide rates, especially among teens, are up;
Substance abuse is higher than ever before;
People are disconnected from their communities, and each other; both enabling, and because of, growing political polarization.
Young people are more lonely than any previous generation;
We are out of beds in in-patient hospitals and emergency rooms are overrun — driving up costs for governments.
We know more about mental health than ever before, mental health is more destigmatized than ever before, and yet we are worse off than ever before.
The question this committee, this legislature, and policy makers facing a similar choice in our communities and across the country is this: what is more likely to break this cycle?
Is the solution charging patients for actions they take while they are experiencing psychosis with felonies instead of misdemeanors? Is it further enabling the inhumane patient to prison pipeline that is? Is it making someone like me — who has been treated miserably — a felon?
Making patient violence a felony instead of a misdemeanor would make sense if we thought that change would disincentivize violence. But, when patients are experiencing psychosis and mania and preparing to hit, kick, or yell at a healthcare provider, do you think they are really weighing the legal consequences of their actions?
Making violence a felony won’t provide any additional safety to providers.
Or, is the solution to create plans to prevent violence before it happens?
Is it to provide hospital administrators blueprints and hospital workers training?
Is it to create a system where the state knows the problematic patterns, learns what is working in one part of the state, and applies that lesson learned in other settings?
Is it to provide services to those who have been injured?
Is it to make it more likely our dwindling workforce stays?
We can address a root cause with a powerful solution, or we can pour gasoline on a fire that is raging.
The answer to me is clear: this committee and this legislature should sign HB24-1066 and grant healthcare providers the workplace safety they deserve. And, as a next step, we should look for similar protections to prevent patients from similarly experiencing physical, verbal, and sexual abuse.