It takes a special mix of talent to treat the patients at the Minnesota Security Hospital. Not just anyone can do it.
“The complexity of our patients is far beyond what other mental health care providers can manage,” explains Dr. KyleeAnn Stevens, a forensic psychiatrist and the executive medical director at the Minnesota Department of Human Services. “Other hospitals simply cannot or will not accept the patients who come to us, because they don’t have the right expertise or staff or facilities to treat them.”
Dr. KyleeAnn Stevens
Security Hospital patients have been civilly committed by the courts as mentally ill and dangerous. Most have multiple impairments: schizophrenia and other serious mental illnesses coupled with chemical dependency, brain injuries, trauma, intellectual disabilities and behavior disorders. They can be emotionally volatile and physically aggressive. While some patients have resided at the hospital for a decade or more, the average length of stay is about six years.
No other health-care system in Minnesota (private, nonprofit or public) has a comparable patient population. So it’s no surprise that the Security Hospital needs a large and specialized staff of doctors, psychiatrists, nurses, psychologists, social workers, direct-care providers, vocational and recreational counselors and behavior therapists to meet the complex needs of patients.
“Most people think our work is all about medication. It’s far more than that. It is critically important to our patients’ recovery that we understand each individual uniquely,” says Carol Olson, executive director of forensic services at DHS. “That means we have to know these patients well, know their personalities, their trauma history, their psychiatric history, their medical history – all the complicating factors that coexist in each person. And we have to develop treatment plans that are as unique as each individual.”
That kind of methodical, patient-centered approach can bring about remarkable transformations for individuals whose conditions might have seemed hopeless even a decade ago, says Olson. "But having the right number and combination of staff is really key to our success."
Lori Olson, a registered nurse at the Security Hospital, tells of a patient she worked with who started hearing voices in his late teens. “The voices were telling him to do things … to hurt people,” she says. The young man used drugs and alcohol to calm himself and quiet the voices. Eventually, he committed a serious crime and was court-ordered to the Security Hospital.
“When he came here, he was scared, he was violent and he was very ill,” Lori Olson recounts. Carefully, she and other staff engaged him. With the right medication, the right kind of therapy and the right amount of support, he gradually got better. “Today, he lives in the community,” she says. “He holds a job. He attends school. And he’s doing very, very well. “
While such successes are common at the Security Hospital, more patients could get better faster if the facility had all of the clinical personnel it needs, says Stevens, who notes that compared to peer facilities in other parts of the country, the Security Hospital is significantly understaffed.
For instance, facilities in other states have 3.3 staff for each patient, which is considered minimal staffing to provide both effective treatment and adequate safety for patients and staff. Currently, the patient-to-staff ratio at the Security Hospital is 2.1 to 1. The total number of staff is important, but so is having the right mix of clinical staff – psychiatrists, nurse practitioners, psychologists and other personnel. At the Security Hospital there is one psychiatrist for every 42 patients. At the Oregon State Hospital in Salem, OR, that ratio is 1 to 18, and at Fulton State Hospital in Fulton, MO, the ratio is 1 to 15.
Recognizing the need for more staff, Gov. Mark Dayton is proposing an additional $22.86 million in funding for the Security Hospital. The increase would cover about 146 new full-time equivalent positions. The additional staff would allow for expanded evening and weekend programming for patients, reduce mandatory overtime and burnout for current employees, make ongoing specialized staff training possible and provide incentives to attract and keep qualified employees.
The governor’s bonding recommendations also include $70.25 million to complete the second and final phase of a renovation at the Security Hospital. The project is aimed at creating safer and more therapeutic living, treatment, work, activity and program support spaces.
The proposed staff and facilities investments are not just important to effective patient care and treatment. They are critical to improving and maintaining safety for patients and staff, says Tim Headlee, a direct-care counselor who works closely with patients every day.
Because the potential for violent outbursts from patients is ever present, safety is a top priority at the Security Hospital. Staff injuries, which had been alarmingly high, have fallen substantially over the past year, thanks in large part to better and more frequent staff training. But preserving those gains and improving upon them will rely heavily on having more staff and safer physical spaces, says Headlee.
“Safety and effective treatment go hand-in-hand,” he says. “When we have the right amount of staffing – a safe level of staffing – we have the right amount of training, the right response in crisis, and the right treatment and care. Our patients depend on it … it’s what they need and it’s what they deserve.”
The current staff makeup in forensic services
About 835 full-time equivalent direct care staff work in Forensic Services in St. Peter, MN, which includes the Security Hospital, Transition Services, Competency Restoration Program and the Forensic Nursing Home. Together, these dedicated staff care for nearly 350 individuals who cannot be treated anywhere else.
Clinical staff include doctors, psychiatrists, psychologists, pharmacists, advanced-practice nurses, social workers, behavior analysts, and a variety of therapists. Direct care staff, who have the most day-to-day interaction with patients, include forensic support specialists, nurses, human services support specialists, occupational, recreational and work therapy assistants.
Other staff fill a wide variety of roles that keep programs and facilities running smoothly. They include pharmacy and lab technicians; carpenters, electricians and plumbers; cooks, custodians and mechanics; as well as managers and administrators.