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Back in April, emergency department staff at Providence St. Joseph Hospital experienced a dramatic uptick in workplace violence, forcing administrators to implement 24/7 security and initiate de-escalation training for hospital staff. 

Dr. Roberta Luskin-Hawk, chief executive for Providence in Humboldt County, largely attributed the surge in violence to patients struggling with mental illness and increasing substance abuse.

“We are seeing more and more patients with behavioral health issues,” Luskin-Hawk told the Outpost. “…Workplace violence has been increasing across the country for a couple of years now…but it definitely increased in April. Any single event is unacceptable, but what we’ve seen recently really requires a call to action.” 

St. Joe’s is not alone. Verbal threats and physical assaults against healthcare workers have risen sharply across the country since the onset of the coronavirus pandemic. According to the American Hospital Association (AHA), 44 percent of the organization’s member nurses reported physically violent behavior from a patient during the pandemic and 68 percent reported verbal abuse. 

Lesley Ester, Chief Nurse Representative for the California Nurses Association, said the incidences of abuse at St. Joe’s “run the gamut from profanity-laden threats of violence to spitting, biting, slapping, kicking, shoving [and] punching.”

“The increase in both mental health crises and substance abuse in our county has led to additional [emergency department] visits for behavioral health reasons during the pandemic,” Ester told the Outpost. “…Some of them are put on psychiatric holds for their own safety. But truly, we don’t have the resources in our [emergency department] to give the type of mental health treatment that they need. This is a crisis for Humboldt County.”

Many of these patients are being taken to the hospital on a 5150 hold which allows an adult who is experiencing a mental health crisis to be involuntarily detained for a 72-hour psychiatric hospitalization when evaluated to be gravely disabled, a danger to others, or to themselves. When COVID hit, the evaluation process was performed by a Sempervirens clinician working remotely.

Before the pandemic, individuals experiencing a mental health crisis in Humboldt County would be taken directly to Sempervirens. When COVID hit, the Department of Health and Human Services (DHHS) implemented a mitigation plan that required all patients on a 5150 hold to receive medical clearance and COVID testing from St. Joe’s emergency department before being admitted to Sempervirens.

“If you have a patient who has mental health issues, you would want them to be in a nice calm environment with mental health workers,” Luskin-Hawk said. “We’re not a designated [psychiatric] facility, but we do our best to stabilize them.”

DHHS Behavioral Health Director Emi Botzler-Rodgers said the uptick in violence in the emergency department “is related in part to individuals with mental illness and in part to other factors, including individuals needing to be detained or arrested and decreased capacity at the jails.”

In fact, 5150s have actually gone down in the last year. In 2021, the Eureka Police Department averaged nearly 20 5150 holds per month compared to about 13 holds so far this year.

“This type of violence was happening prior to COVID at the [emergency departments] and at [Sempervirens],” Botzler-Rodgers told the Outpost. “It is currently happening in other counties throughout California and is a terrible and traumatizing problem in many communities. It is confounded by the profound lack of beds and placement options throughout California that are available for individuals needing treatment and support for mental illness.”

The county is working with elected officials and community partners to create both short and long-term solutions to the mental health crisis. Immediate strategies include the return to in-person evaluation of patients in the emergency department, reallocating staffing resources to increase bed capacity at Sempervirens to 16 and working with local hospitals to find funding to hire support staff for positions Sempervirens is unable to immediately fill, Botzler-Rogers said. They’re also working to loosen COVID mitigation requirements, such as accepting an antigen test instead of a PCR and working with emergency departments and the jail to streamline medical clearance processes.

To address 5150 holds specifically, the county is making training available to emergency department doctors that would allow them to rescind a 5150 hold and expedite the clearing process when appropriate. The county is also working with local law enforcement to allow mental health professionals to respond to and stabilize an individual before they are put on a hold.

“Longer-term strategies include the establishment of two local crisis residential treatment facilities,” Botzler-Rogers said. “Sorrel Leaf Healing Center for youth has purchased property on Indianola Road, and the adult facility, to be operated by Willow Glen, is actively seeking a site to provide services. There have also been conversations with St. Joseph’s around a triage center that we are committed to providing resources for when a viable location that meets regulatory requirements is identified.”

Along with implementing 24/7 security at the hospital and providing training in emergency psychiatric management for emergency department staff, Luskin-Hawk said Providence will continue to work with local law enforcement and community stakeholders to ensure staff and patient safety.

“We’re entering this phase now of looking at all of the mental health consequences of [COVID] and we have to respond as a country and as a community,” she said. “…When our caregivers are impacted, it affects all of our emergency services. …We need to be fully able to respond which means that the rest of our community stakeholders need to do their fair share around mental health. It’s not just small interventions, it’s a global look at how we can do better. We’re starting to do this but we absolutely need to come together.”