Napa forensic patients voice concerns
of their own about hospital security issues

By Kevin Courtney
Register Staff Writer

If you think city residents are the only ones unhappy about changes in the works at Napa State Hospital, you're wrong.

The Penal Code patients also are fuming.

They oppose plans to take away their Lee and Bugle Boy jeans, their 49er shirts and other expressions of individuality and dress them in khaki uniforms.

The idea of a 16-foot razor wire fence around their living areas doesn't thrill them either.

Their anger bubbled over at a recent ward government meeting attended by more than 40 patients.

The first complaints were about too few washers and dryers and limited visitation hours.

Things really heated up when the topic turned to tougher security. More than a dozen men and woman lashed out, attacking proposed clothing, field trip and fencing restrictions.

"Wearing my own clothes gives me more dignity, more self-esteem. I feel better about myself. Normal is as normal does," said a female patient who was wearing jeans and a blouse.

"Most of us have been to maximum security (at Atascadero and Camarillo state hospitals)," said another woman. "We feel we've come up to another level to come here. We think we've won the right to wear street clothing. We don't want to dress like prisoners. We've been there."

"Khakis are not something I'd be Interested in," said a young man. "I don't think I'm a criminal. Other people think I'm a criminal, but I don't think I'm one."

A young woman, whose pastel outfit suggested she was going to a garden party, said a uniform would harm her recovery. "I like to look pretty, not for anybody else but for myself. It's very therapeutic for me," she said.

Patients feared they would become public spectacles on field trips into towns. No one seemed to realize that administrators may eliminate such outings.

"We think of this as a higher place to be than where we've been. I think we represent ourselves well in the community," said a female patient who has been on escorted trips to Target, Mervyn's arid Napa Premium Outlets.

"We present ourselves well," she said. "They wouldn't know we were patients if we didn't have to ask the social worker for money."

Groups of adults, all wearing identical khaki outfits, would "scare the children," she said.

"I hear what you're saying," said Fred Hollander, a program administrator. "A lot hasn't been decided yet."

Why the prison-like security fence? a middle-aged woman asked. "Napa is a very beautiful community. I can't see them wanting a fence. A fence would be offensive," she said.

Penal Code patients aren't the ones who cause occasional problems in the community, a man said. "The LPS (civilly committed patients) are really a lot of the ones causing most of the stuff that's happening. What's the purpose of isolating us from the rest of the hospital?"

"Now it's almost time to get out. I need less security. I need to get used to community living again," a woman said.

Why beef up security for Penal Code patients whose next stop is release to their home communities? a female patient asked.

Eugene, a young male patient, spoke contemptuously of community fears. "The community Is not educated enough to understand the level of care we need in this hospital. We don't need a fence around this hospital. We don't need khakis around this hospital," he said.

"This isn't a prison," agreed a female patient. "this is a hospital. Keep it lower security."

REALITY HITS

In fact, the issues of concern to patients have all but been decided. State mental health officials are planning a 16-foot fence staffed 24 hours a day with guards.

Bowing to local law enforcement desires, administrators will mandate uniforms. Individual passes into town are now history. Group field trips may also be banned.

"The community does not want these forensic patients In the community. I have to respect that," said Frank Turley, Napa State's executive director.

As of May 1, no new passes into Napa were issued for individual Penal Code patients, Turley said. Eliminating group outings also seems likely, he said.

I haven't finalized it yet, but they'd have to give me one hell of a justification" for off-grounds field trips, Turley said.

By wrapping treatment areas with 1.5 miles of new fencing, the hospital will give patients more freedom on grounds to compensate for restrictions on off-grounds travel, Turley said.

The enclosed security compound will "simulate" the outside world, Turley said. Patients will enjoy greater off-ward activity without putting the Napa community at risk, he said.

Turley was the administrator who first put Patton State Hospital patients in khakis in the early 1980s.

How will he explain the clothing policy change to NSH patients? "I'll tell them, 'Clothing isn't the issue here, folks,' Turley said. "I'll tell them they haven't paid their dues. They're here."

Today's political climate requires enhanced security for mental patients who have been arrested for crimes, Turley said. "There is an expectation from the courts that not only do we treat, but we maintain custody," he said.

Stephen Mayberg, the state mental health director, has called the proposed fence and guards security "overkill." As a practical matter, future NSH patients won't be much more dangerous or likely to escape than the current ones, he believes.

But local law enforcement wants the fence and the community will appreciate the added security, Turley said. "It's reassurance that you have better control.

(NOTE: Original text missing her. Has first names and titles of some of the people mentioned later...)

SECURITY MEASURES

While they downplay the dangerousness of penal patients, many clinical staffers support plans to build a 16-foot security fence around treatment areas and hire an around-the-clock perimeter guard force.

"I think the fence is the start proving to the public that the Hospital and the state will take their security seriously," Cooper said.

"It will make the community feel better," said Steenman. Equally important, it will create a secure zone within which more patients can enjoy off-ward passes, she said.

"Anyone who's reasonably well put together we'll be able to let out on the grounds because it's behind the fence," she said. "It will really improve our ability to deliver services."

It's another of those great ironies that penal patients, generally the best-behaved group at Napa State, stay far longer than civilly committed patients with the same symptoms, said Dr. Splane.

Why do civil patients turn around so fast? Because the counties that pay their tab want to move them on to less expensive treatment as quickly as possible, staff said.

Finances aren't an issue for penal patients -- the state is paying for their court-ordered treatment. Their issue is community safety.

"I tell patients, 'What gets you here isn't what keeps you here,' " said Steenman. 'What gets you here is insanity. What keeps you here is dangerousness.' "

AN INEXACT SCIENCE

Predicting dangerousness is still an inexact science, she said. That's why judges, clinicians and administrators are loathe to rush anyone along.

On a floor above Q 1&2 is a treatment unit with another type of Penal Code patient: those judged incompetent to stand trial: PC 1370's for short.

For them, Napa State is a sort of psychiatric boot camp to get them ready to return to court to be tried. As they become more rational, they're put through a mock trial, with treatment staff acting the roles of judge, prosecutor and defense attorney.

This day, George and Derek were the patients on the witness stand. Chester was arrested for arson after allegedly setting his own apartment on fire. Witnesses saw him feeding furniture into the flames. Derek was arrested for a drug charge -- possessing methamphetamine.

Neither man had a criminal record, but their psychiatric histories went back years, staff said.

With psychologist Tom Knoblauch acting as the judge, George admitted he had "seemed incoherent" the day of the fire. He had "undifferentiated schizophrenia," but was doing better now. "I've learned to feet more competent. I can communicate better," he said.

Once he believed he could have his case dismissed simply because his name was misspelled on a court document. He no longer did, he said.

Derek denied possessing an illegal drug. He said his inability to stand trial had been a "misunderstanding." He admitted to being a paranoid schizophrenic, but denied having a recent drug problem.

Derek said he hoped to bargain a guilty plea in which his state hospital time would count toward his jail sentence.

Derek knows how the system works, Cooper said later. Plead guilty and he'll be free in a flash. Plead not guilty by reason of insanity and he could be in the mental health system for years.

After the mock trial, outside the presence of the patients, staff concluded that George was still "too fragile" to return to court. His medications needed fine tuning so he could better understand what's going on.

The treatment team liked Derek's performance. Would he continue to take his antipsychotic medications if the court released him? Staff thought so.

"Neither of these guys thought they were incompetent to stand trial," noted Roxanne Bay, a psychiatric social worker. "They're not using Napa State to get away from the charge. They're not happy being here."

Over the next three years, the number of NSH patients who are not guilty by reason of insanity is expected to jump from 250 to almost 500. The incompetent-to-stand-trial group will nearly double from 122 to 200.

LIFE ON THE WARD

Ward life on Q 1&2 has a special rhythm. Each hour on the hour, formal activities come to a halt so patients can enjoy the only street drug permitted at Napa State: nicotine.

Some 90 percent of patients smoke. Cigarettes are handed out one at a time in the outdoor courtyard to prevent black market trafficking and bedroom fires.

Why do patients smoke so much? Because life on a locked ward can be mighty boring, said J.R., who is young, full of energy, but has no place to go.

Unlike most, J.R. doesn't use his $12.50-a-month state stipend on smokes. "I spend my money on CDs," he said.

J.R. dreams of getting out someday and getting a job. But for now he's taking life one treatment session at a time.

Rightly or wrongly, people fear the J.R.'s of this world, said Frank Turley, Napa State's executive director. Their mental illness makes them uneasy. Their criminal histories freak them out.

When we left Q 1&2 at day's end, neither of us experienced a moment of concern for our safety.

Patients had been either friendly or indifferent. They had gone about their business and let us go about ours.

This left us wondering. Are penal units usually this quiet, this orderly? Had we caught Napa State on a good day?

I carried with me a poem that Eugene had posted on a ward bulletin board. It was titled "Who Am I?"

I am a patient at Napa State Hospital.

I am a patient with a mental illness.

I am someone who fights every morning

And every night with my thoughts

even my dreams.

I cry during the day.

I cry when I dream.

I cry when I wake up.

I know someone up there understands.

EDITOR'S NOTE: Several names in this article have been changed to protect the confidentiality of the patients.

Photo Captions

JAMES -- "Number one, I should have told someone about the voices in my head. And number two, I never should have run out of medication," said James, who was arrested for firing a gun alongside his cousin's head.

The voices did him in, said James, who mistakenly believed that the cousin was trying to harm his family.

After almost four years undergoing psychiatric treatment, James today is symptom-free and remorseful. He calls the shooting "a truly tragic thing."

SAMMY -- Arrested for firing a weapon into an occupied dwelling, Sammy said he was a victim of paranoid thinking. "I thought people were out to get me," he said. "I was mentally ill. I wasn't taking my medications at the time."

At Napa State, he takes a half-dozen medications daily and works as a part-time custodian, earning $85.50 every two weeks. "I want the community to know we're not dangerous to the public," he said.

For Eugene, a 22-year-old patient, life on Q 1&2 has highs and lows. Below, he wears his best suit while waiting for a visit from a friend. He kills time by smoking and listening to music on his Walkman. Unfortunately, the friend never showed.

Above, Eugene reacts with despair when he's forced to stay behind while fellow patients go to eat. He was forced to dine alone while staff observed the effects of a change in medication.

James, 49, above, makes his bed. His clothes locker is adorned with pictures of his grandchildren. Left, the sun has risen but Sammy catches a few extra winks before getting up for a full day of activities.

Eugene, right, disposes of a safety razor after his morning shave. Patients aren't allowed to keep razors, pens or silverware in their possession. Below, a patient is issued a cigarette. Cigarettes, a prized commodity, are tightly controlled by staff.