Healing Perkins

Our view: After two patients were killed at the Clifton T. Perkins state mental hospital last month, new CEO David S. Helsel is the right man to lead the institution on the long road to emotional recovery

November 27, 2011

Investigators delving into the circumstances surrounding the deaths of two patients at the Clifton T. Perkins Hospital Center in Jessup last month are likely to find there are no quick fixes for the state's troubled maximum-security mental hospital. Staff morale has collapsed, a climate of fear has gripped the institution, and it may take the Perkins community years to recover a sense of normalcy.

The fact that the victims were killed by two of their fellow patients has renewed concerns over safety that were raised by the 2010 killing of a mentally ill female patient under similar circumstances. Yet, so far, there's no indication that lax security or low-level staff misbehavior were factors in the most recent killings. That suggests the problems may go deeper and require more fundamental changes in the hospital's institutional culture. But such change won't happen overnight.

In the meantime, the first priority for Perkins' new CEO, Dr. David S. Helsel, must be to reestablish the confidence of his staff so the hospital can regain its effectiveness as a center for treating the state's most dangerous mental patients. If doctors and caretakers are afraid of their patients, therapy is unlikely to produce good outcomes. Such work will never be entirely without risk, but it can be accomplished in a way that minimizes the dangers that violent, mentally ill people pose to themselves and others during the process of getting well. Dr. Helsel was appointed to the post last month by Gov. Martin O'Malley after serving as director of the Spring Grove Hospital Center in Catonsville, and by all accounts he possesses the broad experience and outstanding leadership qualities needed to get the job done.

Perkins serves the state's most violent mental patients, and those committed to care there are extremely ill. Of the 239 patients at the facility, more than half were diagnosed with schizophrenia or schizo-affective disorder, which produce vivid visual or aural hallucinations in some victims. Other patients struggle with severe mood disturbances such as major depression and bipolar disorder.

Most of these people never received treatment for their illnesses before they came to Perkins. But that's not why they're there. People only come to Perkins for one of two reasons: because they've committed a violent crime and a judge has declared them mentally incompetent to stand trial, or because they've been found not criminally responsible by reason of insanity for a serious act of violence. Perkins is the state's only mental hospital equipped to deal with the violent mentally ill; nonviolent patients are sent to lower-security institutions for treatment.

It's unclear whether the recent deaths at Perkins signal its patient population has grown more dangerous or violent in recent decades, as some have suggested. While it's true that before last year, no patient had been killed by another patient in half a century, the types of crimes for which people were sent there 20 years ago are no different from today's, nor are the nature of the illnesses. Incidents of violence have always been a hazard of working with mental patients who have committed serious crimes, but doctors and staff can mitigate the threat by being vigilant and anticipating problems before they spiral out of control. The only way they can do their job safely is by never forgetting that the consequences of complacency can be deadly.

The investigators probing Perkins will include both internal hospital staff and a team of outside experts. They will painstakingly comb through mountains of medical records, charts and personnel files and will interview the entire staff and every patient to identify what went wrong. A root-cause analysis would look at such questions as whether clinical methods and security procedures need to be revised and whether weaknesses that turn up affect the whole system or are confined to a particular unit. Everything must be scrutinized, and changes made immediately when potential issues are identified.

While this is going on, Dr. Helsel's leadership will be essential in rebuilding an emotionally shattered hospital community of patients, doctors and caretakers who, in the wake of the recent deaths, are left in a state of paralyzing anxiety. He must figure out a way to acknowledge their distress and help them move back to a place where they can again function effectively and patients can get better.

Dr. Helsel can start by reassuring the Perkins community that they are all in this together, that if they are willing to build on their strengths things will get better, and that he will support them fully on the painful journey from sudden disaster to a renewed sense of balance and control.

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