A View from the Inside with Charles Sayer

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HOPE on the Other Side Episode 24 Program Notes:

Mr. Charles Sayer is a Licensed Psychiatric Technician in California, commonly knows as a “Psych Tech.”   He and I worked at ASH, the Atascadero State Hospital, in the Central Coast area of California some years ago in the early 2000’s.  He currently resides in the Sacramento area of California.

To open up the interview, Mr. Sayer gave some of his personal background noting that there are relatives in the mental health profession who interested him in a career in that field.

He went on to describe the Atascadero State Hospital facility.  It is located in the Central Coast area of California in San Luis Obispo county. Regarding the physical plant, there are 30+ units in the hospital, a medical ward, recreation patios, a vegetable garden area.  There is one main auditorium area, and a classroom / education area, a set of classrooms  for drug/alcohol programs, a medical clinic area, and one unit for physically ill individuals.  Each unit has a commons room, an interview room, offices, bedrooms, shower / bathrooms, a medication dispensary, and a Unit Station.  Each Unit usually has one psychiatrist, and a complete treatment team which includes psychologist, nurses, rehab staff, social worker, medical officer and a Unit Supervisor. The Unit Supervisor is a senior psych tech and usually has a lot of institutional memory and provides much continuity.  The units house about 30 patients each.  The backbone of the staff is the psych tech workers.   The psych tech care for the day to day operation of the various units in the hospital, and have some specialized roles, too. Total patient population is about 1000.  There are many routines to life in the hospital:  meals, medication times, classes, recreation time, shower time, and bedtime.

Legal matters for the patients were addressed.   With the “recovery model” we usually referred to the patients as “individuals” in our clinical discussions, and called them by Mr. and their last name.  Most of the men there are on a special condition of parole, so only the local court can release them from the hospital care.  There is a smaller group who were judged by the court to be “NGI, Not Guilty by Reason of Insanity” and are at the State Hospital for treatment, rehabilitation and possible return to their home county, as determined by the court system. There is a group of psychologists that do most of the court work and testimony based upon the records of the unit staff over each past year.

Aggression in the hospital is a key issue for those annual reports, and unfortunately a weekly if not daily part of State Hospital Life. When we worker there, the daily events numbered between 5 to 25 incidents per day of aggression or even fights.  Those events would require an emergency response, and often police presence, and sometimes the use of seclusion, or even mechanical restraints.  The use of restraints was handled according to nationally approved use of straps and restraints to humanely contain the patient.  The goal was to restore the individual’s ability for self-control so he could safely get along with himself, the peers and the staff. Sometimes the acute emergency use of medications was required from the psychiatrists as well.

The Atascadero State Hospital has it’s own internal police force.  The usually first and most immediate responders to such events are the psych techs.  Safety of the patients, and of the staff is the primary concern, avoiding property damage is a lesser concern.   Building and maintaining respectful rapport and personal relationships with the individuals was see by both of us as a key and very fundamental part of having a safe place to live and work.

In an earlier podcast, T. Collins Logan spoke of nurturing and caring for the caregivers.  He also gave the opinion that places like prisons and state hospitals are very disruptive to the self-care of the caregivers.  He spoke of self-esteem, and self-love as a primary foundation for self-care of the caregivers.  Mr. Sayer reviewed some of the ways he and his peers at the State Hospital would care for themselves,  Mindset is very important, a pre-work shift meditation / affirmation / intention setting exercise can be quite useful.  Staff meetings with the treatment teams were held daily.  And the psych tech would sign off and give report between each of the three shifts per day.  These could be a part of the self-care for the caregiver Psych Techs.

Mr. Sayer’s final words of hope and encouragement for family or other community caregivers included the challenge to create a community of care so that you don’t have to do this alone, there are systems of support for both the family and the patient.

Links

FaceBook @HopePodcast

Facebook Schizophrenia caregivers online support group / forum: https://www.facebook.com/groups/140778123234472/

www.SchizoPhreniaCareProject.org  (the SP-Care site)