Using data to shed light on an invisible population

A friend who works for the federal government once laughed when I told him I was having trouble getting interviews with scientists at a public health agency. Agencies with a mission to protect health are most guarded, he told me, because it’s so hard for them to uphold their mission.

His words resonated as I started investigating conditions at psychiatric facilities operated by California’s Department of State Hospitals. The risks facing workers at the state’s mental hospitals made national news in 2010, when a popular psychiatric technician named Donna Gross was strangled by a patient on her way back from a break. Although the patient had a violent history, he’d been given a pass to walk freely on the hospital grounds.

State officials claimed they’d taken measures to improve safety after Gross’ death, including distributing personal duress alarms and tightening screening for grounds passes.

But were those measures enough to keep workers, and the patients they cared for, safe? State facilities don’t allow reporters on the wards to interview staff or patients, outside of official tours. One psychiatrist likened the situation to North Korea. And getting access to documents, records and statistics to answer this question has proven difficult.

The first logical place to look is the DSH web site, which includes links to reports and data. To the department’s credit, these reports include statistics on violence, but they are shared only in PDF, not in spreadsheets that lend themselves to analysis. When I started thinking about this issue, only the 2014 Violence Report was available, which reported stats only across the system, not broken down by hospital, which could mask trouble spots.

A subsequent report came out in the fall of 2015, which did include rates by facility, but again, the reports come  only in PDF. To get the underlying data, I had to file public records requests. And though I requested the records in electronic format, preferably Excel, the spreadsheets I received had weird formatting with narrative interspersed with data on assaults that required hours of processing to get ready for analysis. 

DSH also participates in California Health and Human Service’s Open Data Portal, but don’t expect to find much there.

When agencies offer records through open data portals, as Sarah Cohen, IRE president and New York Times’ computer-assisted-reporting team lead, told the Data Journalism fellows last year, they’re often just steering you to the information they want you to have.

For the DSH, that data does not include statistics on assaults. If officials did share that data there, the agency would be making it easier for the public to come to their own conclusions about how well DSH is fulfilling its mission: “Providing evaluation and treatment in a safe and responsible manner, seeking innovation and excellence in hospital operations, across a continuum of care and settings.”

It sounds like any hospital’s mission. But the facilities operated by DSH aren’t typical hospitals. These facilities, like other state mental hospitals across the country, were originally designed for civilian psychiatric patients but now serve an entirely different population.

Decades of well-intentioned policies and court decisions pushed civilian patients with mental illness out of state hospitals with the promise of treatment in the community. That promise went largely unfunded and unfulfilled, leaving many with the most severe mental disorders untreated. Many ended up on the streets or in increasingly overcrowded prisons.

And now state hospitals, which were designed to treat the vast majority of mentally ill people who are not violent, have increasingly filled their beds with the subset who are.

In California’s state hospitals, over 90 percent of patients are forensic, meaning they come through the criminal justice system, many after committing horrific crimes. The patient who killed Donna Gross was sent to Napa after he’d been declared legally insane when he’d repeatedly stabbed a Sacramento woman, who miraculously survived.

California houses 37 percent of forensic patients in the country. Most come to the hospitals after spending time in jail, where they are unlikely to receive treatment and so are more likely to be mentally unstable. That also increases the risk of violence.

About half of assaults at the state hospitals occur within 120 days of admission, according to the DSH’s 2015 Violence Report. Since there are rolling admissions, and the other half of assaults occur throughout the year, that means that staff and patients are at risk of being attacked on any given day.

My sources, including workers at one the state hospitals, union reps and academic scholars, say that statistics on assaults at forensic facilities are routinely underreported. Workers get so used to being victims they learn to accept it, one psych tech told me. They often downplay the risks on the job so their spouses and children don’t freak out.

That meant I needed to find other data sources to check against the assault statistics I got from the state. None of these alternate sources was available on California’s Open Data Portal. All required public records requests. There are several resources to help you increase the success of obtaining records, starting with knowing what’s exempt, what to know before filing and what kind of wording to use.  The Reporters Committee for Freedom of the Press offers a state-by-state guide. Know the law, before the file a records request.

Napa State Hospital has its own police department on the grounds. So I requested police logs for several years from the Napa Department of State Hospitals. I requested records on overtime worked by staff over the past two fiscal years from the DSH. I requested records on worker injury claims filed against the DSH for the past few years. (You can look up individual cases through the Department of Industrial Relations Electronic Adjudication Management System, but you need to know the name of the injured worker. You can’t do a bulk search by facility.)

And because hospitals must fulfill federal and state requirements to keep their license to operate, I requested 2567 reports, which detail hospital inspections, along with “plans of correction” to address any findings of deficiencies, from the California Department of Public Health, which oversees licensing and certification of the state hospitals. You can find complaints about hospitals on the CDPH’s long-term care portal.

The Association of Health Care Journalists offers resources devoted to increasing transparency to hospital inspections, including a database of 2567 reports for states across the country. You have to be a member to access these resources.

It took months and months to receive all those records, as well as considerable back and forth with public information officers who would not let me talk with program staff. Because my story has not yet been published, I can’t tell you what I found. Watch this space.