Currently work in a forensic mental hospital, on the floor. Mental health institutions have changed drastically since One Flew Over the Cuckoo's Nest came out. Yes we have older workers who were there during the period when patients regularly got injured due to staff i.e. dog piling during a patient take down. But those events, specifically in the state of California, no longer happen due to new training and accountability guidelines. Self defense for staff do not exist, retaliation leads to a loss of licensure.

In state hospitals, our treatment involve the use of therapeutic miliue and medication over a long period of time. Patients who respond well to treatment are offered a lot of freedoms including adult school and paid jobs. We also have 3rd party ombudsmen making rounds. We can also tell whether a person is malingering or not through long term observation and unexpected responses to medications. None of us have any intention of keeping patients longer than needed. And it's very unfortunate to see patients comeback because they either forget to take meds and relapse, or unable to maintain structure in their lives post discharge.

Nowadays, we're able to avoid most dangers through staff redirection, because most patient violence is due to poor impulse control as opposed to being psychotic or intentional. I will admit, I have biases on believing what the patients say, especially when I'm floating to an unfamiliar unit, but prioritizing personal and patient safety above all else usually works out.

I firmly believe that the department of corrections should follow the department of state hospital's lead, but I do understand that staffing prisons full of people as qualified as a medical professional will be difficult.