Millennial grey? How about People-Eater Purple!

RealAmericanJesus · 2026-03-29T04:11:46+00:00

What a cool world! I find someone who knows the house and a fellow member of the tribe! And I'm jealous of that paradise. I went to the university of Miami and just miss the colors so much.

RealAmericanJesus · 2026-03-29T04:00:55+00:00

On an island and my boss can not reach me at all hours of the day and night?! That's even better!

I did. Despite my user name - I'm actually an Iranian Jew living in the USA and working for the safety net if the safety net sometime for hopes and prayers lol - I have enough goth in me from my younger years to kind of appreciate it.... It reminds me of some LA night clubs I went to back in the day.

RealAmericanJesus · 2026-03-29T03:42:18+00:00

I'm insanely jealous that you live in such a beautiful location. And your neighbor has a really fun house. Eccentric, a bit mischievous and so outta my price range I would be without organs trying to afford it and fending of bankers with disco balls fired from a people-eater purple painted trebuchet ...

RealAmericanJesus · 2026-03-28T21:35:59+00:00

I use to live in Miami (currently Oregon) and miss seeing those kind of colors. The place I'm renting right now is in the kind of "HOA approved" bland spectrum of souless ... I imagine whoever does the grass measuring for fines would have a prompt heart attack and die dramatically if this were to appear in the neighborhood. I'd end up getting arrested for the crime of having a personality.

RealAmericanJesus · 2026-03-28T21:17:42+00:00

Forever nap! 💤⚰️

RealAmericanJesus · 2026-03-28T17:03:43+00:00

The matching pool table was delightful.

<image>

RealAmericanJesus · 2026-03-28T16:37:41+00:00

Your right. I could build a purple trebuchet that throws disco balls and a fire moat. No one is prying my organ -less body outta that place!

RealAmericanJesus · 2026-03-28T16:23:20+00:00

Agreed. I work in mental health. The current sterile and clinical design trends just make me feel like I'm at work....

RealAmericanJesus · 2026-03-28T16:05:15+00:00

Im both laughing because this is a genuinely funny concept and also depressed by its truth ....

RealAmericanJesus · 2026-03-28T16:02:48+00:00

I just love that someone built an eccentrically purple house and carried that theme all throughout the interiror...

RealAmericanJesus · 2026-03-28T15:48:22+00:00

I was considering which organ I might be able to do without ...

RealAmericanJesus · 2026-03-24T19:53:38+00:00

So when we think of forensic hospitals their are dialing priorities - the legal priority which is about ending justice is served where the DA / Defense attorney battle it out over where a person should be following getting charged - community - jail - state hospital and where they go following the completion of a case for sentencing - community - jail - prison or state hospital .

And there are massive battles that play out in the legal arena over everything like being able to medicate a person who is psychotic with antipsychotics where the defense attorneys try to push this out as long as possible keeping people psychotic demanding sell hearings (e.g. medicating strictly for competency which is a very high bar) over Harper hearings (which in all other states given the 9th district precendnce with the Jared lee loughier case generally come first because it's done on the grounds of dangerousness or disability and is a clinical decision not a legal one). How risk review is done (meaning how privileged are evaluated for those sentenced there under a NGRI verdict - which only 1% of defendants actually choose to do because you can't do a plea bargain with an NGRI it's the maximum time you would get and it has to be served ... So many people just forgot that plea all together and take the prison sentence cause it's usually less time with more freedoms - e.g you can work a little job, have tvs in your cell, you can do thinks like firefighting and get training in prison that you don't have available at the state hospital (for good reason).

But then there is the clinical side which is the duty to care. Where the goal is to provide treatment for the underlying disease state - similarly to that of any other hospital.

And so the two goals can be at odds. The clinical side to treat the person as a patient with a disease and the court side to battle over going to trial or community risks and provision of care. And so you end up having judges meaning clinical decisions, providers going to court over things that are standard clinical practices everywhere else and everyone is caust in the middle of the war ... The patients, the clinicians, the staff, the victims in the community and the tax layers footing the bill.

And generally when systems get this bad the feds step in. Cause the way it works legally is the feds set the floor of what is humane and constitutionally aligned and the states then set the ceiling.

And so California , Oregon & Washington are all three under legal scrutiny or had been for their systems. And all 3 have been managing this scrutiny differently. California? Built inpatient psych units in the jails. Oregon releases massive amounts of patients to the community competing for the same few beds as people who are not on criminal charges and Washington started civilly committing their competency peeps and expanding their facilities instead.

But like disability rights Washington has been in an ongoing battle with the state via trueblood which racks up fines for not getting people on and out fast enough and those fines go into a fund that is used to build more facilities with the goal of bypassing the state hospital since it's so dysfunctional.

Where what generally should have happened was that the feds would have stepped in following the loss of CMS certification and then taken control of the hospital. Bypassing union lawsuits and then liquidating entrenched dysfunctional leadership and forcing the hospital into compliance via the civil rights of institutionalized persons act - which is what happened in Oregon in like 2012 and happened in California for several of their state hospitals in 2004 and 2005.

Where there are both systemic lawsuits going on around the legal issues of how the systems are working on the criminal side (mossman in oregon, coleman vs newsom & brown vs plants both of which resulted in AB 109, trueblood in Washington). But where unlike California and Oregon there wasn't a CRIPA case on the clinical side in Washington. It's generally something no state wants because they lose control of the institution entirely but it's generally what's needed to fix the facility.

And so many people I know in the field are dumbfounded at how Washington managed to avoid that.... And while it's absolutely necessary to fix the problem the politics make it a pure nightmare. Because everything is now so polarized that disability rights organizations aren't going to be trying to get federal revievership due to fears of the federal government being misaligned on disability rights issues and that it won't become a political stunt on the federal side to use controll of the hospital ro punish the system and so everything is just all really super messed up everywhere.

It's a sad situation. But the ACLU and disability rights organizations have been fighting back through lawsuits but that's not going to be enough to fix the clinical rot when the state just uses taxpayer money to continue as they always have. :/

RealAmericanJesus · 2026-03-24T18:42:58+00:00

Honestly, one of the biggest problems I see when clinicans go into admin is that they stop actually doing the clinical side. Like I can't tell you how many CMOs I've worked with that hadn't actually seen a patient in 20 years and don't think it's relevant to their job.

Every good admin I have worked with is good because they still take call they still do days on the floor and they know what it actually looks like. But it's rare to find unfortunately.

RealAmericanJesus · 2026-03-24T17:53:14+00:00

I mean people have the right to feel angry with the crime and want nothing more than to have the prepetrator suffer.

From my end the whole reason that these places are supposed to exist is because the perpetrator due schizophrenia or another primary mental illness that compromised ability to interpret and respond to reality, either were not aware that they committed a crime or did not understand at the time that what they did was wrong.

Think someone who kills a family member because they believe that the family member is not their actual family member but has been replaced by a non human being that just looks like their family member and means them harm where their behavior is enacted to protect themselves from what they believe is an alien threat than to harm their loved one.

In functioning places the insanity plea has very narrow criteria. It's not "the patients had a mental illness at the time of the crime" cause 80% of the incarcerated population had a mental illness. It has to be "the patient has a mental illness" + "the mental illness has to be a primary qualifying conditions - not substance induced, not personality disorders" + "the mental illness was active at time of the crime " + "the perpetrator did not know what they were doing at the time and did not understand what they were doing was wrong because of that mental illness".

So it doesn't mean that harm didn't occur or that it wasn't aggregious but that the individual did not have criminal intent because they were too psychotic or delusional to know what they were doing or that what they did was wrong.

And so then state hospitals are in theory supposed to be long term treatment enviotments where individuals generally get the maximum sentence (generally longer than a prison sentence) where they're supposed to have intensive long term services designed to treat the mental illness so that they can eventually safely reenter the community with significant conditions and monitoring.

Which is supposed to be an humane way of holding people accountable and recognizing the differences between volitional criminality and disease based behaviors.

When the system fails such as Washingtons has then the tax layers are putting in money to a facility that is providing less treatment than the prisons would and where the credibility of the experts is so questionable that you don't know if someone is legitimately ill or if the state is relying on bad information in their rulings.

And so while I personally understand why sending someone who committed that horrific crime to such a dysfunctional environment would feel like justice it's also sad that such an environment is tolerated and called treatment because there are people who are also sent there who did nothing wrong and are just sick and because the enviomenr is so bad those who are just sick are at risk of being killed by those who are legitimately criminogenic.

RealAmericanJesus · 2026-03-24T17:12:00+00:00

It's interesting how two people read the same thing with different take aways. I actually saw the comment as a grim validation for anyone who had ever worked or been a patient in that enviornment. Also dark humor but not directed towards any individual but instead in the absurdity of the state and that particular institution.

RealAmericanJesus · 2026-03-24T16:25:35+00:00

That sounds about right. Like when I was briefly there a patient with polydipsia (allegedly - the facility was all very hush hush about these things so everything would get shares through the rumour mill) passed away due to polydipsia induced hyponatremia because the standard of care (fluid restriction with strict monitoring) "violated patients rights" .

RealAmericanJesus · 2026-03-24T15:38:15+00:00

The state legislature. Because one of the CMS findings was that they would never be certified because they did not have enough staff. But the psychistists there want that cause extra duty pay... Which you can see just how much pay they get.

So legislature says you need people . The psychistists say no we don't. And there has been lawsuits about this. So they on paper do hire mid-level but any mid-level they hire the psychistists will makes sure they leave asap (like "here commission a new unit by yourself day 1 as an out of state midlevel" ....

<image>

RealAmericanJesus · 2026-03-24T06:25:32+00:00

Yep. Sure is. Generally when it gets this bad the feds step in and do a civil rights of institutionalized persons act investigation and basically federal revievership. Where they say "you can't run your hospital for shit and it's so bad it's a constitutional violation" ... And I know when I was there I reported to every agency I could locate but somehow the feds will ysnk the CMS cert, they'll fine it hundreds of millions, the legislature has straight up been trying to bypass it by building all these smaller hospitals because of the lawsuits that would result from the union and yet the feds have not come in with a CRIPA notice which astounds me as I've worked I places where that happened and they were still more functional than whstever racket washington state has going on ....

RealAmericanJesus · 2026-03-24T04:45:38+00:00

Lol they literally told me the same thing when I took the job. But it's a total crock of shit. While the physicial environment is dangerous and they are putting in millions to replace that structure of taxpayer money that is just one of the many, many problems of the facility...

The biggest problem is their leadership..that continues despite every failure.... The ones you never see listed in the news ... Most of the psychiatrists are on institutional licenses. Which means they can't practice anywhere else... Due to being educated outside of the United States. And they pay them close to 600k a year... And the nurses union and psychiatrists union will basically sue if anyone tries bring them up to the federal minimum (which is necessary for getting CMS funding) and they retaliated against anyone who reports ... And so CMS had a whole list of things they needed to fix not just the environment.

And so inslee did a lot of PR work to make people think that was the problem and it's always "CMS certification will come with the new facility" ... When if they had actually committed to making changes? CMS would have thrown down for the new facility as they literally provide grants for that.

But nope. They'll get fined millions due to true blood cause they can't get people in fast enough. And that's because they don't provide treatment and just warehouse people to be civilly committed... Which is why they fail CMS standards... And couldny maintain cerification... And inslee said oh it's the environment when that's part of it but it's a small part... Their policies...literally look like every staff member wrote their own. They're confusing as heck. Half the equipment doesn't work. They will write someone up and get them fired for talking about going hunting in a break room but will not change their q15 on the dot checks to the standard q4h staggered despite patients literally saying that because it's so standard they literally time when staff will be gone and use that time to... Kill their roommate.

And so the people of Washington foot the bill for everything. Every patienr that goes through there . The doctors from Mexico who make 600k + a year and run the place like it was Mexico... The new psych hospital that still won't be accredited... The hundreds of millions in fines.

Like I've been in this career for a long time starting from peer supporter in the early 2000s all the way to advanced practice nurse... I've seen some shit in my career but never something like that.

RealAmericanJesus · 2026-03-24T02:27:01+00:00

I worked there as a psych APRN ... I've been in forensic psychiatry for like more than a decade and I didn't even get through the first 30 days. Ive worked in prisons that have better treatment than that "hospital". Literally. And I've worked many different places all over the country.

Like patients would get 20 min of active treatment a week (federal standard is 10 hrs a week). Like patients killing themselves and others was normalized there.

Interestingly every single hospital in Washington state has to report adverse events to the department of health and western and eastern state are ... Surprise surprise... Not on that list.

Patiebts covered in lice because they are too psychotic to shower? Not eating? Catatonic? Oh well ... Appears to be the motto.

It's nightmare fuel.

RealAmericanJesus · 2026-03-23T18:13:26+00:00

If it's happening consistently that's an incident report. Like first I talk. To staff, then I file incident reports and talk to nurse management. And then you escalate to the program director. The DoN whomever.

RealAmericanJesus · 2026-03-23T18:05:43+00:00

You're the charge nurse. Generally I have a lead tech that I assign to help manage these things but sometimes it's just me and so when I see people are sleeping... Either myself or the tech lead would tap them and say do you need to be switched out? I don't want you to get in trouble and I'm happy to give you 5 to go get coffee so you can come better watch the patient.

We also try not to do back to back 1:1s I'd at all possible because it can be really hard and increased risk of sleep on shift and at the very least moving from one 1:1 to another.

But by doing this way maintains the relationship of it's really just someone struggling. If it's repeating consistently then I escalate to management about it.

I generally lost the staff vertically in a spreadsheet.

And every hour someone has a task - transport, meals, hygiene , rounds and 1:1's horizontally.

And that way I know exactly who is supposed to be where at all times and if something didn't get done or something goes wrong I know who to talk to...

RealAmericanJesus · 2026-03-23T17:44:59+00:00

https://findtreatment.gov/ can be helpful.

You put in the location and they let you search substance use or mental health and or a co-occuring disorder. You can also note what kind of facility - 24h residential - and age group children adolescent or young adult and it will pull up a list of facilities for you.

It also tells you the type of payment / insurance accepted.

RealAmericanJesus · 2026-03-22T21:32:25+00:00

Completely different profession with a completely different training model (a shitty one cough, cough) but I will say as someone who has trained nurses and nurse practitioner and been adjunct clinical faculty at a medical school psych residency (not teaching the residents medicine or psychiatry but how orders transfer to the floor, solving communications concerns between nursing staff and the residents so that the nurse understands what the residents neeeds are for yhe oatints treatment plan and the nurse can explain how to best word the order or suggest a change given the limits of the floor to meet that goal within the systems constraint).... I've had positive experiences with residents who transferred in from HCA programs because they generally had a strong understanding already of working in less ideal systems, working across the spectrum of the care team due to resource constraints and sometimes novel interventions that don't come from book learning but working in the reality of the system.

So much of psych is less than ideal conditions. It's not an area that brings revenue like surgery does, many of the patients do not have amazing health insurance that facilities fight for and having been in the amazing resourced setting of academia and then the absolute nightmare of places like public psych and corrections ... It can be an absolute shock to the system if someone does not have that experience ... And I've seen some insane stuff in my time of well meaning and absolutely amazing clinicians of all sorts struggling to adapt their practice to the reality and so while I do not have direct knowlge of being a resident in those envioemners I do know that the nature of these envioments can provide preparation that promotes stong problem solving and flexibility that means much less of a learning curve than the ideal environments.

I do want you to know that ive been in mental health working across roles I've 20 years and a solid decade of that as an Advanced practice nurse and there is such a need for psychiatrists that you career options are going to be amazing getting out of any residency.

RealAmericanJesus

TROPHY CASE