At 10:30 AM, Sunday, May 5, 2024, at the American Psychiatric Association's Annual Meeting in New York City, a session was held which was entitled, "Responding to Reports of Sexual Violence on Psychiatric Inpatient Units."
It should have been entitled, "Responding to Reports of Sexual Violence on Psychiatric Inpatient Units, as long as No Staff are Suspected Perpetrators." (Sorry for my bitter sarcasm here, but this was the most discouraging moment of the whole APA weekend in New York!)
Four clinicians were presenters: Benjamin Brody, M.D., of Weill Cornell Medical College; Victoria Wilkins, Ph.D., also of Weill Cornell; Elizabeth Ford, M.D., of Columbia; and Kati N. Lake, Ph.D. About 40-50 people attended, most of whom were mental health professionals who work on in-patient psychiatric units.
Dr. Brody was very fidgety and nervous. He was a little hard for me to hear, although I was actually sitting in the first row. He spewed loads of statistics. (That seems to be a sort of automatic response to the whole world by these people, as though numbers and raw, unevaluated data in sufficient mass can protect them.) The important point Brody made early on was that some kind of investigation must be conducted into every patient allegation of sexual abuse, even if the patient says they were raped by Santa Claus.
He didn't say what kind of investigation, and I had no opportunity to ask whether it should be... thorough or a sham, honest or part of some cynical political cover-up.
There was in fact a carefully suppressed undertone throughout this session of minimizing, or even dehumanizing, patients. Of course they will say they were raped by Santa Claus, right? They're crazy after all, they don't have real points of view. I didn't like some of the things people laughed at.
Dr. Brody was followed by Kati Lake. Her contribution was all about trauma-informed care. Being subjected to sexual violence in a psychiatric institution sure does cause trauma! In fact, Dr. Lake made the quotable statement, "The hallmark of sexual violence is betrayal of trust." She also repeatedly suggested that mental health professionals ought to ask patients a different question than what they have been trained to ask: they should not ask, "What's wrong with you?" but instead, "What has happened to you?"
At some point Victoria Wilkens mentioned that patients know everything that's happening on a clinical unit. This was a point of agreement for Dr. Brody. He replied (nervously fidgeting), "Yes, they certainly know what's happening better than staff: that is 1000% correct!"
Almost all of this hour-and-a-half session was about how to deal with patient-on-patient sexual violence. E.g., the perpetrator has to be treated, too; but there are legal, even criminal implications, and that complexity along with the trauma factor (which extends beyond individuals to the whole milieu) must be competently managed.
Only Dr. Ford ever mentioned the elephant in the room, and she did so very briefly, with a mere passing comment: "Sexual violence can also be perpetrated by visitors, or even (implying... as unlikely as it may seem, or as rare as we all may know it to be...) by staff."
I stood up immediately when they called for questions or feedback from the audience, and thanked Dr. Ford for acknowledging, if only barely, the reality that my entire legal practice is all about. Sexual abuse of involuntary mental patients by staff is absolutely endemic in state operated psychiatric inpatient facilities. I asked the panel why this reality was so severely, desperately, avoided in the session.
Dr. Brody fidgeted a bit more. He offered what was to my mind a comment, not an answer: There are other ways to deal with that, like strict rules about boundaries and the ability to fire or even prosecute staff who violate the rules. "We don't owe staff any treatment, we only owe that to patients."
I responded that if indeed patients know what's going on on a clinical unit better than staff, and if indeed the hallmark of sexual violence is betrayal of trust, then surely the whole therapeutic milieu that's necessary for any mental health treatment to occur at all will be utterly ruined by the kinds of situations that I am suing people for in Illinois. I described the claims we have filed, e.g., for a young black man who was seduced by his middle-aged white female social worker into a three-year sexual affair that took place entirely on the inpatient clinical unit. I mentioned that the social worker did eventually get fired and go to prison for that; but the patient still attempted suicide three times within a few months after he was released, and he will never again trust anyone who offers to "treat" him.
There was some back-and-forth with the panel, but nobody in the audience was willing to comment or engage. This was obviously not their preferred subject of discussion. I can't say for sure whether that was because it just wasn't very relevant to their experience, or whether it was all too relevant. I sure suspect the latter.
Afterwards, I had a collegial conversation with a Dr. Kayla Isaacs, M.D., who spoke about a patient she recalled, obviously delusional, who complained virtually every day that she'd been raped the previous night in her psychiatric hospital room. (What to do, what to do?)
I also asked Dr. Lake if she was familiar with Lucy Johnstone, the psychologist from England, who as far as I know invented the idea that patients should be asked what happened to them instead of what is wrong with them. She didn't know of Lucy, but Dr. Wilkens piped up to say that she was familiar with her.
As I walked out of that room, I got the funny feeling that these people might be talking about me, and they might have been suspicious of me.
They sure as hell should have been!
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