Report 97121 Summary - March 1998

Department of Mental Health:

Changes in State Hospital Security Measures Can Reduce Annual Costs While Maintaining Public Safety

Results in Brief

The Department of Mental Health (department) operates four hospitals for mentally disabled patients. Our audit focused on the security measures used to prevent forensic patients at these hospitals from adversely affecting the safety of the staff, other patients, and the public (forensic patients have either been convicted of a crime or found incompetent to stand trial). During our review of the security measures at the four hospitals, we found the following areas where security costs could be reduced:

  • The perimeter security at Napa and Patton hospitals could be operated more cost-effectively by using enhanced security measures such as double-fencing, redundant electronic detection systems, and dedicated patrols.

  • Additional savings could result at Patton hospital if the department took over the perimeter security function currently provided by the Department of Corrections.
During our audit, we also identified the following security issues:
  • Internal security procedures and practices should be standardized.

  • Staff at some hospitals are complacent toward security policies and needs.

  • Qualifications and training for hospital police officers need to be upgraded.

  • In limited situations, hospital police officers should be armed.
Finally, we reviewed the department's estimates for forensic population growth, and found that after June 2003, patient population growth will exceed the number of available beds. In addition, because the department's security risk-assessment process is based on excessively narrow criteria, patients are considered high-security risks solely based on their history of prior escape. Moreover, some patients may be considered low- or medium-security risks even when their behavior may suggest that they represent a threat to the community.


To increase the cost-effectiveness of its perimeter security operations, and to reduce the State's annual security costs by approximately $7.4 million, the Department of Mental Health (department) should:

  • Complete the detailed planning, design, and construction of an enhanced double-fence security system at Napa and Patton hospitals, including redundant electronic detection systems.

  • Upon completion of the Napa and Patton fence projects, initiate mobile internal and external patrols, thereby permitting reductions in staffing. All patrol units should be equipped with portable alarm receivers for immediate notification when the fence sensors are activated.

  • Eliminate two of the four guard posts at Metropolitan hospital.

  • Install additional perimeter fencing with disturbance sensors at the front of Atascadero hospital and on roof lines of the administration building.
To increase the overall internal security at each hospital and to reduce staff complacency toward internal security matters, the department should:

  • Implement a plan to improve the internal physical security at all hospitals. The plan should survey all buildings to identify the specific needs, including glass and window spaces, fences and courtyards, exterior door alarms, personal alarm systems, portable metal-detection equipment, X-ray and metal scanning equipment, and alarm systems for courtyards.

  • Centralize fundamental physical security decisions for all hospitals.

  • Improve the standardization of important operating practices, especially daily patient counts, key control, locking and alarming doors, and patient transportation.

  • Conduct periodic unannounced audits of internal and perimeter security. Such audits could be conducted by staff from headquarters and other hospitals as a form of training and peer review.
To protect staff and the public from potential assaults by patients, the department should seek legislative change to make certain patient acts a felony. Specifically, any forensic patient who escapes or assaults staff should be charged with a felony.

To increase the overall qualifications, training, and effectiveness of its hospital police officers (HPOs), the department should require all new HPOs to complete the same level of certified training that Napa and Metropolitan HPOs receive. In addition, to protect patients and officers, officers who transport patients off-grounds should be armed. The department should ensure that all armed officers are fully trained and screened.

To improve overall coordination and control of security at its hospitals, the department should centralize coordination and control of hospital security.

Finally, to meet the expected shortage of hospital beds in June 2003, the department should plan facilities with more beds. In addition, to allow the greatest flexibility to treat and house its growing population of forensic patients, the department should revise its security risk-assessment process and request that the Legislature remove the current law that restricts admitting forensic patients directly to Napa hospital.

Agency Comments

The Department of Mental Health generally agreed with our recommendations and indicates that it will review the findings with local legislators, law enforcement agencies, concerned community groups, and others to determine the course of action it will take.