STRIKE

AND STRESS IN A MAXIMUM

SECURITY

HOSPITAL

Raul H. Vispo, M.D. Denise Shine, Ph.D.

The eighteen day strike of correction officers in New York State in April-May 1979 impacted u p o n Central New York Psychiatric Center (CNYPC) in upstate New York. While not a correctional facility, CNYPC is a maximum security hospital treating mentally ill offenders in the correctional system. All patients are involuntary, actuely ill, convicted persons, some serving life sentences who are returned to the correctional system upon discharge from the hospital? CNYPC was opened in September 1977. Until this time, Matteawan Hospital (circa 1892) of the Department of Correction Services had taken care of the above mentioned population. After a famous class action suit against the State by the inmates at Matteawan (Negron v. Ward, et al.), it was decided that Matteawan should be closed and a new smaller facility (150 to 200 patients instead of 1,100) opened but under the responsibility of the Department of Mental Hygiene (tbday's Office of Mental Health). By agreement of the two departments a new director was appointed with the mandate of: (a) screening all the patients in Matteawan and deciding the level of care that they needed; (b) closing Matteawan and opening CNYPC. A core of senior staff joined the director in this task (that also involved the move of 98 patients over 200 miles away). The new director and his core group of staff were committed to integrate security and treatment. There would be no more correction officers in the hospital, instead Security Hospital Treatment Assistants (SHTAs), in which the fundamental integration of keeping a secure environment and treating the inmates as patients was based. But the SHTAs, some of them from the old Matteawan, decided to keep their alliance with the union of the correction officers (Council 82). They were paid commensurately to the correction officers and not as the Mental Hygiene Therapy Aides (MHTAs) of the other State Psychiatric Centers. The rest of the staff of CNYP was represented by two other unions. Clerical and maintenance staff by the

At the time of this study, Dr. Vispo was Deputy Clinical Director and Dr. Shine was Chief of Psychology Services at Central New York Psychiatric Center. The third researcher besides the authors was David Snyder, Central New York Psychiatric Center Director of Quality Assurance. He died at the early age of 38 in February of 1984. Address reprint requests to: Raul H. Vispo, M.D., Associate Clinical Director, Harlem Valley Psychiatric Center, P.O. 330, Wingdale, New York 12594. PSYCHIATRIC QUARTERLy, 57(2) Summer 1985 © Human Sciences Press

11 1

112 PSYCHIATRIC QUARTERLY

Civil Service Employees Association (CSEA), which also represents the MHTAs in the other State Psychiatric Centers and the Professional Employees Federation (PEF), which represents physicians, nurses, and other professionals. This succinct review alerts two problems that crystalized during the strike and after it: (a) the strong commitment o f the director and some of his core group to the new hospital made them react to the strike as a personal injury; (b) the covert tension between SHTAs and the professional staff, due to levels of salaries and roles in the security--treatment couple, exploded during the strike and lingered for a long time afterwards.

T H E STRIKE On April 18, 1979 Council 82 declared a '~job action" term used in trying to avoid being considered on "strike" and being penalized. Strikes by state employees in N.Y.S. are forbidden. Very soon picket lines were around all the prisons of the State and the two hospitals with SHTAs (CNYPC and Mid-Hudson Psychiatric Center). To the surprise o f the director and other senior members o f CNYPC, 93% of the SHTAs followed their leaders and remained out until the end of the strike. At that moment there were 144 patients in the hospital. The staffwas composed of 310 members; 150 SHTAs and safety officers, 50 professionals, and 110 administrative and supportive personnel. The first 48 hours were the most critical hours but the situation became more stable with the arrival and deployment of 175 National Guards (only permitted by the Governor to help with "life support" functions), and the arrival of volunteer staff from other psychiatric centers. As days went by the frustrations of the striking staff members grew. A shed on the grounds was set on fire, there were bomb threats, threatening phone calls to non-striking staff and their families, tires slashed, clerical staff intimidated as they crossed pickets lines, twenty-eight strikers arrested for trespassing, etc. After a very generous compensation package was offered to the non-strikers, volunteers from other hospitals were abundant and morale was high. Conversely as the strike dragged on with no solution in sight, the strikers became increasingly disenchanted. Negotiations were being carried on in Albany and were geared primarily to the needs of the corrections officers not the relatively small group o f hospital workers also included, A siege mentality developed as each day seemed to bring the situation no nearer to a solution. After two long weeks a settlement seemed imminent and a transition plan had to be developed for the re-entry of the strikers to the facility and a resumption of normal functioning. Feelings and emotions were strong on both sides. The plan eventually implemented sought to minimize face-to-face contact between the departing volunteers and National Guardsmen and the incoming strikers.

PRELIMINARY STUDY When it finally appeared that the strike was to be settled within the next 24 hours, a preliminary study was done with 12 staff members (including the director and se-

113 RAULH. VISPOAND DENISESHINE

nior members of the administration) who had remained within the institution during the strike in order to get some assessment as to feelings, attitudes, and problems of the preceeding two weeks, The most prevalent moods were apprehension and hope. Some respondents expressed feelings of anger, disappointment, fear, rejection, and detachment. Primary concerns during the two weeks of the strike were related predominantly to issues of patient and staff safety as well as the adequacy of staffing during the crisis situation. Major concerns expressed at the point when the strike was just about over tended to center about the upcoming re-entry process. The potential for animosity between strikers and non-strikers was particularly at the forefront, ttaving succeeded in meeting the crisis without the SHTAs, professional staff wanted to maintain the positions of authority that they had assumed at the time of the strike. Concern was expressed about the patient reaction to the return of the strikers. On some wards patients expressed their anger and disappointment at being "deserted" by the treatment assistant staff. The exhaustion and stress that many respondents seemed to indicate on this preliminary survey led to the decision to undertake a more comprehensive, indepth appraisal of both strikers and non-strikers with specific regard to the various physical and mental stresses endured by each.

JOB ACTION SURVEY A search of available literature on the subject of emotional, social and physical reactions to strike situations in both strikers and non-strikers proved unsuccessful. George L. Hogben and Robert Shulman z in 1976 studied the patient and staff reactions to the eight day strike of employees at Mount Sinai Hospital, N.Y. They used a questionnaire devised to survey feelings and attitudes about the situation and the participants in the strike. Kenneth Meinhardt ~in 1978 discussed the effects of a 17 day strike by mental health workers in Santa Clara County, Cal. His emphasis is on how to cope with a strike and how that can provide an opportunity for innovation. In our study, in order to best assess the stresses and problems experienced by strikers and non-strikers alike, a job action interview guide was developed. Lengthy (one to two hours) semi-structured interviews were prepared. The interview consisted of 48 questions, organized into sections related to specific time periods.* The period before the job action was defined as being the time period within one month of the beginning of the strike. The period covered by the strike is from April 18 to May 4. The re-entry period is from May 4 to May 19 during which time-off staff resumed their former duties. The resolution period was categorized as being between May 19 and the time of the interviews in the fall of 1979. Participation in the survey was voluntary, with anonymity protected. The interviewees chose the time, place, and which of the three researchers they preferred as an interviewer. The director supported the project and permitted the meetings to take place during working hours. In total, 54 interviews were conducted, 25 with strikers (out of a total of 132) and 24 with non-strikers (nine nurses, three recreation therapists, one M.D., one psychologist, one social worker, three occupational therapists, two medical records *Interviewguide availableupon request from main investigator.

114 PSYCHIATRICQUARTERLY

personnel, and four supply services). Five non-striking Council 82 members were also interviewed but considered as a special group. Additional information was obtained from logs kept during the strike and the personal recollections of key participants such as the Director, Personnel Officer, Business Officer, Director of Nursing, Chief of Security, and others.

RESULTS

Expectations Strikers and non-strikers alike had unrealistic expectations of the strike. Nobody expected it to last more than two days. T h e administration had initially planned that there would only be 40 to 60% participation in the job action. In reality, as it turned out, there was almost total participation (127 out of 136 or 93.4% of the union went on strike). The strength of the union was grossly underestimated. Almost uniformly the strikers expected to gain much more money and a higher standard of living as a result of the strike. In particular, the affiliation with the correction officers was felt to be a strong impetus towards the quick solution of the strike by the state. The upper limit expected by strikers was one week, while in reality it lasted 18 days.

Major Considerations in the Staff~ Decision to Strike or Not Generally, the strikers listed as most important the fact that they were members of the union, that their co-workers were on strike, that it was necessary to strike in order to obtain a fair contract and in general, that peer pressure coincided with true belief in the position of the union. A few expressed concern at leaving the patients unguarded and unattended, but believing that the strike would be of short duration they felt that management could cope with the situation. The most important consideration for the non-striking staff members were given as loyalty to patients and the lack of support of their unions for the striking union. Several cited financial problems or a provisional civil service status which could lead to dismissal. Several questioned the legitimacy of the strike because of the no-strike provisions of the State's Taylor Law. In some cases, members of the same family were on opposite sides o f the picket line, leading to situations of personal conflict.

Symptoms of Stress When questioned about symptoms of stress which occurred before and during the strike as well as during the period of re-entry and resolution, 84% of the strikers and 91% o f the non-strikers reported some symptoms o f stress. Symptoms were similar between both groups but the pattern o f time-frames varied. Disturbances in sleeping or dreaming were common. Reports of insomnia, early-morning awakening and the need of medication in order to obtain any sleep were reported. Terrible dreams and recurrent nightmares were described. Some related dreams of violence, one of children crying. Sleep problems often persisted

115 RAULH. VISPOAND DENISESHINE

after the end of the strike. Few spouses, parents, or children were having sleeping problems as well. Many respondents reported being tense, high-strung, anxious. Some felt "uptight," quick and jumpy, and depressed. Some had difficulty concentrating and doing detailed work or becoming "hysterical." In some cases, spouses and children were also affected, showing symptoms of anxiety. Flare-ups in physical symptoms were also reported by many respondents. Such things as higher blood pressure, nausea, lower back pain, upset stomach, diarrhea, loss of appetite, vomiting, loss of weight, and bronchitis were mentioned. In one case psoriasis flared up. In another case, there was an abnormal rhythm and fluttering of the heart. In general, gastrointestinal problems seemed to predominate with such things as "nervous stomachs," ulcer pain, diarrhea, nausea, and poor appetite being prominent. In general too, there were changes in habits of drinking and smoking. Some reported increased consumption of both, although some found an opportunity to quit smoking. Some noted heavy consumption of coffee in order to stay awake for long hours on duty. Alcohol consumption tended to increase on off-duty hours. However, most respondents reported that three months after the strike their drinking and smoking consumption had returned to pre-strike levels. Interpersonal problems were cited often in great detail. Financial problems headed the list for the strikers. Since the day that the strike started was a payday, some had received no paycheck for two weeks before the strike and received no paycheck during the strike. In some cases, this resulted in severe financial hardship. In one case, a home about to be purchased was lost. Financial stresses seemed to cause particular problems in cases where the marriage was already shaky. A few strikers ended up divorced or separated, partially due to the stresses of the strike. In some cases spouses were upset when strikers were arrested for trespassing and resented the impact of the strike on home life and children. The non-strikers reported other kinds of interpersonal problems. The basic problems here seemed to revolve around the long periods of time away from the home with no social life and with concern expressed about the personal safety of the non-strikers. One respondent was worried about his pregnant wife and 18 month old baby at home. Many non-strikers had friends and relatives who were striking and friendships were lost. In some cases there were personal threats to the safety of the families and cars or other vehicles damaged. In one case graduation plans had to be changed because the non-striker was forced to drop a course. Former friends suddenly became enemies. As the financial pressure on the strikers increased, the amount of expected overtime pay and bonuses of those non-striking, increased. The impact of the financial disparity between the two groups ended up in great friction. In addition to the loss of the regular paycheck, the strikers knew that in the future they would also be paying Taylor Law penalties on two day's pay for every day on strike.

Patterns of Response Of the 25 strikers 21 reported symptoms of stress (84%) of the 24 non-strikers 22 reported symptoms of stress (91%). While both strikers and non-strikers alike showed many symptoms of stress which in general tended to be similar, the time pe-

116 PSYCHIATRICQUARTERLY

riod during which greater stress was experienced differed. While both reported the greatest incidence of symptoms during the strike, the strikers tended to keep high levels of stress symptoms during the re-entry and the resolution periods. The nonstrikers had high incidence of stress symptoms during the strike but these quickly abaited in the re-entry and were no longer present during the period of resolution to any significant degree. The continued high stress symptoms for the strikers during their re-entry and resolution period was very possibly heavily related to their financial circumstances. Strike penalties had been assessed or were pending and the financial problems at the time of the strike were still ongoing burdens to many. It is interesting to note that in their group "problems at home" increased in the resolution periods over the re-entry periods. In contrast, the non-strikers could took forward to substantial bonuses. The stress symptoms that continued in the non-strikers during the re-entry and resolution periods were generally related to the hostility and anger to which they were subjected by the returning workers. This varied considerably according to the job that the person had performed during the strike and the perception by the strikers as to the role they had played in running the ward successfully during the strike. Chi-square tests were performed between the 21 groups comparing the number of stress symptoms in each period. There was not a significant difference beTABLE 1 Strike and Stress Problems

During

Re-entry

Sleep/Dreams

13

7

Nerves

14

i0

9

4

Increase Alcohol & Tobacco Use

14

14

Problems at Home

19

Sl eep/Dreams

19

4

Nerves

ii

7

Physi cal Symptoms

11

6

Increase Alcohol & Tobacco Use

12

Problems at Home

12

Physical Symptoms

&

Before

Resolution

13

117

R A U L H. VISPO AND DENISE S H I N E

tween strikers and non-strikers before d u r i n g or the re-entry periods. But at the resolution period the strikers showed significantly more symptoms of stress (X21 = 25.87, p < .01). W h e n asked to rate their j o b satisfaction on a scale o f 1 to 6 (6 being most satisfied to 1 being least satisfied) before and after the j o b action, it was discovered that non-strikers t e n d e d to have about the same level of j o b satisfaction before and after the strike. However, strikers indicated that they were much less satisfied with their j o b after the strike than before. A t-test suggests that there were no differences between strikers and non-strikers prior to the strike on measures of j o b satisfaction but in the resolution p e r i o d the same test suggests significantly less j o b satisfaction in the strikers than in the non-strikers (t46 = 2.127, p < .05). W h e n it is reviewed what periods were most and least stressful for the strikers and non-strikers the following results were found. A.

B.

that "During" was the most stressful period for both groups, but that "Resolution" was significantly "more stressful" for strikers than non-strikers. T h e r e were no significant differences between the two groups in the other stages. that "Before" was the least stressful period for both groups, but "Resolution" was significantly "less stressful" for non-strikers than strikers.

T h e r e were no significant differences in the other stages. T h e r e was no significant difference in overall level of stress between the two groups prior to the strike but in the "Resolution" the strikers r e p o r t e d significantly m o r e overall stress than non-strikers as reflected in the t-test (t45 = 2.545, p < .05). T h e last issue to review is "Relationship with Immediate Supervisor and Administration" before and after the strike. A.

In relation with the immediate supervisor, t-tests were p e r f o r m e d on all possible differences between strikers and non-strikers both before and at TABLE 2 Strike and Stress Most Stressful - Least Stressful Period Least Stressful

Most Stressful

Strikers

4

14

4

7

13

5

3

Non-Strikers

I

16

6

i

10

i

2

Chi-square test significant (X2(l) : 3:94, p /__.05) for the Resolutlon Period.

NOTE: Some "Strikers:' gave more than one answer.

4 ii

Chi-square test significant (X2(1) = 4.31, p~-,.05) for the R~solution Period.

118 PSYCHIATRIC QUARTERLY

B.

resolution. There were no significant differences. It may therefore be concluded that strikers and non-strikers rated their relationship with immediate supervisors similar to each other and similar both before the strike and at resolution. In relation with the administration, the results are quite different. Strikers rated their relationship with the administration significantly poorer than the non-strikers before the strike (t46 = 2.773, p < .05) and even worse at r e s o l u t i o n (t46 = 4.332, p < .001).

Additionally, non-strikers ratings of immediate supervisors and administration were not significantly different either before the strike or at resolution while strikers rated administration significantly lower than immediate supervisors both before the strike (t24 = 8.178 p < .001) and at resolution (t23 = 11.328, p < .001).*

CONCLUSIONS Strikes in Health Services are always more dramatic than in other fields. They are much less frequent and they directly involve the safety and care of a third party (patients). The strike studied in this presentation has another unusual characteristic related to the type o f patients: inmates, which meant serious security considerations. The strike at CNYPC only brought out in the open problems that have been under the surface from the opening of the hospital. Although in theory the security-treatment dilemma has been resolved in a very positive manner, in reality the situation was somehow different. T h e security hospital treatment assistants (SHTAs) were seeing their role mainly as guards or correction officers. Special pay scale and their membership in the correction officers union is a clear indication of this. To TABLE 3 Strike and Stress Relation, shi p with ,I,mmediate Supervisor and Admin,i,stra,t,,i,on

Immediate Supervisor Resolution

Before

Strikers

1553

14

7

-

2

Before

(B/79)

1

11 (2

Non-Strikers

Administration

1

-

9

1

2

-

Resol uti on

5 8 7 4 -

1 7 7 7 2

absentions

12 101

1

-

8

151

-

*The statistic calculations were prepared by Charles D. Horowitz, M.A.

-

9 9 6 -

119 RAUL H. V1SPOAND DENISESHINE

the surprise o f many o f them the institution d i d n ' t collapse after the first few days o f the strike and no major incidents were reported. It has been said that it takes years to heal the wounds provoked by strikes, this one is no exception. Still today after six years the strike is a c o m m o n subject o f discussions and a possible cause o f some administrative problems such as the high level of overtime.* T h e survey demonstrates not only the acute disturbance d u r i n g the strike in the p h y s i c a l - - e m o t i o n a l make u p o f the participants (strikers and non-strikers) but also the lingering effects in the personal and family life mainly in the strikers that were considered the losers in the confrontation. T h e decrease of j o b satisfaction and the deterioration in the relationship with the administration of the hospital on the part o f the strikers were also warning signs o f future problems. Similar reactions in both groups d u r i n g the strike period is understandable. Both were u n d e r considerable pressure in difficult conditions. Most of the clinical staff, except physicians, decided to live on the campus through all the strike period. !n that way they avoided the daily harassment at the crossing o f the strike lines but they isolated themselves from their families. T h e strikers' families expressed increased concern as the strike lingered and the optimism for a favorable settlement decreased. T h e re-entry period, especially the first two to three days, was a very tense period for the two confronting groups. T h e strikers were defiant and angry, trying to deny that they were really the losers and blaming the clinical staff that have done their jobs for their lack of success. Friendships were lost, the silent treatment was used mainly against the three senior S H T A s that didn't join the "job action." T h e strikers' reaction against the volunteers o f other state institutions was even more intense. For the contrary, they felt that the National G u a r d had just obeyed orders and therefore couldn't be blamed for their participation. T h e non-striking clinical staff were not in a mood for letting the situation go back to the previous status-quo in which security was dictating in many occasions patient programs and management. T h e p r o l o n g e d a n d persistent effects o f the strike d u r i n g the resolution period was d u e in part to an u n f o r t u n a t e coincidence. T h e penalties that the Taylor Law imposes on Civil Service employees when they strike was contested a n d appealed but to no avail. T h e r e f o r e , the striker's paycheck was quite m e a g e r for a while. Meanwhile, the non-strikers received generous rewards for the long hours worked d u r i n g the strike. T h e disparity was obvious and d i d n ' t help to calm the situation. This survey is one o f the first attempts to study the effects that a strike has on the participants (strikers and non-strikers) a n d their families. A strike should be considered a stressor and efforts should be m a d e to minimize its consequences for the well being o f the participants and their families as well as for the function o f the affected institution. REFERENCES 1. Von Holden MH: ProvidingQuality Mental tteahh Inpatient Servicesto ForensicClients - A FiveYear Experience. Psychiatric Quarterly 55: 35-41, 1983. *The second part of this study willaddress the broader subjectof the interaction betweenthe administration of CNYPC and the staff before and at:t.erthe strike and the repercussionsof it in the functioning of the facility.

120 PSYCHIATRIC QUARTERLY

2.

Hoshen GL, Shulman R: Patient and Staff Reactions to a Strike by Essential Hospital Employers. Ameri-

can Journal of Psychiatry 133: 1464-1465, 1976. 3. Meinhardt K'. Strikes and Community Mental Health Services. Hospital and Community Psychiatry 29: 50-53, 1978.