Addressing the Challenges of Riots in Adolescent Psychiatric Hospitals

Lauro Amezcua-Patino, MD, FAPA.
6 min readJun 9, 2024

by Lauro Amezcua-Patino, MD, FAPA.

by Lauro Amezcua-Patino, MD, FAPA.

Navigating the landscape of an adolescent psychiatric hospital comes with its own unique set of challenges. As a veteran in this field for over 35 years, I have experienced firsthand the immense pressure and obstacles that accompany such a role.

Nurses, therapists, and psych techs are often thrust onto the front lines, tasked with ensuring safety and providing care to patients who may be experiencing severe mental distress. All too often, however, these dedicated individuals are met with limited resources and support from administration. It is within this complex environment that riots can erupt, causing chaos and danger for both patients and staff.

In order to fully comprehend the occurrence of riots in a psychiatric hospital setting, it is important to understand their root causes. From profit motives to inadequate support systems, there are numerous factors at play that contribute to these unsettling events. With this knowledge in mind, it is crucial for those working in these facilities to have access to practical strategies and tools that can help prevent or effectively manage riots when they do occur.

In this blog, I aim to provide you with a comprehensive understanding of why riots occur and the role that various factors play in their escalation. Through sharing my own experiences and insights gathered throughout my career, I hope to offer valuable guidance for navigating this challenging aspect of working in an adolescent psychiatric hospital. Whether you are a seasoned professional or just starting out in this field, I believe that by equipping ourselves with knowledge and resources, we can create safer environments for both patients and staff alike.

Understanding the Roots of Riots in Adolescent Psychiatric Hospitals

1. Emotional Volatility and Trauma Histories:

Adolescents in psychiatric settings may present with a complex history of trauma, which can manifest itself through intense and unregulated emotions. This may lead to impulsive and aggressive behaviors that can be challenging for both the individual and those around them. For example, a teenager who has experienced abuse in their past may struggle with managing their emotions in response to perceived slights or lack of attention from staff. Without proper intervention, these emotional responses can escalate into group disturbances, highlighting the importance of early and effective management strategies in such situations.

2. Group Dynamics and Peer Influence:

During adolescence, individuals are particularly susceptible to the influence of their peers. This can have a powerful effect on group dynamics, as even a seemingly minor incident or act of disobedience by one individual can quickly spread and incite larger-scale unrest within the group. For example, in a group therapy session, if one patient begins to act out or display disruptive behavior, others may be encouraged or feel pressure to join in. This seemingly small incident can rapidly escalate into a significant disruption for the entire group, causing potential setbacks in their therapeutic progress. It is important for educators and counselors to be aware of this phenomenon and address any disruptive behavior promptly to maintain a positive and productive learning environment for all individuals involved.

3. Perceived Injustice and Boredom:

Emotions such as anger and frustration can often stem from a sense of unfair treatment, lack of meaningful engagement, or simply boredom. When patients in a particular setting, such as a hospital or rehabilitation center, feel neglected or misunderstood by staff members, their resentment can quickly escalate into collective unrest. This can manifest itself in behaviors such as protests, violent outbursts, or even full-blown riots. It is important for facilities to create an environment that not only meets the physical needs of patients, but also provides engaging activities and fosters open communication between staff and patients to prevent these negative emotions from bubbling over. Failure to do so can result in a dangerous situation for both patients and staff alike.

The Impact of Profit Motives on Patient Care

One of the major concerns surrounding for-profit facilities is the issue of understaffing and overworking. In order to keep costs low and maximize profits, these facilities may operate with minimal staff, leading to employees that are overworked and unable to provide adequate supervision and care for their patients.

This can have a significant impact on patient well-being, as overwhelmed staff may miss early signs of agitation or distress among patients. This could potentially lead to situations that could have been prevented with proper staffing and supervision.

Furthermore, for-profit facilities may also cut corners when it comes to allocating resources for staff training and therapeutic programs. Without sufficient investment in these areas, staff may not be equipped with the necessary skills and knowledge to effectively handle crises and provide quality care to patients.

This lack of proper training can have devastating consequences, as staff may inadvertently escalate situations rather than calming them due to a lack of understanding of de-escalation techniques and trauma-informed care.

Additionally, for-profit facilities often prioritize admissions in order to maximize revenue, which can result in high patient turnover and an overcrowded environment. This can have a negative impact on the stability of the patient community, making it difficult to establish trust and consistent care routines.

In conclusion, these issues within for-profit facilities highlight the importance of adequate staffing, resources, and training in providing quality care for patients who are often in vulnerable and delicate conditions.

Strategies for Frontline Professionals to Prevent Riots

The prevalence of systemic issues and profit motives within the mental health care industry can create challenging working conditions, making it essential for staff to employ effective strategies to prevent riots and maintain a therapeutic environment.

One crucial strategy is building strong therapeutic relationships with patients. This can be achieved through actively listening, validating their feelings, and showing empathy. Regular one-on-one check-ins with patients provide opportunities to identify and address grievances before they escalate.

In addition to building trust and rapport, promoting structured and predictable routines also plays a critical role in preventing unrest. Consistency can help reduce anxiety and provide a sense of security for patients. It is essential to ensure that daily schedules are clear and predictable, including therapeutic activities, recreational time, and group sessions.

Boredom can be a significant trigger for unrest among patients, so it is crucial to provide access to a variety of engaging and therapeutic activities. This could include organizing regular recreational activities such as art therapy, sports, or music sessions.

De-escalation techniques are another powerful tool when managing potential riots. Training in techniques such as active listening, maintaining a calm demeanor, and using non-threatening body language can help defuse tense situations. In the event that a patient begins to escalate, approaching them calmly, using a soft voice, and acknowledging their feelings can help reduce their agitation.

Moreover, involving patients in decision-making processes related to their care and the unit’s rules can foster a sense of ownership, reducing feelings of helplessness. Regular community meetings where patients can voice their concerns and suggest changes to routines or rules are an excellent way to encourage patient involvement.

Lastly, while it may feel daunting, advocating for better working conditions is crucial for maintaining a therapeutic environment. Documenting incidents and communicating the need for improvements in staffing levels, training, and resources is vital. After a significant incident, preparing a detailed report highlighting these needs and presenting it to supervisors can lead to positive change within the facility.

Final Thoughts

As a frontline professional in an adolescent psychiatric hospital, your role is crucial in maintaining a therapeutic environment and ensuring patient safety. You wear multiple hats — building strong therapeutic relationships with patients, promoting structured routines, engaging them in meaningful activities, utilizing de-escalation techniques to handle tense situations, involving them in decision-making processes, and advocating for better conditions.

These efforts are vital in creating a safe and supportive space for vulnerable adolescents who are facing mental health challenges. Despite the profit-driven motives of the system, your commitment to their wellbeing shines through as you work towards a better future for these young patients. Together, we can strive towards a more compassionate and supportive system that prioritizes patient care above all else.

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Lauro Amezcua-Patino, MD, FAPA.

Dr. Lauro Amezcua-Patiño: Bilingual psychiatrist, podcaster, clinical leader, educator, and researcher. Expert in forensic medicine and mental health issues.