Josh Akeo doesn’t remember if he lost consciousness but he knows he was kicked in the head at least twice.

Since then he’s lost 30 pounds, and has been diagnosed with symptoms related to post-traumatic stress disorder, something more commonly found in soldiers than in people of his profession.

Akeo is a registered nurse at the Hawaii State Hospital in Kaneohe, and helps provide mental health services to patients who have been committed to the facility.

But he’s also one of many victims who have suffered beatings at the hands of some of those patients who some say are too violent to control with the resources available.

While there are contract security staff on hand, officials say they’re not allowed to wrestle the patients into submission.

There also aren’t trained correctional officers on hand to help the psychiatric staff handle patients who were committed to the hospital by a judge.

“We have nothing to protect ourselves,” Akeo said. “All we are trained for is to take care of the mentally ill. We are not trained in self defense.”

Akeo is one of four state employees who have recently come forward after being assaulted while working at the state hospital.

He spoke during a press conference at the State Capitol on Wednesday. State Sens. Clayton Hee and Josh Green announced they were launching a far-reaching investigation that could result in sweeping changes in how Hawaii cares for its mentally ill and those who treat them.

“This whole system may need to be overhauled,” Green said. “It certainly needs to be reviewed, which is what Sen. Hee and I are describing. It’s going to be a big process.”

Hawaii News Now first reported on a rash of violence taking place inside the walls of the state hospital. Among the revelations was that assaults are frequent, and in 2012 attacks were occurring on average once every three days.

According to the employees who are speaking out, much of the problem has to do with understaffing, mismanagement and a severe lack of training that puts everyone in the hospital at risk.

Even more concerning are allegations of retaliation by supervisors against their employees who report being assaulted.

“Sometimes at work you don’t know if you’re going to be punched in the head, kicked in the head or taken down and slammed against the bricks,” said Ryan Oyama, a psychiatric technician who says he has been assaulted 60 times in the past 10 years.

“It’s really hard to speak out because I was already threatened with being fired from my job. This is something I need. Everybody needs to work. Everybody needs to live. Something needs to be done.”

But history seems to be repeating itself. This isn’t the first time that the Hawaii State Hospital has come under the microscope for a spate of assaults on staff.

Hee said he thought he addressed the issue in 2008 when the Legislature passed a new law that made it a felony for assaulting a state mental health worker.

But now that it appears the problem hasn’t gone away, he said it’s time to hold people accountable for a lack of solutions.

In particular, Hee called out Mark Fridovich, who is the adult mental health administrator for the Hawaii Department of Health. Fridovich had downplayed the staffing issues in the Hawaii News Now article, saying that it was “adequate.”

“For him to suggest staffing is adequate is very unfortunate because that suggests an attitude that the status quo is OK,” Hee said. “I would submit to you that if Dr. Fridovich was assaulted he might not feel the same way.”

Fridovich had also told the television station that his agency takes each assault “very very seriously” and that there’s follow up to see if any policy changes need to be made.

But to hear the victims tell their story paints a different portrait.

They say there are many people who are afraid to come forward because they fear retaliation from their superiors. They also say that being a victim of assault is just something that comes with the territory of working inside the hospital.

“We’re getting hurt,” said Kalford Keanu, another psychiatric technician at the hospital who has decided to speak out. “They say it’s part of the job, but half of these assaults can be prevented.”

Another disconcerting trend that will likely be explored during the investigation is the response of the employee unions, specifically the Hawaii Government Employees Association and United Public Workers.

Each of the four victims is represented by one of the two unions, but they said they did not receive much assistance in the way of getting help after the assaults. Some victims have said they have since had contact with their union representatives.

Hee and Green have scheduled the first hearing for Dec. 1.

It’s unclear exactly how long the hearings will last, but the senators made clear that they intend to tackle every facet of the issue from committing patients through the criminal justice system and providing more security to looking at new psychiatric treatment options and studying how to properly house mentally ill criminals.

This means that in addition to the Department of Health, the senators will also be talking to the Hawaii State Judiciary and the Department of Public Safety, which earlier this year said had a crisis on its hands after a several suicides and escapes.

Hee said the investigation will also ferret out who exactly is to blame for what to him is a recurring problem, and that he expects to get pushback from the state. He acknowledged that any solutions, which could range from hiring more staff to building new facilities, will likely be expensive.

“The costs to the injured workers is a cost borne by all of us regardless,” Hee said. “The state has a duty to protect all employees of the state with reasonable care. It’s apparent to me that the state’s not meeting that obligation.”

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