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Western State Hospital officials are planning a renewed focus on staff safety after an independent review found that violence there is rising again after five years of decline.

The 827-bed Pierce County psychiatric hospital is on pace for 412 patient-on-staff assaults this year, according to the review. There were 322 such assaults last year, 345 in 2011 and 301 in 2010.

The surge has taken place even as the number of patients and staff has gradually shrunk, according to the hospital.

Assaults by patients against staff at the other state hospital, a 287-bed facility in Spokane County, dropped from 108 in 2010 to 94 in 2011 and 90 last year, according to the review. Numbers for 2013 were not available.

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The 58-page report did not list theories for the increase at Western. Nurses mostly pointed to reduced staffing levels.

The report did find that many incidents are not reported. One nurse was quoted saying that’s because, “There are so many of them, we would do nothing else.”

Another said she felt safe “about 75 percent of the time.” And another referred to her workplace as a “crisis operation without vision.”

Officials said it’s a better situation than in 2006, when assaults on staff peaked and the state launched a concerted effort to address the problem. But they said the recent rise is concerning.

“There’s clearly work that needs to be done,” said Jane Beyer, assistant secretary for behavioral health at the state Department of Social and Health Services (DSHS).

The review listed 27 recommendations to reduce violence, included testing higher staff-to-patient ratios on some wards, creating a “float pool” of nurses that could move between wards and banning smoking, because smoke breaks disrupt therapy and takes up valuable staff time. Other suggestions included more training, new patient risk-evaluation and assessment tools and a reduction in paperwork, so nurses can focus on patient care.

The review, ordered as a condition of a new workers’ contract signed last year, was completed last month but has not yet been publicized because of disagreements between hospital management and union leaders on the language of a joint statement.

The hospital plans to form a committee to study the report and identify recommendations to implement, Beyer said.

The Legislature this year allocated $9.5 million for increased safety at state hospitals. Beyer said there are no plans to ask for more based on the new report.

“Funding is still tight everywhere,” she said.

It was unclear how much it might cost to implement the review’s recommendations.

The author, longtime New York workplace-safety consultant Jonathan Rosen, said he does not know.

Rosen’s report focused only on recent history. But safety has long been a major issue at Western State Hospital, which treats patients who have been civilly committed for at least three months as well as those who have been found incompetent to stand trial for a crime.

In 1999, a major report offered recommendations for addressing the problem. But between then and 2006, the number of severe assaults on staff doubled, according to a report to the Legislature at the time.

In 2006, due to assaults, about 5 percent of the workforce was unable to work at any given time and the hospital’s disability-insurance tab rose to $6.5 million annually.

But a concerted effort implemented shortly thereafter appeared to work. By mid-2010, the rate of assaults dropped to its lowest level since 2001.

The number of patients and staff also declined during that time — a trend that has continued. The number of staffers fell from 1,934 in 2010 to 1,917 last year.

Current staff at both Western and Eastern this week offered mixed reviews of administrators’ response to the violence.

Chris Forsythe, a 24-year nurse at Western, said, “They’ve taken this very seriously for many years. Safety is everybody’s concern here.”

But Sharon Silar, who has been at Eastern for 13 years, disagreed.

Silar, who said she suffered a dislocated jaw after being attacked in June — the fourth time she has been assaulted while working at a state hospital — hopes that will change.

“We’re hoping that with this safety report, they’ll hear us,” she said.

Information from Seattle Times archives is included in this report.

Brian M. Rosenthal: 206-464-3195 or On Twitter @brianmrosenthal

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