From a distance, the campus looks like a small suburban office park. Buildings are fringed by a wide lawn, but on the perimeter is a tall metal fence, topped by barbed wire. This is Napa State Hospital, a psychiatric hospital managed by California's Department of State Hospitals.
Here, anyone who enters the secure area, workers and visitors alike, passes through multiple doors, metal detectors and locked gates.
While most people with mental illness are not violent, more than 80 percent of Napa’s patients are referred here by the criminal justice system. Some of them committed horrific crimes but were found not guilty by reason of insanity or incompetent to stand trial but ordered to a psychiatric hospital.
Many of these patients can still be dangerous. Last year alone, the hospital says they committed more than 1,800 physical assaults.
For staff here, this week marks a somber anniversary. It was here, on October 23, 2010, that psychiatric technician Donna Gross was murdered by a patient -- grabbed, dragged and strangled to death.
"Everyone who was here the day that Donna died on these grounds has PTSD, and we will never be able to address it. We just carry it. It's there," says Michael Jarschke. He has worked as a psychiatric technician at Napa State Hospital for 32 years.
At the time of Donna Gross’s murder, staff members all carried alarms to call for help. But Jarschke says that back then the alarm worked only inside the buildings -- not outside, where Gross was murdered.
"When you think about it today, that's almost ludicrous that we would do this," Jarschke said. "We always look back five years [later] and say, 'Wow, we were really dumb back then.' ''
As president of the union representing psychiatric technicians, Jarschke helped form the “Safety Now Coalition," employees who organized -- and demanded -- change.
Hospital Executive Director Dolly Matteucci says there have been changes, like limiting the ability of potentially dangerous patients to walk around freely.
"At this point in time, we have a much more stringent and informed and comprehensive grounds access policy," Matteucci said.
Matteucci describes the most important change at Napa -- a new personal alarm system with GPS to help hospital police respond more quickly to emergencies anywhere on the grounds. She has one hanging around her neck and explains that by pulling it, it sends an "immediate notification to dispatch and to all hospital police."
When I asked how frequently staff members are pulling the alarm, I was astonished by her response.
"The tag gets pulled from 11 to 17 times in a day," she told me. "Staff might see a patient escalating and say, 'That’s looking a little precarious. I want a little help before I engage that patient.' "
She says that the heavy use of the alarm system illustrates how difficult it can be to serve such a challenging population "in a very complex, active environment that was not built for a forensic patient population."
Napa State Hospital opened in 1875. Until 20 years ago, most of its patients were civil commitments. Today, the vast majority have criminal backgrounds, including gangs. In fact Napa patients include members of the Crips, Bloods, Aryan Brotherhood -- they're all there.
To address that, Matteucci says, Napa has added more hospital police. But the hospital remains a dangerous place for staff.
At a hearing of the state Senate Health Committee last year, psychiatric technician Stephanie Diaz gave tearful, halting testimony, recounting her recent experience with one patient. As she was escorting him up a stairwell, she said he tripped her, pinned her to the floor and attempted to rape her.
"I started screaming at the top of my lungs," she told the committee, "praying that someone would hear me. I wasn’t sure if I (had) pulled my alarm completely, and after a slight delay I heard the alarm sound and help arrived. It felt like an eternity. And I feared for my life."
Diaz was testifying on behalf of legislation that would allow California's five state mental hospitals to isolate the most dangerous patients and give them more intensive treatment. The bill, AB 1340, passed and was signed by Gov. Jerry Brown last year, but it will take time to implement.
Napa psychiatrist Steve Seager is a vocal critic of hospital administration. He says much more needs to be done to protect both patients and staff.
"Violence is part of our life every day," he said. "It’s just a constant thing. It’s not like violence happens now and again. Violence is part of the daily life at Napa."
It begs the question: Why would anyone want to work here?
Despite the violence, despite their criminal records, the clients at Napa are patients, not prisoners. Hospital director Matteucci reminds us that as patients, they have certain rights.
"They have the right and ability to be out and about in their treatment environment, treatment in groups. Exercising as a group. So it's just a demonstration of the complexity of our system," she said.