DSHS launches virtual reality training to develop patient empathy at Western State Hospital

Empathy is seeing with the eyes of another, listening with the ears of another and feeling with the heart of another.” Anonymous

The Department of Social and Health Services is using the latest in state-of-the-art technology to enhance its efforts around safety and patient empathy at its oldest and largest 24/7 facility — Western State Hospital.

To create the five-part virtual reality (VR) training, the agency used funding provided by the state Legislature and Governor Jay Inslee for safety and training investments. On the first day of orientation, new employees put on a high-resolution virtual reality headset and immerse themselves, with a 360-degree view, in a person’s life who is living with a mental illness. This person-centered learning approach is designed for staff to better understand how patients might be feeling and what they are going through.

“This is cutting-edge technology with proven results and it is just one of the ways we are headed towards a transformation of mental health care in our state,” said Cheryl Strange, Secretary of the Department of Social and Health Services. “We know that just how you say ’no’ to someone experiencing symptoms of mental illness, for example, can make the difference between a good interaction with a patient and violent episode.”

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“When a Voice Returns” follows the fictional story of Lena, right, a musician and single mom to Kayla, left, as she copes with a psychiatric crisis.

Part of Western’s New Employee Orientation, the training introduces staff to Lena, a single mom and a musician who is living with schizophrenia. They learn about Lena’s trauma as a child, are there when she first experiences auditory hallucinations and when, due to her disorienting illness, she makes a terrible mistake. The trainees go with her on her journey through the legal system and eventual admittance to Western. They also get to see Lena as she enters recovery from her mental illness.

Lena’s story was informed and developed by real former and current patients at Western and Eastern State Hospital who shared about their experiences with mental illness, hospital care and their recovery journey. Seasoned staff from both hospitals, such as nurses, clinicians, trainers, social workers and mental health technicians, also ensured a realistic portrayal of staff and patient experiences in the training.

Dr. Jordan Charboneau, a forensic psychologist at Western, advised the cast and crew with nuanced progression of symptoms and treatment. “It’s often the case that I hear about from patients that its very difficult differentiating what’s real and what’s not real. It is the patient’s reality, but it might not match what’s going on around them. And that can be a terribly confusing and frustrating experience,” Charboneau said.

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In pivotal moments, viewers morph into Lena’s perspective as symptoms of schizophrenia warp her sense of reality, such as this interaction with her boss and a customer.

The decision to invest in virtual reality training was heavily influenced and inspired by research pointing to virtual reality as a strong tool to affect and deepen people’s level of empathy. A 2018 Stanford study simulating the experience of becoming homeless found VR to be more effective in developing long-lasting compassion than other types of media.

Similar applications of VR include CPR training found to be as effective as instructor-led courses and verbal de-escalation and empathy training designed for police departments.

Since 2019, violence at Western has been reduced by 15% with safety initiatives such as the opening of the STAR Ward, which allows for specialized treatment for the 10 most violent patients at Western, and Advanced Crisis Intervention Training that is mandatory for all employees at Western.

“This VR training will prepare people for the job ahead while helping staff, who are often young and inexperienced with the unpredictable situations that happen in a psychiatric facility, build empathy for those who have been diagnosed with a mental illness,” Strange explained. “This will allow them the ability to actually walk in the shoes of our patients and help them understand and look for different reactions so they are able to provide care in a safer environment for all.”

“Safety is our number one priority,” added Sean Murphy, Assistant Secretary for DSHS’ Behavioral Health Administration. “Making sure our staff are equipped with all the necessary tools they need to be successful in their jobs means that patient care along with safety will improve.”

Lena’s story in VR compliments a 2-week course that embeds verbal de-escalation techniques, understanding mental illness and person-centered care approaches. Western Instructional Safety Administrator James Ortega helps new staff understand the importance of supporting themselves and patients stay in balance.

“The emphasis is to help ourselves self-regulate so that we don’t let adrenaline and fear get the best of us in the process of supporting a patient in crisis,” Ortega said.

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Frustrated and scared by a triggering event, Western hospital staff work with Lena, other patients and each other to de-escalate a crisis situation on the ward.

The training has been underway for over a month and is getting great initial reviews from staff. Terry Stevenson, a registered nurse who recently took the training, said VR was intense and gave a strong feeling of how Lena is suffering.

“I’ve heard people say they hear voices,” Stevenson said. “But I’ve never seen something make it more real. I think this will help me more when I’m talking to somebody and they’re not responding. It makes it more real.”

Patients have also noticed a difference. One patient, who is not being named to protect their privacy, said of the entire new employee training experience staff receive before working on the wards: “It’s been phenomenal. It’s changed peoples’ demeanor and the way they handle things. They handle patients with more care.”

DSHS’ strategies for ensuring safety at the hospital include enhancing engagement between staff and patients, implementing early intervention strategies, preventing patient escalation, maximizing preventive approaches to maintaining a safe environment and implementing evidence-based practices and treatment interventions to decrease assaults. All of these strategies require the implementation of effective training — and VR is just one of the tools the agency will use to address the above approaches.

For more information about the VR project, please see visit the DSHS website.

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