An Interview with Linda Zangl: Peer Advocate at the Buffalo Psychiatric Center
By Karen Welch

Linda Zangl is the peer advocate assigned to the Buffalo Psychiatric Center, a state-run hospital located in Buffalo, New York. She has been employed in this position for the last five years.

"I do many different activities throughout the day including peer advocacy and peer counseling for patients. I also assist them with legal problems. I deal with family members of patients. This frequently happens when family members do not understand treatment plans. I provide reassurance and assistance with issues. I assist patients with seeking self-help.

"I also run self-help programs. One of these groups is a woman’s group. I facilitate a weekly Alcoholics Anonymous (AA) meeting. This meeting is strictly voluntary. It is not a designated program.

"I also facilitate an inpatient counsel which consists of a representative from each ward of the hospital. We meet every other week. There is a person from the hospital administration at these meetings. We deal with systems issues in these meetings. Patients bring their issues to the counsel meetings from their community meetings which are held in the wards. I also attend many of these community meetings.

"I also produce an inpatient newsletter. I try to get as many patients involved in this process as possible. This is a monthly newsletter written primarily by patients.

"I do an introduction group in the admissions ward for people who are new so that people learn who I am, what I do, and how to get a hold of me.

"I participate in discharge groups with the discharge coordinator so that people can choose where they want to live. I have assisted individuals with learning about the various places where they can live and helped them determine if they can afford this housing.

"When I first started working here, smoking for patients was a big issue. I helped patients write a petition to allow smoking indoors in inclement weather. This petition was successful so that now smoking is allowed indoors.

"I also run recreation (rec) groups and take people out on community outings. I take people to activities at the Wellness Center at BPC. They are able to swim or bowl. This allows people who are inpatients to interact with others who have been discharged.

"I have run a voting registration campaign the last three or four years. In the last several elections, we have had anywhere from 60 to 100 people register and vote. We take any individuals who are allowed by their legal and privileged status to leave the building, to the Buffalo State College campus where they vote. Most people request that I go in the voting booth with them so that I can answer their questions.

"The executive director of the facility has decided that he does not want to be involved with the patient grievance process. He has asked that I take over some of his role in the grievance procedure process. The current procedure is for me to assist patients with writing out a grievance. I then give it to the executive director who in turn gives it to the treatment team. I may or may not be called in to assist with mediating this grievance.

"I, along with a committee, rewrote the grievance procedure. The new process will allow me to have a role in mediating, and working out patient grievances directly with the treatment team unless it is a really serious issue that must go directly to the executive director or to the Office of Mental Health in Albany. This policy has been sent to Albany for approval.

"We are also hoping to get an advocate on each ward so that patients can see someone. I also work with the social worker when the patients are not happy about where they are being discharged to or if they feel that their discharge process is taking too long. I also do a discharge questionnaire with the patients as they leave BPC. I offer them any self-help information so that they can obtain this after discharge. I am able to follow some of them into the community for a short time but not too long because I have so much to do here at the hospital. However, I tell them that they can call me. I occasionally visit them out in the community.

"I am also on the Leadership Counsel. This group consists of all of the administrative people. They actually value my opinion here. The administration has been very supportive and I am backed by them 100 percent.

"I am also on the critical incident team. A critical incident is when someone has to be restrained or been involved in a serious incident on the ward such as violence between patients. This is a new team that I just received training for debriefing. I had complained that patients also needed to be debriefed after an incident. I am now on this team and I am able to debrief.

"I also attend treatment team meetings when a patient asks me to go. I may ask the team about a problem such as a lack of privileges.

"I am on the safe and therapeutic committee and helped to rewrite a policy. I am also on the restraint and seclusion committee. We also changed the policy there. Restraint and seclusion have now been reduced significantly in terms of frequency of use and the amount of time that you can keep a patient in these situations.

"I am on the program content committee. We set up things specific for our programs so that we can utilize the materials of other programs. I am also on the trauma and abuse committee. I have done many workshops in this area.

"There is consensus that we need to have a continuum between inpatient and outpatient services. I am working with the new director of operations at the hospital to try to close the gap between the outpatient and inpatient services.

"When patients request it, I have accompanied people to court for moral support to attend their retention hearings. I also accompany patients to the Erie County Medical Center and Buffalo General Hospital when they receive ECT if they request it.

"I also do some training of the mental health therapy aides so that they can understand what I do here. I help them to understand how they can advocate for patients also. These aides are the line staff, the ones who are with the patients every day. I also encourage them to get involved with other administrative things because they are very much involved with patient care. There are usually four or five aides on each ward per shift. They do a really good job with the patients.

"This ward is where patients receiving their daily programming so that they have easy access to my office. I have developed a library here in my office that is open to the patients whenever they are here. Patients can take any books, magazines, or self-help information that is here. Patients can also come in here and talk to me about anything. Patients can also request to see me.

"The only patients that do not receive programming on this ward are the elderly. However, I will go visit them if they call me. I also go down and see the elderly when they have their programming. I have sat with them. Many of these patients have dementia and do not communicate well.

"Right from the start, I have had a good relationship with the hospital administration. I continue to have a good relationship. The administration has found that I do not go to them with every small problem. In the beginning, it was difficult to interact with the staff. They did not want to talk to me. I understood that. However, over the years, that has changed.

"There are certain issues that I do not believe will ever be worked out to everyone’s satisfaction. One of these issues is smoking. The director of the hospital is not fond of smoking. Most hospitals have gone completely non-smoking. However, we have a large smoking room. We also have an outside area that patients can use. Yet, the director is not happy with this. We have started some smoking cessation groups for the patients. I myself quit smoking a year ago. I see smoking as very harmful. There are other things to look forward to in life than a cigarette. It’s a balance.

"When there has been anything that is really important, the administration takes all the steps that are needed to resolve it or I would take steps and repeatedly go after things so that I could get an answer and a resolution.

"I have a good rapport with the patients. When I first started here, I wanted patients to understand that I was not a state worker. I basically just hung out with the patients in every area that I could so that I got to know the patients.

"My own experience enables me to help patients. Knowing how it feels and what it is like to be in a hospital is what puts me on the same level. I do not know more than anyone else. This is a good feeling. I let the patients know this about me. I explain to patients that I have received mental health services in the past.

"There are often issues on the ward that I help mediate. Sometimes there are personality clashes between nurses and patients. Sometimes patients do not feel that they are getting their needs met in time or they are dissatisfied with their privilege status. Some people complain about the food or that they are not getting enough cigarettes. Some patients believe they should be discharged.

"I am proud of the self-help groups that I have created here. The AA meeting is very good. There are no other staff allowed in the meeting. We have a nice core group of people and there is a lot of good happening at this meeting.

"I also worked on the issue of access to fresh air for patients. I investigated that and determined that patients were getting out for an hour a day. If this is not happening, it is something that I want to know about.

"There have been a lot of good changes with the new administration at the hospital. Our director is very client oriented.

"So many of the people who come here are chronically mentally ill. There have been people here for years and years. People who are here are definitely long term. I encourage people to stay until they are stabilized. It is a very lonely life out there with the stigma and the lack of money. The hospital is not really all that bad a place compared to what awaits them outside.

"Medication has always been very beneficial to me. Counseling and therapy has also been very helpful to me. As long as I continue with that, I know I will be okay. As long as I continue with my self-help groups on a regular basis, I know that I will be okay. I am also very high energy. When I feel that I am getting to a place where I am going to burn out, I need to stop. I know what I need to do and I know what works. It has taken me years to fine tune it.

"I really enjoy what I do and I really enjoy the patients. We have a good rapport. I look forward to coming to work every day."