Mental Health Association of Portland

Oregon's independent and impartial mental health advocate

Grand Jury Transcripts Released in Springwater Corridor Police Shooting

Posted by admin2 on July 21st, 2014

From the Portland Mercury, July 18, 2014

The Multnomah County District Attorney’s Office this afternoon put out the transcripts—some 170-plus pages—of the grand jury probe this month that cleared a Portland police officer in the June 12 shooting of a homeless man, struggling with mental illness, along the Springwater Corridor trail.

READ – Multnomah County Grand Jury Death Investigation of Nicholas Drake.

Two officers, Matthew Nilsen and Robert Brown, had come looking for a man accused of trying to steal another man’s bicycle (as we first reported last month). That turned out to be Nicholas Glendon Davis. Davis took a pair of bullets after, cops say, he suddenly pulled a crowbar from underneath his shirt and charged at Brown, who fell down after taking his gun out.

The Mercury will look more deeply at the transcripts next week. But here are several excerpts from Brown’s testimony.

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28 Seconds : The Killing of Fouad Kaady

Posted by admin2 on July 21st, 2014

Eds. Note – the text below is from The Portland Indymedia Video Collective. Their online film was an important inspiration to the makers of Alien Boy: The Life and Death of James Chasse.

In the early afternoon of September 8, 2005, police encountered Fouad Kaady shortly after he was in an accident that left him in shock and bleeding, burned over much of his body. Rather than calling for medical help, the police commanded him to lie on the pavement, even though they could see the burned flesh hanging from his body, and even though they said he appeared to be “in a catatonic state.” When he did not comply with their orders, but instead continued to sit on the ground in a daze, they tasered him repeatedly. And then, they shot him to death.

In a report that was typical of the corporate media’s response to this killing, Channel 8′s ever-mealy-mouthed Kyle Iboshi held up a wad of papers left over from the “investigation” into the death, saying, “you can see how extensive this investigation was.” He then commenced to highlight (literally, with a yellow highlighter pen) what he claimed to be the relevant details of the case. Not surprisingly, Iboshi was very selective in what he chose to focus on. He accepted, without question, everything that the PIO had told him to say. He never asked a single question about why two officers might have shot an obviously unarmed man to death. And, he concluded his report by implying that Kaady must have been “on drugs” at the time of the killing, as if that might excuse the officers’ behavior.

And so, in a pattern of violence that is repeated almost every day in this country, the police got away with murder. So far, anyway. They did so because they have the power and the authority to carry guns and to use them, and to avoid facing the consequences of their actions. And, they got away with it because the complicit corporate media helped them to weave a story that would lull the public into silence. As in so many incidents like this one, they told a story that was engineered to cause people to blame the victim, and accept the violence. No questions asked.

The truth about what happened to Fouad Kaady is important. It’s important to bear witness when a member of our community is cut down like this. It’s important to stand up for the person he might have been, rather than accepting the media’s portrayal of him as merely some drug-crazed monster who “had it coming.” It’s important to know just how deep the culture of police violence runs through our cities and towns, and just how fist-in-glove the corporate media has been with the police state. And that’s why this video is important. Even if you think you know the story, you’re not going to believe this. Over the course of a year and a half, Videoistas painfully and meticulously gathered evidence, combed through records and reports, spoke with witnesses, and pieced together the real story. It’s much more disturbing than what you might have seen on KATU, but it’s the truth. And the least we can do for a fallen comrade is to take the time to learn the truth about what really happened to him.

Believe it or not, this story is told in the officers’ own words. And you won’t even believe what you hear.

This five part video series was made by The Portland Indymedia Video Collective and does not represent or speak for the Kaady family.

28 seconds : The Killing of Fouad Kaady, Part 1 of 5

28 seconds : The Killing of Fouad Kaady, Part 2 of 5

28 seconds : The Killing of Fouad Kaady, Part 3 of 5

28 seconds : The Killing of Fouad Kaady, Part 4 of 5

28 seconds : The Killing of Fouad Kaady, Part 5 of 5

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90 Corvallis residents parade silently around courthouse, thinking of those lost to suicide and how to save the next one

Posted by Jenny on July 20th, 2014

Corvallis Gazette-Times, July 20, 2014

Jeff McDaniel speaking at the rally

Jeff McDaniel speaking at the rally

As about 90 people stood in front of the Benton County Courthouse in Corvallis Saturday morning, a father climbed the building’s stone steps, stepped to the microphone and shared his pain.

“My son Kevin killed himself a year ago on Monday,” Jeff McDaniel told the crowd gathered for a march and rally to draw attention to youth suicide in the mid-valley, where an estimated nine teens and young adults have taken their own lives in the past year.

Many of those in the audience knew Kevin, or someone just like him. Those in attendance included staff and clients from Yes House, a residential treatment facility for young people battling addiction and other issues, as well as clients from other local treatment programs and family and friends of suicide victims from Linn and Benton counties.

McDaniel recalled his son as funny and charismatic.

“I loved him tremendously, and I miss him tremendously,” he said.

He also talked about the stigma surrounding suicide — and how stigmatizing mental health issues only makes the problem worse.

“I was ashamed,” he admitted. “I didn’t want to say it. I would have much rather kept it a secret.

“Nobody wants to talk about it,” McDaniel added. “Everyone wants to keep it a secret — and when we do that, we give it so much power.”

He urged the young people in the audience not to keep suicidal feelings bottled up, but find someone to talk to.

“Make it so it’s not a secret any longer,” he said.

Corvallis march 1 - people walkingOther speakers echoed that theme.

March organizer Vanessa Frias grew tearful as she recalled the names of some of the young mid-valley residents who had made the irreversible decision to take their own lives.

“They were really special people,” Frias said. “They meant a lot to other people, and we’re going to remember them today.”

State Rep. Sara Gelser, who helped pass a bill last year to add a second statewide youth suicide prevention services coordinator position, thanked the group for focusing public attention on the issue.

“We really don’t talk about it enough,” she said.

Gelser noted that efforts were underway at both the local and state level to make more services available for young people in crisis, but families still often face a three- to six-month wait to get help.

“We have a lot more work to do,” she said.

From the courthouse, the participants marched three blocks to Central Park, where they planned to make 10 circuits around the grassy open space.

“We wanted to do one for every life lost (in the past two years),” Frias said, “but we couldn’t get an accurate number.”

The march was organized by Yes House and the Oregon affiliate of Youth Motivating Others through Voices of Experience, known as Youth MOVE Oregon. Staffed largely by young people, the group has drop-in centers in Lane and Clackamas counties and has launched a program called Silent Watch aimed at raising awareness of youth suicide.

Corvallis march 2 - people walking (from further back) tree backgroundSome of the participants in Saturday’s march wore black Silent Watch hoodies bearing the slogan “Always remembered, never forgotten.”

Frias said she’s working with Youth MOVE Oregon to establish a chapter in the Corvallis-Albany area and hopes eventually to establish a local drop-in center.

Several organizations, including Youth MOVE, Yes House and the Oregon Family Support Network, set up informational tables near the gazebo at Central Park, where more speakers addressed the marchers.

One of them was Nikki Stagner of Blodgett, who talked about losing her 14-year-old daughter, Lilly, to suicide last October. She described her daughter as kind, thoughtful and loving and said she never saw any signs that Lilly might have wanted to take her own life.

“I don’t believe Lilly wanted to die that day. I just believe she wanted the pain — whatever pain it was she was feeling — to go away,” Stagner said.

If her daughter were still alive, Stagner added, she would have a message for those she left behind.

“I think she would tell us to speak out — speak out about suicide, speak out about how final it is,” she said.

And then Stagner added a message of her own.

“If you’re hurting, talk to somebody,” she pleaded.

“Suicide is final, and silence is deadly.”

Need help now? Call and talk to someone who understands

Clackamas County
24 hour crisis line: (503) 655-8585

Centerstone Clinic
11211 S.E. 82nd Avenue, Clackamas, Oregon – bus #72 & #71
Phone: 503-722-6200
Walk-in: Mon.-Fri., 10 AM – 8 PM and Sat.-Sun. 10 AM – 7 PM

Clark County
Crisis line: 360-696-9560 or 1-800-626-8137

Multnomah County
24-hour crisis line: 503-988-4888 or 1-800-716-9769

Urgent Walk-In Clinic
2415 SE 43rd Avenue, Portland, Oregon – bus #4 Division
Open 7 AM to 10:30 PM, seven days a week

Washington County
Crisis line: 503-291-9111

Also see our excellent resource for handling crisis.  Under the web banner, select “Get Help Now.”

Don’t wait.
The right time to prepare for crisis is BEFORE crisis.

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Recreational therapy makes a difference for OSH patients

Posted by Jenny on July 19th, 2014

Statesman Journal, July 19, 2014

Guy Forson (standing) works with Nick Stalheim

Guy Forson (standing) works with Nick Stalheim

“Down, down, sideways.”

Guy Forson repeats the words over and over in a way that is almost soothing. Nick Stalheim uses a scalpel to follow Forson’s directions, cutting squares out of a flat piece of clay that he intends to make into a castle for his eventual fish tank.

Stalheim’s face is scrunched into concentration, his blond mohawk bowed over the clay. Making these simple cuts isn’t easy for him, but he is utterly focused.

This is the goal of the recreational therapy classes Forson teaches at the Oregon State Hospital. Pottery, leather working, yoga: They are not as much about the skills themselves as about teaching patients behavioral skills most of them don’t have.

Forson, 57, has taught at the hospital since 1988. He has worked with patients ranging from children to the most violent criminals, from people just entering the hospital to those about to leave.

He has great faith in recreational therapy.

Every patient has a treatment plan that describes their mental illness diagnosis, what skills they need to work on and how they might go about treating their conditions.

Many take medication and attend traditional therapy. However, recreational therapy allows a place for them to apply their treatment plans in a realistic setting, Forson said.

For example, pottery can help a patient who can’t cope with frustration. Clay can be molded and re-molded again, over and over, flattening over mistakes and smoothing out imperfect edges.

“It’s just dirt,” Forson said. Little failures and frustrations don’t loom so large when one is working with clay.

Some recreational therapy can be very simple, he said. Often when working with new patients who have yet to make real progress in dealing with their mental illnesses, he takes them for walks outdoors.

It can be a triumph for someone with severe anxiety to leave the building, he said. Sometimes recreational therapy is about small steps.

The first time I toured the state hospital, I was skeptical. People who committed terrible crimes were making pots, painting pictures, learning to play the guitar and tossing basketballs around. It seemed, in some way, like a lack of justice. At the very least, it seemed like they should be in therapy.

Sitting in Forson’s class, I came to realize this is therapy.

He offered to let me participate, but at first I declined. I’m not artistic, and I felt shy about showing that off. But when I said, “I can’t,” Stalheim, Matthew Rhorer and Benjamin Purdy all let out an “Ooohhh…”

That’s not something you say in Forson’s class.

I tied an apron over my work clothes, which suddenly felt mildly ridiculous next to Forson’s washable purple plaid shirt and blue jeans, and his mental health aide, Evelyn Thompson, handed me a ball of clay.

I felt about as comfortable as a 19-year-old man holding a newborn baby.

Recreational therapy was never Forson’s plan in life, although in hindsight it seems like it could have been.

He grew up in Las Vegas, one of three children and the only boy. His father was the director of the parks and recreation department for Clark County, and his mother was a homemaker.

He played countless sports, from soccer to skiing to fencing to diving. Forson even became a professional trampolinist and toured around the Pacific Northwest doing shows. He also helped his younger sister, who was developmentally delayed, train for the Special Olympics.

“She’s a great bowler,” he said.

That experience led him eventually to recreational therapy. However, he started out at Brigham Young University with a major in psychology, and he was studying “biofeedback.” It’s an area of study that involves hooking people up to a machine, much like the ones used in a polygraph test, and using the data from the machine to teach people to relax.

They can even learn to slow their own heart rates, Forson said. It can be helpful for people with test anxiety or gastrointestinal problems, for example.

A bachelor’s degree won’t get you very far in the field of psychology, he said, so when he heard about BYU’s master’s program in recreational therapy, it seemed like a great choice.

He had seen how sports had helped his sister flourish, and both sports and creative activities, such as leather working, had helped him cope with his own birth defect: no fingers on his left hand.

“I always feel sorry for people with fingers on their left hand. How do you tie your shoes?” He chuckles at his own joke.

Recreational therapy allowed him to do all the activities he loved, he said, and help people at the same time. The perfect fit.

“All the skills of life can be taught through recreational therapy, and that’s why I love it so much,” he said.

At first I made the sides of my bowl too thin. I pulled the clay up far too quickly and aggressively, stretching it too much, too fast. Thompson watched me and eventually helped me fix it. She also helped me slow down, showing me how to keep my fingers wet and gradually smooth out the bowl.

I had had a bad morning that day. I’d run late and been trapped behind a minivan doing 10 mph under the speed limit, which is a pet peeve of mine. I was tense and stressed out, although I would have said I was fine.

The clay knew I was not. All of my nervous energy came out through my fingers. As I followed Thompson’s instructions and slowed down, so did my heart rate and my thoughts. My mind calmed down, and my bowl looked a lot better.

I chatted with Thompson and with the patients. Stalheim told me how the seated clay man he created was inspired by Kronos, father of Zeus in Greek mythology. Purdy told me how he loves music therapy, having been a musician before, and how pottery has forced him to use an entirely different set of skills. Rhorer told me some about his recent breakup and two friends who helped him through it.

Everyone was calm, focused on what our hands were doing, and conversation flowed easily. I imagined what it would mean to be someone suffering from debilitating anxiety or schizophrenia to achieve that sense of mental peace, and what Forson said about recreational therapy started to make sense.

The class projects Forson’s patients take on run the gamut.

There is Stalheim’s miniature castle for a fish tank, which is essentially one round turret.

There are Rhorer’s intricate, detailed projects, from a Spongebob Squarepants (complete with eyelashes and fingers and toes), to a jewelry box that is really a set of interlocking boxes with tiny chambers for earrings and necklaces. He is the quietest of the three patients in the class, with long hair and a skull ring, easily imagined as the shy high school junior who plays Dungeons and Dragons over the weekend.

Inside that quiet exterior, however, is a creative mind come alive under Forson.

Thompson has worked with Forson for years, ever since he started in the children’s unit. He is patient and helpful, she said, but willing to let people try something new and make mistakes on their own.

Creativity is part of a healthy life, he said, and that is true for everyone. It allows self expression and focus, yes, but it also allows patients an opportunity to connect to the world, he said. People stay in the hospital for years, and they don’t hold jobs, manage families or join community activities while they’re there. That sense of isolation can work against therapy, Forson said, because it creates anxiety about how they fit into society at large.

“The most scary thing in the world is not knowing,” he said.

He teaches patients activities that can help them connect to the world when they leave, from pottery to yoga to hiking. Those activities can help them bond with others and find a healthy way to spend their time, he said.

Recreational therapy also provides patients a metaphor for their mental health treatment, he said. The act of creating something out of nothing but dirt and water takes time, takes small failures and setbacks, takes patience and making connections, Forson said. All of that can be a metaphor for the path toward recovery from a severe mental illness, and it often helps patients understand that path and why they can’t recover immediately.

While his job requires Forson to approach creativity and recreation as therapy, he said those leisure activities are crucial for all humans.

“We know we feel better when we take time for recreation, for recreating ourselves again,” he said.

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BOLI complaint, filed after woman’s service dogs were barred from store, will go before judge

Posted by Jenny on July 19th, 2014

The Register-Guard,

Psychiatric service dog in training

Psychiatric service dog in training

A yearlong dispute between a Springfield woman and a convenience store owner that the woman says barred her service dogs from entering the store is headed to a labor judge.

Springfield resident Michel Hilt-Hayden filed a complaint with the state Bureau of ­Labor and Industries against Kara Johnson, owner of the Duck Stop Market on Franklin Boulevard. Hilt-Hayden alleges that Johnson discriminated against her in April 2013 by not ­allowing Hilt-Hayden’s two dogs, which she said are service dogs, to come into the store with her and her husband.

State and federal laws have granted people with disabilities the right to bring service dogs into public places, such as stores, restaurants, ­hospitals and government buildings. Hilt-Hayden’s case hinges on the question: What qualifies a dog to be a service animal?

Hilt-Hayden declined to comment on her complaint on Thursday, writing in an email, “I am a person with disabilities whose rights to public ­access rights were denied.”

She has said on several blog posts that she’s legally blind, and suffers from post-traumatic stress disorder.

Service animal laws

  • The federal Americans with Disabilities Act forbids privately owned businesses that serve the public from banning service animals in their establishments. Those include restaurants, retail stores, hotels, theaters, concert halls, taxis and other spaces.
  • Only dogs are defined as service animals under the ADA.
  • Dogs have to be trained to perform specific tasks for disabled people under the ADA, but they don’t necessarily have to be licensed as service animals. Nor do they have to be “specifically identified with certication papers, a harness, special collar, or any other form of identification.”
  • Animals that perform tasks such as providing companionship or emotional support do not qualify as service animals.

Federal law says service dogs must be “individually trained to do work or perform tasks for people with disabilities,” such as guiding blind people and calming people with PTSD who suffer from anxiety attacks.

Johnson referred questions to her attorney when reached for comment Thursday. The attorney, Jill Fetherstonhaugh, said in an email that the store owner had reason to believe the dogs weren’t performing the ­duties of service animals.

“Duck Stop Market denied access to two dogs brought into the store by Michel Hilt-Hayden because the two dogs were not ‘service animals’ as defined by state and federal law,” Fetherstonhaugh wrote. “At no time did Duck Stop Market deny ­Michel Hilt-Hayden access to the store.” She declined to go into details about the case, citing a hearing before a labor judge scheduled for Tuesday.

An investigation into the case by the Bureau of Labor and Industries found “substantial evidence of unlawful discrimination” by Johnson against Hayden, BOLI spokesman Charlie Burr said Thursday.

In general, if a blind person seeks to enter a store with a service dog, it’s rare that such a dog would be barred, according to Bill Perry, vice present for government affairs with the state Lodging and Restaurant ­Association.

Far more often, the association hears complaints from store owners when customers try to bring small animals such as Chihuahuas in the store, claiming they keep the pet around as an “emotional attachment,” Perry said

“That’s not covered under the law, and tends to disrupt other customers,” Perry said.

Hilt-Hayden is a board member for Springfield-based Sunstone Service Dogs, which partners disabled people with the ­service animals.

According to the complaint she filed, ­Hilt-Hayden and her ­husband brought her two service dogs into the Duck Stop Market in mid-April 2013. She alleges in the complaint that Johnson told the couple they would have to leave because the dogs weren’t allowed inside.

Hilt-Hayden said she referred Johnson to a poster in the Duck Stop window stating that service dogs are allowed, but alleges Johnson said she would lock the door to block them from coming back in if they tried to re-enter.

Hilt-Hayden alleges in the complaint that she returned the next day with her daughter to provide documents about service dogs’ access rights, but Johnson yelled at them and tried to swing the door shut, pinning Hayden’s ­daughter between the wall and door.

BOLI’S Burr said the state’s preference is for two sides in a labor dispute to work out a ­resolution between themselves.

But with no resolution in this case, a labor judge will hear their ­arguments starting Tuesday in Eugene.

“It’s a somewhat unique case,” Burr said, because Hilt-Hayden has written extensively about service dog issues.

A ruling against Johnson could result in civil penalties, he said, but there’s no timetable for a ruling to come down, and any decision could be appealed.

BOLI’S Burr said the state’s preference is for two sides in a labor dispute to work out a ­resolution between themselves.

But with no resolution in this case, a labor judge will hear their ­arguments starting Tuesday in Eugene.

“It’s a somewhat unique case,” Burr said, because Hilt-Hayden has written extensively about service dog issues.

A ruling against Johnson could result in civil penalties, he said, but there’s no timetable for a ruling to come down, and any decision could be appealed.


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In prison, shocking violence and mistreatment are common for inmates with mental illness

Posted by Jenny on July 18th, 2014

The New York Times, July 17, 2014

Naked man kneeling with cops trying to get him in, or out, of his cellAfter being arrested on a misdemeanor charge following a family dispute last year, Jose Bautista was unable to post $250 bail and ended up in a jail cell on Rikers Island.

A few days later, he tore his underwear, looped it around his neck and tried to hang himself from the cell’s highest bar. Four correction officers rushed in and cut him down. But instead of notifying medical personnel, they handcuffed Mr. Bautista, forced him to lie face down on the cell floor and began punching him with such force, according to New York City investigators, that he suffered a perforated bowel and needed emergency surgery.

Just a few weeks earlier, Andre Lane was locked in solitary confinement in a Rikers cellblock reserved for inmates with mental illnesses when he became angry at the guards for not giving him his dinner and splashed them with either water or urine. Correction officers handcuffed him to a gurney and transported him to a clinic examination room beyond the range of video cameras where, witnesses say, several guards beat him as members of the medical staff begged for them to stop. The next morning, the walls and cabinets of the examination room were still stained with Mr. Lane’s blood.

The assaults on Mr. Bautista and Mr. Lane were not isolated episodes. Brutal attacks by correction officers on inmates — particularly those with mental health issues — are common occurrences inside Rikers, the country’s second-largest jail, a four-month investigation by The New York Times found.

Reports of such abuses have seldom reached the outside world, even as alarm has grown this year over conditions at the sprawling jail complex. A dearth of whistle-blowers, coupled with the reluctance of the city’s Department of Correction to acknowledge the problem and the fact that guards are rarely punished, has kept the full extent of the violence hidden from public view.

But The Times uncovered details on scores of assaults through interviews with current and former inmates, correction officers and mental health clinicians at the jail, and by reviewing hundreds of pages of legal, investigative and jail records. Among the documents obtained by The Times was a secret internal study completed this year by the city’s Department of Health and Mental Hygiene, which handles medical care at Rikers, on violence by officers. The report helps lay bare the culture of brutality on the island and makes clear that it is inmates with mental illnesses who absorb the overwhelming brunt of the violence.

The study, which the health department refused to release under the state’s Freedom of Information Law, found that over an 11-month period last year, 129 inmates suffered “serious injuries” — ones beyond the capacity of doctors at the jail’s clinics to treat — in altercations with correction department staff members.

The report cataloged in exacting detail the severity of injuries suffered by inmates: fractures, wounds requiring stitches, head injuries and the like. But it also explored who the victims were. Most significantly, 77 percent of the seriously injured inmates had received a mental illness diagnosis.

Covering Jan. 1, 2013, to Nov. 30, 2013, the report included no names and had little by way of details about specific cases. But The Times was able to obtain specific information on all 129 cases and used it to take an in-depth look at 24 of the most serious incidents, including Mr. Bautista’s and Mr. Lane’s. The Times also examined numerous other attacks on inmates by jail employees uncovered independently of the report.

Rikers Island, the second-largest prison in the U.S.  Of 11,000 inmates, 4,000 have a mental illness

Rikers Island, the second-largest prison in the U.S. Of 11,000 inmates, 4,000 have a mental illness 

What emerges is a damning portrait of guards on Rikers Island, who are poorly equipped to deal with mental illness and instead repeatedly respond with overwhelming force to even minor provocations.

The report notes that health department staff members interviewed 80 of the 129 inmates after their altercations with correction officers. In 80 percent of the cases, inmates reported being beaten after they were handcuffed.

The study also contained hints of efforts to cover up the assaults. More than half of the inmates reported facing “interference or intimidation” from correction officers while seeking treatment after an altercation.

In five of the 129 cases, the beatings followed suicide attempts.

Many of the cases were similar to Mr. Bautista’s and Mr. Lane’s, in which several guards ganged up on a single inmate. At times, a slight aimed at a correction officer set off a chain of events that ended savagely.

While it was often hard to know what precipitated the altercation or who was at fault, the severity of the inmates’ injuries makes it clear that Rikers guards regularly failed to meet basic professional standards.

Even so, none of the officers involved in the 129 cases have been prosecuted at this point, according to information from the Bronx district attorney’s office. None have been brought up on formal administrative charges in connection to the cases so far either, though that process can sometimes be lengthy, and the Correction Department does not comment on pending investigations.

The assaults took place as guards have been struggling to contain surging violence at Rikers. The number of fights between inmates has increased year by year since at least 2009, according to Correction Department data. Assaults on correction officers and civilian staff members have also risen.

The growing numbers of mentally unstable inmates, with issues like depression, schizophrenia and bipolar disorder, are a major factor in the violence. Rikers now has about as many people with mental illnesses — roughly 4,000 of the 11,000 inmates — as all 24 psychiatric hospitals in New York State combined. They make up nearly 40 percent of the jail population, up from about 20 percent eight years ago.

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Portland Police lieutenant outlines new response to crises

Posted by Jenny on July 18th, 2014

The Lund Report, April 8, 2014

Cliff Bacigalupi, lieutenant, Portland Police Bureau

Cliff Bacigalupi, lieutenant, Portland Police Bureau

Portland Police Lt. Cliff Bacigalupi was a seasoned street cop when his police chief asked him to head up a new unit designed to address an unintended but growing part of the police force’s scope of practice — performing triage on the high number of people with mental illness in Portland who are not receiving appropriate care and end up the source of 911 calls.

Bacigalupi said up to 10 percent of all police calls in Portland involve a mental health crisis, including many people living on the streets in the rough-and-tumble Old Town area near the west end of the Burnside Bridge.

“We get a lot of calls of people jumping out into traffic, laying down in the train tracks,” Bacigalupi told the public at a Portland City Club forum last week. “If we have repeated calls with the same person, it increases our chances of having an adverse contact.”

Bacigalupi blamed the rise in police on the shuttering of state mental institutions and hospital psychiatric units. He said the wars in Iraq and Afghanistan had also left a large number of returning veterans with post-traumatic stress disorder and traumatic brain injuries, which too often lead to disturbances in which police become involved.

The U.S. Department of Justice forced the Portland Police Bureau to move in a new direction after a series of violent encounters between cops and people with mental illness. In a September 2012 directive, Assistant U.S. Attorney General Thomas Perez and U.S. Attorney Amanda Marshall wrote that they had reasonable cause to believe that Portland’s police were using excessive force during interactions with people who had actual or perceived mental illness, including an overuse of tasers to electrically shock suspects.

In August 2010, police repeatedly shocked a naked man in the midst of a diabetic emergency; in May 2011, a police officer punched an unarmed man in the face seven times while responding to a call to check on the man’s well-being.

“We believe strongly that in addition to protecting constitutional rights, addressing this problem will increase officer safety,” Perez and Marshall wrote.

A month after the directive, Bacigalupi was put in charge of the all-new behavior health unit, which partners police officers with mental health professionals who are better trained to respond to people in the midst of a crisis related to mental illness, alcoholism or drug abuse.

Nearly all Portland patrol officers now undertake a certain amount of training on how to recognize and respond to a mental health crisis. Another 50 to 80 officers receive enhanced training, and more specialized mobile crisis units are sent directly to the scene of incidents. After Bacigalupi spoke at Kell’s Irish Pub in Old Town, one such unit responded to a man in crisis within sight of the pub entrance.

In addition to connecting someone with immediate medical attention, the behavioral health unit works to connect the mentally ill person with resources and develop a long-term plan they can follow once out of their immediate crisis. “I am amazed at the results if you create a custom-made plan — how effective that really is,” Bacigalupi said.

Billy Kemmer, a civilian employee of the Portland Police Bureau, said similar services exist for people struggling with addiction, although services are limited by the number of program slots. “Being an addict needs to be addressed in a different way, same as mental health,” Kemmer said. “People have to go through [treatment] and change the trajectory of their existence.”

Chris Bouneff, the director of the National Alliance on Mental Illness — Oregon chapter, told The Lund Report that a poorly funded mental health system had inevitably made police the first responders and point of contact for many people needing treatment. “That was not a role that they were expected to play.”

He commended police officers like Bacigalupi for making an effort to change the culture at the Portland Police Bureau. “They seem to be sincere about their efforts to improve,” Bouneff said.

But Bouneff countered other opinions offered by police that the flood of mentally ill people living on the street is a result of the closing of institutions such as Dammasch State Hospital and its 375 beds in Wilsonville in 1995. He pointed to a separate Department of Justice investigation into the state’s over-reliance on mental institutions and dearth of funding for community mental health programs.

“There’s a reason DOJ is here asking whether we are needlessly putting people in institutions who do not need to be there,” Bouneff said. “You can only put so many people in a system and park them there. You can’t build your way out of this problem.”

Gov. John Kitzhaber has responded to that federal inquiry by leading a boost in funding from the general fund on mental health in the current biennium, including a recommitment of money saved by the federal Medicaid expansion. Senate President Peter Courtney, D-Salem, followed that budget up last fall with the passage of a small cigarette tax that will give mental health a dedicated funding stream.

The coordinated care organizations that Kitzhaber helped create for the Medicaid population are tasked with treating mental health along with other health needs, and CCOs have an economic incentive in making upstream investments in mental health care since that will cost the organizations less in total medical costs in the long run. But Bouneff said progress has been slow; in Portland, FamilyCare has integrated mental health services but Health Share has not.

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Suspicions, money drive MultCo’s near split with state health reforms

Posted by admin2 on July 18th, 2014

From the Oregonian, July 16, 2014

Emergency rooms flooded with people mentally ill or on drugs. A mental health program poorly managed. Agencies and health systems dumping people’s problems on each other to improve bottom lines.

Oregon’s health reform law, approved with much fanfare and hope in 2012, was supposed to solve problems like these.

Instead, Multnomah County, the state’s largest, has come to the verge of divorce with the main reform group set up to care for low-income residents in the region, documents and interviews show.

Clashes over money and control in the mental health system caused the Multnomah County’s near-breakup with Health Share of Oregon, the nonprofit organization founded by five competing health systems to oversee care for the Oregon Health Plan. The systems include almost all the region’s hospitals.

Multnomah County officials were so frustrated that in February, they hired a consultant for $83,000 to explore pulling the agency out of the group.

County officials told the consultant Health Share used its clout to pressure Multnomah County mental health to pay inappropriate claims from hospitals, thus shifting their costs to the county.

The mistrust is mutual. Health Share officials were so exasperated that they threatened to impose an outside manager over Multnomah County mental health services, according to county officials. (Health Share denies that assertion.)

The simmering dispute, which was not discussed publicly until late June, is a high-profile threat to reforms spearheaded by Gov. John Kitzhaber.

A breakup would have punted to Health Share the nearly $50 million-a-year program that provides for the mental health needs of more than 100,000 low-income county residents, leaving the already fragmented system even more so.

For now, the county has decided to try to negotiate a more favorable contract with Health Share.

But first it must counteract years of sloppy fiscal management, according to a report by County Auditor Steve March in April. He found that if the county doesn’t better track its own spending under the Health Share contract, the new arrangement could cost taxpayers.

March likens Health Share to an arranged marriage with state funding the dowry.

“I’ve seen arranged marriages by government before,” he said. “Sometimes they work, and sometimes they don’t.”

Reform’s promise

To understand how health reform is supposed to improve health outcomes of all kinds while reducing costs, consider the case of a homeless Multnomah County man with an alcohol problem as well as schizophrenia.

Under the old system, he’d be picked up by police over worrisome behavior: being threatening or suicidal while under the influence. He might be covered by the Oregon Health Plan for low-income residents, but he’d be dropped off at a hospital emergency room because alternatives are scarce and require more paperwork than the officer can handle.

The hospital would keep the alcoholic man under a mental health hold for up to five days, sending him back to the street with his underlying problems unaddressed.

The county and the hospital would be left fighting over the bill. If the county found that the man was in the ER because of alcoholism, the hospital would pay. If the hospital successfully argued it was mental illness, the county would be on the hook.

Before long, the man would be back, picked up for more worrisome behavior.

In the new world of health care reform, the state makes one entity, Health Share, responsible for the well-being of the homeless man with alcoholism and mental illness.

Rather than let him slip through the cracks while the county and hospitals discuss who pays for his hospital stay, Health Share is supposed to get providers to work together to keep him out of costly emergency rooms. Health Share also is supposed to save money by paying for care that will be more effective in improving the man’s long-term prognosis: supervised treatment programs, say, preferably coupled with housing.

But a June report by a consultant for Multnomah County paints a different picture of Health Share’s focus.

Instead of seeking lasting solutions for the homeless man, the Massachusetts-based Technical Assistance Collaborative report — as well as other documents and interviews — depicts a year of strife during which Health Share tried to make Multnomah County deny fewer claims from hospitals.

Susan Myers, the county’s just-departed human services director, told Multnomah County commissioners in a June 24 briefing, “Health Share believes that we deny too many claims for payment, with most of the complaints being from our hospital partners.”

Why is Health Share doing this?  The consultants suggest the reason is that the group’s board of directors is dominated by providers, mainly hospital executives.

The consultants’ report flagged this “unusual” arrangement as one the county might want its lawyers to review.

Shifting responsibility?

Multnomah County Mental Health, which receives state funding to care for 100,000 residents who are Oregon Health Plan members, conserves this money by denying what it considered inappropriate claims from providers.

What’s changed under health reform is that the county’s state funding under the Oregon Health Plan now passes through Health Share. And Health Share is using its new authority to question decisions by the county about whether or not to reimburse providers.

The consultants wrote that the county’s new relationship with Health Share has led to “considerable tension and concern” among county staff as well as “political pressure” to pay claims that county employees considered improper.

The consultants said Health Share had circumvented the county’s policies for bringing grievances and intruded on county cost controls, “undermining the county’s ability to appropriately manage care.”

Last fall, Health Share threatened to bring in an outside overseer to “take over” Multnomah County mental health, Myers told the board of commissioners.

County auditor March, a former lawmaker well-versed in healthcare policy, attributed Health Share’s pressure to a basic fact.

“Providers tend to want the highest reimbursement rate possible,” March said. “And they don’t want anyone scrutinizing it too much.”

Health Share responds

Health Share, for its part, says it did discuss bringing in an outsider reviewer but never made a decision to follow through.

The group’s leadership noted that outside reviewers overturn county denials of services at a high rate. Health Share officials suggested the statistic showed the county was being too stingy and denying too many claims.

Janet Meyer, chief executive officer of Health Share, said the group is working to better coordinate care to make sure clients’ needs are met, but it will take time to work out kinks in the system.

“What we’re trying to do as a company is figure out how we work with all our partners and the available funds to make sure clients get the services they need,” she said. “We’re working it out.”

She agreed that the short hospital stays faulted by the consultant are a longstanding problem but denied the group’s focus is on payments for hospitals.

“We don’t disagree that these clients that are cycling through on these really short stays need to get connected to outpatient services in the community,” Meyer said. “That’s a part of what we are working with our partners about… It’s obvious that there are hospitalizations that can be avoided.”

Asked whether the Health Share board has a conflict of interest when it comes to its staff pressuring the county to be more lenient with its payments to hospitals, she said the board stays out of operational issues and “meets the legislative requirements” of health reform.

County management issues

The county’s consultants concluded that before the county tries to negotiate more favorable terms with Health Share, it should address management issues of its own.

Multnomah County doesn’t just serve Oregon Health Plan members.

It receives funding to care for indigents, employs case managers for the mentally ill, and operates services open to anyone like the 24-hour crisis line. It has mixed state, federal and county funds as needed in the past to support the integrated program, the consultants wrote.

In the end, the consultants suggested the county negotiate better terms with Health Share while hiring new managers and purchasing a data management system to better track and justify spending.

They said if the county pulled out, the growing power of Health Share and other coordinated care organizations would put the county in danger of being shut out of important decisions.

County Chairwoman Deborah Kafoury said she didn’t know about the conflict with Health Share before she took office in May but agrees with the consultants’ recommendations. She said she would monitor Health Share closely.

“We will need to up our game,” she said. “We can’t be afraid to challenge the way we do things. These are people’s lives at stake.”

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