Jackie Feik, left, and her sister Bonda Powell sit in their sister’s Redmond home Thursday evening. Their sister, Cindy Powell, committed suicide Monday at St. Charles Bend.

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Cindy Powell’s sisters both say her 50 suicide attempts weren’t what they seemed.

“She didn’t want to die; she just wanted help,” said Jackie Feik, who traveled from her Port Orchard, Wash., home to Redmond to settle her younger sister’s affairs.

She sat in Cindy Powell’s normally tidy studio apartment in Redmond on Thursday night, wondering what went wrong when her sister committed suicide at St. Charles Bend this week.

Feik, 54, pointed out blood stains on a white and pink bedspread from Powell cutting herself in her apartment last week. Her sisters found a blood-stained knife they think Cindy used to hurt herself.

Powell jumped from a balcony in the hospital’s main lobby Monday after she broke free from two escorts who were taking her to a secure mental health facility, said Robin Henderson, director of behavioral services at the hospital.

Powell, 51, had been a patient since Saturday, when she attempted suicide by overdosing on a sedative, Henderson said.

When she jumped from the balcony, Powell landed on her back, hit her head and ultimately died of head trauma, Henderson said.

But Feik and her youngest sister, Bonda Powell, say Cindy was more than just a mental health patient. She was a “girly girl” who loved to watch thunderstorms and had her proudest moments when she worked with the Redmond Civil Air Patrol as a spotter, Feik said.

And she had the rather un-ladylike habit of chewing “bandits,” small packets of chewing tobacco.

Pleas for help

Cindy Powell lived a life of depression and darkness, with brief moments of sunshine, her sisters said.

“I don’t think Cindy’s had many bright spots for, I don’t know, 10 or 12 years,” Feik said. “She didn’t enjoy anything anymore.”

Meticulous notes Powell left behind document her misery. Physical problems like severe headaches and an inability to sleep are listed in the notes.

Powell wrote things like “I feel like I’m fading away” and “Please help me!!!”

Other notes have mundane details like what medications she took and when.

They affected her short-term memory, Feik explained, so Powell wrote down nearly everything she needed to remember.

Powell had been diagnosed with borderline personality disorder, post-traumatic stress disorder and chemical dependence, according to St. Charles.

Years of medical documentations show she also had severe depression.

The bag of pills she took for those conditions sat on a large area rug as Powell’s sisters talked about her lifelong struggle with mental illness.

Troubled teen

Powell started behaving oddly when she was about 14, her sisters said. She believed that she could conjure spirits with a Ouija board and once tried to jump out of a second-story window.

Her parents were alcoholics, Feik and Bonda Powell said, who moved around a lot to avoid bill collectors.

As she got older, Powell became a regular runaway and ended up in homes for runaway girls more than once, Bonda Powell said.

“Her mental illness built up and built up,” she said. “Mom and dad would try to take her to the doctor, but nobody could ever find anything wrong with her.”

When she got into her mid-20s, Cindy Powell went to work with the Redmond Civil Air Patrol, where her father was employed as well, her sisters said. She worked as a “spotter,” going up in planes to look for fires, people lost in the woods or downed planes.

“That was her greatest love,” Bonda Powell said. “I don’t know what went wrong after that, but something snapped in her.”

The women said that Cindy Powell had been on a downward spiral ever since.

And the family’s greatest challenge has been getting her the care she needs, they said.

“You talk about a breakdown in the mental health care system in Oregon, I mean our sister is the example of that,” Feik said.

Medical documents show visits to numerous doctors, but Powell didn’t seem to get better.

She tried committing suicide so many times her sisters lost count.

“My father-in-law was in the hospital for open heart surgery in 1970, and she was in a nearby hospital for attempted suicide,” Feik said.

But she always hurt herself in a place where she knew someone would find her, Feik said.

“When you try to commit suicide that many times, if you really want to, you’re going to succeed,” Feik said. “She really just wanted help.”

Final attempt

Powell’s final suicide attempt came as she was being taken to get the help she craved for so long, said Henderson, of St. Charles.

She had been under 24-hour observation since Saturday, Henderson said. Two doctors had determined she was a danger to herself and placed her on an involuntary mental health hold.

Just before she died, she had made a “verbal contract” with health care providers that she wouldn’t hurt herself and agreed to go to Sageview, a 15-bed secured facility for intensive mental health treatment.

Her purse was left in the admitting area downstairs, Henderson said, because patients who are a possible danger to themselves or others aren’t allowed to have their belongings in their rooms.

Two health care workers took her to get her things and then, in a deviation from normal protocols, walked her through the lobby, Henderson said.

“Our standard procedure is not to go through the main lobby, but we took a little bit of a detour because of her circumstance,” Henderson said.

That’s when she broke away from the two hospital workers, who were not restraining her.

“At that point, she bolted, ran up the stairs to our cafeteria area, jumped over the railing and stopped ever so briefly, then fell,” Henderson said.

Emergency responders were there within seconds and restored Powell’s breathing.

But it was too late, Henderson said. The injuries she sustained left her brain-dead.

Henderson said that Powell was not restrained because that could have done “extraordinary psychological and emotional harm.”

And the practice of restraining a mentally ill patient who is not violent is not allowed by the Joint Commission, which accredits Cascade Healthcare Community, St. Charles’ parent company, Henderson said.

The police weren’t notified about Powell’s suicide until Tuesday because she had survived the fall, said Shelly Brooks, communications director for Cascade Healthcare. Hospital officials confirmed her brain death and then, because Powell was an organ donor, she was maintained on life support until the necessary procedures could be performed.

Henderson said the hospital is reviewing its transfer protocols and has implemented the use of a wheelchair with every patient transfer.

But her sisters say they don’t understand why more wasn’t done to prevent Cindy Powell’s suicide.

“How does somebody go to a hospital who is suicidal and looking for help and ends up committing suicide with two hospital personnel by her side?” Feik said.

She said they hope to sprinkle Cindy Powell’s remains over the Redmond Airport area.

By Shawn Levy, The Oregonian, February 18, 2008

One of the greatest and most inspiring surprises for me last year was “Finding Normal,” a gripping and moving documentary by local filmmaker Brian Lindstrom, who went deep into the world of recovering addicts and turned up an amazing fly-on-the-wall portrait of the addicts and the peer mentors who help them find a new path in life through a downtown Portland program.

Well, Lindstrom has set his sites on another story set on the local streets: the case of James Chasse, a troubled 42 year old who was effectively beaten to death in September, 2006, in broad daylight on a Pearl District corner by three Portland cops. The Chasse case has been a real lightning rod for critics of the training and technique of police officers, particularly in their encounters with the disenfranchised and/or disturbed. (You can read details of the incident and the shockwaves it produced here.)

Lindstrom has begun work on “Alien Boy,” a documentary about Chasse’s life and death and the issues his killing has raised, and, being a virtual one-man show operating on a not-even-shoestring budget, he could use a hand. It seems to be a perfect marriage of artist and subject matter, and you could feel pretty good about yourself if you visited the film’s web site and donated money or support or even helped tell other folks about the project.

The word you’re looking for is mitzvah.

Shirt

The Icarus Project, Process Work Institute, and Mental Health Association of Portland present:

Madness and Disability Rights: A Community Forum on Mental Health

Sunday, March 9th, 7-9pm
Process Work Institute – 2049 NW Hoyt St., Portland Oregon
Free and Open to the Public, Wheelchair Accessible; please avoid scented body products; call with other access needs

Extreme states of madness usually get labeled psychiatric disorders, including schizophrenia and bipolar, and treated with medications. What are different ways of understanding these experiences, and what are other options for helping people? What lessons can we learn from care in different countries?

Come discuss a disability rights view on madness and extreme states of consciousness. This perspective respects individual choice to take or not take medication, welcomes a diversity of treatment possibilities, and is open to different interpretations of the mysterious experiences we call “crazy.” We will also look at the economic and political forces influencing mental health.

Diagnosed with schizophrenia, presenter Will Hall (pictured) is co-founder of Freedom Center, an award-winning peer-run support and advocacy community in Massachusetts. He is also on the collective of The Icarus Project, exploring art, creativity, spirituality, and political activism as alternatives to mainstream mental health care. Will has traveled internationally in his work, including recent visits to Toronto Canada and Buenos Aires Argentina.

Help promote this free event – DOWNLOAD COLOR FLYER (3.4 MB PDF) DOWNLOAD GRAYSCALE FLYER (1.8 MB PDF)

The Mental Health Association of Portland is proud to announce its new association with the Portland-based theatre company, From the Inside Out.

From the Inside Out has been providing interactive theatre productions for the past two years focusing on issues important to people with mental illness.

Interactive theatre comes from a method taught by Augusto Boal (pictured) in his Theatre of the Oppressed, which invites spectators into the play to solve problems and respond emotionally to the content presented by the actors.

The Mental Health Association of Portland will act as a fiscal agent for From the Inside Out to assist in raising funds and awareness for the program.

You can learn more about From the Inside Out on their web page.

From the Portland Mercury, February 8 2008

The Mercury’s Guide To Civil Commitment

“I once sat transfixed listening to a bipolar patient deliver this remarkable narrative about how he had become God,” says Alex Bassos—chief attorney for special courts with Metropolitan Public Defenders. “Honestly, it was as good as anything a novelist could come up with. He talked about all these tunnels that he’d gone down and people who’d spoken to him. It was incredible, although of course, it didn’t help his chances at the commitment hearing.”

We’re talking about delusions. Specifically, the kind of delusions that might accompany behavior making you a danger to yourself or others, and that might land you up, if you’re lucky enough, or unlucky enough depending on how you look at it, here:

CIVIL COMMITMENT COURT: Can deprive mentally ill people of their liberty…

I’ve followed two of Bassos’ colleagues around over the last month—community court defender Chris O’Connor, and criminal court supervising defender Liz Wakefield. Both experiences were real eye-openers, but in terms of my eyes, and how open or closed they were and are now, yesterday’s morning with Bassos was a real doozy. Thanks to him for showing me around.

“I see two monks sitting with their palms together,” says Bassos. We’re looking at one of the Rorschach blots that are framed on the wall of his downtown office. “My legal assistant sees the gaps in between—she says it looks like a skull.”

Alex Bassos

BASSOS: Good taste in wall art and neckties…

Introductions

Bassos, 38, has been doing this work in Portland for five years. He was a criminal defender in Michigan before he decided he hated the place, and moved to Portland to take the bar. The son of two therapists who is now married to one, there’s no denying Bassos’ interest in the inner workings of the human mind.

If people’s minds are like iPods, one senses you would have to upload a hell of a lot of material onto Bassos’s before it overloaded. He likes to think “big picture,” he admits, which apart from defending each and every client on a very specific basis, is what he enjoys so much about the work he’s now doing.

We begin by going through a presentation he’d designed for doctors about the civil commitment process—Bassos is also currently writing a book on the subject, too—then, to continue the iTunes-related metaphor, we set the conversation to “party shuffle.” Perhaps “grim, Samuel Beckettian shuffle,” might be a more appropriate for discussing Oregon’s mental health system, but Bassos hardly seems beaten down by his job, so it’s hard to feel downhearted.

After coming to Portland, Bassos moved, with his wife, to the Thai city of Chiang Mai for a year—they wanted to “have an adventure.” Bassos learned to read and write Thai, which he taught to expatriates, and the pair of them took a series of self-improvement courses together, including a 10-day class in meditation, (“it was all internal, they wouldn’t even let you nod to each other, or speak, or write, or anything…it was the hardest thing I’ve ever done,” he says) and a three day Reiki retreat—for which the Grade One Reiki Practitioner’s certificate is his wall’s reward.

“That was more of a joke,” he explains. “You’re supposed to channel the universal energy of the universe to heal the person. But the initiation ceremony was like a fraternity hazing, they had us all wear blindfolds and blew on our backs. That was the final nail in the coffin for me. Still, who knows, maybe my channel is now open!”

After the Rorschach blots, Bassos teaches me a few Thai characters using some of the labeled blocks he made in Chiang Mai for the expatriates, which now sit on his bookshelf—then we head out to the courthouse, room 220.

In Commitment Court

“I love you, Dad,” says the allegedly mentally ill person. “There’s no hard feelings, it’s court.”

This is the second of four commitment hearings this morning, of which I’ll see two–they tend to last around two hours. The man talking is about 35, white, dressed in a thick navy coat with a high collar. His hair is closely cropped, and he reminds me of Bruce Willis in Die Hard. Bassos and I are watching proceedings from the back row of the audience, in a courtroom that looks like this:

COMMITMENT COURT: Set up to feel less adversarial than criminal court…

The man’s father has just finished testifying about his son’s alleged mental illness as a witness and gone back to the audience. Next, the District Attorney calls the man’s brother, who steps up to the witness stand.

“Oh boy,” says the man. “Who do I get to call?”

His defense attorney, Rachel Phillips, who works for Bassos, tries to calm him down. It won’t help his case if he’s speaking out of turn, even if it is to tell his father he loves him, or simply to express bewilderment. In ten minutes since we entered, he’s asked for more water to drink, several times.

The courtroom feels both familiar and alien, simultaneously. Like most others in the building, it is bathed in institutional fluorescent light, has some dogged gray carpet, and solid wood doors. The judge wears a robe, there’s a court clerk, and two sheriff’s deputies, dressed in green, to ensure order. Yet this court is unlike any other: It makes judgments about a person’s mental wellbeing, not their guilt of any crime.

That’s not to say the cops aren’t usually involved. This man was brought to Emanuel Hospital by police five days ago, when the civil commitment clock started ticking—the state has five days to commit a person, or let them go free. It’s not clear what prompted the officers to engage the man to begin with.

When the man arrived in hospital he was agitated, disorientated and delusional, and told a doctor he thought the ER machines were weapons. He’s been sleeping on the streets for several weeks now, and has lost a considerable amount of weight since his last arrest at the end of last year, judging from his appearance compared to a booking photo I can see being waved around by his parole officer, who should probably be a little more discrete with it.

Because of his behavior, the doctor placed an initial “hold” on the man, committing him to Emanuel’s psych ward. Emanuel is one of six hospitals in Portland with a certified psychiatric ward: OHSU, Emanuel, Adventist, Providence, Good Samaritan and the Veteran’s Association Hospital.

Such wards are locked, they have rooms with nurses, medication and so on. But they very often fill up. That means doctors have no option but to hold psych patients in the ER, where they sometimes have to remain for the entire five days, ideally with proper supervision, until a bed opens up on the psych ward.

“Emanuel was telling me three months ago that they were on a complete divert because their ER was completely filled with people on psychiatric holds,” says Bassos. “That means they couldn’t even take patients having heart attacks.”

It costs the state roughly $1000 a day to keep someone in a psych bed, and more to keep them in an ER bed. Most patients, once stabilized, only need 3 hot meals a day, a bed, and medication, in order to stay that way. But there are few “post-acute” or “sub-acute” facilities for people with mental illness in Oregon, so they only usually end up in hospital once their situation has gotten particularly dire, and for the state, particularly expensive.

“We’re left with this conveyor belt system that can’t move because it’s overloaded,” Bassos explains.

Proving Someone is Mentally Ill

Committing someone to be treated in a psych ward against their will is obviously not something to be done lightly—depending on how seriously ill the person is, they can end up staying in hospital for some time, although the usual length of involuntary commitment is around 3 weeks, according to Bassos. Nevertheless, the state statutes on commitment are written to entitle the alleged mentally ill person to a fair shake.

In the mid ’70s, a precedent was set by a case called O’Connor vs.Donaldson, when a man was committed against his will in Florida for many years, without actually suffering from any mental illness. The civil rights movement has since grabbed hold of mental health issues, and so has the Multnomah County appeals court—it has overturned 50 civil commitments in the past two years, Bassos estimates. So it’s no easy task for the state to commit somebody.

On the day that the person has been issued a hold, a Multnomah County mental health investigator visits them to prepare a report for the court. Mental health investigators need to be masters-level clinical psychiatrists, or above. It’s their job to decide by talking with the person, their doctors and any witnesses, whether the person is willing to be voluntarily treated, is able to be let out soon, or whether to proceed to a hearing to commit.

In the case of “Bruce Willis,” the county investigator met him sitting in the quiet room in Emanuel’s psychiatric ward. He was difficult to redirect, loud, diverting, tangential, and demanded, “Where’s my fucking cigarettes, why am I in here?”. When the investigator left the room to walk out of the hospital, he heard yelling and banging coming from the room.

WILLIS: Pissed…but is he mentally ill?

The issue, of course, is that the man’s behavior could also be consistent with somebody who wasn’t mentally ill, but had in fact been held against their will in a hospital for three days. It’s up to the commitment process to figure out the difference.

On day 3 of the hold, the county has to decide whether to proceed to a hearing or get the patient into some kind of diversion program. If the patient agrees, and a doctor agrees, then that’s usually what happens. Only about 10% of initial holds ever proceed to a commitment hearing. In “Willis’s” case, the patient doesn’t believe he has a mental illness and doesn’t want to remain in hospital, so the investigator decided to proceed to a hearing.

On day 4 of the hold, the Defense Attorney (that’s Bassos, or one of the attorneys he works for) sends a legal assistant to the hospital to write up a report of their own on the alleged mentally ill person.

On day 5, the hearing happens.

So Many Commitments, So Little Time

The upshot of the quick, 5-day process is that Bassos, or one of the attorneys he supervises, only gets to meet the client 5 minutes before the hearing. That’s very different from a criminal case and obviously has an impact on the defense attorney’s ability to adequately defend the person against the accusations being made against them.

During the hearing, the District Attorney has to prove a clear and convincing case to the judge that the person is mentally ill. That means, specifically, that the person not only has a mental disorder, but is likely to pose an imminent danger either to themselves or others. The DA can rely on witnesses, such as the person’s family, or a police officer, or an alleged victim of the person’s behavior to prove the case. Today’s judge is Connie Isgro.

The person is also examined, in public, by two mental health examiners from the county, during the hearing. Today’s mental health examiners are David Mohler and Linda O’Malia.

“They are two of the most competent examiners in the county,” Bassos tells me. “But there’s a catch. An examination is supposed to include a whole slew of different things in terms of taking the patient’s history, talking about medications and observing behavior and so on. But what actually happens in civil commitments is the examiner gets to talk with the client for 10 or 15 minutes, and they have to form an opinion based on that.”

“No psychologist would do a patient evaluation in public,” Bassos says. “Much less while the District Attorney was cross-examining their patient, sometimes quite aggressively.”

No Winners

Today’s hearing could have go either way. “Willis” is homeless, and has shown up at his family’s house over recent weeks with a heavily bleeding face and they say, has threatened suicide if his family won’t help. He’s also come into contact with a cop, following an alleged altercation at a Shell gas station—where his face was also covered in blood, according to the officer, who also testifies at the hearing.

Bassos writes notes on his legal pad as the case proceeds, and tells me this case is fairly typical of a commitment hearing.

As “Willis” is questioned by the county examiner, he tells her he has recently fallen into the Willamette River. He’s unspecific about how or why—he says “a wave came over” while he was sitting on a pier, then, that someone may have pushed him.

These incidents are weird, but not sufficient in and of themselves to prove the nexus between the person’s mental disorder and his imminent danger to himself or others. It’s not the court’s role to take good care of the person, only to ensure he isn’t dangerous, or in danger. And there’s a whopping gulf in between.

In a 1995 case, State vs.Sea, the committed person had a lot of weight loss, delusions, cessation of contact with their case worker, and blackouts. But the state didn’t prove the nexus between those incidents and the person being a danger to themselves or others, thought the appeals court, when it overturned the commitment. It said the commitment court had taken an “overly paternalistic” approach to the alleged mentally ill person.

It is not the commitment court’s job to replace a parent. Perhaps the biggest irony of today’s hearing is that if “Willis” wins, he’ll probably be little better off than if he loses. If he’s let out this evening, he’ll continue to wander the streets, or perhaps end up in a shelter, if he’s lucky. Or perhaps, if he’s really lucky, with a room at the Joyce Hotel on Stark Street.

Either way it’s likely his mental health will continue to deteriorate. People are frequently kicked out on the courtroom steps after winning a hearing, with no money, no bus ticket, and nowhere to go. Is that a recipe for their continued success in life? Probably not. But it’s their right, in this country, to live free, or die hard.

This Bruce Willis obsession is ridiculous. I apologize.

“I Work For The FBI…”

In “Willis’s” case, the court decides to commit him not only based on the evidence presented, but on the manner of his conduct in the courtroom. After demanding water repeatedly he left the room to pee, only to return with the following statement:

“Okay. I’m going to lay it out for you. I work for the FBI. I do pedestrian reconnaissance. You can contact the senators Binder and Binder, they represent me.”