Public Screening of “Hearing Voices” Documentary and Discussion of New Educational Project

Tuesday, March 31 2009 6 – 7:45 PM
Downtown Multnomah County Public Library meeting room
801 S.W. 10th Avenue @ Yamhill
Portland, Oregon

Contact: Portland Hearing Voices portlandhearingvoices@gmail.com
413-210-2803 On Tuesday, March 31 2009 at 6 PM the hour-long BBC documentary video

A small percentage of people hear voices no one else hears and have other unusual sensory experiences. Sometimes these voices and sensations can be painful and terrifying, but sometimes they are creative and even spiritual. Throughout history the mysterious meaning of hearing voices has defied any final explanation.

What is it like to hear voices and have unusual sensory experiences? How do people learn to live with their voices? Are voices always part of pathology and disorder, or are they related to sensitivity and creativity or have other meaning? How are Hearing Voices Groups in England and Europe providing ways for voice-hearers to gain greater control of their lives?

This event is sponsored by Portland Hearing Voices, a new community learning partnership dedicated to education around hearing voices, unusual sensory experiences, and mental diversity. The discussion will be led by Will Hall, a voice hearer diagnosed with schizophrenia and the program director of Portland Hearing Voices.

This event is free and open to the public, on public transit, and wheelchair accessible. Because of chemical sensitivities, please do not wear scented body products.

For information, contact Jess Jinkies, Outreach Director Portland Hearing Voices @ 413.210.2803
http://www.portlandhearingvoices.net/files/03-31-09HearingVoicesLibraryEventPressRelease.pdf

and the poster/flyer here

http://www.portlandhearingvoices.net/files/HearingVoicesMarch31Flyer.pdf

From the Salem Statesman Journal, March 30 2009

Orr feels great about first year at hospital – Goals for state’s major psychiatric facility on track

A year after he took the reins of the embattled Oregon State Hospital, Superintendent Roy Orr touts sweeping changes at the 126-year-old psychiatric facility.

“I feel great about our first year,” Orr said. “If somebody would have told me on my first day that this is where we’d be a year later, I would have said, ‘I’ll take that.’

“This is a large organization. It’s a very expensive organization to run, and we’ve got a lot of work ahead of us. But I’d be hard pressed to try and design a better first year to build on.”

Orr spotlighted these achievements and planned reforms:

Recruitment of new employees has exceeded expectations, with the addition of nearly 300 new staffers in the past year.

Staff use of seclusion and restraints to control combative patients has decreased nearly 80 percent.

A streamlined process for hiring registered nurses has reduced from 80 days to 7 days the average time period for hiring new nurses. Accordingly, the hospital’s nursing vacancy rate has dropped from 22 percent to less than 10 percent.

Patient morale has been boosted by the opening of six cottages on the hospital grounds as transitional homes for patients nearing their discharge dates.

Planned addition of a $26 million computerized records system will replace the hospital’s antiquated paper records system.

Creation of an innovative “peer bridger” program employs three former patients to work with current patients as they prepare to leave the hospital and transition back into Oregon communities.

The south wing of the dilapidated J Building soon will be demolished, marking progress toward construction of a new $280 million replacement hospital in central Salem.

Senate President Peter Courtney, D-Salem, gave Orr high marks for his first-year performance.

“I think he came into a very difficult, if not impossible, situation,” Courtney said. “I think he has worked very hard to make a tremendous number of changes, including adding staff we should have had a long time ago.”

A concerted state push to transform psychiatric care at the oldest psychiatric hospital on the West Coast was spurred more than a year ago by a scathing federal investigation report.

In a 48-page report issued in January 2008, , the U.S. Department of Justice Civil Rights Division rapped the hospital for unsafe conditions and widespread flaws in patient care.

Orr became hospital chief less than two months after the report shocked state leaders.

Despite improvements in patient care and conditions, Orr acknowledged that the hospital remains severely understaffed and still faces the potential threat of a federal lawsuit that could place it under court control.

Hospital administrators are seeking to hire nearly 1,000 more employees during the 2009-11 budget period, which starts July 1, and in 2011-13. Total cost for the proposed staffing increases has been pegged about $125 million. The Legislature will decide how much money to allocate for extra hospital staffing.

Besides a huge infusion of workers, Orr said continued progress at the hospital requires a change in the institutional culture, shifting from a “make do” attitude to a “can do” attitude.

Here are Orr’s answers to further questions about his first year as superintendent.

Question: Where does the hospital stand now with the U.S. Department of Justice?

Answer: Oregon DOJ and U.S. DOJ continue to talk about settlement issues. Here at the state hospital we’re not intimately involved in those conversations. I feel that in a number of important respects we’re a very different organization today than what the U.S. DOJ found. I remain really hopeful that like many other state hospitals we’ll be able to come to an agreement.

Q: Demolition of the south wing of the old J Building is going to occur in early April. Do you see that as a milestone?

A: It is a milestone. It’s not just getting old buildings out of the way for the new, I think it’s symbolically significant. To me, it respectfully asks our past to get out of the way for our future, and at the same time it tears down some of the things that we’d like to move away from: the stigmas, the associations and the problems of the past.

Q: Initially, some neighbors weren’t happy about the plan to turn six cottages into transitional homes. As that program gets under way, why do you see it as a big step forward?

A: Imagine the difference between being a patient in an overcrowded ward day after day, for months, if not years, and then to earn the privilege to be in one of these beautifully renovated, historically renovated, homes. To wake up each day and enjoy an almost 360 degree view around the park that the cottages are set in …

We’ve got some great staff members who have transferred into those positions down there who are every bit as excited as the patients.

Q: What benefits will come with the planned shift to a computerized records system?

A: We’ve really been hamstrung historically because of our lack of automation. By capturing our data electronically we will have the ability to turn it into really useful clinical and management information.

This is really going to be the backbone of what will ultimately be a network for knitting together the community mental health providers with the state hospital. That will be a huge advantage for us all.

Additional Facts – Live chat Tuesday

Roy Orr, superintendent of the Oregon State Hospital, will talk with the Statesman Journal Editorial Board at 11 a.m. Tuesday. Go to StatesmanJournal.com to watch the discussion live.

From the Oregonian, March 24 2009

The Portland Police Bureau today released the names of people arrested during an undercover enforcement operation at what has been described as the city’s ground zero for street drug dealing.

As reported in The Oregonian, Portland’s Street Crimes Unit and Neighborhood Response Team officers began making arrests five weeks ago at Southwest Fourth Avenue and Washington Street, targeting mainly crack cocaine sellers.

According to Officer Greg Pashley, a police spokesman, the following 25 people were indicted on felony charges of possession and/or distribution of a controlled substance: Malcolm Jared Hubbard, 19; Alexander Alan Johnson, 21; Jasmine George, 19; Jamal David Williams, 39; Brittany Welday, 18; Antonio Howard, 18; Deante Deshawn Nelson, 23; Barron Cedric Williams, 54; Jefferson Bryant Davis, 20; Jonathan Carey Franks, 24; Anthony D. Armstrong, 20; Tierra-Faye Frison, 18; Wesley Lloyd Hunt, 23; Montez Terrell Taylor, 26; Keith Dawson, 43; Cynthia Anginique Crane, 21; Calvin Ray Baker, 52; Laurence D. Farrington, 21; Perry Lee Steven, 46; Michael Tige Belcher, 35; Isaac Lee Jones, 24; Adrean Deone Williams, 27; Tracy Scott Walls, 46; Marques D. Johnson, 36; and Ryan Earnest Moore, 37.

The following five people were arrested on misdemeanor distribution of an imitation controlled substance: Eddie Beal, 42; Laronzo Murphy, 25; Nikata Lindley, 28; Douglas Vaughn, 41; and Clinton Waters, 37.

And the following six people were arrested on felony warrants: Deante Nelson, Barron Williams, Anthony Armstrong, Keith Dawson, Michael Belcher and Calvin Baker.

OUR COMMENT – These arrests come as Oregon legislator’s prepare to end services for thousands of recovering addicts and persons with mental illness, and as Secretary of State Hillary Clinton admits America’s role in the intercontinental drug war – that untreated addicts in the US fund terrorism worldwide.

From Disability Rights Oregon, March 27 2009

On March 19, Senator Alan Bates and Representative Tina Kotek, co-chairs of the Ways and Means Subcommittee on Human Services (DHS), released a memorandum entitled: System Reform for Mental Health and Addiction Services.

The memo stated that in order to maximize the quality, effectiveness, and efficiency of Oregon’s mental health care and addictions treatment system, the legislators want to discuss options for system reform. In particular, they want to consider ways to integrate physical and mental health care, promote wraparound services, and reduce administrative and delivery costs.

To achieve this, the legislators proposed that two changes be discussed:

1. A change in management — Contracting with the state’s Medicaid Managed Care Organizations (MCO’s) to manage funds to purchase core mental health, addiction, and physical health services.

2. A change in payment structure — Developing a system of payment that rewards positive outcomes for patients, not the number of patient-provider encounters.

On March 24, Richard Harris, Assistant Director, Department of Human Services, Addictions and Mental Health Division, released a “system change concept” at the request of Senator Bates and Representative Kotek. The document sets out five guiding principles for the mental health and addictions service system, a description of the current system and proposed changes. It essentially supports the proposals contained in the March 19 memorandum and suggests that three pilot projects be established for 2009-11 to test the changes.

On March 25, the Ways and Means Subcommittee on Human Services heard invited testimony from representatives of Community Mental Health Programs, Fully Capitated Health Plans and Mental Health Organizations regarding the co-chair’s proposals. At the conclusion of the hearing, Senator Bates asked that DHS convene a work group to further discuss the proposals. He asked that DHS report back to the committee on April 13. DHS has set a first stake-holder meeting for April 3 from 1:00 -5:00 p.m. in Room 260 at the Labor & Industries Building, 350 Winter Street NE, Salem. Senator Bates and Representative Kotek plan to attend.

MAP – Labor & Industries Building, 350 Winter Street NE, Salem

The members of the state Ways and Means Subcommittee on Human Services

Sen. Alan Bates, D-Ashland, co-chairman
Sen. Margaret Carter, D-Portland
Sen. Jackie Winters, R-Salem

Rep. Tina Kotek, D-Portland, co-chairwoman
Rep. Mitch Greenlick, D-Portland
Rep. Bill Kennemer, R-Oregon City
Rep. Carolyn Tomei, D-Milwaukie
Rep. Dennis Richardson, R-Central Point

From the Oregonian, March 22 2009, by Andy Dworkin

The first time diabetes landed Richard Perez in Providence Portland Medical Center, the homeless man was discharged with little more than a bottle of pills and a bus pass.

“You’re putting me out just to the streets, and I’m having all these meds, carrying them around with me,” Perez remembers thinking during his discharge last spring.

Homeless since his 2004 release from prison for crimes including robbery, statutory rape and compelling prostitution, the Portland native wandered the city looking for places to rest and to hide his pills so others wouldn’t steal them: “I was up for days, because I slept for days in Providence.”

In December, Perez landed back in the Providence medical center after a car hit his right leg. His diabetes, rampant from the poor diet and rough life on the streets, made that wound a crisis. Doctors gave him a choice: Lose the leg or lose your life.

This time, when Perez left the hospital, a van drove him to a new home in downtown Portland’s Henry Building. The nonprofit Central City Concern runs a Recuperation Care Program there for homeless adults who need regular nursing after a hospital stay. Providence paid roughly $4,000 for Perez to get 30 days in a small, tidy room, nutritious food and regular care for his amputation site, while staff helped him look for benefits and stable housing.

Perez shows both sides of a system that tries but often fails to protect homeless people leaving local hospitals. Portland is one of a few dozen U.S. cities with “respite care” programs to help the homeless recover medically, and Central City’s program is something of a national model.

But Portland’s programs don’t come close to meeting the full need. Homeless people recovering from poisoning, broken bones and other conditions that don’t need intense post-hospital care are often left to fend for themselves in Portland’s fragmented, underfunded network of homeless services. Some get discharged back to temporary shelters where they can get a few nights in a bunk. Others just return to the streets, until they get sick enough to land back in the hospital.

“It’s not a system,” said Alvin Taylor, a mission manager at Union Gospel Mission, which provides meals to the homeless in Old Town. “What happens is they keep coming back, over and over.”

ER visits

Portland’s homeless population is especially sickly. A survey of 646 people sleeping outside in Portland last October found nearly half had asthma, hepatitis, heart disease or other conditions that make them “medically vulnerable.” More than 40 percent of the people surveyed said they visited an emergency room at least three times in the previous three months.

The revolving door between the streets and the emergency room affects anyone who uses a hospital or has health insurance. The 646 people surveyed used almost $1.5 million in ER services in 2008. Since two-thirds of the surveyed were uninsured, that totals $1 million in unpaid bills — losses that get passed on to paying patients through higher hospital charges and insurance rates.

City officials estimate that 4,000 people sleep in shelters or outdoors each night, and the actual toll of unpaid ER costs for the homeless could be roughly $6 million. Local hospitals say that, on an average day, more than a dozen homeless people are spending the night as inpatients, adding millions more to the annual cost.

No one tracks how many of these patients get discharged to a street in Old Town, where Portland’s homeless service agencies cluster. But workers at those agencies say they commonly see people seeking help, still wearing their hospital wristbands.

“Sometimes we’ll get people in our lobby, and I’m like, ‘How did you get down here? How are you back on the street?’” said Andrew Anderson, outreach chaplain with Portland Rescue Mission’s men’s shelter.

At nearby Union Gospel Mission, staff have “dealt with three or four people recently who have hospital tags on their arm, who were just released and don’t know what to do next,” communications director Stacy Kean said. One man in particular sticks in mission manager Taylor’s mind.

“He had a walker, he had his identification badge on his arm, he had his meds on his walker and he had no socks on,” Taylor said. “He should never have been let out of the hospital, in my opinion.”

Post-hospital planning

Local hospitals are in a bind when they have to discharge homeless people. It’s unethical to send patients into a dangerous situation. But hospitals can’t keep healthy homeless patients. That would just fill up beds sick patients need and court bankruptcy.

“The hospital’s not designed to be a shelter or a hostel or a domiciliary. They’re designed to be a profit-making enterprise,” said Jason Renaud of the Mental Health Association of Portland.

Federal law and accreditation rules require hospitals to make discharge plans for each patient. But nothing bars discharging someone to a homeless shelter or a part of town with homeless services.

Discharge planners at Providence, Oregon Health & Science University and Legacy Health System handle homeless patients in similar ways: Case managers look at a patient’s diagnoses and resources to help them apply for housing and other benefits, such as Social Security. Sometimes case managers help patients contact friends or family who may provide a bed, even for a while. If that fails, the hospitals consider a program such as Central City Concern’s.

As a last resort, case managers call temporary shelters, hoping to snag at least a few days of food and rest. The shelters usually try to make space for just-released patients, though they are often full, especially in winter.

So some homeless patients get sent from local hospitals with just a list of shelters and a travel voucher. Although OHSU won’t discharge homeless patients to an unsafe place, care manager Paul Vergeer said, some just get cab or bus rides to Old Town.

And some are OK with that.

“A fair number really don’t want to go to the shelter. They’d rather sleep under a bridge somewhere,” said Robin Weisshaar, manager of social services at Legacy Good Samaritan.

Seeking solutions

The realization that hospitals and homeless agencies were trading clients back and forth spurred the search for a humane solution. Providence made an early effort, paying Central City Concern to offer shelter and care to discharged homeless patients. But that program had “way too many barriers” to succeed with homeless patients, said Ted Amann, Central City director of health care, including bans on guests and alcohol and a 9 p.m. curfew.

The nonprofit’s Recuperation Care Program began in 2005 when OHSU decided to try a similar approach with fewer restrictions. It began with just a few beds, program manager Nic Granum said. Impressed by the results, OHSU expanded the project, and Providence, Legacy and other Multnomah County health providers signed on.

Today, the program has 25 small rooms in the Henry Building. Hospitals pick whom to send through the program and pay roughly $4,000 per patient, depending on their insurance. The hospitals also agree to give a month of medicine and specialty care for free. Program staff help residents care for their injuries and look for jobs, benefits and more stable housing. Most residents go on to live with friends and family or move into transitional or permanent housing, Granum said.

Though they hate talking numbers, the Recuperation Care Program seems to save hospitals millions. Over three years, OHSU leaders say they paid Central City $500,000 to take patients, which averted $3.5 million in costs OHSU would have paid for housing or retreating the patients. And “if a hospital’s willing to publicly say $3.5 million, I’m thinking the real number is between $10 and $15″ million, Amann said.

Support from hospitals is key to the program’s success. The federal government has no steady funding for medical respite care for the homeless, said Sabrina Edgington, a policy analyst with the National Health Care for the Homeless Council. Budget woes have closed many programs that weren’t funded by hospitals or cities, she said.

That fate killed an infirmary trying to fill the biggest gap in Portland’s respite care system, help for homeless people who are sick but don’t need daily nursing.

In late 2005, OHSU and the Salvation Army opened a 15-bed infirmary on the second floor of the Salvation Army’s Harbor Lights shelter downtown. “A fair number of people came in throughout the week, or were dropped off by taxicabs,” said manager Marna Flaherty-Robb, then-associate dean of OHSU’s School of Nursing.

But demand soon outstripped the infirmary’s resources. It was hard to find enough volunteers to staff the program. Donations used to fund the infirmary started to run out and the Salvation Army had many demands for that space, Flaherty-Robb said. The program petered out in early 2007.

Hole in safety net

Housing moderately sick homeless people remains a big hole in Portland’s safety net. Portland’s Ten Year Plan to End Homelessness lists not transferring people from hospitals to the streets as a top priority. But the plan’s funding is focused on the toughest cases: addicts, felons and other chronically homeless, single adults who use the most resources. The consequence is that couples, the sober and the simply sick have the hardest time finding help.

“There’s this gap between a full-blown recovery program and the street,” Portland Rescue Mission’s Anderson said. And with the economy faltering, he said, that gap is filling with people “who don’t necessarily have serious addiction problems, but they just ran out of money.”

“If something doesn’t change on how this community spends its resources,” he said, “we’re going to end up pushing away the most needy.”

The economy also may test the Recuperation Care Program. It’s never operated in a recession, and though hospitals save in the long run, they must spend up front to send patients through. Meanwhile, demand probably will rise as more people are pushed out of homes.

But for Perez, life is looking up. With decent food and regular access to medicine, his blood sugar stabilized in his month at the Henry. Earlier this year, he moved into the Clark Annex, a supportive housing unit run by Transition Projects Inc. And last week, he was approved to move into a new apartment complex on Northeast Martin Luther King Boulevard.

“That’s my ultimate goal: I’ve got an income coming in and am able to pay my rent, pay some bills,” Perez said. “Hopefully that works out, because that’ll be a blessing. That’ll be a success story. Right now, I don’t know what success is.”

Resource guide

• Learn more about the Recuperation Care Program

• Information on homeless respite care programs nationwide

• Portland services for homeless adults; or call 2-1-1

• Services for homeless families; or call 2-1-1

• Survey of health issues and hospital use among Portland’s homeless population

• Portland’s 10-Year Plan to End Homelessness

OUR COMMENT – Best wishes for good health to our friend David Yandell and a good transition home.

“Our insatiable demand for illegal drugs fuels the drug trade.” Secretary of State Hillary Clinton, speaking 3 25 2009 in Mexico City.

We’ve survived, over the decades, several rearrangements of payment-for-services from the feds to the state to the counties to the providers to their staff for persons with mental illness and addiction. Most rearrangements, in hindsight, responded to acute concerns, more often reducing than adding services. Most, in hindsight, diminished, confused, or obscured the notion of people getting well.

The state’s mental health and addiction graybeards released a concept” paper on March 24, and held a meeting on March 25 to explain new ideas. Chief of the Division now is Richard Harris, former longtime director of celebrated Central City Concern. Harris was interviewed by Street Roots when he started in October, where he laid out several key ideas about how things could be different.

These ideas are incorporated in the concept paper, and are rooted in evidence that the strongest motivator for recovery and wellness is self-sufficiency. We hope they get a complete hearing – and complete funding from the legislature.

Elements of an Effective Mental Health Addictions Treatment Care and Delivery System, March 24 2009

Memo from Senator Alan Bates and Representative Tina Kotek, Re: System Reform for Mental Health and Addiction Services, inviting “stakeholders” to March 25 meeting

Harris’ proposed changes come as Governor Ted Kulongoski suggests public addiction and mental health services be cut, in some areas as much as 90%. The governor’s proposal is both selfish and stupid.

EXTRA – Hillary Clinton has admitted that the US demand for illegal drugs and its consequent supply of weapons is fuelling the wave of violent killings in Mexico’s drug wars, Guardian 3 26 2009
EXTRA – Clinton: U.S. shares blame for Mexican drug wars, El Paso Times, 3 26 2009

From the film One Flew Over The Cuckoo’s Nest, filmed at the Oregon State Hospital in 1973.

From the Salem Statesman Journal, March 21 2009

Oregon may be forced to hire hundreds amid budget crisis

Despite dramatic improvements in patient care during the past year, Oregon State Hospital still faces a potential federal lawsuit that could place it under court control, hospital superintendent Roy Orr told legislators Thursday.

“The threat of a federal lawsuit continues to hang over the organization,” Orr said during testimony before the Legislature’s Ways and Means subcommittee on human services.

Orr also told legislative budget-writers that a massive infusion of workers is necessary to rectify chronic understaffing at the 126-year-old psychiatric facility and keep hospital reforms on track.


Hospital administrators are seeking to add 958 new positions — more than half during the 2009-11 budget period, which starts July 1, and the remainder during the 2011-13 biennium.


The proposed staffing package calls for adding 540 positions in 2009-11 and carries a price tag of about $40 million.

Long-range plans call for adding a further 418 positions in 2011-13.

Total costs for adding nearly 1,000 new employees during the four-year period are pegged at nearly $125 million.

Orr and other hospital administrators said the extra staffing is required to make up for habitual short staffing, prune dangerous and costly overtime shifts by current employees, and provide the kind of patient treatment demanded by federal regulators.

“It’s not only long overdue, it’s the right thing to do,” Orr said.

Legislators asked Orr to report back with more information about hospital staffing and how it compares with similar psychiatric facilities in other states.

The hospital has hired nearly 300 employees in the past year, boosting its work force to more than 1,300.

Ultimately, legislators must decide how much general fund money to allocate for additional hospital staffing in the next two-year budget. They face a tough decision because the hospital remains under federal scrutiny, while a $3 billion state budget shortfall looms for 2009-11 — raising fears about potential cutbacks in many state programs and services.

In January 2008, the U.S. Department of Justice Civil Rights Division issued a blistering report that cited numerous flaws in patient care and conditions at Oregon’s main mental hospital.

Among the defects listed in the 48-page report: poor supervision of patients, high rates of patient-on-patient assaults, excessive use of seclusion and restraints, severe understaffing, medical errors and subpar psychiatric treatment.

The federal report shocked top state officials and legislators, prompting a flurry of reform-minded changes.

Orr, who became superintendent in February 2008, cited progress in all of the areas targeted by federal investigators.

Even so, he said, the threat of a federal lawsuit remains a daunting reality. That’s reportedly because federal Justice Department lawyers want Oregon to enter into a consent decree, which would spell out court-approved marching orders for additional hospital improvements.

Oregon lawyers and mental health officials don’t want the state-run psychiatric facility subject to federal court monitoring and enforcement action, which would crimp state authority over the institution and could prove enormously costly.

More than a year after the federal report put a spotlight on chronic state hospital problems, federal and state lawyers still have not resolved the key sticking point.

Meanwhile, the state is moving forward with plans to build a new $280 million replacement facility on the grounds of the decayed and obsolete hospital complex in central Salem. The new 620-bed facility is projected to open in 2010 and become fully operational in 2011.

EXTRA – Roy Orr’s presentation to the Ways and Means subcommittee on human services, 3 20 2009

EXTRA – Civil rights violations found at Oregon State Hospital, January 16 2008

EXTRA – Read the full DOJ report on the Oregon State Hospital.

From the Catholic Sentinel, March 19 2009

This parishioner would wash her doughnuts in the baptismal font.

She camped overnight outside the church doors and added words to the liturgical responses in a loud voice. She stole things.

One Christmas, just when other members of the Downtown Chapel in Portland were getting fed up, the woman, who has schizophrenia, went up to the crib scene. Would she take something? Would she knock figures over?

Instead, she pulled out a fine, folded purple blanket and put it in the manger, her gift to God.

Though few parishes face a situation this dramatic, every faith community has mentally ill members. From bi-polar choir singers to depressed catechists, parish life includes the same puzzling conditions as the rest of society.

Some simple steps can be be helpful, say two Portland Catholic mental health experts who have written a pamphlet for national distribution.

“The starting point is the issue of awareness,” says Dr. Tom Welch, a psychiatrist and member of St. Philip Neri Parish in Portland. “Mental illness is so common. Every family either has a member with a mental illness or knows somebody with mental illness. It is so prevelant but so often invisible.”

Welch is writing the pamphlet, based on an article for Church magazine, with Dorothy Coughlin, director of the Archdiocese of Portland’s Office for People with Disabilities.

Parishes may want to be supportive of mentally ill parishioners, but don’t know how.

The Coughlin-Welch pamphlet will give simple suggestions, insisting that no one needs to be a mental health expert to do what should be done.

Praying for those with mental illness during the petitions is a good start. That offers not only spiritual aid but also public recognition. Coughlin says the main idea is to extend genuine welcome.

“What is it that gives any of us hope when we are ill?” she says. “What we need is friendship, support — someone who understands me for who I am.”

Parish education programs on the topic and facts in the church bulletin would help, say the two writers. A 12-week seminar called Family to Family has proven effective at many churches.

Dr. Welch says the parish can offer what mentally ill people need the most — relationships.

The National Catholic Partnership on Disability has given a grant to the Archdiocese of Portland to raise awareness about mental illness at parishes. That is paying for the production of a DVD for Catholics. Oregon parishes also can look to the Downtown Chapel for experience.

Holy Cross Father Ron Raab is in his eighth year at the chapel, a church with many homeless and mentally ill worshipers.

“I really believe that the last frontier of our culture and the last frontier of the church is dealing with mental illness,” Father Raab says. “It is something we fear. We can talk about helping ‘those poor people,’ but when it comes to being in relationship, which is what the Gospel is all about, we have not learned that when it comes to mental illness.”

From the Guardian, March 20 2009

Clutching a photograph of her son, Andrew Hanlon, and choking back the tears, Dorothea Carroll told the waiting media gathered outside Dublin County Coroner’s Court that she often thinks about her son lying in a pool of blood dying and wishes she could have been with him.

“There’s no closure for us whatsoever,” she said reflecting on the jury’s finding of “open verdict” at an inquest into the shooting dead of Mr Hanlon by a US police officer in Silverton, Oregon.

“I understand there could only be an open verdict, but I just want somebody, anybody to say to me that the shooting of my son was wrong,” she said.

“From here we have nowhere to go – that’s the bottom line,” said Mrs Carroll, who was accompanied by Mr Hanlon’s stepfather, Justin Carroll.

“My son. . . was 20 years old. He was unarmed.

“ Tony Gonzalez took it upon himself to put five bullets into my son.

“And my son died alone on a dark street with no one who cared around him.”

Mr Carroll criticised the portrayal of Mr Hanlon as having mental health problems in the American media and in some of the Irish media following his death, describing it as “disgraceful”.

EXTRA – everything about what happened to Andrew Hanlon

From the East Oregonian, March 18 2009

A children’s psychiatric clinic is taking up residence in the Pendleton Academies building on Airport Road.

Mind Matters East, an offshoot of a large Beaverton psychiatric outpatient facility, Mind Matters, opened Monday – a couple months after the state essentially closed down the Pendleton Academies children’s residential facility. Citing safety issues, the state withdrew its certificate of approval. Loss of the certificate meant the facility could no longer treat Medicaid patients.

The closure left a void.

No child psychiatrists offered mental health care to privately insured children, said Terry Edvalson, Pendleton Academies’ interim executive director.

“Ironically, only children with Medicaid insurance had access to outpatient child psychiatrists in Umatilla County, Oregon, and Walla Walla County, Washington,” he said.

To fill the niche, Pendleton Academies acted as a business incubator, courting the Portland facility and offering a subsidy to offset startup costs. The subsidy will end when the facility proves sustainable.

The clinic will operate Mondays, Tuesdays and Thursdays. Dr. David Conant-Norville, president and co-founder of Mind Matters and supervising child and adolescent psychiatrist, will fly to Pendleton each Tuesday and also consult via interactive video conferencing. Conant-Norville practiced privately in Pendleton for six years and later served as Pendleton Academies’ medical director, flying weekly from Portland.

Nurse practitioner Diane Cort-Wagner and counselor Carrie White round out the staff.

Edvalson said Conant-Norville has a passion for children’s mental health care.

“Dr. Conant-Norville is making a huge financial commitment – he’s losing billable hours in Portland,” Edvalson said. “Mind Matters is coming to the table to see if they can’t develop a practice here that would be self-supporting.”

Conant-Norville worries about children in rural Oregon.

“Like everywhere else in the state, child psychiatric disorders are very common,” he said. “We see ADHD, anxiety, depression, post traumatic stress disorder, developmental disabilities and family problems.”

Parents concerned about their children’s mental health can seek treatment through their pediatrician, general practitioner or counselor, or they can call Mind Matter’s Beaverton or Pendleton offices directly.

The start-up of the Pendleton clinic happened at warp speed, Conant-Norville said.

“We had a short time frame,” he said. “We don’t even have our sign up yet.”

EXTRA – Oregon slow to deal with troubled facilities for troubled kids

OUR COMMENT – Lost in the shuffle are two facts. One, Mind Matters is a private company, less accountable and less transparent to the public interest than Pendleton Academies. Two, Mind Matters was a primary clinical adviser and provider to Pendleton Academies.

From the Associated Press, March 20 2009

Following sharp criticism that included a tough report from the U.S. Justice Department, Oregon leaders have been planning to add employees, open a modern institution and close the existing Oregon State Hospital.

Then along came the big recession and the state budget hole.

The crowded, understaffed hospital has added 300 new employees in the past year, said OSH Superintendent Roy Orr.

The Legislature now must decide if the financially strapped state can afford to add hundreds more in the next biennium, and, if not, will it cripple ongoing reform-minded efforts.

A new 620-bed complex, described by state leaders as world-class, is scheduled to open next year and become fully operational in late 2011.

Adequate staffing is said to be a key to success. But budget restrictions will make that hard to pay for the 500 to nearly 1,000 new employees deemed necessary by Orr and other officials.

Gov. Ted Kulongoski’s recommended 2009-11 budget earmarked $43 million for state hospital staffing, far below the $124 million outlined last November in a proposed budget package.

If legislators go along with the lesser amount, Orr said, the hospital could hire about 540 new employees in 2009-2011.

“It was reduced given the condition of the economy and the state budget, Orr said in a recent interview, referring to the governors proposed funding level.

“We’re certainly not isolated from those things. We still don’t know what the Legislature will approve. I don’t want to jump to any conclusions. I just feel at this point that it will be a challenge for this organization to deal with the opening of the new hospital with a reduced number (of staff) as exists in the governor’s recommended budget. But it all depends on what the Legislature ultimately approves,” he told the Salem Statesman Journal newspaper.

Senate President Peter Courtney said hospital staffing remains a high priority but he can’t make any promises about specific increases for 2009-11.

“We are in a heck of a crisis, he said, “I’m scared to death because of what’s coming in May with the new (revenue) forecast. I’m frightened.

“I’ve just seen the beautiful drawings of what they hope the new hospital is going to look like. But if you don’t have enough staff, then we probably won’t be any better off out there than we’ve been before.”

The Legislature previously agreed to spend $458 million to replace the dilapidated hospital in Salem and build a second hospital in Junction City. The state will use bonds to finance construction of a 620-bed hospital in Salem and a 360-bed hospital in Junction City.

State funding for additional hospital staffing in the 2009-11 budget period, which starts July 1, would come from the general fund budget, which also pays for schools, prisons, parks and many other state programs and services. Concerns about potential costs for state hospital staffing have been simmering since November.

Since then, the recession has intensified doubts about the states ability to pay.

State officials have discussed taking a longer-term funding approach to staffing.

Under one scenario, the kind of staffing envisioned by Orr would occur in phases.

Orr said its too early to say how staggered staff increases might impact operations, patient care and safety at the new psychiatric hospital.

Orr said the hospital needs more workers before the new hospital opens.

Orr said the hospital is on track to spend about $25 million in overtime pay during the 2007-09 budget period ending June 30.

“Without adequate staffing,” he said, “we’ll just forever rely on overtime, and we know how expensive and in some cases how dangerous that can be.”

From the Sandy Post, Mar 17 2009

It was around Christmas 2007, and Tessa Sieler, who had periodic bouts of mental illness for about eight years, realized she was getting sick again.

She sought a doctor, but none would take a new Medicaid patient. Sieler’s mother, Michelle Veenker, offered to pay, but she was still turned away.

Finally, last May, things got so bad she couldn’t be brushed aside anymore.

“She was suicidal, she was burning out in her yard in a garbage can all her paper items, all her IDs, she was burning her memories,” Veenker said.

When Sieler’s landlord spotted her walking out across Highway 26 without watching for traffic, she called the police.

Sieler, from Sandy, spent three days in a hospital behind a guarded door because she was there involuntarily. She then spent five and a half months in two different treatment facilities. The ordeal cost Sieler her home and months of trauma that could have been avoided.

“Now she’s out and she’s doing OK, but it took us a year and a half and her losing her home,” Veenker said. “And all of that could have been avoided had we been able to find someone who could prescribe her medication when she was willing and able, before she got too sick to comply with medications and treatment.”

That was when times were good.

Now, with recession slamming the state and the country, the future funding of Health and Human Services programs, such as behavioral health support, could be in jeopardy.

A $3.1 billion shortfall

The state is projecting a $3.1 billion budget shortfall for the 2009-2011 biennium, a number that could rise as the recession continues. In December, when the projected shortfall was only $1.2 billion, Gov. Ted Kulongoski sought to close more than that predicted gap with human services cuts. By axing $1.43 billion from the Department of Human Services – $634 million from the state general fund and $789 million in federal funding – he wanted to bolster education funding, his top priority.

Kulongoski’s plan was not to simply cut human services. It was to cut administrative costs and reduce or eliminate certain programs – such as care for seniors and the disabled and dental care for adults on the Oregon Health Plan – and use some of those savings to give all children health care under the Healthy Kids Plan and add 75,000 people to the Oregon Health Plan.

But those improvements required acute cuts to the mental health and addictions department of DHS, including: a 90-percent reduction in outpatient mental health services for non-Medicaid consumers; a 50-percent reduction for acute inpatient care; closing the Blue Mountain Recovery Center, losing 60 state hospital beds; a 50-percent cut for alcohol and drug treatment services for non-Medicaid clients; and eliminating a residential treatment program for non-Medicaid clients.

The governor’s spokeswoman, Anna Richter Taylor, said that budget isn’t even in consideration anymore. Cuts will be larger, and even education and green technology funding, which Kulongoski had hoped to bolster, will likely falter.

Legislators say that while cuts will be necessary, they’re committed to protecting the most vulnerable in society.

“We’ve got a set of core principles that really focus first on protecting services for those who are the neediest,” said Speaker of the House Dave Hunt (D-Gladstone).

So far the Legislature has followed those principles. In the 2007-2009 budget rebalance earlier this year, it reduced a state DHS shortfall of $136.5 million to just $6.3 million by supplying emergency funds and “management actions.”

Hunt also said he’s confident the governor will sign whatever budget the Legislature puts forward.

“His budget was just based on a whole different era of budget realities,” he said. “It’s as though it was decades ago, eons.”

Despite that assurance, many who rely on those services are still scared.

Cuts coming

Those fears are warranted, said Cindy Becker, Clackamas County’s director of the Department of Human Services.

“Here’s the reality: what I’m hearing is the $3 billion shortfall is the floor right now and they’re expecting that to go up,” she said. “So while the specific cuts that the governor outlined may not happen, we will get significant cuts.”

That prospect has kept Veenker awake at night.

“If they cut services and at some point again (my daughter) ends up dropped, if she becomes ill, she’ll end up dead,” Veenker said. “They committed her (in 2007) because she was so disorganized in her thought process that they didn’t think she could manage to get her own food, that she’d die somewhere.”

Veenker and Sieler are far from alone.

Lorayne Dille, 57, was diagnosed in 1975 with bipolar disorder and manic depression. Even after 30 years, she needs support to remain stable.

“I occasionally will have a psychotic break where I lose contact with the world for a few minutes,” she said.

To cope with her condition, she has a number of medications, goes to group sessions weekly, sees a psychiatrist once a month and sees a counselor once a month.

“(Without services) I’d be lost,” she said. “I would feel real vulnerable … I wouldn’t be able to afford my medications.” She said she also could lose her housing, at a supportive group home in Oregon City.

Both Sieler and Dille receive Medicaid, which helps pay for their prescription drugs, counselors and other services.

Under the governor’s initial plan, at least 2,500 Oregonians would have lost services altogether. The income eligibility ceiling for Medicaid would also have dropped, cutting about 4,000 people from their services.

“Basically you’ve decimated the whole service,” Becker said of the behavioral health cuts. “It’s just so stunning. Never in the 30 years that I’ve been in this business have I seen anything like this.”

But until the May budget forecast comes out, no one – not Hunt, not Richter Taylor, and not Becker – knows how the situation will end up.

“I’m not used to saying I don’t know so much, but it’s a really unique situation,” Becker said. “The $3 billion, people were gasping at that, but more and more people are saying, $3 billion, we’ll be lucky with that.”

From the Salem Statesman Journal, March 19 2009

Adequate staffing — as many as 1,000 new workers — is seen as crucial to success

The chronically overcrowded and understaffed Oregon State Hospital has added 300 new employees in the past year, spurring notable improvements in patient care at the much-criticized psychiatric facility, OSH Superintendent Roy Orr said.

Now, the 2009 Legislature faces a thorny question: Can the financially-strapped state afford to add hundreds more workers in the coming 2009-11 budget period, which begins July 1?

And if a massive staffing infusion doesn’t materialize, will that cripple ongoing reform-minded efforts at the existing 126-year-old facility, as well as a planned $280 million replacement facility? The new 620-bed complex, described by state leaders as a world-class facility, is scheduled to open next year and become fully operational in late 2011.

By all accounts, adequate staffing looms as crucial for the hospital’s success. But stark budget realities will make it difficult for legislators to come up with enough money to pay for the kind of staffing infusion — anywhere from more than 500 to nearly 1,000 new employees — deemed necessary by Orr and other officials.

The issue will start to draw sharper focus today when Orr gives testimony before legislative budget writers.

As it stands now, the state hospital employs about 1,300 workers at its campuses in Salem and Portland.

Gov. Ted Kulongoski’s recommended 2009-11 budget earmarked $43 million for state hospital staffing, far below the $124 million outlined last November in a proposed budget package unveiled by Orr and the state Department of Human Resources.

If legislators go along with the scaled-down staffing level recommended by the governor, Orr said the hospital would be able to hire about 540 new employees in the upcoming two-year budget period. That’s far below the nearly 1,000 positions Orr previously deemed necessary to provide the kind of patient care demanded by the federal Department of Justice, which harshly criticized hospital care and conditions in January 2008.

“It was reduced given the condition of the economy and the state budget,” Orr said, referring to the governor’s proposed funding level. “We’re certainly not isolated from those things.

“We still don’t know what the Legislature will approve. I don’t want to jump to any conclusions. I just feel at this point that it will be a challenge for this organization to deal with the opening of the new hospital with a reduced number (of staff) as exists in the governor’s recommended budget. But it all depends on what the Legislature ultimately approves.”

Senate President Peter Courtney, D-Salem, said hospital staffing remains a high priority but he can’t make any promises about specific increases for 2009-11.

“We are in a heck of a crisis,” he said. “I’m scared to death because of what’s coming in May with the new (revenue) forecast. I’m frightened. I’m worried.”

Where does that leave state hospital staffing?

“I can’t give you the numbers or the exact way we’re going to do it, but I know we’re committed to keep trying to make progress,” Courtney said. “I’ve just seen the beautiful drawings of what they hope the new hospital is going to look like. But if you don’t have enough staff, then we probably won’t be any better off out there than we’ve been before.”

The Legislature previously agreed to spend $458 million to replace the dilapidated hospital in Salem and build a second hospital in Junction City. The state will use bonds to finance construction of a 620-bed hospital in Salem and a 360-bed hospital in Junction City, which is scheduled to open in 2013.

State funding for additional hospital staffing in the 2009-11 budget period, which starts July 1, would come from the general fund budget.

Concerns about potential costs for state hospital staffing have been simmering since Orr told legislative budget writers in November that the Department of Human Services intended to request $124 million to hire nearly 1,000 new employees in 2009-11.

At the time, legislators used words such as staggering and sobering to express their reservations.

Since then, the deepening economic recession and its toll on the state’s finances have intensified doubts about the state’s ability to pay for hundreds of additional therapists, nurses and support staffers.

In recent talks, state officials have discussed the possibility of taking a longer-term funding approach to state hospital staffing. Under one scenario, the kind of staffing envisioned by Orr would occur in phases, with partial funding in the 2009-11 budget, followed by another round in the 2011-13 budget.

Courtney estimated that it could take multiple two-year budget cycles to reach the staffing levels sought by the hospital.

Orr said it’s too early to say how staggered infusions of extra staffing might effect operations, patient care and safety at the new psychiatric hospital.

Orr said the hospital sorely needs more workers before the new hospital opens.

Large staffing increases are necessary to reduce the hospital’s enormous reliance on employee overtime — voluntary and mandatory, Orr said. The hospital currently is on track to spend about $25 million in overtime pay during the 2007-09 budget period, which ends June 30.

Without adequate staffing, he said, “we’ll just forever rely on overtime, and we know how expensive and in some cases how dangerous that can be.”

By Prasanna Pati, MD and Bob Nikkel, guest opinion, published in the Oregonian, March 18, 2009

In spite of the current state budget problems, we are pleased that the Oregon Legislature has continued to support plans to replace the state hospital in Salem with a facility that will support state-of-the-art treatment and security for the citizens of this state who are committed by the courts to recover from major mental illnesses. While more Oregonians recognize that these disorders are not simple choices that people make — but rather much more complex combinations of genetics, social environments and individual dynamics — the need to further destigmatize and educate the public about mental illness remains.

A critical part of the state’s mental health system should be support for a modern museum that would provide a unique opportunity for visitors to learn about mental illness and mental health. Over the past year, we have been gathering interest in the development of this kind of museum as part of the preservation of the historic Kirkbride building on Center Street in Salem. The state of Oregon is already in the process of investigating the possibility of gathering artifacts and memorabilia, for example, from the classic movie filmed in Salem, “One Flew Over the Cuckoo’s Nest,” which could be on display as one part of the educational component of this section of the new facility.

The museum should be planned and organized through a partnership between the state of Oregon and perhaps an institution with expertise in operating such a facility. The museum should be a place for not only public education but also research. The opportunity with modern technology for a multimedia interactive site could present many opportunities to promote understand and reduce fears that many people still have about persons with mental illness. Students, faculty and others interested in advancing the cause of reducing stigma and increasing community attention for prevention, early intervention and treatment could make use of historic materials and documents for this purpose.

As mental health professionals with a combined experience in Oregon of over a century’s worth of service, we believe that the museum should be dedicated to and named after Dr. Dean Brooks, the longtime superintendent of Oregon State Hospital from 1955 to 1983 and the man responsible for bringing “One Flew Over the Cuckoo’s Nest” to the hospital. But more importantly, Brooks was an early innovator and advocate for recognizing the humanity of the patients he served. One of the documents that should receive prominent attention in the museum is the article he published entitled “A Bushel of Shoes,” in which Brooks fearlessly examined his own institution’s efforts to assure respect due persons struggling through mental illnesses in their lives.

Both the movie and Brooks did a great deal to bring attention to issues of how people with mental illnesses have been viewed in the past. Now that we are more willing to acknowledge that most of us are personally familiar with mental illness — our neighbors, our friends, our relatives, and even many of us–we can take advantage of the state’s commitment to new facilities and move Oregon to the forefront of enlightened approaches to care and support for persons who are recovering and seeking wellness and inclusion in society. We urge the state to continue with plans for the new facilities and to include a museum that would validate the efforts of so many dedicated individuals like Dr. Dean Brooks.

Prasanna Pati of Salem is a retired Oregon State Hospital psychiatrist and a distinguished life fellow of the American Psychiatric Association. Bob Nikkel was head of the state Addictions and Mental Health Division from 2003-2008 and is an associate clinical faculty member in the Department of Psychiatry at Oregon Health & Science University.