Oregon State Hospital

-By Jenny Westberg, Portland Mental Health Examiner

A striking transformation could be in store at the Oregon State Hospital, according to the facility’s new leadership team, Supervisor Greg Roberts, MSW, and Chief Medical Officer Mark Diamond, DO, who spoke about the future Thursday evening at Oregon Health & Science University.

Roberts and Diamond weren’t talking about cosmetic fixes, although those are badly needed as well. They spoke of a rethinking of institutional culture that would change OSH from the inside out.

“Construction of a new building certainly helps, but it will not, by itself, get us where we need to go,” said Roberts.

Diamond led off the presentations with facts, figures and PowerPoint slides. But it was Roberts who blew the doors off the auditorium with talk of a patient-based, recovery-oriented institution.

“Research clearly shows that recovery is not only possible, but more than likely for most individuals,” said Roberts.

“OSH needs recovery-oriented systems of care,” he said, announcing his intention to take it “from research to routine practice, from rhetoric to reality.”

Real-world competency

Roberts said he is planning a culture change, and it will start with staff training.

“Employees,” he said, “often receive no training after their new employee orientation. Without this training, they will continue with custodial, control-oriented methods.” And that’s not all: They must demonstrate real-world competency.

Roberts said that staff must:

• Be confident in their ability to help people recover, and in each person’s own ability to recover.
• Treat each other and patients with dignity and respect.
• Inspire hope.
• Become non-reliant on threats, force and coercion.
• Listen to patients, instead of directing them. Let patients take the lead.

Will Hall: “Restraints have nothing to do with recovery”

Roberts went even further, calling for the elimination of seclusion and the “near-elimination” of restraints. To many observers, that would be a significant step toward improvement.

But some, like Will Hall, say “near-elimination” of restraints is not sufficient.

“Greg Robert’s remarks on restraints aren’t enough,” said Hall, a Portland therapist known internationally for mental health advocacy, who himself recovered from a diagnosis of schizoaffective disorder and experienced firsthand the terror of being restrained.

“The federal agency SAMHSA set the goal back in 2003 of eliminating all restraints,” Hall said. “I still suffer the traumatic scars of restraints from my hospitalization. Restraints have nothing to do with recovery.””

During Diamond’s presentation, the Chief Medical Officer explained that patient populations used to be primarily composed of civil commitments. Now, forensic patients are the largest group by far.

There are 432 forensic patients at OSH, and 63 geriatric/neurological patients. The Portland campus (“POSH”), meanwhile, houses 85 people with extended civil commitments. OSH also provides forensic evaluation services, such as “aid and assist” evaluations to see if an individual is competent to stand trial. For patients found incompetent to proceed in court, OSH attempts to restore competence.
Diamond mentioned the importance of making sure people are in the right place. There are hospital patients, he said, who should be in corrections, and vice versa.

More than “Cuckoo’s Nest”

Another vital element, said Diamond, is making sure that people who recover make it out of the hospital and into the community – and that they stay there. Factors affecting successful community placement include staying off drugs and tobacco (OSH is smoke-free); maintaining good nutrition, especially since many psychiatric drugs contribute to weight gain; continuing to take prescribed medications; acquiring occupational skills; and the use of  Wellness Recovery Action Plans, or “WRAP plans.”

Diamond would like to see OSH become a community resource, “working with community providers to extend outreach to the homeless population in order to prevent admission or readmission to the hospital.” He would also like to establish an inter-agency formulary, to minimize medication changes as an individual moves from one service to another. Also, he wants to see the development of a master’s-level forensic mental health curriculum.

Diamond and Roberts have set a high bar.

But Roberts promised targets and accountability. He is confident that “OSH will become the recovery-based organization we want and need it to be.”

“We’d like to be famous for more than ‘Cuckoo’s Nest.”

LEARN MORE – Greg Roberts speaks about the future of the Oregon State Hospital
LEARN MORE – Mark Diamond speaks about the future of the Oregon State Hospital

The DSM once contained homosexuality. It still contains Gender Identity Disorder. (Photo: Flickr.com/Stephen Cummings)

By Jenny Westberg, Contributing Columnist
Published in Street Roots, Oct. 29, 2010

In December 1973, a psychiatric breakthrough wiped out all signs and symptoms of mental illness for millions of Americans.

It wasn’t a new drug. It was an ex cathedra pronouncement by the American Psychiatric Association, declaring that homosexuality was not, in fact, a mental disorder. The change meant that more than 100,000 Oregonians went to bed one night with a diagnosable psychiatric problem and woke up the next morning with none at all.

Thirty-seven years later, however, being transgender — nothing more — is still enough for a psychiatric diagnosis, with a seven-page listing in the official diagnostic manual, the DSM-IV. Clinically, it’s called Gender Identity Disorder (GID).

The label is bad enough. But with GID, it’s not just, “You’re sick.” It’s often, “You’re sick… or else.”

GID is a gateway requirement for surgical transition. That means some people have little choice; like it or not, they have to submit to a psychiatric diagnosis that identifies them as “disordered.”

There are all sorts of reasons to get rid of GID. It lacks clinical sufficiency. It supports the idea that transgender persons are “sick” or “weird.” It treats distress as a psychiatric symptom, even when it’s due to discrimination and harassment.

At the same time, there are people who really need surgery, and removing GID from the manual could add to their difficulties. Portland therapist Reid Vanderburgh, MA, says it can be hard to object. “Most people bite the bullet and accept a GID diagnosis,” he says. “The desire for surgery trumps any activist instinct they might have to fight back and NOT accept it.”

But Vanderburgh, who has transitioned himself, manages to avoid GID in clinical practice. “I don’t include GID in my referral letters, for either hormones or surgery,” he says. “I find that my letters are accepted.”

“This leads me to question the actual usefulness of the diagnosis,” says Vanderburgh. “Is GID really necessary at all?”

Mental health for transgender persons doesn’t begin and end with GID; some people have a contrived problem, plus a real one.

Julie Trana, MS, who practices therapy in Portland, often sees transgender clients with depression, “likely resulting from years of feeling rejected or ‘not normal.’ They can also struggle with low self-esteem and suicidal ideation associated with the depression.”

Anxiety is frequent, as is substance abuse. There may be high rates of PTSD, stemming from harassment, discrimination, verbal assaults, attacks, beatings and rapes, which frequently go unreported to police. In addition, transgender people are subject to the same mental health problems as nontransgender people, such as bipolar disorder or schizophrenia.

But trying to get help can be difficult and discouraging. Alix Kemp wrote about the experience in a zine called “Genderfailz.” As a 21-year-old college student, Kemp’s mood began to drop. He became more and more depressed. It took months to gather the nerve to go to the campus health center, and still more months to get an appointment. He was near suicide when he finally talked to a psychiatrist.

Kemp was born female, but carefully explained to the doctor, “I’m trans.”

“But – you’re so pretty!” the psychiatrist said. To Kemp it meant, “You’re not going to find help here.”

He tried again, this time choosing a clinic specializing in gender issues. A nurse introduced him to the psychiatrist.

“This is Alix,” said the nurse. “She’s female-to-male, she’s 21, she’s a student…” The “trans-friendly” clinic worker was using the wrong pronoun.

Misunderstandings such as these are the rule, not the exception, and stigma is everywhere, even where you would ordinarily look for support. In groups of mental health consumers, transgender people may need to hide their gender identity. In LGBT communities, they might have to hide their psychiatric problems.

Inpatient treatment facilities have “male” patient rooms and “female” patient rooms. Clinicians may tell patients to act more “masculine” or “feminine,” and chart conformity as progress.

Some mental health professionals think transgender people suffer from psychotic delusions, believing they’re male when they’re actually female or the other way around. Transgender persons may be misdiagnosed as having borderline personality disorder because of the upheaval, confusion and conflict that often accompany being transgender. Or they may be labeled “manic” because of overwhelming relief at transitioning.

In hospitals and residential programs, some of the worst treatment can come from other patients, including hostility, physical aggression and name-calling that becomes a group sport.

Outpatient treatment isn’t much better. One person told Alicia Lucksted, Ph.D., “(During my transition from male to female), my psychiatrist asked me to dress as a man to meet with him, then said I wasn’t really transgender because I hadn’t had any suicide attempts.”

If you’re looking for transgender-friendly mental health care, where do you start?

“It can help to interview more than one therapist in order to make sure you find a good fit,” says Trana. “Be sure to ask specific questions about their comfort with and knowledge of transgender folks. You can also join support groups with other transgender folks if you want to talk to other people about their experience.”

Vanderburgh agrees. “Find someone who understands the issues.” Do you need to find a therapist who is transgender? “It’s useful to have gone through the process, it’s a shortcut to understanding, but everyone’s experience of gender is different anyway, whether they’re trans or not; being a trans therapist doesn’t convey automatic understanding of another’s experience.”

Most important: Seek out someone who makes you feel safe and comfortable. The resources below aren’t endorsements, but they are a starting place.

Resources

Reid Vanderburgh, MA, LMFT, 503-341-7001  – www.transtherapist.com

Julie Trana, MS, 503-330-5312 – www.julietrana.com

Sexual Minority Provider Alliance – http://www.glbtcounseling.com/directory.html

Oregon State University LGBTQ, “I might be transgender…” http://oregonstate.edu/lgbtqqia/question6

HealthCommunities.com – http://lgbthealth.healthcommunities.com/transgender/index.shtml

Jenny Westberg is a board member of The Mental Health Association of Portland, a nonprofit advisory organization that supports advocacy efforts on issues around mental health. Information about their work is available at www.mentalhealthportland. org

From KATU.com, October 29, 2010

Mark Casterline

According to the sheriff’s office, deputies responded to a domestic dispute between Mark Thomas Casterline and his sister at her apartment at 25182 E. Broadway.

A sheriff’s office representative said when deputies arrived around 4 p.m. Casterline had a knife. Deputies made contact with him inside his sister’s apartment and ordered him to drop the knife, but Casterline refused.

That’s when they say a deputy fired a beanbag round into the apartment at Casterline. That beanbag round was followed by another shot: this one from a deputy who fired a fatal gunshot.

“I didn’t hear the first shot,” said a Broadway Park Apartments neighbor Rebecca Ford. “But I did hear him say ‘I can’t believe you shot me.’ Then I heard that particular last shot.”

Casterline’s sister was not harmed in the incident, but neighbors said she was visibly shaken.

“She was hysterical,” said Ford. “We brought her into our home so she could talk with investigators but she was just in shock.”

Authorities did not say what Casterline did to provoke deputies.

Casterline was staying with his sister temporarily. Neighbors said they have seen him around the apartment complex recently.

Many neighbors said Casterline had mental disabilities. A spokesperson at the Lane County Sheriff’s Office refused to comment when asked if the man was mentally handicapped.

Several neighbors said they think the shooting was unnecessary and that Casterline could have been subdued with less-lethal forces.

The deputy who fatally shot Casterline is on administrative leave. This is routine with officer-involved cases.

The shooting is under investigation by the Interagency Deadly Force Investigation Team, which consists of investigators from Oregon State Police, Eugene Police Department, Springfield Police Department and the Lane County Sheriff’s Office.

A ruling on whether the use of force was justified is expected from the district attorney next week.

READ – Deputy shoots, kills man after reported domestic dispute, from KVAL.com
READ – Man killed by deputy: ‘I can’t believe you shot me’, from KATU.com
READ – Man shot by deputy refused to drop a knife, from Eugene Register-Guard
READ – Authorities Investigate Veneta Officer-Involved Shooting, from KEXI.com

Excellent article by Oregonian newcomer Amanda Waldroupe, published October 20, 2010

Aja Stacy, 14, loves school so much, she would crawl to get there if she had to, she says.

A bubbly and headstrong freshman at Troutdale’s Reynolds High School, Aja is enrolled in all honors classes and plays oboe for the school band. In middle school, she was on the volleyball, track and wrestling teams. She also plans to get involved with dance this year. She explains her busy academic and co-curricular schedule by referring to a weekly schedule in the back of a thick binder. As she talks, her words almost run together, making her pause and speak a bit slower.

Her excitement quickly fades when her living situation is brought up. During the summer before seventh grade, she became homeless. Now she shares a bedroom with her aunt, who is a live-in caregiver. Her father is unemployed and disabled.

Aja insists her tenuous housing situation has not effected her academics. School-based social workers, however, say situations like hers are daunting ones that create challenges for other homeless students. Many miss days of school, cannot find transportation, cannot complete homework and sometimes simply disappear.

Growing problem

And it is a problem that is growing. The number of homeless students in east Multnomah County school districts — Centennial, David Douglas, Gresham-Barlow, Parkrose and Reynolds — increased by 23 percent from the 2008-2009 school year to the 2009-2010 school year, according to Oregon Department of Education data.

Gresham-Barlow saw the highest increase: 40 percent. Reynolds increased by 34 percent to 754 homeless students in the 2009-2010 school year.

Molly Frye, Reynolds homeless liaison, is seeing those numbers again this year and is worried there are more homeless students she and her colleagues have not yet identified. Many students don’t admit they are homeless out of shame. Aja says Frye “had to get it out of me” when they first met.

Frye says the numbers are growing because of the economy, because poverty is increasing in east county and because schools are simply getting better at seeing the warning signs — missed days, incomplete homework, poor hygiene, the appearance of anxiety, among others.

Social workers say the increase is so substantial that local service agencies are being turned to for help. Judy Allen, executive director of SnowCap, says the social agency started a new mobile food pantry Aug. 1.

“If they’re well-fed, they can focus on their lessons,” Allen says.

Substantial hurdles

Homeless students, Frye says, face many obstacles for keeping up with academics.

“They’re focusing on their hunger, and situations where they might be evicted or housing may be tenuous,” Frye says. “And if you have to help out at home, or if you have a job, it’s hard to do your homework consistently.”

Aja says she has to “go around and do stuff other kids don’t have to worry about.” At times, a “feeling on your mind” of anxiety, worry, sadness or disbelief manifests itself, she added.

Frye works with students, even making home visits, to make sure they are attending school, doing well and connecting them with whatever services they need to help succeed academically. In Aja’s case, Frye helps her get a monthly bus pass so the 10- to 15-minute daily bus ride from where she is staying is free.

Other organizations are helping. Last year, Gresham’s East Hill Church donated $12,500 to Gresham-Barlow and $7,500 to Reynolds to give $100 Ross Dress for Less gift cards to homeless students. Last summer, the church also gave $3,000 to Reynolds to buy 300 calculators for students who couldn’t afford them.

And the church expects to open a new clothing closet for homeless students Nov. 9.

Aja does not expect to live with her father again. But she can continue counting on her aunt and is determined to continue not letting her living situation affect her school life.

“It’s rough,” Aja says, “but I keep my head held high.”

Dr. Mark Diamond, OD, spoke about the future of the Oregon State Hospital to about 100 friends of the Mental Health Association of Portland at Oregon Health Sciences University on October 28, 2010. The event was co-sponsored by Portland Hearing Voices, Disability Rights Oregon, the Empowerment Center, and NAMI of Multnomah County.

Mark has been in his current position as the Chief Medical Officer of the Oregon State Hospital for the past year. Prior to that, he was the Chief of Psychiatry for The Institute of Forensic Psychiatry at the Colorado Mental Health Institute at Pueblo and was also the Chief of Psychiatry and Acting Chief Medical Officer for the Colorado Dept. of Corrections. He is Board Certified in Psychiatry and has added qualifications in Forensic Psychiatry. He is a Certified Correctional Health Professional, a Distinguished Fellow of the American Psychiatric Association, as well as a Affiliate Assistant Professor with the OHSU Department of Psychiatry. Dr. Diamond has lectured nationally on the topics of Correctional Mental Health and Cost Containment related to Psychotropic Medications.

Greg Roberts, MSW, spoke about the future of the Oregon State Hospital to about 100 friends of the Mental Health Association of Portland at Oregon Health Sciences University on October 28, 2010. The event was co-sponsored by Portland Hearing Voices, Disability Rights Oregon, the Empowerment Center, and NAMI of Multnomah County.

Greg Roberts joined the Oregon State Hospital as the new Superintendent just a few weeks ago in September. He is the former director of the Office of State Hospital Management in New Jersey. Roberts brings with him nearly 40 years of experience in the mental health field, and he has a track record of turning around hospitals facing challenges to the state hospital’s, such as obsolete facilities and scrutiny over patient care. Robert has filled many roles, including spending time as chief executive officer at each of New Jersey’s five psychiatric hospitals. In his most recent position as hospital administrator, Roberts supervised four adult psychiatric facilities.

From the Portland Mental Health Examiner, October 28, 2010

In 1883, the Oregon State Insane Asylum opened its doors in Salem. In 2010, now called Oregon State Hospital, it is a crumbling reminder of the past.

Chief Medical Officer Mark Diamond, DO, and Superintendent Greg Roberts, MSW, think they have what it takes to lead OSH into the future, and tonight, they’ll have a chance to explain how. It’s the first time they will speak in public since their recent hires ended a lengthy, nationwide search process.

“They’re charged with making a big change, and we’d really like to hear how they plan to do that,” said Jason Renaud of the Mental Health Association of Portland.

The lecture on “The Future of Oregon State Hospital” will take place Oct. 28 at Oregon Health & Science University in Portland. The reception begins at 6 p.m., with speakers at 7 p.m. Presented by the Mental Health Association of Portland and OHSU Dept. of Psychiatry, the event is free and open to the public.

Diamond, an osteopath with a background in prison psychiatry, told the Statesman-Journal he’s looking forward to being “part of a care system driven by patient needs, and a plan of continuous improvement to meet those needs.” Roberts, who has managed psychiatric hospitals in New Jersey, is also optimistic: “There is no problem that can’t be solved.”

The difficulties facing Oregon State Hospital might cause Diamond and Roberts to reconsider their optimism.

In 1975, the hospital was a grim backdrop for the film “One Flew Over the Cuckoo’s Nest.” Since then, it has gone from grim to patently unsafe. Inside the dilapidated buildings, recent investigations have found inadequate patient care and rights violations. There have been tragedies like the death of Moises Perez, whose body lay for hours across from the nursing station before staff noticed he was dead.

A 2008 U.S. Dept. of Justice Civil Rights Division investigation documented conditions and practices such as these:

* “Inappropriate and inadequate care… Patients can receive medication and other treatment for conditions they do not have.”
* “In practice, planned seclusion and restraint often is the only component of a patient’s treatment plan.”
* “…many of them remain in seclusion indefinitely.”
* “No member of the Department of Justice site visit team had ever encountered the use of continuous seclusion as a planned treatment strategy.”
* “Staffing shortages fall dangerously below the minimum levels…”
* “Clinicians prescribe [antipsychotics and benzodiazepenes] for their secondary sedating effects and as a substitution for appropriate therapeutic interventions… This practice constitutes chemical restraint.”
* “[The building] is in a state of severe deterioration and serious dilapidation.”
* Problems with infection control; lack of hand-washing… “Indeed, of the 28 patient deaths [in one year], 15 were from pneumonia…”
* Problems with ventilation or cooling leading to risk of heat stroke… “It is fairly routine for indoor temperatures to exceed 90 degrees.” Mice in patients’ rooms; norovirus outbreaks; scabies outbreaks…
* “Some patients remain at OSH for months or even years after having met the criteria for discharge.”

Can Roberts and Diamond turn it around?

“I expect them to be leaders,” says Jason Renaud. He adds, though, that he has not met many who have lived up to that expectation.

Join us for an eye-opening presentation:

Thursday, October 28, 2010 Reception 6 PM, Speakers 7 PM – 8:30 PM

OHSU Auditorium (Old Library) 3183 SW Sam Jackson Road Portland, Oregon 97239

Free and open to the public

Presented by the Mental Health Association of Portland and OHSU Dept. of Psychiatry
Sponsored in part by Portland Hearing Voices, NAMI of Multnomah County, Disability Rights Oregon, Cascadia Behavioral Healthcare, and others

The Mental Health Association of Portland and Oregon Health Sciences University together welcome Greg Roberts, MSW, and Mark Diamond, DO, for a public talk on October 28, 2010 at 7 PM.

Greg Roberts is the new superintendent of the Oregon State Hospital. Mark Diamond has been the Chief Medical Officer for the past year.

The Oregon State Hospital is our most complex, most controversial state organization. With three campuses, over 900 certified beds, a reputation in the media and mental health community for substandard care, new construction, and budget cuts looming, the Oregon State Hospital presents a daunting management challenge.

We’re anxious to hear directly from Roberts and Diamond about their vision for the future of the hospital, about clinical strategies, about recruitment of new staff, about community relations, about responding the the Department of Justice report, the current JCAHO survey, and other items.

A reception will start for Greg and Mark at 6 PM in the foyer at OHSU Auditorium. Their talk will begin at 7 PM. This event is free and open to the public. Medical professionals working with public mental health clients are strongly encouraged to attend.

Download a flyer for this event.

Recent news stories about the Oregon State Hospital are archived here.

This event is co-sponsored by Portland Hearing Voices, Cascadia Behavioral Healthcare, Disability Rights Oregon, NAMI of Multnomah County, the Mental Health America of Oregon, Empowerment Initiatives, and others.