1 in 6 people has a common mental illness at some point in their life (Psychiatric Morbidity Survey, 2000).
About 1% of the population experience schizophrenia at some point in their lives (Mental Health Foundation, 1999).
About 1% of the population experience manic depression at some point in their lives (Mental Health Foundation, 1999).
1 in 200 people have experienced a psychotic illness in the last year (Singleton, Psychiatric Morbidity, 2000).
The average age of onset of psychotic symptoms is 22 (Department of Health, 2001)
Deprived areas and rural districts have the highest levels of mental health problems and suicides (ONS, 2001).
People from Afro-Caribbean backgrounds are 3-5 times more likely than others to be diagnosed and admitted to hospital for schizophrenia. (Mental Health Foundation, 1999)
About 25% of people diagnosed with schizophrenia will make a full recovery; about 60% of people will have fluctuating symptoms; about 10-15% of people experience long term incapacity (Mental Health Foundation, 1999).
35% of people with mental illness are unemployed but want to work (ONS, 2003), the highest want to work rate of any disability.
Only 1 in 4 employers said that they would knowingly employ someone with a history of mental illness (Manning et al, 1995).
Three quarters of employers say that it would be difficult or impossible to employ someone diagnosed with schizophrenia (DWP, 2003).
Less than 5% of people who kill a stranger have symptoms of mental illness (Department of Health, 2001).
People with mental illness are more likely to be the victims than the perpetrators of violence (Walsh, 2003).
More than 1 in 4 people with severe mental illness report being shunned when seeking help (Rethink, 2003).
30% of GPs’ time is spent with people with mental health problems (Sainsbury Centre for Mental Health (Maudsley Monograph, 2002).
44% of people with mental health problems report discrimination from general practioners, such as physical health problems not being taken seriously (Mental Health Foundation, 2002).
Almost 80% of carers for someone with a severe mental illness say that caring has had an impact on own their mental health (Rethink, 2003).
Almost 80% of carers for someone with a severe mental illness say that caring has had an impact on their own physical health (Rethink, 2003).
Only 48% of mental health professionals know about local policies on sharing information with carers (Rethink/IoP, 2006).
Mental health problems cost the economy untold billions per year through care costs, economic losses and premature death. (Sainsbury Centre for Mental Health, 2003).
21% of people with schizophrenia have a dual diagnosis (Cantwell, 2003).
Up to half of people dependent on alcohol have a mental health problem (Turning Point, 2003).
People with schizophrenia and bipolar disorder die 10 years younger due to physical health problems (British Journal of Psychiatry, 2000) and have double the average rate of heart disease (British Journal of Psychiatry, 2006) and five times the average rate of diabetes (Department of Health, 2004).
People with severe mental illness smoke twice as much as average, do half as much exercise and eat less fruit and vegetables than average (Running on empty report, 2005).
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“Infuriating, tragic, heartbreaking and incendiary in equal measures... plays out like a horror film and leaves you absolutely breathless.”
~ AP Kryza, Willamette Week
A year has passed since Jennifer Warren was murdered by a mental health patient she was trying to help.
Today, Warren’s mother and her family are outraged laws haven’t changed to protect other workers in the mental health field, nor that her daughter’s employer has made any safety changes. Warren’s adult daughter has filed a lawsuit against the state of Oregon.
Warren was killed after she had just stepped through a doorway at Columbia Community Mental Health to deliver medication to patient Brent Redd, who lived in a transitional housing apartment in St. Helens.
“I don’t think she saw it coming. In fact, I know she didn’t,” mother Theresa Armstrong said.
Redd grabbed a 12-inch knife, stabbing Warren.
Her mother is angry other workers are continuing to do the same job – alone.
“They said, ‘Well, this doesn’t happen,” her mother said. “Well, it did happen.”
Warren’s director at Columbia could not be reached for comment for this story.
Documents obtained by Armstrong show the organization now sends out other workers when a panic alarm is triggered. The alarm also alerts police if a worker is knocked to the ground.
Still, a state investigation revealed that it wasn’t clear whether additional staff members could have prevented Warren’s death. But the same investigation showed mistakes were made in handling the accused killer’s deteriorating mental state.
The report showed “critical gaps in how this risk information was communication” between Columbia and the Oregon State Hospital.
About the mistakes, Armstrong said: “I hope to God it doesn’t happen again.”
Hundreds of family members, friends, colleagues and acquaintances gathered in the St. Helens High School auditorium for a memorial service to honor Jennifer Warren on June 3.
Warren, who worked at Columbia Community Mental health as a mental health worker, was fatally stabbed two weeks earlier while delivering medications to a patient. That patient, later identified as Brent Redd Jr., in now being held on murder charges at Oregon State Hospital. Warren was just three days shy of her 40th birthday.
Jennifer Warren
Rather than remembering the tragic way her life ended, the memorial service focused instead on the positive way Warren lived. Family members often described her as the kind of person who would tell you the truth, no matter how much that truth might hurt, but always in a loving and caring way.
Sister Shirley Warren II said it was important to Jennifer Warren to share her positive approach to life with others in her hometown and never traveled too far away.
“My sister did many selfless acts for me through the years,” said Shirley Warren II. “She taught me that honesty might sound brutal and that it does not have an expiration date.”
She said her sister had also made great strides in life and that she stood her ground when it came to those things she believed in. “She had achieved a certain generosity about her that I am so grateful for and proud of,” she said.
Younger brother Kenny Warren Jr. recalled his older sister’s never ending support.
“Jennifer was a good big sister. She was always there for me when I needed help,” he said. “And she would always give me her honest opinion. Even if it wasn’t what I wanted to hear.”
Joining family members in paying tribute were Warren’s coworkers from CCMH. While they may have been colleagues, many of her coworkers also considered Warren a treasured friend.
Julie Knapp had known Warren since her coming to work at CCMH nearly a decade earlier. In preparation for the service, Knapp spent time during the week prior talking with others to hear their thoughts and remembrances.
“I found that there was a theme when talking about Jennifer. Her smile was on top of the list and how it became contagious. It made me wonder if Jennifer thought, ‘If I smile, others will too,’ as that seemed to be the result,” Knapp said.
She went on to add that along with her reliability, Warren was most remembered for her generous nature, citing a time when Warren donated unused vacation to another employee and how she would often rescue stray cats and find them homes,
“Her follow through and responsiveness to others and how she gave praise or let you know when she was upset with you were all qualities of Jennifer’s that her co-workers remembered” said Knapp. “She was able to draw people in and make you a friend. She was never just a co-worker.”
Following the memorial service, family and close friends gathered for a private reception.
The Psychiatric Security Review Board is fairly modest about its existence. There’s little useful information provided in a obvious place on the web – so we created this web site to list the staff contact information and relevant statutes.
Filling in for a co-worker on the weekend shift, Jennifer Warren stepped into Brent Redd‘s home last Sunday morning to deliver his anti-psychotic medication.
Doctors, though, were reducing Redd’s dosage in preparation for a medical procedure. Committed to the Oregon State Hospital five years ago for trying to murder his mother, Redd had been released to living semi-independently in a St. Helens duplex. The 30-year-old was stable, even holding down a job at a thrift store.
But he was worried about being taken off his drug therapy.
“He was scared,” said his mother, Debbie Redd, who lives in The Dalles. “Those meds are what regulate him every day.”
Later Sunday, Redd was arrested in Warren’s fatal stabbing. Redd reportedly called 911, and St. Helens Police Chief Steve Salle said police recovered a kitchen knife as evidence. Prosecutors charged Redd Thursday with Warren’s murder.
The St. Helens homicide is in many ways unusual. Redd was under the supervision of the Psychiatric Security Review Board. The homicide is the program’s first in about 30 years, but it raises troubling questions about safety and protocols:
Should caseworkers travel in pairs and take precautions when medications are changed? Who makes the rules? Does the state do enough to protect health care providers, the community and the patients themselves?
Many questions can’t be answered until the investigation is complete. Dr. Joseph Bloom, former head of psychiatry at Oregon Health & Science University, said officials should determine whether a solo visit by Warren was appropriate considering Redd’s dosing. “I would expect that the programs involved would do a lot to understand what happened.”
LITTLE-KNOWN PROGRAM
The psychiatric board supervises criminal defendants judged guilty except for insanity in felony cases, roughly 600 in Oregon.
Many were convicted of murder or attempted murder like Redd, while other charges include arson and sex abuse. Currently, 183 are in the Oregon State Hospital and 413 are on conditional release.
Two dozen locked facilities around the state house 76 of those on conditional release, while 175 are in residential treatment centers or supervised adult foster homes. About 64 live semi-independently, in housing where a staff member lives, and the rest live on their own.
The psychiatric board’s five members, appointed by the governor, act as judge and parole office. For each felon judged guilty except for insanity, the board is advised by mental health professionals and county officials and decides:
Whether patients can be released from the state hospital. For Redd, found guilty except for insanity in the attempted murder of his mother in 2007, a judge decided on 20 years of supervision. The psychiatric board sent Redd to the state hospital and, in its 2009 review, kept him there.
Where they can be released. The psychiatric board in September 2010 released Redd to a residential treatment center in St. Helens. In May 2011, it approved his transfer to a duplex supervised by Columbia Community Mental Health, the nonprofit that provided his day-to-day therapy and monitoring.
Conditions of release. Redd took random weekly drug tests, attended group therapy sessions five times a week, saw his therapist weekly and his caseworker checked in twice a day. He attended three substance abuse meetings a week and passed random drug tests weekly. He had to stay at home between 10 p.m. and 7 a.m. and swallow medication in front of a caseworker.
Mary Claire Buckley, executive director of the psychiatric board, said monthly reports indicated Redd was doing well.
The psychiatric board has been under fire for years by lawmakers and mental health advocates saying it is too strict. In the last 15 years, of more than 1,600 people released from the hospital, 15 people have committed felonies while under board supervision, including three since 2009.
Clackamas County District Attorney John Foote says the tragedy shows public safety should be the priority when it comes to people with a history of violence.
“I hope this is a wake-up call,” he said.
Bob Joondeph of Disability Rights Oregon, sees it differently: “We think it’s very important to understand what happened here, but not to jump the gun and not to paint everyone with the same brush.”
LOCAL AUTONOMY
Oregon spends about $400 million a year on mental health, about half on local programs like the one Redd was in, Columbia Community Mental Health, which receives more than $3 million yearly. The state inspects nonprofits every three years.
Columbia Community Mental Health, which employed Warren, declined to be interviewed. But according to state and other county officials, providers are directed to set their own safety policies.
The state requires crisis response training for caseworkers. They don’t carry defensive weapons such as pepper spray due to legal issues, mental health officials said.
“You have to have training — you can harm people,” said Schneider.
There is no standard policy on when a solo visit is appropriate.
It’s not uncommon for caseworkers to visit patients individually, but they need to be cautious, said Greg Schneider of Lifeworks, which provides mental health services in Malheur and Umatilla counties. “If that person had anything happen in their life recently or had any mental health deterioration, then you may not want to go out alone,” he said.
NO SIGNS OF TROUBLE
In April, Redd’s mother said he was being weaned off anti-psychotic medication for Hepatitis C treatment. It had taken years to find the right medication to keep his paranoia and schizophrenia at bay. She asked him if it was a good idea, and recalls his response:
“They told me it’s going to be OK,” he told her. “They told me that I will know. That I’ll see signs” if there are problems.
Redd’s caregivers knew about the medication change, said Gina Nikkel, a consultant with Warren’s employer, Columbia County Mental Health, adding that it’s too early to draw conclusions.
“People feel that he was not a risk,” she said. “Columbia mental health staff were doing everything in accord with the protocols that have been used for a long time.”
Redd’s roommate also said there was no sign of trouble. “He was being double and tripled monitored. How on earth could they have known that this would have happened?”
The state is reviewing whether state and county rules and provider policies are adequate.
On Thursday, Linda Hammond, interim director of the state Addictions and Mental Health Division, met with county mental health directors from around the state.
A parallel state investigation is looking at the care Redd received, while the Oregon Occupational Safety and Health Division is examining whether Warren’s death was preventable.
After his arrest, Redd was taken to Legacy Emanuel Hospital & Medical Center to treat wounds that were apparently self-inflicted. He’s expected to be arraigned soon in Columbia County.
A makeshift memorial to Warren, a 39-year-old single mother, has sprung up on the front lawn of Redd’s unit, one of four in two ranch-style buildings situated on a corner.
Brent K. Redd Jr. seemed to be turning his life around. For a year, he lived in an apartment in St. Helens under the care of Columbia Community Mental Health.
He was taking his medication. He attended group therapy sessions five times a week. He saw his own therapist weekly and his caseworker checked in on him twice a day. He also attended three substance abuse meetings a week and passed drug tests weekly.
But Sunday morning, the 30-year-old man who was committed in 2007 for trying to strangle his mother was taken into custody in the death of Jennifer Warren, a 39-year-old mental health worker who delivered his medication.
Warren died from stab wounds to the chest, according to the state medical examiners office. Steve Salle, St. Helens police chief, said Redd suffered knife wounds to the neck and throat and was taken to a Portland hospital for treatment. When he’s recovered, he’ll be arraigned, likely for murder.
“It’s a very tragic situation,” said Mary Claire Buckley, executive director of the Psychiatric Security Review Board.
The killing stunned the board, which has had jurisdiction for Redd since he pleaded guilty except for insanity in 2007. Buckley said the board had no indication that Redd was not doing well.
“I’ve never had any concern expressed by his community provider about his performance,” Buckley said.
Since 1978, the board has supervised more than 1,400 people who’ve been found guilty except for insanity. Only 2 percent have committed new crimes.
Redd was born in Burley, Idaho, and grew up with two half brothers and a sister, said his paternal grandmother, Doris Stanger, who lives in Idaho. His parents, Brent K. Redd Sr. and Debra Redd, moved the family to Oregon when Redd Jr. was about 10 but Stanger said she and her husband would take the children for weeks at a time as the parents struggled.
She saw no indication that BJ — as Brent Redd Jr. was called — had mental problems when he was young. But he acted out as an adult. In 1999, he was convicted of felony assault and sentenced to a three-year probation term. His probation was revoked in 2001 for theft, vehicle theft, a drug charge and burglary.
Redd served nearly 2 1/2 years in prison, released in June 2004. The following year, he was living with his mother at her home in The Dalles. In August, he tried to kill her. Debra Redd said that she got up, made coffee and asked if he wanted some. He said no. Then, she sat on the sofa and turned on the TV. She told police he came over, sat down, turned the TV off and suddenly started choking her.
“Go to sleep Mom, go to sleep,” she told police he said.
She fought and managed to flee but he came after her. She passed out and was lying on the street, gasping for breath and with a bloody knee and elbow, when he caught up.
“Look at you; we need to get you help,” she quoted him as saying.
He told her voices in his head made him do it. He tried to pick her up but she ran to a neighbor’s home. When police arrived, Redd shot his hands into the air.
He mumbled to police that Mother Nature made him do it and in jail, withdrew into himself.
“He would sit in his cell and not communicate with anyone,” said Eric Nisley, Wasco County district attorney. But after being seen by medical staff, his condition improved.
“His mental status improved dramatically,” Nisley said.
He was eventually committed to Oregon State Hospital, under the jurisdiction of the Psychiatric Security Review Board.
Buckley said that in August 2010, hospital staff recommended that he be placed on conditional release. The board asked Columbia Community Mental Heath, which offers the services he would need, for a second evaluation. That agency agreed he was ready.
“They interviewed and agreed that he could be adequately controlled and treated in the community,” she said.
The agency reported to the board monthly on his progress. The reports said he was following the terms of his release.
News of the stabbing shocked Warren’s relatives. Shirley Warren, 33, Jennifer Warren’s younger sister, said she’s angry Columbia Community Mental Health allowed her sister to visit an unsecured residence on her own.
Corina Fesler, a 41-year-old mental health worked at the agency, had similar concerns. She too delivered medication to clients under the authority of the board.
“There’s been concerns all along that we go out and do this by ourselves,” Fesler said. “To me, this is kind of the final straw. It just made me sick, because it didn’t have to happen that way. If someone else could have been there, at least she would have had back up.”
Fesler quit on Sunday: “This just isn’t worth it,” she said.
After Warren’s killing, Columbia Community Mental Health told staff they could partner up when visiting clients in the community, an official said.
Monday afternoon, the agency issued a statement: “Our thoughts and prayers are with the family and friends after this terrible incident. We are working closely with the proper authorities and have initiated an independent review to ensure the safety of our mental health workers.”
The Columbia County district attorney’s office is still trying to piece together what happened. But one person isn’t surprised by the attack — the Wasco County DA.
“That’s the nature of this guy,” Nisley said. “He’s very scary.”
Slain St. Helens mental health worker ‘took care of people who were struggling’
Jennifer Lynn Warren was killed three days before her 40th birthday, an hour into her Sunday shift as a mental health support worker for Columbia Community Mental Health.
The St. Helens woman who had struggled much of her young adulthood to overcome a methamphetamine addiction had spent the past 10 years giving back to the community, delivering medications to people with mental illness.
“She took care of people who were struggling and she loved them,” said her father, Kenny Warren Sr., 63. “What I taught my kids is helping others is more than any kind of money. I’ve lost an angel.”
Kenny Warren said he was readying to go to church when one of his daughter’s co-workers came to his home with his 22-year-old granddaughter, Jessica Warren. He sensed something was amiss.
The co-worker broke the news. “She said, ‘my daughter is dead,’ ” he recounted. “I think of myself as a strong person, but that just knocked me for a loop. I had to sit down. I felt very weak and dizzy.”
Jennifer Warren lived with a longtime companion and was engaged to marry him this summer. Besides her daughter, she had three sons, but had to give the boys up for adoption, relatives said. Relatives described her drug recovery as successful.
She spent Saturday jet skiing on the Columbia River with a friend, and reported to work by 7 a.m. Sunday.
Jennifer’s daughter, Jessica Warren, said she knew some of the people that her mom delivered medications to had been found guilty except for insanity of various crimes. “I was concerned about her safety. It was something that I brought up to her. But she loved her job,” she said. “My mother was very nice to these people. I don’t know what made the guy snap, but it was definitely out of the ordinary.”
Jessica Warren, who lost a brother to suicide last year and her father to suicide in 2001 (both not related to Jennifer), said she feels lost without her mom. “This isn’t the first tragedy in our family,” she said. “Hopefully, it will be the last.”
Co-workers were crushed by the news. Corina Fesler, 41, who like Jennifer worked as a community support specialist for the non-profit agency, said Jennifer Warren was warm and supportive to clients, and used humor to handle challenges.
When Jennifer Warren wasn’t able to work at one home because a client was having delusions about her, she took it in stride and worked elsewhere, she said.
“She was funny, outgoing,” Fesler said. If anyone needed help, Warren would step in, Fesler said. “I just can’t imagine. She left home yesterday morning to go to work and do her job.”
Amid their sorrow, there is anger.
“We know for a fact that everybody – when these people coming down off their medication, or are changing their medication, anything can happen,” Kenny Warren said. “So the administrators — if they don’t step up and take responsibility — they’re just as guilty as the man who did that.”
