Mental Health Association of Portland

Oregon's independent and impartial mental health advocate

Recreational therapy makes a difference for OSH patients

Posted by Jenny on 19th July 2014

Statesman Journal, July 19, 2014

Guy Forson (standing) works with Nick Stalheim

Guy Forson (standing) works with Nick Stalheim

“Down, down, sideways.”

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

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

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

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

He has great faith in recreational therapy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“She’s a great bowler,” he said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tags: , , ,
Posted in Uncategorized | No Comments »

Portland hospitals increasingly dump psychiatric patients in long-term ER beds

Posted by Jenny on 16th July 2014

Willamette Week, July 16, 2014

One of the rooms in Legacy Emanuel's ER used for psychiatric boarding.

One of the rooms in Legacy Emanuel’s ER used for psychiatric boarding.

Jennifer Ann has found herself in Portland emergency rooms more than two dozen times in the past 20 years—almost always for the same reason. 

“Usually I go,” she says, “because I feel I’m going to kill myself.”

On good days, Jennifer Ann, 56, is a high-functioning mother of four. She’s a lifelong Portlander with bobbed hair and a self-deprecating wit. She’s held administrative positions in the wood products industry, and now works as a mental health advocate. 

On bad days, Jennifer Ann (who asked that WW not use her full name) is helpless as schizoaffective disorder—a combination of bipolar disorder and schizophrenia—takes over. Last September, she went to the ER at Providence Portland Hospital at Northeast 47th Avenue and Glisan Street during a crisis. Hospital staff loaded her onto a gurney and lodged her in a stark room for 44 hours without therapeutic services.

“It’s the worst thing you can do to a person in crisis,” she says. “You just put them in a room and leave them there with minimal contact. It’s scary and depressing.”

What Providence did happens at Portland ERs all the time: Psychiatric patients held for days because there is no place to send them. Doctors and medical journals call it “psychiatric boarding.” Patients and mental health advocates call it “warehousing” or “dumping.”

“It’s a broken system,” says Cindy Scherba, clinical director of behavioral health services at Oregon Health and Science University.  

The hospitals say they have little choice. Doctors, patients and mental health advocates say the practice is an unintended consequence of the state’s flawed mental health policies.

The U.S. Department of Justice, which has been monitoring Oregon’s mental health system, criticizes the practice. Documents show state leaders have created an expensive approach that treats too few patients and leaves many more stranded in ERs.

“There’s a lot of money in the mental health system, but it’s not being spent wisely,” says Jason Renaud, a board member of the Mental Health Association of Portland. “We’ve chosen the most expensive, least effective method of dealing with people in crisis.”

Nonetheless, boarding is the default treatment for thousands of patients who come to Portland emergency rooms each year. Nobody tracks the exact number, but statistics that do exist show the problem is getting worse.

The Oregon Health Plan paid to treat 15,407 patients for mental illness at emergency rooms last year—a 47 percent increase since 2009.

Meanwhile, the time such patients spend held in ERs is lengthening.

The typical patient with a physical complaint who comes to Legacy Emanuel Medical Center’s ER in North Portland, for example, is in and out within 2½ hours.

Emanuel’s median ER stay for psychiatric patients in May was 40 hours—more than twice what it was a year ago.

“There’s not a system of community alternatives for people in distress,” says Beckie Child, a patient advocate who teaches in Portland State University’s School of Social Work. “Right now, the only option we have is the ER.”

The parade of psychiatric patients to emergency rooms began 60 years ago with a national policy of deinstitutionalization. The theory was that moving patients from hulking mental hospitals into their communities would produce better outcomes.

Institutions opened their doors, but state and local governments have struggled to find community-based alternatives.

Typically, a patient who arrives at an ER suffering a psychiatric crisis gets evaluated by a doctor. The patient may elect to remain voluntarily until an inpatient bed is available, or a doctor may order an involuntary “psychiatric hold.” In the latter case, a county investigator must assess within three days whether the patient should be committed. A commitment hearing must then be held within five business days. 

Without local beds, patients are typically put into what have become improvised holding cells in hospital ERs. For safety, that space typically contains no furniture other than a bed bolted to the floor. The patient is in a netherworld: not free to go, not admitted, and often not treated. 

“Some folks end up being boarded for as long as three weeks,” says Liz Wakefield, a lawyer with Metropolitan Public Defenders who handles commitment hearings.

Nicole Currier says that boarding patients in ERs often makes their conditions worse.  

That’s what Currier, 31, says happened to her in 2011. A Northeast Portland native who loves the Woodsman Tavern and her pit bull-greyhound mix, Sadie, Currier has been diagnosed with PTSD. She says she had just been put on a new drug called Luvox that caused her to experience mania and to consider cutting herself.

Her fiance called police for help, and an officer drove Currier to the Providence Portland ER, where medical staff placed her in an ER triage room, with a guard outside the door. Later, she was moved to a locked room within the ER. 

“It was in no way therapeutic,” Currier says. “I felt like a caged animal.” 

Currier says she was in a fog. Her fiance implored hospital staff to take her off Luvox, and her condition rapidly improved. Currier says she thinks if she’d been seen by mental health specialists, the results would have been much better. 

“It felt like I went somewhere seeking help and, instead, I was punished,” Currier says. “I was on a psychiatric hold, but I was not in a psych unit. That’s very confusing.” A Providence spokesman was not available for comment.

Key decisions by state leaders in the past decade have turned Portland emergency rooms into warehouses. 

First, despite the national trend toward deinstitutionalization, the Oregon Legislature, led by Senate President Peter Courtney (D-Salem), has doubled down on building big, centralized mental hospitals. 

Led by Courtney, lawmakers voted in 2007 to replace the decrepit 125-year-old Oregon State Hospital in Salem with a new facility, plus build another state hospital in Junction City, 17 miles north of Eugene—both far from the Portland area.

State hospital beds are increasingly taken up by forensic patients—persons judged guilty of a crime except for insanity or found incapable of aiding in their own defense at trial. Such patients comprise 400 of the state hospital’s 601 patients. That leaves little room for patients from outside the criminal justice system.

“The state hospital is more and more clogged,” says Dr. Tony Melaragno, Legacy’s vice president of behavioral health administration. “For a patient who’s been committed, the wait list is increasing; it’s three or four weeks now to get a bed.” 

What’s worse, the new Oregon State Hospital is extraordinarily expensive—it costs $345,000 a year to keep a patient there, and that money comes out of the state’s general fund. 

By comparison, community-based mental health treatment—which the state lacks, requiring patients to be held in ERs for days at a time—costs $15,000 a year. And such costs are largely reimbursed by the federal government.

Oregon’s reliance on the state hospital is a sore point for federal officials. The U.S. Department of Justice has ordered the state to improve its mental health system. 

“Movement from an institution-based system and a subsequent reinvestment into a community-based system will result in major savings,” the DOJ said in a January report. 

The state’s reliance on an expensive system that’s leaving mental patients stranded in hospital ERs enrages many advocates.

“The Oregon state legislature is to blame for underfunding mental health and for mismanaging the money they do have,” Renaud says. “It’s a jobs program to Peter Courtney, and he’s supposed to be a mental health advocate.”

Courtney says he’s indeed a strong advocate. He says he has pushed to fund a wide variety of community-based options, but says Oregon will always need a state hospital.

He says replacing the existing facility in Salem rather than in Portland minimized disruptions and that the Junction City facility will serve the rest of the state outside the Willamette Valley. He notes the Junction City hospital has been downsized from a planned 360 beds to 175.

“I’m not ashamed of what we’ve done at the state hospital,” Courtney says. “I do agree that community mental health is where we need to pour it on right now. We need to elevate that effort.”

Pamela Martin, the state’s director of addiction and mental health services, acknowledges boarding is a big problem. 

She says, however, the Legislature in 2013 allocated $60 million over the next two years to add mental health services in communities.

The money will not pay for new inpatient beds, but it’s intended to prevent many of the triggers that cause people to seek emergency help. The funding will cover the costs of more crisis response teams, for example, and provide earlier treatment for people developing mental illness.

“The Legislature has made an extraordinary investment in the mental health system,” Martin says.

Private psychiatric hospital beds are disappearing rapidly. The primary reason: economics.

At OHSU, each psychiatric hospital bed loses about $500 a day. That’s because many patients lack insurance, and Medicaid reimbursement is far less than the cost of services.

“It’s just not sustainable,” says OHSU’s Scherba.

Conditions in Oregon are worse than in nearly every other state. Oregon now ranks 47th in the country for private hospital inpatient psychiatric beds, according to the American College of Emergency Physicians. Five years ago, Oregon had 28.8 psychiatric beds per 100,000 people. The rate is now to 8.7 per 100,000.  

The flood of psychiatric patients keeps coming. Last year, Portland police dropped off 1,138 patients at ERs and took only 50 to community-based treatment centers.

That reliance on ERs troubles Oregon’s federal overseers.

“Treating an individual with mental illness or in a mental health crisis in an emergency room is the most expensive form of treatment,” wrote Judy Preston, a civil-rights lawyer with the U.S. Department of Justice overseeing Oregon’s mental health system, in a Jan. 24 letter to state officials. “And one that also runs the increased risk of institutionalization and does not provide the services necessary for the prevention of future crises.”

Even in the face of failure by state leaders to fix Oregon’s system, there are solutions. 

One way is to go to court to force change. In Washington state, two hospital groups have successfully sued the state, arguing that boarding violates their patients’ civil rights “because it does not provide a realistic opportunity for improvement.” The Washington Supreme Court heard the state’s appeal of that case in late June.

There’s no such case currently in litigation in Oregon, but last month, a team of medical experts—including representatives from OHSU and Legacy, and Dr. Sharon Meieran, a Kaiser ER doctor—visited a model program in Alameda County, Calif.

There, police no longer drop people experiencing psychiatric crises at the closest hospital. Instead, officials established a psychiatric emergency room at John George Hospital in San Leandro.

The outcomes, according to a study published in the Western Journal of Emergency Medicine in June 2013, are remarkable.

Patient boarding time declined from an average of 10 hours to less than two. And because patients received appropriate treatment rather than simply being warehoused, the need for inpatient hospitalization decreased by 75 percent.

“It’s pretty incredible what they’ve done,” says Meieran. 

The economics are far better as well. 

MediCal, the California equivalent of the Oregon Health Plan, pays for up to 23 hours of treatment at John George with Medicaid dollars. 

That Medicaid billing code exists in Oregon, but nobody’s using it. 

Legacy and OHSU are pressing state officials to activate the billing code in Oregon. The two hospital systems, often competitors, have identified space in central Portland in which they hope to replicate the Alameda model next year.

“They’ve been doing it for five years down there, so it’s sustainable,” says OHSU’s Scherba. “This is probably one of the most exciting opportunities I’ve seen in my career.” 

Patients say a better approach cannot come soon enough.

Jennifer Ann, for one, is still haunted by her last experience in an ER.

“I felt abandoned and lost and frightened,” she says. “And not really having a conception of this ever having an end.”

Tags: , , , , , ,
Posted in Uncategorized | 1 Comment »

Opinion: Return dignity to 1,566 persons, cremated at OSH, whose identities won’t be sought

Posted by Jenny on 14th July 2014

By William Hughes, Guest Column in The Oregonian, July 11, 2014

UrnsOn July 4, I should have been celebrating. Instead, I was sitting, saddened and appalled, having just read an article in The Oregonian. It reported on newfound evidence of 1,500 citizens and wards of the state of Oregon who have become lost forever. Authorities are unable to answer relatives’ questions about them and show little continued interest into what happened to them. I’m proud to be an Oregonian, but very disheartened that the state cares not to pursue what happened to these lost souls. Please listen to this story. If you feel as I do, and the state continues avoiding the issue, consider helping solve the mystery.

Indignation at finding 3,600 cans of mental patient cremains at the Oregon State Mental Hospital prompted citizens and the Legislature to build two new hospital facilities and a memorial for the cremains. Half of these cremains were thought to be patients who had died between 1883 and 1914 and who had been buried on state property. All were exhumed between 1913-1914 and cremated so the property could be developed. In 1959, headstones from the cemetery were found dumped on a nearby farm. However, none of the deceased patients were accounted for in the 3,600 cremains originally found. The patients’ fate is now a cold case.

When I showed this article to a younger person, he commented, why care? They are long gone, and their relatives, too. I feel differently. Maybe it’s my age. I’m 71, and that puts me closer to the end than the start. This promotes thoughts of burial or cremation. Where do I want my remains to be? Society affirms our dignity and responsibility in making such decisions.

Well, those lost mental patients couldn’t make those decisions. They were left to the state. And the state failed their responsibility to them.

That’s just not right. This bothers me to tears. It’s hard to put into words. Where is the dignity of it? I know it’s there, like the argument of whether a tree falling in the forest makes a sound if nobody is around. Do you hear the loss of dignity in this story?

On Monday, July 7, there was a dedication ceremony for the Oregon State Hospital Cremains Memorial. I attended. state Sen. Peter Courtney acknowledged the newly discovered missing cremains, which number 1,566. He said there would be a canister or memorial urn placed at the OSH Cremains Memorial to represent these lost souls and expressed his desire that answers would be found about their loss. Acknowledging the loss of these cremains is the first step toward returning some of these lost souls dignity.

A state researcher at the ceremony told me they felt they had applied diligent effort and time in pursuing this mystery. They now classify it as a cold case and they will not continue searching.

I’m moved to do more. The memorial was one of the most moving and dignified I have ever seen. It is a must see, if you are as moved by this mystery as I am. It cries out for continued research and possible solution. It is time for a citizen committee to pursue closure. There must be some volunteers with expertise here in Oregon who would be welling to step up and help. One of these lost souls may be a relative of yours or mine.

Please contact me cremainsearch@frontier.com. Let’s see if we can make a difference.

William Hughes, a retired veterinarian, lives in Beaverton.

Tags: ,
Posted in Uncategorized | No Comments »

Unclaimed remains at Oregon State Hospital are not from Asylum Cemetery, officials say

Posted by Jenny on 4th July 2014

The Oregonian, July 3, 2014

For years, Oregon officials assumed that some of the thousands of unclaimed urns at the Oregon State Hospital belonged to patients who were buried in a hospital cemetery, exhumed in 1913 and 1914, then cremated.

Now, officials said this week, researchers don’t think any of the urns are linked to the old Asylum Cemetery — and that the fate of the cemetery bodies, about 1,500 in all, is a mystery.

“We believe they were obviously disinterred and cremated,” research project manager Sharon Tucker said. “We just don’t know what happened after that point in time.”

Of the urns, about 3,400 remain unclaimed from the approximately 3,600 discovered a decade ago stacked like paint cans in the hospital’s “Cremains Room.”  Continue reading at OregonLive.com

Info on Cremains Memorial

Statistics

  • Number of urns in 2007: About 3,600
  • Number of urns left unclaimed: 3,447
  • Urns in memorial: 3,423
  • Urns to be returned to Native American and Sikh communities: 24
  • Where those in the urns came from: Oregon State Hospital, Oregon State Tuberculosis Hospital, Mid-Columbia Hospital, Dammasch State Hospital, Deaconess Hospital, Oregon State Penitentiary, Fairview Training Center and the Salem community
  • When they were cremated: 1913-71
  • Number of states represented: 48 (no one from Alaska or Hawaii)
  • Number of countries: 44
  • Veterans: 182 (110 unclaimed; of those, 88 urns and their records were sent to Oregon Veterans Affairs for research)
  • Infants: 11 (6 unclaimed)
  • Executed inmates: 9 (6 unclaimed)
  • Employees: 8 (5 unclaimed)

Timeline

1883: The Oregon State Insane Asylum and Asylum Cemetery are completed in Salem.

1910:  Steiner’s Chimney is built on the grounds for cremations and disposal of waste and infectious material.

1913: The Legislature orders all the bodies exhumed from Asylum Cemetery and cremated to free the land. A notice runs in a Salem newspaper April 19 notifying relatives that cremations of unclaimed bodies will begin June 3. The facility’s name is changed to Oregon State Hospital.

1971: The cremation facilities are used for the last time, and an inventory is done on the hospital’s cremated remains.

2004: Oregon Senate President Peter Courtney tours the Oregon State Hospital and is appalled at the conditions, including the storage of corroded copper urns in a small “Cremains Room.” He leads the Legislature to approve $467,000 to kick-start a hospital replacement project.

2005: The Oregonian writes a series of stories and editorials on the hospital and neglected urns.

2006: The Oregonian wins the Pulitzer Prize for Editorial Writing for its hospital coverage.

2007: The Legislature approves $458 million to build two new psychiatric hospitals, in Salem and Junction City.

2008: The U.S. Justice Department issues a scathing report, warning that hospital conditions threaten patient and staff safety.

2011: Researchers with the Oregon State Hospital Replacement Project discover that none of the urns is connected to those removed from the cemetery. Ultimately, they can’t find records on the fate of the cemetery remains.

2012: Construction is completed on a new 620-bed Oregon State Hospital in Salem.

2014: Remains in the urns are transferred to ceramic urns and placed in a new memorial at the hospital. The Oregon State Hospital Cremains Memorial will be dedicated July 7. A 174-bed state psychiatric facility in Junction City is set for completion this year.

 

Tags: , , ,
Posted in Uncategorized | No Comments »

Oregon State Hospital patient’s death likely due to heart problem, ME says

Posted by Jenny on 23rd June 2014

The Oregonian, June 12, 2014

Oregon State HospitalAn Oregon State Hospital patient who died in January likely suffered fatal heart arrhythmia due to hypertension, the state medical examiner’s office determined.

Christopher Patrick Crawford, 48, was found unresponsive at the hospital during 8 a.m. rounds Jan. 3.

Other heart conditions, including microscopic abnormalities with scarring, contributed to Crawford’s death, said Christopher Young, a deputy state medical examiner.

Extensive toxicology tests indicate medications Crawford was taking at the time of his death were within therapeutic limits, Young said. No unexpected substances or alcohol were found.

Tags: , ,
Posted in Uncategorized | No Comments »

Oregon State Hospital Oversight Board Missing More Than Half Its Members

Posted by admin2 on 12th June 2014

From the Lund Report, June 12, 2014

Despite the U.S. Justice Department investigation into Oregon’s mental health system, Gov. [John] Kitzhaber has let a board go unfilled that’s meant to ensure patient safety and care at the state mental hospital. Advisory board members report long lines to get appointed and mishandled applications.

John Kitzhaber

John Kitzhaber

An oversight board tasked with ensuring transparency and accountability at the Oregon State Hospital has been running on empty, with 55 percent of its voting positions vacant.

The Oregon State Hospital Advisory Board is meant to have 16 members — 11 voting members and 5 non-voting, or ex-officio, members, which includes Senate President Peter Courtney, D-Salem and Rep. Carolyn Tomei, D-Milwaukie.

But the board has only 5 of its 11 voting positions filled. Critically, there are no consumers — former hospital patients — serving on the board to give their perspective on conditions at the hospital.

“There are no patient advocates on the advisory board, so the patient voice, in an advisory board whose sole charge is to work on safety and patient care of state hospital patients — there is no patient voice, either a current patient or one out in the community,” board member Shannon Pullen told the Senate Health Committee last week. “We’ve been especially frustrated that in the past few years, that when people apply to be on the state hospital advisory board, it can take months and months if not a year to get a placement.”

The board is operating at greatly reduced capacity despite a series of legal troubles for Oregon and its treatment of people with mental illness. The threat of federal lawsuits from the Department of Justice during the Bush era forced the state to close its rundown state mental hospital in Salem and open a new modern facility next door in 2010.

That same year, current Attorney General Eric Holder opened an investigation into Oregon’s delivery of mental health services, questioning whether the state was relying too much on state institutions when community settings would be more appropriate for a high number of patients.

Among its voting members, the advisory board also has only one mental health professional — Yamhill County Health and Human Services Director Silas Halloran-Steiner. There are supposed to be three.

Pullen, a Portland resident, has a brother who is a patient at the state hospital. “As someone who’s had a lot of skin in the game, who’s been in it as a family member, I really want to feel that the state still continues to see that this advisory board is important,” she said.

Gov. John Kitzhaber’s office would not elaborate in great detail on why this board has been neglected or when it will be restaffed. His spokeswoman Melissa Navas said only that the governor appoints more than 3,000 people to more than 300 boards and he continues to look for qualified appointees. The Oregon Senate also must confirm his appointees, and they will not meet again until autumn.

Navas added that the advisory board positions call for people with specific experiences with mental illness and the state hospital. She said members can stay on after their terms expire and vacancies do not count against a quorum, so the board is able to approve business with less than half of its positions filled.

Other boards, such as the Public Employee Benefit Board, have not suffered for lack of appointments. Deputy administrator Kathy Loretz told The Lund Report that she could not remember when one of their spots went unfilled for more than two months and PEBB currently has no vacancies.

Hospital advisory board member Beckie Child said she knew of long lines getting through the application process and a mishandling of the applications. “Even mine, when I was renewing mine, my application got lost for a while,” said Child. In a sign that the state continues to struggle with computer systems, Child said hers was not a paper application that the state lost but an electronic one.

One of the openings on the board is for someone who simply lives near the state hospital, which may be important to soothe relations between neighbors of the new mental hospital getting built in Lane County. “We want to have neighborhood representation with the Junction City hospital,” said Child, the former director of Mental Health America of Oregon.

Tags: , , ,
Posted in Uncategorized | No Comments »

Legislators finally hear of unchecked increase & expense of criminal defendants at Oregon State Hospital

Posted by admin2 on 30th May 2014

From the Oregonian, May 29, 2014

Two-thirds of the patients admitted to the Oregon State Hospital last year were criminal defendants admitted under court orders, a legislative panel heard Thursday.

Sixty percent of those patients faced felony charges, and the other 40 percent faced misdemeanors, said Greg Roberts, hospital superintendent. Patients facing relatively minor offenses such as public urination are costing Oregon taxpayers $345,000 a year to treat at the state hospital.

The news didn’t make for happy lawmakers.

“Public urination?” asked a dismayed Rep. Carolyn Tomei, D-Milwaukie, chairwoman of the interim House Human Services and Housing Committee.

State officials have struggled for years to treat more mentally ill patients in less costly community-based programs. Oregon is also in the middle of a four-year agreement with the federal Justice Department, which examined whether the state provides adequate community mental health programs as alternatives to institutions. A January report found the state lagged far behind in providing community programs.

Criminal defendants admitted under court order are often referred to as “370 patients,” shorthand for the statute under which judges can admit them to the hospital for treatment. The goal is to treat them so they’re competent to “aid and assist” in their criminal defense.

The hospital can keep 370 patients for up to three years, or the maximum sentence that could have been imposed if the defendant was found guilty, whichever is shorter.

The number of 370 patients has risen from 88 in January 2010 to 151 last month. The increase requires adding a new unit for 370 patients every six months, Roberts said.

“This trend is unsustainable,” he said. “We just don’t have the ability to do that, but that’s what’s been happening over the last few years.”

Those patients are also more likely to assault hospital staff — an ongoing problem at the hospital — and to face seclusion as a result, Roberts said.

Part of the problem stems from the lack of community mental health programs to serve those in need, Roberts said.

“Any absence of community programs and services to help restore a person to the ability to aid and assist (in the defense), then the only option becomes the state hospital,” he said.

Lawmakers pledged to revisit the topic during September meetings.


House Interim Committee On Human Services and Housing, 2013
Meeting Details 5/29/2014 8:00 AM, HR D

Members – Carolyn Tomei, David Gomberg, Andy Olson, Joe Gallegos, Sara Gelser, Vic Gilliam, Alissa Keny-Guyer, Ann Lininger, Gene Whisnant, Gail Whitsett.

Meeting log – transcripts of testimony – have not yet been uploaded.

Update on Agreement with United States Department of Justice – presentation by Pam Martin, Director of the Oregon Health Authority’s Addictions and Mental Health Division.

Increase in Oregon’s “Aid and Assist” Population – testimony by Cheryl Ramirez, Executive Director Association of Oregon Community Mental Health Programs.

No title. Subject: “Aid and Assist” – presentation by Greg Roberts, Superintendent of the Oregon State Hospital.

Differential Response Strengthening, Preserving and Reunifying Families – Implementation of SB 964Lois Day, Child Welfare Director; Stacy Lake, Differential Response Manager.

Investment in the Mental Health System, letter from Amanda Marshall of the the U.S. Department of Justice to John Dunbar of the Oregon Department of Justice, January 2014.

Interim Report to the State of Oregon – Integration of Community Mental Health and Compliance with Title II of the Americans with Disabilities Act , report from the U.S. Department of Justice, January 2014.

Tags: , , , ,
Posted in Uncategorized | No Comments »

Call for action concerning Oregon State Hospital, Native American residents, and CPE program

Posted by admin2 on 20th May 2014

We recieved this urgent email today from Melissa L. Bennett, M.Div., Umatilla/Nimiipuu/Sak & Fox, and an Oregon State Hospital Clinical Pastoral Education graduate, 2013


Dear Oregon Tribal leaders, representatives of the Association for Clinical Pastoral Education, representatives of the Oregon State Hospital, and other concerned parties:

I am writing to you today from a place of deep concern for the indigenous residents of the Oregon State Hospital (OSH), the hospital’s indigenous staff, and the integrity of its Clinical Pastoral Education (CPE) program.

Oregon State Hospital, about 1910

Oregon State Hospital, about 1910

As a 2013 graduate of the OSH Clinical Pastoral Education program and as a descendent of the Confederated Tribes of the Umatilla Indian Reservation I was startled to learn of a new job opening at the Oregon State Hospital. The title of this position is: Clinical Pastoral Education Supervisor and Native American Coordinator. When I first read the position description, I assumed it was a poorly written posting of two separate jobs. When I inquired further I learned that OSH has, in fact, merged these two positions into one with NO NATIVE AMERICAN CULTURAL KNOWLEDGE AND/OR COMPETENCY REQUIREMENT in the job description.

Currently, the Oregon State Hospital employs an enrolled Cherokee tribal member, Cynthia Prater, Psy.D. as its Native American Services Coordinator. Dr. Prater has officially filled this role since its inception in February 2011, though she began undertaking her duties in 2010. Dr. Prater works closely with Chehalis/Wintu elder and addictions counselor, Larry Presnall (paired with support from both Native and non-Native staff and allies) to successfully provide traditional Native American spiritual and cultural services to the hospital’s 10% indigenous population. Together they provide culturally relevant one-to-one and group counseling, treatment team advocacy, programming that includes smudge, sweat, and talking circle ceremonies as well as treatment groups that discuss and explore issues of Native American history, culture, trauma, spiritualities, and addictions recovery. Dr. Prater, Elder Presnall, and the former Oregon Health Authority tribal liaison historically worked to keep the Native American Services Program separate from the OSH Spiritual Care Department due to the complicated historical trauma inherent in the relationship between mainstream Christian religions and tribal communities.

The Oregon State Hospital’s decision to combine a position currently held by Dr. Prater with the role of a Clinical Pastoral Education Supervisor is ludicrous. OSH has effectively made Dr. Prater ineligible to apply for her own job.

The process to become a CPE Supervisor (as defined by the Association of Clinical Pastoral Education) is an arduous one. A person must first possess a Master of Divinity degree (or equivalent) from an accredited institution. The M.Div. degree takes between 3 and 4 years to complete post undergraduate education. A person must then complete one year (four units) of Clinical Pastoral Education before they can apply for a Supervisory CPE education. Once approved, it may take from 3 – 10 years for the Supervisory CPE Candidate to reach Associate Supervisory Status with an additional 2 – 3 years of work and study before becoming a full CPE Supervisor (for more information on the Supervisory CPE process please see:
http://www.acpe.edu/NewPDF/Core%20curriculum.pdf and
http://journeyingalongside.wordpress.com/2012/03/27/the-crazy-cpe-supervisory-education-process/).

The process of achieving the certification of a full CPE Supervisor requires between 9 and 18 years of study beyond a bachelor’s degree. Despite the rigorous certification process established by the Association of Clinical Pastoral Education (ACPE) the current OSH job opening for a CPE Supervisor has a minimum requirement of a bachelor’s degree from a seminary and one year of clergy or teaching experience (again, see the above link for the official job description).

As a result of the strenuous path toward becoming a fully certified Clinical Pastoral Education Supervisor, the number of both Associate and Full CPE Supervisors in the country is very small. When combined with the Oregon State Hospital’s request that their CPE Supervisor also fulfill the duties of a Native American Services Coordinator the number of qualified candidates is infinitesimal (there is only one Native American CPE Supervisor in the country and he is located on the east coast).

After participating in my own CPE experience at the Oregon State Hospital, where my specialization was in the spiritual/cultural care of indigenous peoples, I feel confident in stating that the tasks required of this new position are impossible for one person to fill. It is completely unreasonable to expect one person to both supervise the education of CPE students and tend to the myriad needs of the hospital’s diverse indigenous residents. The fact that the Oregon State Hospital’s job description does not contain requirements for cultural knowledge or competency and does not fulfill the ACPE guidelines of a CPE Supervisor leaves me fearful for the spiritual and cultural needs of the hospital’s indigenous patients and future CPE residents.

I am writing this letter in an effort to stop the Oregon State Hospital’s attempt to hire one person to fulfill the responsibilities of both the CPE Supervisor and the Native American Services Coordinator. I write because I see the Oregon State Hospital’s attempt to hire one person for the role of “CPE Supervisor and Native American Services Coordinator” as a threat to the cultural and spiritual well-being of the Oregon State Hospital’s indigenous resident population and as a threat to the success of the hospital’s Clinical Pastoral Education program. I write because, as a traditionally endorsed and trained Native American spiritual care provider, I believe it is my responsibility to speak up for the spiritual and cultural needs of indigenous peoples.

To the Oregon State Hospital: I urge you to immediately withdraw the proposed job entitled “Clinical Pastoral Education Supervisor and Native American Coordinator” in order to thoroughly examine the best ways to provide for the cultural and spiritual needs of your indigenous residents while also upholding the integrity of your CPE program.

To Oregon Tribal Officials: I urge you to use the full weight of your sovereignty to intervene in this matter and ensure that the cultural and spiritual needs of our people, particularly of those unable to advocate for themselves, are upheld and protected.

To representatives of the Association for Clinical Pastoral Education: I urge you to intervene in the Oregon State Hospital’s hiring process to uphold the dignity of your OSH CPE program.

Thank you for your time and for your just action.

Tags:
Posted in Uncategorized | No Comments »