Dangerous decisions: In Clatsop County, gaps in the mental health safety net

Daily Astorian – August 2015

Patients placed into custody because of mental illness in Clatsop County do not always receive adequate notice of their legal status or clinical services and can face lengthy delays to get into psychiatric hospitals for treatment.

The findings, issued last year by the state Addictions and Mental Health Division after a review of Clatsop Behavioral Healthcare, the county’s mental health contractor, are not a revelation to law enforcement or mental health workers.

The problems identified by the state have been ongoing for more than a decade, leaving dangerous gaps in crisis response for the mentally ill.

Clatsop Behavioral Healthcare assured the state that the county will better coordinate services for the mentally ill and direct law enforcement where to take patients to receive appropriate care.

A crisis respite center planned for Warrenton could also provide an alternative to jail or hospitalization.

But Clatsop County District Attorney Josh Marquis said in July that the county is in crisis on mental health, and documents reviewed by The Daily Astorian under the state’s public records law confirm a perception that the county is falling short.

Columbia Memorial Hospital and Providence Seaside are not certified to provide involuntary care, custody or treatment for the mentally ill, so Clatsop Behavioral Healthcare has to find acute care psychiatric hospitals elsewhere in the state, a challenging and often unpredictable process.

Astoria Police Chief Brad Johnston believes law enforcement is left in an impossible situation.

“No one wants the police to be the people that are dealing with the critically mentally ill,” he said. “Nobody wants it to become criminalized. Nobody wants force used. Nobody wants tragedies to occur.

“But, because of a lack of other resources, the police tend to be that safety net for all of the other social agencies. And we end up being the people that are responding.

“And we’re responding to people that professional mental health workers have been unable to reach, family has been unable to reach, and then a stranger in a blue suit is being asked to come in and solve the problem.”

A tragic suicide

The county’s struggle to care for the mentally ill was brought into public focus in April after Carrie Barnhart, a 54-year-old mother of six with a history of mental illness, jumped off the Astoria Bridge.

Astoria Police had responded to Barnhart’s suicide warnings four times in the months before her death. The week before Barnhart killed herself, police had taken her off the bridge after midnight and brought her to Columbia Memorial Hospital, where she was evaluated by Clatsop Behavioral Healthcare and released after two hours.

The Daily Astorian, through the public records law, requested documents related to suicide from the county and the police after Clatsop Behavioral Healthcare chose not to answer questions about what steps the agency had taken to prevent similar tragedies.

The documents show, and the newspaper has confirmed, that the state Office of Adult Abuse Prevention and Investigations is conducting an investigation into Barnhart’s death.

While Clatsop Behavioral Healthcare may have done everything available under the law to help Barnhart, the documents suggest a serious degree of concern about the agency’s performance.

County Manager Scott Somers, after reading a news article about Barnhart’s suicide, called a meeting with staffers who work on mental health services to discuss ongoing concerns with the agency. He said many in the community were “pretty outraged.”

“From the article, it sound(s) like another case of denying admission to someone in need,” Somers wrote in an email. “This is the consistent message we’ve been hearing.”

Sumuer Watkins, the executive director of Clatsop Behavioral Healthcare, has been sensitive about public perceptions of the agency and her leadership.

In an extraordinary email sent to community leaders in June, Watkins apologized and sought to repair any potential rifts. She said she had heard of consistent feedback that she had not been displaying appropriate leadership skills and was defensive and abrasive.

“I am reaching out to all community partners that I have personally interacted with over the last year to apologize for any offensive behavior that I may have exhibited,” Watkins wrote. “Please know that this is not the person that I wish to be nor has it ever been my intent. If even one person has experienced this with me, I am truly saddened.”

Clatsop County Sheriff Tom Bergin offered Watkins some encouragement.

“You personally have done a great job but the problem is that the system is broken, not you,” the sheriff wrote in an email.

“The bar has been raised so high over the last 20 years to actually identify one with mental illness for detention, is sad to say the least. There are no beds, the facilities that do exist are overwhelmed and let’s face it, it’s just easier to walk away and ignore people in our society, especially when a lot of the current mental illness in our communities is from people making poor choices with the methamphetamine and drug epidemic.”

Improving crisis response

Cracks in mental health care are not unique to Clatsop County or other rural parts of the state. The federal government has prodded Oregon to improve mental health treatment.

But counties and cities have complained that federal and state money does not match the mandate, leaving local officials with the responsibility — but not the resources — to respond to patients in crisis.

This year, the state Legislature approved an additional $20 million for housing for people with mental illnesses or addictions.

Lawmakers also adopted a change to the law that expands the definition of mental illness for purposes of civil commitment.

In Astoria, Mayor Arline LaMear has appointed a task force to look at homelessness and mental health issues that includes Police Chief Johnston and Watkins of Clatsop Behavioral Healthcare.

Watkins, in a written statement, said Clatsop Behavioral Healthcare has committed to hiring an additional worker to coordinate care and provide outreach to people in need of crisis services, arranged for the training of all employees in the sanctuary model approach to providing services, and continued to reduce the time between initial assessments and treatment.

Kevin Campbell, the chief executive officer of Greater Oregon Behavioral Health Inc., which manages mental health services in Clatsop and several other counties, said in a statement that the agency has been working closely with Clatsop Behavioral Healthcare to improve the lines of communication with law enforcement and the justice system.

At a Clatsop County Board of Commissioners work session in July, Scott Lee, the board chairman, expressed his confidence in Clatsop Behavioral Healthcare and joined others in suggesting that the agency simply needed to publicly share successful outreach.

But public and private agencies that make life-and-death decisions often get measured — fairly or not — by failures.

After near misses or crashes, airlines — as District Attorney Marquis said after the work session — do not get judged by how many planes land safely.

‘A danger to himself and others’

On a Wednesday afternoon in July, an Oregon State Police trooper came across a blue Saab sedan parked on the shoulder of U.S. Highway 26. A 25-year-old man — a former star football player, 6’4” and about 270 pounds — had configured his belongings along the roadway and covered the car with a tarp.

A good Samaritan had pulled over and was trying to help.

Wearing only athletic pants, the man, who was attempting to hitchhike, explained that his car had attacked him and that he feared the car and his belongings.

The man removed his clothes, then put his pants back on. “In my opinion,” the state trooper wrote in his report, the man “was clearly a danger to himself and others. I knew I would not allow him to drive a vehicle in his condition.

“I also began to be concerned for my own safety, as (the man) would speak to me briefly and coherently, and then abruptly stop speaking and stare at me as if he were looking through me.”

After talking on the phone with the man’s mother, the trooper learned the man had a mental health condition and had experienced a great digression in the past few weeks. The trooper convinced the man, after a lengthy discussion, to be handcuffed and taken to Columbia Memorial Hospital for evaluation by Clatsop Behavioral Healthcare.

What happened next illustrates the shortcomings with the county’s mental health safety net.

A long wait

A Clatsop Behavioral Healthcare worker asked the state trooper — according to his report — whether he needed any paperwork about the man. The trooper said he did not.

Four hours later, the trooper learned the inquiry was actually about whether he wanted to place a mental health hold on the man. “I was completely unaware she had meant that at the time,” wrote the trooper, who wondered why it took so long to initiate a hold.

When the man’s mother arrived at the hospital late that evening, the man refused to leave with her.

Instead, he walked out of the hospital and reached the parking lot of the Columbia River Maritime Museum, near the Peacock pilot boat, before being stopped and handcuffed by the trooper, who had also called Astoria Police for help.

Back at the hospital, Clatsop Behavioral Healthcare finally placed a hold on the man.

Yet over the next few days, Astoria Police were called multiple times about the man acting erratically or leaving the hospital. In one episode, a police report shows, the man dropped his pants and flashed his genitals towards a police officer and a nurse. After pulling up his pants, the man, with an odd smile on his face, started to shadow box while staring at the police officer.

The frustration, spelled out in police reports and emails, was whether Clatsop Behavioral Healthcare or the hospital had a plan to treat the man, who was allowed to walk around the emergency room and out of the hospital. There was also substantial confusion, according to police, about the legal status of the mental health hold.

Police officers worried that confronting the man, who police described as “very strong, and very big,” and forcing him to come back to the hospital could escalate into deadly force.

“I was alarmed by the fact that the hospital didn’t have a plan to deal with the potential threat that (the man) could pose, other than to call the police,” one police officer wrote.

Watkins, of Clatsop Behavioral Healthcare, would later explain that the problem stemmed from not being able to access any psychiatric beds in the state. At one point a bed for the man had been found, she said, but the placement was rescinded after a critical incident at the facility.

“This seems to be a perfect storm that resulted in a significant strain on all partners involved and highlighted gaps in our continuum of care,” Watkins wrote in an email to law enforcement.

‘Absurd failures’

By that weekend, a decision was made to release the man to the Astoria Rescue Mission, a Christian ministry that works with the homeless.

But the man did not want to stay at the rescue mission, and was no longer welcome at Columbia Memorial, which had reported him to police for trespassing.

On Sunday afternoon, four days after he was picked up by the state trooper for having a mental breakdown on Highway 26, the man was given a courtesy ride to the Astoria Transit Center. Police bought him a bus ticket back to Portland.

“This may have been one of the most absurd failures of our local system that I’ve been involved with,” Police Chief Johnston wrote Marquis in an email. “It was certainly amplified by the sheer size and combative experience of the patient.”