Medford police see “astonishing” increase in mental health calls

From the Chinook Oberver, May 20, 2014

Patrolling the streets of Medford, Oregon for more than 15 years now, Officer Bob Mccurley knows the dangers he could face on the job.

“Regardless of all the information you get, there’s still the complete unknown of how the person is going to react when you show up,” said Mccurley.

Hotel Medford

Hotel Medford

He’s had to deal with more unknowns every day as the number of mental health calls to Medford Police skyrocket.

“The numbers are astonishing how much of an increase it is,” said Medford Police Lieutenant Curtis Whipple.

Skyrocketing mental health calls

According to data out of the Medford Police Department, between 2012 and 2013 there was a 26% increase in mental health holds, where people are brought to the Psychiatric Care Unit at Rogue Regional Medical Center.

Police also saw a 23% increase in the number of referrals to Jackson County Health and a 38% increase in suicide calls.

So far for 2014, the trend is continuing with a 31% increase in mental health holds, an uptick of 24% for referrals and 14% in suicides. Those are the calls police actually report.

“There are a lot more individuals with mental health issues that we’ll contact during the day when we’re out on patrol,” said Whipple.

The reason for the increase is largely unknown.

“I don’t know if anybody has the answer as to why that number has increased so much,” Whipple said.

Jackson County may be worse off than the rest of the state.

“According to the Oregon Health Authority, our depression rates are 16% higher than the state of Oregon’s average and our suicide rate is 20% higher,” said Matthew Vorderstrasse, the Executive Director of Compass House, an organization aimed at helping people with mental health issues by using peer support.

Jackson County Mental Health officials said when it comes to the 10-24 year old age group, suicides are a big problem.

“We’re one of the highest counties in Oregon that have the number of people that died by suicide,” said Anna D’amato with Jackson County Mental Health.

A revolving door at Rogue Regional Medical Center

At Rogue Regional Medical Center, psychiatrist Dr. Anne O’Connel said it’s a revolving door, with many of the same, troubled people coming in and out.

“My feeling is that a lot more needs to be done at preventing these kinds of crises,” said O’Connel.

The Psychiatric Care Unit at Rogue Regional is the only hospital in Southern Oregon and Northern California accepting mental health patients in crisis. Like police they too have seen more people come through their doors.

Too many people, too few beds

“We’re a relatively small unit. We have 18 beds and it’s almost always full,” said O’Connel.

According to Oregon’s Addictions and Mental Health Services Division there are roughly 386 beds statewide for people who are in a mental health crisis.

“We kind of patch people up … then we got to keep them moving because the demand for beds is so high,” O’Connel said.

According to O’Connel, there are a lack of beds and a lack of people to treat patients.

“We are federally designated by the Department of Health and Human Services as a shortage area,” she said.

O’Connel said Southern Oregon in particular has a mental health professional shortage and she said it has a lot to do with psychiatrists and nurses choosing to stay in larger cities like Portland and San Francisco.

In addition, O’Connel and many others say, for years the funding to provide adequate service just hasn’t been there. It leaves many who need help stuck with nowhere to go and few people to turn to.

It’s important to note that people who live with mental illness aren’t always violent. In reality most people struggle silently.

However, it’s not just adults who are having trouble finding help for their mental illness.

O’Connel, said available mental health care for young adults and children is grave.

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Salem officer justified in killing Michael Conley, whose death by cop was ruled “suicide”

Statesman Journal, May 20, 2014

Michael Conley

Michael Conley

A Salem police officer was justified in shooting and killing a man armed with a knife last month, according to a Marion County grand jury’s findings, which were announced Monday afternoon.

READLinks to all prior news coverage of Michael Conley’s shooting

Officer David Baker shot Michael Conley, 46, on April 30 after Conley threatened him with a knife. According to police reports and the grand jury’s account, the events unfolded this way:

Baker responded to a domestic violence call from Conley’s wife, Heidi, at 7:12 a.m. at their home at an apartment complex on the 4700 block of Lancaster Drive NE. She said her husband was threatening her with a knife and wouldn’t let her leave the apartment.

She wasn’t injured, but Conley had a history of suicidal behavior.

Baker arrived and Conley confronted him, armed with a foot-long military-style knife. Baker told him to put it down multiple times, but Conley refused and told Baker he was going to stab him.

Baker could be heard on police scanners telling dispatchers, “He’s coming at me with the knife, telling me to shoot him.”

He advanced toward the officer, still brandishing the knife, and Baker backed away from him to create a safe distance, still ordering Conley to drop the knife.

He wouldn’t, and he lunged at Baker, knife drawn.

Baker fired twice, shooting Conley in the head and the right shoulder.

He called for a medical team, and other officers arrived to help. They administered first aid to a bleeding Conley, who was still holding the knife. He was taken to Salem Hospital for treatment and died there shortly after.

The Oregon State Medical Examiner ruled his death a suicide.

The Oregon State Police investigated the shooting, and Baker was placed on administrative leave, which is common practice after an officer-involved shooting.

Baker has worked for Salem Police for 14 months and previously worked as a reserve officer in Philomath for three years.

District attorney Amy Queen said evidence presented to the grand jury included witness testimony, photographs, scene diagrams, 911 dispatch and police radio recordings, and the medical examiner’s autopsy report.

The jury found that the evidence presented showed Baker had “reasonably believed that (his) life or personal safety was endangered in the particular circumstances involved,” which is the applicable legal standard, Queen said.

This shooting was the first of two officer shootings in the course of two weeks. Jacklynn Ford, 25, was shot by Salem Police Officer Trevor Morrison on May 9 after she fled a traffic stop, according to police reports.

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

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: and

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.

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“Open Notes” program allows mental health clients to view their therapists’ notes

Washington Post, May 18, 2014

stock-footage-therapist-taking-notes-while-woman-explains-her-problemsFor years, the woman went to a Boston hospital to talk to a therapist about being depressed and overweight. The therapist, listening closely, asked questions and jotted down notes on a memo pad.

Until recently, the 54-year-old woman didn’t know what her therapist was writing. Then, last month, her therapist offered to share his notes with her regularly.

Lori, who for privacy reasons did not want her last name used, initially was reluctant. She didn’t want to know what her shrink was thinking. What if he wrote, “She’s really going crazy”?

But when she read two pages of notes from two visits last month, she was pleasantly surprised by the level of detail. He wrote, for example, about how much she disliked using the treadmill. “He really is listening,” she said.

Lori is among several hundred patients taking part in an experiment at Beth Israel Deaconess Medical Center that began March 1 and gives them electronic access to therapy notes written by their psychiatrists, psychologists and social workers. Beth Israel is the first private hospital system to do so, and the practice has set off a spirited debate among mental-health professionals and patients.

Supporters argue that note-sharing provides many benefits. More transparency, they say, reduces the stigma and isolation of mental illness while boosting patients’ self-image. They also say that having patients read about their problems could empower them to change their behaviors in positive ways.

Other mental-health practitioners are leery, and some at Beth Israel have decided against taking part in the program for now. They say that therapists’ notes about patients’ behaviors and feelings are fundamentally different from medical assessments about diabetes and hypertension. Some patients could feel unfairly judged, they warn. What if schizophrenia patients, for example, read that their firm convictions were seen as delusional?

And would psychiatrists and therapists, worried about patients’ reactions, censor their own note-taking?

“Bringing transparency into mental health feels like entering a minefield, triggering clinicians’ worst fears about sharing notes with patients,” Michael Kahn, a psychiatrist at Beth Israel, wrote in an article in the Journal of the American Medical Association last month. Kahn is taking part in the pilot program.

“In principle, I’m all for it,” said Jeffrey Lieberman, past president of the American Psychiatric Association. He said note-sharing was a way to handle mental illnesses that was like the approach to nonpsychiatric ailments.

But, he added: “The devil is in the details. How you manage complexities, that’s where we are right now. They’re in uncharted waters.”

Same for mind as for body

Beth Israel’s pilot program grew out of a national initiative, called Open Notes, that the rest of the hospital started more than a year ago for outpatient medical — but not behavioral health — cases. Led by Tom Delbanco, founding chief of the division of general medicine and primary care at Beth Israel, and Jan Walker, a hospital nurse, the program is part of a growing movement to give patients full access to their medical records.

The program gives participating patients electronic access to their mental health notes for the first time. (The notes have always been part of the electronic health record; doctors have access to them, but only for valid clinical reasons.)

“I feel patients have as equal a right to see what the doctor writes when their minds hurt as when their knees hurt,” Delbanco said.

Patients can access the encryption-protected notes only through a secure portal and can read them on their home computers. In Lori’s case, electronic access had not yet been activated, so she read printouts that her therapist mailed to her.

All 15 clinicians in the hospital’s psychiatry department are participating. They have offered 10 percent of their patients — 350 people — access to their notes, according to Pam Peck, a psychiatrist who is managing the department’s participation. Individual clinicians are selecting those patients they feel could safely read the notes at home.

On April 1, two dozen social workers at the hospital began offering notes to 360 of their patients, said Stephen O’Neill, social-work manager for psychiatry and primary care at the hospital. Each participating patient must have a computer and Internet connection. Individual social workers decide whom to invite; most patients have diagnoses of depression and anxiety.

Victims of domestic violence are excluded out of concern that their partners might see the notes.

Clinicians say they have been surprised by the feedback. Some patients have been eager to see the notes. Others are less interested because “it’s not that big a deal,” O’Neill said. One patient told his social worker, Deborah Judd, that his treatment was like taking his car in for repairs: He trusted the mechanic and did not want to look under the hood.

Five of the 29 social workers who bill insurance for outpatient services have declined to share their notes. Some say they are worried that some people may not understand the diagnoses or that patients with paranoid thoughts might react badly to reading certain observations while alone at home.

Others fear that note-sharing could affect the core of therapy.

“It is VERY important to consider that the relationship between therapist and patient is an extremely human and personal one and that this is part of what is healing,” one social worker wrote in an e-mail to O’Neill explaining why she did not want to participate in the program.

“I believe that adding the dynamic of computerized notes in the middle of this relationship will lessen its effectiveness,” she added. She did not want to be identified, to protect her patients’ privacy.

Nina Douglass, a social worker in obstetrics and gynecology, is also opting out for now. Many of her patients have drug addictions and do not always understand the risks for their pregnancies. Douglass is worried that she might “inadvertently alienate” these patients if she is not “very thoughtful of how I write that note.”

Right to see records

Under federal law, patients have a right to request all their health records, including those involving mental health, although the process can be lengthy. (In special cases, doctors can withhold information if they feel it could endanger patients or others.) It is up to individual health systems and clinicians to decide how best to provide those records. Only some health systems have electronic records, and only the Boston pilot project and the Department of Veterans Affairs allow patients to see their mental-health notes online.

The Open Notes program — which gives patients secure electronic access to their medical notes — is in place at several health systems, including Beth Israel, the Mayo Clinic, the Cleveland Clinic and Geisinger Health System. VA has a similar system.

At Beth Israel, outpatient medical notes have been available since July 2013. All but about a dozen of the hospital’s 800 doctors use that system. More than 70,000 medical patients use a secure, confidential portal to view their doctors’ notes. Despite doctors’ great initial fear that they would be overwhelmed by patients asking follow-up questions, “the expected avalanche did not materialize,” said Walker, the Beth Israel nurse.

A group of researchers from five health systems surveyed patients who use the online system to view their medical notes. The researchers found that most felt more in control of their care. About one-third of patients surveyed had privacy concerns, but that did not prevent them from accessing the notes.

At VA, about 1.5 million veterans have been able to see their clinical notes since January 2013, including notes related to mental-health visits. Anecdotal information suggests that patients who read their notes want to be more involved in their medical care, said Susan Woods, a physician at the Portland VA Medical Center in Oregon and director of patient experience for VA’s electronic access initiatives.

VA has just begun studying the interactions of veterans who read their mental-health notes with their therapists, she said.

Geisinger Health System in Pennsylvania, which already has 1,302 medical-care providers giving access to visit notes, with 220,000 patients using the system, is also thinking about sharing that access for psychiatric notes this summer. But patients with anxiety would probably be excluded, Geisinger spokesman Michael Ferlazzo said.

Lori, the woman who is in therapy at Beth Israel for depression, said reading the notes boosted her confidence and self-esteem. Her therapist is O’Neill. In one note, he described a situation in which Lori felt a friend was laughing at her. He wrote: “We explored that [the friend] was laughing with her rather than at her.” He also wrote that she would work on improving her self-observation skills by being more aware of “trigger points” and find ways to address concerns “more directly so as to be less prone to internalizing/keeping inside which only worsens her depression.”

She smacked her forehead, saying, “Oh yeah, yeah.” She had forgotten about this. “See, this is why notes are good.”

O’Neill has offered his patients access to his notes over the years and has found that this helps even seriously ill patients. One patient with major depression who has regularly come close to being hospitalized read that O’Neill thought she was “very resilient.” When she saw that, “it helped her to feel confident,” he said.

How much detail is in a note is up to individual therapists. Clinicians try to use terms that are precise for other doctors but are still understandable to patients. Some clinicians simply assume their patients are going to read their notes. Social worker Judd recently wrote a note about a patient with agoraphobia, an anxiety disorder in which people fear places or situations that cause them to panic and feel trapped. Initially, Judd wrote that the two discussed the issue “at some length.” But concerned that the patient might find those words judgmental, Judd changed “at some length” to “in some detail.”

After Lori read a note that referred to her “affect dysregulation,” she asked O’Neill during their next session to explain it. He told her it meant her emotions sometimes prevented her from functioning as well as she could. She said she has not seen that particular term in subsequent notes.

Beth Israel is reviewing patient and clinician feedback every three months over the next year before deciding what comes next.

“At the end of the experiment, will we say, ‘It’s not as scary as we thought,’ or will we say, ‘We’re uncovering a whole can of worms here’?” said Barbara Sarnoff Lee, head of the social-work department. Part of the reason that mental health is so stigmatized, she said, is that people do not see what happens in the relationship between the clinician and patient.

By opening up the notes, she said, “we want to take the mystery out from behind the curtain, if you will.”

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