Portrait of a broken mental health system: Jackson County Oregon

From the Medford Mail Tribune, January 27, 2013

Journal entries penned a year before Rachel Rice‘s death tell the tale of a loving mother struggling with serious mental illness, and of a failed mental health care system, her daughter says.

“Many unfortunate local events have stemmed from mental illness, and especially from lack of care,” says Lindsey Rice-Meilicke. “This puts the person suffering in danger and, in extreme cases, others as well.”

Judges, county mental health directors and local police agree and say they are pushing for change.

A fledgling mental health court is taking wing. Properly staffed centers designed to provide wraparound services and a sense of community are in the works to replace those shuttered in recent months. And police are being better trained in handling the mentally ill, as law enforcement officers often are the first responders for those experiencing a mental health crisis, says Stacy Brubaker, the new division manager at Jackson County Mental Health.

The county’s new $28.5 million, 86,000-square-foot, two-story health services complex will handle a caseload that is expected to rise from the current 23,000 clients to 45,000 by the time it opens in 2014. Mental health, alcohol and drug programs, immunizations, vital records, food licenses and disability services all would be available in the new health building, officials have said.

Brubaker was hired as the crisis manager for the county’s Health and Human Services Department in August, and promoted to mental health division manager in mid-November, she says.

“It is really up to us to deliver good services and coordinated care,” Brubaker says. “And I truly believe people are best treated in their own communities.”

Rice-Meilicke is hoping changes are on the way. And that sharing her mother’s story will help take the stigma off of mental illness and persuade legislators and the community to fund and support programs that care for those afflicted. Short-shrifting the mentally ill puts “a huge emotional and financial strain on everyone,” Rice-Meilicke says.

“I wish people would see that. See the realities of what is happening,” she says.

Rachel Rice graduated with honors from Crater High School in 1977. She loved cheerleading, baking, crocheting, making people laugh and being a mother. But for the last two decades of her life, the 46-year-old also battled paranoid schizophrenia. Frightened and delusional when in the grips of her illness, Rice was last seen by a high school friend, walking barefoot on Old Stage Road on Aug. 2, 2005. Moments later she melted away into the Central Point hillside and was lost forever, her daughter says.

“She had a tendency to walk from her troubles when she was scared,” Rice-Meilicke says, adding her mother had a history of running away, but that she was never out of contact for more than a few days.

For seven long years, Rice’s family had little hope she was alive but no closure. Then, on Jan. 5, a miner discovered Rice’s remains in a remote area off Old Military Road. Police found no evidence of foul play. Rice likely died of dehydration and heat exhaustion either around or on that hot summer’s day, Rice-Meilicke says.

“We need to pay more attention to why this is happening and what we can do to help, instead of waiting until things are already happening. And then there’s a crisis that can’t be undone,” she says.

Rice-Meilicke, now 32, was just 7 years old when her mother was diagnosed. Her brother and only sibling, Steve Rice, now 31, was even younger. Before she hit her teens, Rice-Meilicke had learned the hard truth about trying keep her mother safe: There aren’t enough advocates for the mentally ill. Consequently, there aren’t enough beds, there aren’t enough programs, there aren’t enough laws and support systems in place to protect those who need it most. And that needs to change, she says.

“I was about 10 or 12 years old. And I would be in the hospital room with my mother, who would be saying and doing all sorts of crazy things, and they’d be working on paperwork to release her,” Rice-Meilicke says. “How crazy is that?”

Having a mentally ill person civilly committed to care is difficult because of Oregon laws, says Jackson County Circuit Court Judge Lisa Greif. Even when there are good reasons to believe a person would benefit from being placed in a care facility, the legal standard for commitment remains extremely high, she says.

All too often those battling mental illness will end up in the criminal court system — usually not the most appropriate remedy, the former defense attorney says.

“Our options are the state mental hospital, jail or prison,” Greif says, adding the “revolving door” aspects between the mentally ill, police and justice officers had everyone wondering, “What can we do better?”

Rice-Meilicke was disappointed to discover Jackson County’s two client-run, drop-in day centers for the mentally ill, DASIL and Hawthorne House, closed last fall. She had hoped, in lieu of flowers, people might send a check to Hawthorne House.

“She worked in the kitchen and baked cookies there,” Rice-Meilicke says. “People who struggle with mental illness don’t want to focus on that aspect of their lives. They want to have fun and be productive, if they can, and be in a place where they are not judged. They need to have a sense of community.”

Brubaker agreed having to permanently shutter the county-run Hawthorne House was “discouraging.” But plans are in the works to create a better “club house model” area at the new health complex that will be similar to Hawthorne House. It will offer attendees a sense of community in a stable, “peer-supported” manner, and also provide education assistance and job training opportunities, she says.

“We all need a place to be. And when you don’t have a place to be, life gets harder,” Brubaker says.

The county also plans to provide a crisis intervention service center that can care for up to five people at a time, she says.

“It will provide people a chance to feel supported and regroup,” Brubaker says.

Just five months before her final disappearance, Rice was “kicked out of foster home after foster home due to her medications not stabilizing her,” Rice-Meilicke says, adding Jackson County Mental Health workers told her they had “no further options.”

Rice was housed in an apartment and expected to manage her own medication — more than a dozen prescriptions in four or five daily doses, her daughter says.

“It was a recipe for disaster,” Rice-Meilicke says.

Medical records show Rice sought treatment at local emergency rooms half a dozen times in the space of one month. Numerous times, Rice became hysterical and called 911, her daughter says.

“The majority of times when somebody is sick, but not getting the help they need, it puts a huge strain on everyone, including the police,” Rice-Meilicke says.

Brubaker’s goal over the next three years is for every law enforcement officer in Jackson County to receive training in crisis response to the mentally ill. Brubaker and a staff member, along with two Medford police officers and a representative of the Jackson County Sheriff’s Department, will attend a weeklong “empathy-based” training in Utah soon, she says.

The five who attend the February sessions will become trainers for the rest of the county’s law enforcement officers, she says.

All but three members of the Ashland Police Department have received the training, as have several others in departments throughout the valley, she says.

Medford police Chief Tim George says he fully supports the mental health training for his officers. A lack of services because of budget cuts has collided with increased need and burgeoning drug and alcohol issues, he says.

“There’s been a huge snowball effect,” George says, adding mental health calls have jumped 25 to 50 percent in the past two years.

His officers responded to 664 mental health calls in 2012. Of those, 344 were suicide threats or attempts, he says, and officers had to put someone in temporary, protective custody 397 times.

“This can create a serious officer safety issue,” George says. “Any time we can get better training, it helps us get better at what we do. It benefits our officers, and the community we serve.”

There are a dozen beds in the only psychiatric unit in Jackson County. The hospital ward does what it can, but it can only triage those experiencing the most critical mental health crisis. The minimal space available means that often the person whom police brought to the hospital is released before the officer has finished writing up the paperwork on the case, George says.

“We see them walking across the hospital parking lot,” George says. “There’s only so much capacity. When there’s no room at the inn, and someone is having a mental health crisis, what are you going to do?”

George credits the William Moore sobering center at Addictions Recovery Center for providing a stopgap temporary “safety valve.” Dual diagnosis is common in the mentally ill, which brings addiction issues to the fore, he says.

Police officers rely upon the ARC’s sobering services to provide a safe haven for those who cannot be legally or professionally evaluated for mental illness because they also are under the influence of intoxicants, George says.

Sometimes, when that facility also is full, George’s officers have been known to drive mentally impaired citizens around in their police vehicles for a time, or bring them to the police station “for a cup of coffee,” he says.

“It helps us buy time, keep them safe, and try to find a relative or someone who might be able to help,” he says.

Greif, George and others on the county’s public health safety panel have begun identifying “frequent fliers” who are shuttled in and out of the criminal justice system fundamentally because of mental health issues.

With no budget and no formal courtroom, Greif volunteered this summer to perform early morning informal hearings with one woman who was at the top of the list, whom she declined to identify.

“I would definitely consider taking on another individual or two,” Greif says, adding she is hoping to lay a framework for creating a mental health court, similar to the county’s successful family and drug courts, when state and county budgets improve.

“It’s a great start,” Greif says. “And the more we can put our heads together, the better for our whole community.”

The woman, her public defender, her mental health worker, the district attorney and Greif have been meeting regularly. They have created an action plan for her and provided wraparound services to ensure she is getting medical and dental care, and proper housing. The one-on-one attention from a judge and the other collaborators has connected this woman to her community — and changed her life, Greif says.

“She has had no contact with police and no complaints since September,” Greif says.

Rice-Meilicke says she will advocate for the mental health court and the other changes.

“This is all very encouraging,” Rice-Meilicke says.

Rice-Meilicke recently discovered her mother’s journal and a long-lost letter her mother had written to her. Rice writes about being frustrated and afraid, and also about being strong and hopeful, Rice-Meilicke says.

Rice acknowledges she appears to have gone “downhill” to some, countering that she is gaining insights into her own strengths as well, her daughter says.

“She did feel strong,” Rice-Meilicke says. “But she didn’t understand why (her mental illness) had to be happening. She wrote, ‘I’m hoping there’s a reason for all this.'”