The Psychiatric Security Review Board is fairly modest about its existence. There’s little useful information provided in a obvious place on the web – so we created this web site to list the staff contact information and relevant statutes.
Filling in for a co-worker on the weekend shift, Jennifer Warren stepped into Brent Redd‘s home last Sunday morning to deliver his anti-psychotic medication.
Doctors, though, were reducing Redd’s dosage in preparation for a medical procedure. Committed to the Oregon State Hospital five years ago for trying to murder his mother, Redd had been released to living semi-independently in a St. Helens duplex. The 30-year-old was stable, even holding down a job at a thrift store.
But he was worried about being taken off his drug therapy.
“He was scared,” said his mother, Debbie Redd, who lives in The Dalles. “Those meds are what regulate him every day.”
Later Sunday, Redd was arrested in Warren’s fatal stabbing. Redd reportedly called 911, and St. Helens Police Chief Steve Salle said police recovered a kitchen knife as evidence. Prosecutors charged Redd Thursday with Warren’s murder.
The St. Helens homicide is in many ways unusual. Redd was under the supervision of the Psychiatric Security Review Board. The homicide is the program’s first in about 30 years, but it raises troubling questions about safety and protocols:
Should caseworkers travel in pairs and take precautions when medications are changed? Who makes the rules? Does the state do enough to protect health care providers, the community and the patients themselves?
Many questions can’t be answered until the investigation is complete. Dr. Joseph Bloom, former head of psychiatry at Oregon Health & Science University, said officials should determine whether a solo visit by Warren was appropriate considering Redd’s dosing. “I would expect that the programs involved would do a lot to understand what happened.”
The psychiatric board supervises criminal defendants judged guilty except for insanity in felony cases, roughly 600 in Oregon.
Many were convicted of murder or attempted murder like Redd, while other charges include arson and sex abuse. Currently, 183 are in the Oregon State Hospital and 413 are on conditional release.
Two dozen locked facilities around the state house 76 of those on conditional release, while 175 are in residential treatment centers or supervised adult foster homes. About 64 live semi-independently, in housing where a staff member lives, and the rest live on their own.
The psychiatric board’s five members, appointed by the governor, act as judge and parole office. For each felon judged guilty except for insanity, the board is advised by mental health professionals and county officials and decides:
- Whether patients can be released from the state hospital. For Redd, found guilty except for insanity in the attempted murder of his mother in 2007, a judge decided on 20 years of supervision. The psychiatric board sent Redd to the state hospital and, in its 2009 review, kept him there.
- Where they can be released. The psychiatric board in September 2010 released Redd to a residential treatment center in St. Helens. In May 2011, it approved his transfer to a duplex supervised by Columbia Community Mental Health, the nonprofit that provided his day-to-day therapy and monitoring.
- Conditions of release. Redd took random weekly drug tests, attended group therapy sessions five times a week, saw his therapist weekly and his caseworker checked in twice a day. He attended three substance abuse meetings a week and passed random drug tests weekly. He had to stay at home between 10 p.m. and 7 a.m. and swallow medication in front of a caseworker.
Mary Claire Buckley, executive director of the psychiatric board, said monthly reports indicated Redd was doing well.
The psychiatric board has been under fire for years by lawmakers and mental health advocates saying it is too strict. In the last 15 years, of more than 1,600 people released from the hospital, 15 people have committed felonies while under board supervision, including three since 2009.
Clackamas County District Attorney John Foote says the tragedy shows public safety should be the priority when it comes to people with a history of violence.
“I hope this is a wake-up call,” he said.
Bob Joondeph of Disability Rights Oregon, sees it differently: “We think it’s very important to understand what happened here, but not to jump the gun and not to paint everyone with the same brush.”
Oregon spends about $400 million a year on mental health, about half on local programs like the one Redd was in, Columbia Community Mental Health, which receives more than $3 million yearly. The state inspects nonprofits every three years.
Columbia Community Mental Health, which employed Warren, declined to be interviewed. But according to state and other county officials, providers are directed to set their own safety policies.
The state requires crisis response training for caseworkers. They don’t carry defensive weapons such as pepper spray due to legal issues, mental health officials said.
“You have to have training — you can harm people,” said Schneider.
There is no standard policy on when a solo visit is appropriate.
It’s not uncommon for caseworkers to visit patients individually, but they need to be cautious, said Greg Schneider of Lifeworks, which provides mental health services in Malheur and Umatilla counties. “If that person had anything happen in their life recently or had any mental health deterioration, then you may not want to go out alone,” he said.
NO SIGNS OF TROUBLE
In April, Redd’s mother said he was being weaned off anti-psychotic medication for Hepatitis C treatment. It had taken years to find the right medication to keep his paranoia and schizophrenia at bay. She asked him if it was a good idea, and recalls his response:
“They told me it’s going to be OK,” he told her. “They told me that I will know. That I’ll see signs” if there are problems.
Redd’s caregivers knew about the medication change, said Gina Nikkel, a consultant with Warren’s employer, Columbia County Mental Health, adding that it’s too early to draw conclusions.
“People feel that he was not a risk,” she said. “Columbia mental health staff were doing everything in accord with the protocols that have been used for a long time.”
Redd’s roommate also said there was no sign of trouble. “He was being double and tripled monitored. How on earth could they have known that this would have happened?”
The state is reviewing whether state and county rules and provider policies are adequate.
On Thursday, Linda Hammond, interim director of the state Addictions and Mental Health Division, met with county mental health directors from around the state.
A parallel state investigation is looking at the care Redd received, while the Oregon Occupational Safety and Health Division is examining whether Warren’s death was preventable.
After his arrest, Redd was taken to Legacy Emanuel Hospital & Medical Center to treat wounds that were apparently self-inflicted. He’s expected to be arraigned soon in Columbia County.
A makeshift memorial to Warren, a 39-year-old single mother, has sprung up on the front lawn of Redd’s unit, one of four in two ranch-style buildings situated on a corner.
READ – Suspect in St. Helens stabbing had change in meds, AP.com
READ – Stabbing shows how mental health workers are at risk, opinion editoral from the Salem Statesman Journal, May 27, 2012
Her funeral is scheduled for June 3 at 1 p.m. at St. Helens High School.