Category Archives: Oregon State Hospital

Even More From the Cuckoo’s Nest

This came in my work email:

Dear Staff:

This morning I gave the following assignment to my writing group: “What was the favorite gift you have ever either received or given for any occasion (Christmas, Birthday, Anniversary)?  Write about it and answer these questions:

What was the occasion?

Who were the players—giver and recipient?

What emotions were felt or expressed?

J.N. from Bird 3 (Salem) answered:

“Liz, my group home manager in Grants Pass, when I spent Christmas there gave pajamas to me for a present.  I laugh because I needed P.J.’s.  They were navy blue.  I could put them on before bedtime and unwind in writing on the computer.  They were light and comfortable.  I felt like a million bucks in them because it was decades [since] I had a bed, and P.J.’s to sleep in.  You see, I had spent years on the streets and I slept anywhere out of the weather.  My clothes stayed on me, but my shoes came off when I climbed into the sleeping bag.

 When my care-provider gave P.J.’s to me I acted like a child of joy.  The smell of new P.J.’s was pleasant.  Crisp, fresh P.J.’s were like I was high class.  I did thank Liz for the thoughtful gift.  She is a wonderful person and considerate.  Now, feeling human and high class I wrote better with a new mentality…..Liz [fed] us a balanced diet and shows love in working around the house. 

 Love for P.J.’s is the tender feeling while nights pass.  And I sleep…”

When our patient read this aloud to the class, my eyes filled with tears.  What a wonderful expression of thanks flowed from this patient’s pen!  There are a lot of things to be sad and disappointed about in our world today, but as you reflect on this story I urge you to consider “Who can I bless with “P.J.’s” during this Christmas/Hanukkah/Holiday season?”

Dr. **** ******, Clinical Psychologist

If you have followed this blog you are acquainted with JN and his powerful images, intensely emotional poetry. Of course, he is no longer in the 50 Building- which is now abandoned across the street. He lives in this giant new beast, shiny and deceptive. They rolled up the old hospital and brought it here into a new edifice. Here’s something else-

01-31-2009AD

7:24pm

Believe

Understood into self as the clouds drift away

Sun rises to the word of reality with shinning focus

Wind whispers it while awake in the Desert

Mountains’ tree sings it out with a hoot

Rocks roll in the snowy water stream

The birds fly with uplifting wings

Chairs hold you in faithful promise

I absorb it like food for nourishment

Rain falls to the gravities law

Air gives way to breathe of life

Monks hum to it in meditation

Spirit listens in ah while thought is created

Soul will carry it to heaven

God rewards you for understanding

Flowers wilt by it after seeding

A Babies cry with it when born

Believe while doing all things and it will be

Stories are written with the thought of it

Companions make love for a child

Can’t touch it with your hands, but imagination flourishes

Wake- that sun will make it today

Why then doesn’t it happen when we speak?

Truth and lies are from this tongue of ours

By JN

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News from the Cuckoo’s Nest

One-Flew-Over-the-Cuckoo-s-Nest

We got a look at a new report today. The hospital is all about hiring consultants and then systemically ignoring what they tell us. Our latest visit was from Dr. Ragins of MHA-LA.

I suspected we would never see a non-redacted version of his recommendations but I’ve been proven wrong.

Here it is, along with a older report he did as a pdf link. I’ve also included the introductory letter from our CMO, Dr. Rupert Goetz.

December 6, 2013

 

To:                          All affected staff

 

From:                    Rupert Goetz, MD

 

Subject:               Attached Consultative Report

 

 

 

As we move into this biennium, one of the changes we are pursuing is to strengthen our understanding of “Recovery” at OSH. Hope, Safety and Recovery are after all the three core concepts in our Vision Statement.

In strengthening our understanding, we want to build on our past (remember the collaboration between Dean Brooks and Maxwell Jones around the Therapeutic Community concept; remember more recently the visit by Sandra Bloom around the Sanctuary Model). But primarily, we want to look forward. We want to look at the many ways we can grow together. For example, we also want to better understand how peer-delivered services can help us build our desired culture.

To that end, I asked Mark Ragins, M.D., who has for years helped implement the recovery model at The Village in California, to visit with us and share his thoughts. Attached is his report.

The purpose of the visit and of sharing the report is to provide us with an outside perspective. While we want to honor our past, as well as our many current internal champions, we want to creatively plan our path forward together. This additional perspective is intended to help us do so.

There are minor details such as the “not guilty” reference (it is in Oregon “guilty except for insanity”) that we might want to quibble with. There may also be the assumption that this is the blueprint for our work in the coming year – it is not. I hope rather that you find it a thought-provoking place to begin our conversation about how we strengthen recovery at OSH.

 

 

 

 

 

 

Oregon State Hospital Recovery Transformation Consultation Report

Mark Ragins, MD

 

 

 

Acknowledgements:

 

I want to thank the Oregon State Hospital for welcoming me to share your work and your lives with me. A friend of mine defines welcoming as “opening a space in your life for a guest to feel comfortable and opening yourself up to them, knowing full well your guest may change you in unexpected ways.”  I have felt truly welcomed by you.  I hope I have been a good guest.

This report is not meant to be an expert, authoritative evaluation and orders for you.  Recovery transformation is a complex problem and complex problems are not solved by outsiders or by definitive answers. Successful transformation is an evolving, collaborative process that never ends.  At best my influence can by to support, nurture, inspire, instruct, guide, and share your organic process of growth. The explorations, observations, thoughts, and suggestions I’m writing here are just the current iteration of my evolving reactions.

I have attached a large volume of reference material from our work at MHALA and the Village. These are not meant to be blueprints for you to replicate the Village or even an instruction book for you to build your own program.  They are concrete, real world, useful tools we have evolved in our own process that may inspire your imagination of what possibilities you might pursue. Remember that they have evolved over decades of work at MHALA and the Village…and we’re not slow learners; we’re aggressive innovators.

 

A note on language in this report: The words I most commonly heard you use to describe the people you serve were patient and client. There was widespread distaste for the word inmate. In other places I’ve seen people also called residents, guests, members, students, consumers, people in recovery, etc. It’s likely that each of those words would be an accurate description of roles people have experienced along the way.  There is a considerable power in the words we choose and how they reflect our mission and values. Your choice has evolved and may evolve further.  I will use patient and client interchangeably in this report to “meet you where you are”.

 

Recovery and the Oregon State Hospital:

 

For me the initial overriding question for this consultation was “Is it possible to use recovery as an overarching philosophy and approach at a place like OSH?” Recovery emphasizes concepts like empowerment, self determination, self responsibility, and community integration. The patients at OSH have been specifically selected for people who are unsafe, untrustworthy, incompetent to be held self

 

responsible, and who have been forcibly excluded from community life.  Even for a true believer in recovery and strong advocate like me that seems a difficult challenge.

Can people at OSH actually recover? Over my few days at OSH I saw several things that impressed me that the answer is yes. Firstly, the enormous majority of people at OSH will be living free from restriction in our community at some point in the future. Their day-to-day reality at OSH emphasizes risk assessment, confinement and restriction. But if we take the long view, the vast majority of people realistically should be preparing for freedom, not ongoing confinement.  Second, the long term staff I met were all hopeful for the clients they’re working with.  They believe things will get better for them. Third, and probably most importantly, there were widespread examples of patients at all points in their journey who are making progress and recovering. These ranged from someone who was soothing himself with a guitar to reduce his assaultiveness and seclusion from every day to a few times a week to a young man doing Calculus homework for his online college class who has been approved for discharge to a group home hoping to continue his studies on campus. Whether you describe yourselves in recovery terms or not, recovery is happening at OSH now.

For recovery to be a pervasive culture, the wide range of hopes, dreams, and personal journeys of each patient’s recovery need to be unified into a shared collaborative vision and destination. My proposal is: People living at OSH are engaged in a hopeful, healing journey towards freedom, safety, and self responsibility. I believe that those three characteristics of the destination – freedom, safety, and self responsibility – are all mutually interdependent.  None can be sustained independently without the other two. Whichever of the three are not addressed and achieved will ultimately drag down the other two. I believe that vision of recovery can be applied throughout OSH.

My next concern about implementing recovery was “Is it possible for the staff to have relationships with the clients that regularly support and facilitate their recovery?”

The clients at OSH are in a strange, awkward moral place where society has rejected them without convicting them of any crime. The staff must be “abnormal in a certain special way” in order to reach out supportively to people who have been cut off and exiled by our society.  To create a “counterculture of acceptance” at OSH staff must be consistently accepting of them. It seems as though the majority of your staff is already there.

It would be helpful to have a unifying “moral stance” regarding the clients that everyone accepts. I would propose: These people have been determined not to be guilty, bad people who should be punished, but rather incapable people who should be supported to become capable again.  This stance is consistent with the recovery vision above. Staff who become punitive instead would need to be sanctioned. It would also be helpful to include the ability to accept your clients on that basis as part of your recruitment, hiring, orientation, training, and retention.

The other serious obstacle to forming recovery relationships is the danger staff are in because of the patients’ violence and the fear the staff feel as a result.  It is extremely difficult to collaborate with and empower someone we’re frightened of. A good deal of the staff seem to have embraced trauma

 

informed care as a tool for reducing fear, conflict, power struggles, and actual danger.  This should become universal.

Beyond that, the most impressive thing I saw at OSH was the innovative and exemplary practice on a very dangerous unit:  They have come together as an amazingly unified team, using a detailed, highly individualized “engagement” tool that assesses each person’s dangerous behaviors including their triggers, warning signs, helpful relationships, self soothing and care combined with a DBT approach.  The staff never give up and continue to seek out creative approaches for each person gaining administrative approval when exceptions to policy need to be made. They appear to have drastically reduced the dangerousness on the ward.  Beyond that, even though there continue to be assaults and seclusion and restraints, the staff feel safe and are allied with the clients.  This is a remarkable accomplishment that should be analyzed, replicated, rewarded, and treasured.  I believe that if it can be done widely alongside trauma informed care, it can get you through the fear barrier to recovery relationships.

I think more work could be done proactively and on an ongoing basis to keep staff from becoming too fearful and traumatized. Your staff have to have the resilience to feel safe even though they’ve been assaulted and likely will again. They may need to be selected for that trait (from a variety of experiences). They need support when they’re weakened and need recharging. They need each other most of all. Toughing it out alone or feeling trapped with a certain patient or unit are both likely to lead to burnout. Ongoing attention to staff nurturance to avoid fearfulness is essential.

My conclusion is that – with ongoing support and emphasis –  enough hope, acceptance, alongside enough avoidance of fearfulness and punitiveness could be maintained to have recovery relationships throughout OSH.

 

What advantages would recovery likely have at OSH that would make it worth the effort?

 

  • Integration of services:  There is a dazzling array of services at OSH ranging from psychiatric medications, to external controls, to sex offender therapy, to art and music therapy, to supported employment, to peer advocacy and bridging, to access to a legal library, to discharge resource development, to an Empowerment center, to yoga and mindfulness, to anger management and substance abuse groups, to Basketball and a woodwork workshop, etc. Although there are some team meetings and a coordination plan much of what is done is not integrated together.  A recovery focus brings the utility of each activity into focus: Does this activity move the person closer to freedom, safety, and self-responsibility from where they are now?  There is far less need for power struggles and hierarchies to determine whose work gets priority if you’re all in alliance working on the same goals in the same direction. It would also be clearer to the patient how everything fits together to benefit them.
  • Decreasing “staff vs. patient” conflicts:  Recovery emphasizes collaboration, shared decision making, and empowerment rather than compliance, informed consent, and professional authority. Those differences radically reduce conflict. Safety would likely be improved for both staff and patients as a result.
    • Decreased staff burnout and increased satisfaction: One of the most powerful factors behind the spread of recovery is how much staff prefer it once they are doing it openly and together and confidently compared to their previous work. At bottom, recovery feeds our hearts more than standard treatment does.
    • Alliance between administration and staff: if administration embraces and adopts recovery practices for themselves in addition to prescribing it for their line staff the entire program works more synergistically.
    • Improved community advocacy: When community advocacy is based on fear and “demonizing” our patients we can get extra money, but we badly decrease community welcoming and reintegration for our patients.  When community advocacy is based upon recovery, we can ally with our patients, and we have a foundation for promoting community welcoming and reintegration. Telling stories of patients achieving safety, freedom, and self responsibility are far more likely to help them be accepted than billboards of staff injuries at the hands of dangerous, frightening patients.
    • Protection against slipping into dehumanized, punitive, coercive relationships:  Any program that is involuntary, locked, and largely hidden from society is prone to slip into increasingly dehumanized, punitive, relationships and from there into overt abuse. Power is corrupting.  A recovery culture can provide a counterinfluence to these destructive trends.

 

 

Recovery   implementation:

 

Recovery is primarily a treatment culture. It emphasizes less what is done and more how and why it is done. Therefore, implementing recovery is a prolonged, organically evolving, complex process.  It needs to be tended and nurtured like a farmer does, not blueprinted and built like an engineer does.  Take  your time.  Be gentle to the land and be a good farmer:  Till the soil to prepare it, help pick out seeds and pay for them, plant alongside the staff and clients, fertilize and nurture seedlings, pull out weeds (but  not with widespread poisons),  rotate crops to avoid exhaustion, and celebrate the harvests together.

There are many recovery principles and practices – like “client-driven” or managing relationships during times of transition to promote growth and self responsibility or strengths based community advocacy – that require years to explore and master. Be patient. Here’s a link to something I wrote to comfort and guide transformational leaders:  http://mhavillage.squarespace.com/storage/69KeepingPerspectiveandStayingSane.pdf.

 

The land can be plowed by mapping recovery. There are a number of “maps” of recovery to adopt from, but you should create your own and it should be very specific to your clients’ journeys. Years ago I created a four stage “map” for the Village based on the work of Elizabeth Kubler-Ross that includes four stages– hope, empowerment, self-responsibility, and achieving meaningful roles.  http://mhavillage.squarespace.com/storage/08ARoadtoRecovery.pdf  is a link to my short book “A Road to Recovery” that describes this map using lots of stories and learning from our direct experiences at the Village.

 

Your map could include stages like:

 

  • Being involved in a tragic, socially forbidden action,
  • being determined to be incapable of self responsibility and punishment and referred to OSH to rebuild capability,
  • being faced with unwanted external control and coercion,
  • being stuck in resentment and rebellion,
  • resisting change and trying to “fake it to evade it”,
  • feeling ongoing pressure for internal change,
  • demoralization and giving up,
  • maladaptation to living in the institution,
  • having seeds of trust and collaboration with staff to try to rebuild,
  • prolonged internal self-evaluation and skill building in a variety of ways,
    • repeated cycles of failing to do enough to be released,
  • achieving release status but no community opportunities or resources,
  • being released and facing ongoing coercion and control and community rejection,
    • returning to unsafe behaviors and environments,
    • achieving full freedom, safety, and self responsibility.

 

It is essential that this map be from the clients’ point of view to be a recovery map.  (If it’s from the staff’s point of view it’s a treatment map, not a recovery map.)  The “gold standard” is that the clients can recognize themselves and their journeys on the map.  Make every effort to amplify the clients’ voice and experience.  Embellish the map with client stories, artwork, music, video, poetry, etc.   Here’s a link to a touching example of a video created by a group of consumers in Porterville, California:  http://www.youtube.com/watch?v=uH9gV_7jmiQs.

 

You can gain some cultural depth by connecting the map to other human journeys (like achieving death with dignity, Joseph Campbell’s hero’s journey, 12 step journeys, or other recovery narratives, etc.)

You can also gain some spread of this map from just applying to clients to applying to everyone by creating a narrative of the recovery process OSH has experienced going through the same stages as the clients. It almost seems uncanny to me how closely these stages describe the last few years at OSH. MHALA applied the same four stages our members go through to what staff go through when we structured our Recovery Oriented Supervision trainings to emphasize that we need to treat our staff the way we want them to treat our clients.

Your recovery map can then be a direct guide for determining how staff relationships facilitate or hinder recovery at each stage, how services should be organized and integrated “meeting clients where they are at”.  A standard for valuing staff and services becomes “How does this promote your client’s recovery?” rather than which staff has more power or influence within the system or hierarchy. This also makes the resolution more often “and” rather than “or” valuing each staff and service for their strengths and figuring out how they can work together instead of competing against each other. (For example, a team with a united front demonstrating a “show of force” standing behind an individual staff with a soothing relationship trying to help an aggressive client problem solve and re-establish self

 

control can work together without either one being “wrong”.)  It should be possible to promote efforts that strengthen people without weakening someone else.

The Village found that our treatment principles mapped directly onto our four stages map too (see attachment 1).  Notice how precisely stated and focused our principles are. You may have staff that are good at developing clear treatment principles that apply across OSH defining the “beliefs” that underlie your evolving recovery culture.

Administratively, you want to develop parameters to guide staff as they develop individualized recovery relationships rather than highly prescriptive policies, especially avoiding pervasive “thou shalt not” policies that “straightjacket” them. This link has a set of parameters that the LA County Department of Mental Health developed and adopted with our assistance:  http://mhavillage.squarespace.com/storage/82NewRulesforStafftoWorkBy.pdf.

 

OSH staff expressed a lot of change fatigue and burnout. My overall impression is that there are more people who think there have been too many changes, especially administratively engineered changes, than people who think that OSH is stagnant at present. Top down engineered changes engender more change fatigue and resistance than bottom up, organically emerging changes.  Except for three pointed exceptions I’ll describe below, I would recommend cultivating currently emerging changes instead of directing new mandates. (For example, after I visited a state hospital in Provo, Utah each staff member made a large cutout of a helping hand with one thing they would do differently to support hope, empowerment, self responsibility, or meaningful roles and then the patients responded by each of them making a large cutout of a foot with one thing they would do to walk a path with more hope, empowerment, self responsibility, and meaningful roles.  A lot of excitement and empowerment was generated there by this approach.)

 

Promising examples of emerging changes I heard about at OSH included:

 

  • Trauma informed approaches to reducing seclusion and restraint and increasing self control
  • Team based integrated engagement and DBT approaches to reducing aggression and assault
  • Creating more “nimble teams” that could rapidly solidify trust even with staff movement and turnover
  • Enhancing peer support services
  • Specialized ethnic and sexual orientation specific peer support
  • Using music recording to explore personal growth and create positive roles
  • Using yoga to address trauma wounds and healing in non-verbal ways
  • Create a robust family and community volunteer presence in the treatment malls to increase community connections and acceptance
  • Create a client key card system so that increase privileges and self responsibility are directly connected with increased freedom of movement around OSH. (BTW I saw this done successfully in that same state hospital in Provo Utah)
  • Openly discuss and develop parameters for including positive, permissible sexual activities including dating, hugging, dancing together, and conjugal visits.
  • Increase peer bridging to peer run organizations n the community to increase community supports and connections upon initial release from OSH
  • Creating a newsletter with stories of hope and recovery

 

 

I’m sure there are many more seeds and saplings of ideas around that need nurturance.

 

Hope requires a lot of consistent nurturance built into your program or we end up focusing on the crises of the day and the things that go wrong. ( Examples of hopeful rituals include beginning team meetings with stories of hope, regular celebrations, special staff acknowledgments and rewards, etc.) Too many policies are made to make sure one serious incident “never happens again” instead of strengthening us so when something tragic happens, and it inevitably will, we’re able to continue on.

The three area in which I would recommend you do serious course corrections (or to use our sailing metaphor, three places where I think you should tack – including communicating the need for a course change, micromanagement of the course change, and bringing people together to handle the change as a team) are: 1) personal dedicated recovery relationships, 2) peer support services, and 3) board hearings.

 

1)      Personal dedicated recovery relationships:

 

Your present system tries to ensure that everything is in place to facilitate someone’s recovery.  They have written goals and a recovery treatment plan. They have the availability of a wide variety of supports and services which they are scheduled into. And they have clear objective assessments to prepare them for hearings and release.  What they don’t always have is a trusting, collaborative relationship with a single dedicated staff to guide them through the process. This staff also needs to guide them through the internal process of recovery – engagement, motivational enhancement, commitment, dealing with grief and loss, internalizing skill building and role changes, moral development, building self responsibility and self reliance, preparing for discharge and community belonging.

I strongly prefer a “therapist case manager” model to a “broker case management” model for this primary relationship so that the internal and external processes of recovery can be integrated. At the Village we call this person a “Personal Service Coordinator” and have adopted Kansas University’s “strengths based case management” model.

I fear that implementing a PSC model at OSH will require substantial top-down structural reorganization, precisely of the kind resented by your staff and causing change fatigue and burnout.  Nonetheless, I think it’s a crucial course correction.

This is an opportunity to emphasize some of the more personal aspects of recovery relationships instead of making administrative assignments: Which staff is the best personal fit for this patient? Who has the most hope? Who has the least fear? Who has personal life experiences that enable them to connect to this person and inspire them? Who is strongest at the particular phase of recovery this person is in?

Client empowerment can also be overtly included: Who do you want to work with? Who do you trust

 

the most? The Village even has “open enrollment” periods every six months when our members can switch PSCs or teams within the same level of care without needing to give a justification.

2)      Peer support services:

 

There comes a point in the development of peer services when they need to move from being “angry outsider advocates” to “collaborative, insider reformers” to move forwards. As the walls keeping the patients’ voice silenced are lowered, other voices besides aggressive, antagonistic, self righteous voices can be heard. This is a disorienting time for peer advocates. The traits that have been absolutely essential to lowering those walls and bringing about change, that have been nothing less than heroic, are now being criticized and blamed for not being able to progress further. Newer peer staff may not respect their contribution and what they’ve been through so they could have a voice. These experienced peer advocates may not even agree that there has been substantial progress or that the walls have been lowered. They may fear a “trick” to weaken them or co-opt them.   And sometimes they will be right.

But at other times, when the swords are put down, there is a flourishing of other voices and relationships. Sometimes a Nelson Mandela emerges from the fight instead of dying on the battle field like Che Guevara did. Sometimes unions that were regularly striking and being repressed engage in collective bargaining or even shared ownership.

In my opinion, OSH has made enough progress to try to put the swords down. I would recommend substantially increasing the number of peer staff, while substantially decreasing their adversarial “peer advocacy” in favor of collaborative “peer support” services.

Making that course correction will likely be quite difficult. In my experience in other places what usually happens is that some of the most valued and successful long term peer advocates end up removed or reassigned out of the mainstream to move forwards. That seems a shame to me and I don’t know that it’s the only possible strategy.  It does however, open the door for a wider acceptance of, and integration of the other peer supporters with the treatment teams improving the patients’ recovery services directly.

At OSH there is a legal restrictiveness that exists side by side with the clinical services that is very important. This brings up the possibility that some of the most valued, but most dedicated to advocacy, peer staff could be moved into a new robust “peer advocacy” department and separated from the “peer support” department that would become co-supervised by the teams and by peers.  I don’t know if that’s been done in other forensic settings.  If the peer advocacy service was robust and respected enough it could be a valuable “check and balance” against the corruption of power and coercion that is an ever present risk in involuntary, locked settings.

I would advise having a small team of clients, staff, peers, and administration charged with developing a plan to move to a larger peer staff that is no longer emphasizing advocacy. They should seek out guidance from other exemplary peer services. I’ve been exposed to successful programs at Recovery Innovations, Riverside County and Tulare County in California, and King’s County Hospital in Brooklyn.

 

NAPS (National Association of Peer Specialists) can probably point you towards further resources. The team would be expected to inform and guide the process of changing course, but the course itself wouldn’t be negotiable.

In my view, the main emphasis at this point in your development is not to accentuate the differences between clients and staff but instead to blur those differences. Justice and righteousness are less crucial than trust and reconciliation.   Desegregation, power sharing, collaboration, mutual respect, inclusion, and interdependence would be my points of focus. Towards that end I would hire more “blurred people” – both peer staff who have professional skills and degrees and probably more importantly, professional and para-professional staff that have lived experience of mental illnesses.  In addition we need to remember that there are a substantial number of staff who are currently hiding their lived experience out of fear.  That is a terrible burden on them and deprives the patients of a considerable source of support and hope.  Those staff shouldn’t have to take sides. They should be proud of both their personal and professional gifts and be able to use them without fear.

 

3)      Board hearings:

 

Although there have been changes in these hearings recently, they are still clearly the cause of major distress, antagonism, hopelessness, and divisiveness. A patient complained that they are arbitrary and unpredictable, often not following the clinical input of the staff, leading him to withdraw and give up in helplessness. A psychiatrist said that he pisses off the public defenders, the district attorneys, and the hearing officers about equally so he must be doing something right. Frankly, that doesn’t’ sound like a collaborative relationship either.

Over the last decade there have been substantial innovations within mental health legal hearings. There are mental health courts and drug courts scattered around where the hearing officer has a personal relationship with the client and actively participates in their recovery: They engage and motivate clients. They grieve and celebrate with clients. They mediate between staff and clients working to improve their collaboration. They actively secure community resources and services for clients. They even hug clients.  I am aware of an exemplary court and judge in Nevada County, California who handles the involuntary outpatient commitments (Laura’s Law AOT).  The Elyn Saks institute at USC is connected with a large number of resources who could inspire and guide you.

I realize that this recommendation is beyond the scope of my consultation and expertise, but I think these hearings could become a major force promoting recovery – especially as defined by freedom, safety, and self responsibility.

 

Recovery  Accountability:

 

Recovery sometimes seems so nebulous that it can’t be measured or promoted in an accountable manner. This argument maintains that it’s too non-specific, too subjective, too individualized to quantify or track.  Either you have it or you don’t.  I don’t agree.

 

Broadly speaking there are three areas to try to create accountability:  1) Recovery service provision, 2) recovery outcomes, and 3) recovery culture.  There will always be a tension between the accuracy and detail of the measurements in the accountability tool and the burden it places on clients and staff.  (The Mental Health Center of Denver is very sophisticated in their use of data driven management and accountability.)

 

1)      Recovery Service Provision

 

This is the most common way mental health services are held accountable:  Are we providing the services we’re supposed to in sufficient amounts.  In many parts of the system our payments are directly tied to service provision.  It is also the weakest way to assess accountability. There’s no way of knowing if a service is being provided well or not, effectively or not, compassionately or not, etc. All we know is that, at least on paper, someone did something.

 

Recovery services can be described and counted as well as traditional psychiatric or rehabilitation services.  I attached a list of recovery service areas that MHALA uses (attachment 2).  These are included in our EHR alongside the medical service codes.

 

2)      Recovery outcomes

 

It would be nice to know if we’re actually helping people recovery. We can track outcomes that are desirable whether they resulted from recovery or not, and we can track correlates of the recovery process.

California’s statewide AB2034 program that enrolled people who “deinstitutionalization failed” had four targeted outcomes:  Psychiatric hospital days, incarceration days, homeless days, and employment days. The 70% reduction in hospitals, jails, and homelessness alongside a 400% increase in employment days were powerful outcomes for California’s legislature and Governor Schwartzneger.  These four outcomes were specifically chosen to monitor the outcomes society had assigned to us and are relatively easy to track reliably. You could make a small set of similarly targeted outcomes, for example, reduced  incidents of assault or other violence, increased incidence of competency restoration at hearings, employment earnings within the hospital, increase in board approved discharges to lower levels of community care, etc.

MHALA didn’t feel that the variables on our four stage map of recovery (hope, empowerment, self- responsibility, and meaningful roles) would be reasonably measurable to track recovery although they successfully captured subjective experiences of recovery. We created a tool that is uses staff ratings to track individual’s progress through recovery using three correlates of recovery – risk, engagement with mental health services, and skills and supports. This link has the eight point Milestones of Recovery Scale (MORS) and describes its development, validation, and use:  http://mhavillage.squarespace.com/storage/84AGuidetotheMORS.pdf.

 

You could create a similar tool using the three most crucial outcome dimensions for your program – safety, freedom, and self-responsibility to define stages you could track people through; for example

 

stages like extreme danger, high external restriction, low internal control and self responsibility. Remember that the map shouldn’t be linear and should include forward and backward movements to realistically map recovery.

 

3)      Recovery culture

 

On the face of it, culture is the most difficult thing to measure. MHALA has developed a tool for adult community based mental health programs that begins with seven core valued dimensions of a recovery culture and then describes concrete indicators of whether the program is doing nothing, exploring, emerging, maturing, or excelling in each area.  This link  http://mhavillage.squarespace.com/storage/87ARecoveryCultureProgressReport.pdf  has the Recovery Culture Progress Report and a discussion of its rationale, development and usage.  Note how each domain flows from a value statement. You could develop a tool like this for your own program.

 

Conclusion:

 

The same friend of mine I began with said that for hope to be useful it has to include three elements: 1) A vision of where you’re aspiring to get to that is clear and specific enough to become believable (not that you ever get to exactly where you imagined or hoped for), 2) A commitment to take a few concrete steps that lead towards your vision (and see what happens), and 3) Enough passion and understanding of why this vision is important enough to you that you’re resilient enough to make it through the inevitable blockades and setbacks.

 

I think you have enough useful hope to achieve recovery transformation at OSH. Thank you for including me in your journey.

 

 

WE BELIEVE…

MHAVillageGuidingPrinciples and the Stages of Recovery

 

 

  1. Hope makes recovery possible; it facilitates healing of the mind, body and spirit.

 

 

  1. Welcoming people includes creating a culture of acceptance with easily accessible integrated supports and services.

 

 

  1. Focusing on the whole person includes their strengths and weakness, abilities and barriers, wounds and gifts.

 

 

  1. Each person creates their path and determines the pace of their recovery.

 

 

  1. The recovery process is a collaborative journey in support of individuals pursuing their life goals.

 

 

  1. Relationships are developed through mutual respect and reciprocity, including openness to genuine emotional connections.

 

 

 

  1. A solid foundation for recovery is built by helping people to honestly and responsibly deal with their mental illness, substance abuse and emotional difficulties.

 

 

  1. People thrive, grow and gain the courage to seek change in respectful environments that promote self responsibility.

 

 

  1. The practical work of recovery takes place in the community.

 

 

  1. Each person has the right to fair and just treatment in their community ensured through advocacy and social responsibility.

 

 

  1. Everyone deserves the opportunity to have a place to call home.

 

 

  1. Promoting natural supports, having fun and a sense of belonging enhances quality of life.

 

 

  1. Employment and education are powerful means to help people build lives beyond their illness.

 

 

  1. Program success is based on achieving quality of life and recovery outcomes.

 

Recovery Based Service Categories and Vignettes

1)      Welcoming / engagement – connecting the member with staff, program and peers, relationship building, demonstrating our “usefulness” to the member, engaging in collaborative goal setting, shared decision making, connecting with the member through self-disclosure

I asked Ann to bring in the drawings she’d made with the art supplies her mother had sent to the Board and Care, admired them, and made a couple copies to put on the wall.  I also showed them to other members and staff who were sitting around the team area, introducing Ann as a “real artist”.

2)      Crisis interventions / Responding to basic safety needs and community expulsion threats – accessing, collaborating with and/or diverting from hospitals and jails, advocating with the legal system to prevent incarceration, locating, placing in and/or paying for emergency shelter to prevent homelessness, , safety interventions – medical, substance abuse harm reduction and prevention, responding to threats of dangerousness, suicidality, and impending harm (e.g., domestic violence)

Donna wandered into the team area looking quite confused.  She didn’t respond to anything I said, just staring at me. Yesterday she had been coherently calling checking her status on the waiting list for a rehab program, so it seemed likely she was high or coming down. We tried to get her to take some medication, but she wouldn’t.  We watched over her and gave her a ride home where they know she gets like this a lot and can take care of her.

3)      Assessments – assessing goals and needs, understanding their view of themselves, mental health status assessment, Quality of Life assessment, co-occurring conditions (e.g., medical, substance abuse, developmental disability), “eligibility” determinations (voc rehab, disabled students, SSI, bus passes), fitness determinations (legal competence, child custody and driver’s license)

Mike says he wants to get a job, but he seems far too disorganized and our employment staff is hesitant to work with him. We decide to give him a “we pay” job using client support funds to put together new charts and shred paper for us for one hour a day to see if he can show up and if he does, how he’s able to function at those tasks, and if he follows directions. The information gathered can also be used as part of his SSI disability report.

4)      Building and maintaining the safety net / “protective factors” –  assisting in obtaining benefits and entitlements, connecting to poverty services (e.g., COA food bank, multi-service center), charity (e.g., bus tokens, food, clothes, toiletries), safe and secure housing, family connections, assisting in obtaining basic documentation (e.g.,  ID, birth certificate), connecting to basic social

 

services (DPSS, SSA), connecting to cultural connections, (Native American services, UCC), connecting to spiritual strength and security (faith community)

Anna has been staying with a variety of men she finds, but they all end up taking her money and short lived. She seems always surprised when they pressure her for sex. We make a deal with Ann that if she contributes $150 per month out of her GR check, we’ll give her a hotel voucher worth $650 to have a safe place to stay for the month, but she can’t have any one stay in her room with her.

5)      Motivating / Engaging in growth oriented activities – engaging in motivational interviewing, outreaching to isolated members, exposure to opportunities e.g., plays, sports, dances, hobbies, job fairs, schools), exploration of possibilities for the future, career exploration, core gift activities, goal visualizing, peer bridging

Carl hangs out at the sober living all day long, using pot and not following up with anything.  He says he doesn’t have any money to do anything.  I offer to take him out to lunch with a small group of members and on the way intentionally take him by one of the other member’s apartment starting a conversation about what it would take for him to get an apartment of his own too.

6)      Treating mental illnesses and substance abuse disorders to reduce barriers – helping members to gain control over their mental illness, helping members to identify and control their symptoms (e.g., WRAP), 12-step step work, medication services, providing psychotherapy, building emotional coping skills (e.g., CBT, coping with past traumas, anger management, relationship skills), building wellness skills (e.g., meditation, eating and sleeping routines, yoga), treatment of acute symptoms and relapses

Renee is struggling with panic attacks and flashbacks of being raped and is overtaking the Klonipin she’s been prescribed combining it with alcohol.  I teach her several anxiety reducing techniques including a “butterfly hug” to use during flashbacks, relaxation imagery for when she’s not quite as anxious, and to carry around a small tin of coffee grounds in her pocket that immediately calm her by reminding her of her mother when she was a child.

7)      Treating physical illnesses – providing basic wound care, monitoring and treating chronic physical illnesses (e.g., diabetes, hypertension, chronic pain), medication management for physical illness medications, seizure response, physical illness education (e.g., diabetes, hepatitis), smoking cessation, promoting physical wellness (e.g., exercise and nutrition)

Dennis fell in the bathroom at the Village and said he was “knocked out” for a second.  I called a nurse to check his vital signs and make sure he didn’t have any neurological signs that would indicate we should take him to an Emergency Room.

 

8)      Providing and building support – connecting to Village resources (e.g., job development, educational) and community resources ( Jewish Community Center, Gay and Lesbian Center, primary care provider, 12-step support groups, warm lines), connecting to social services (e.g., In Home Supportive Services, Family Preservation), participating together in community

 

activities and opportunities (“giving moral support”), helping families to support members (e.g., family education, consultation, problem solving), providing help directly (e.g., “doing it for them,” adding structure to their lives, making decisions for them, ”caretaking”)

Martin needed to get help to move his stuff from his hotel room into a permanent apartment. He couldn’t get any friends or family to help him and he didn’t have $15 to pay day labor to do it with him. Since there wasn’t that much stuff, I drove my own car over and helped him put his stuff in my trunk and then helped him unload it into the apartment.

9)      Rehabilitation / Skill building – teaching, job coaching, supported models (employment, education, housing), in-vivo teaching, providing work experience, teaching self-help skills (e.g., budgeting, shopping, laundry, hygiene, medication management), helping the member to build and practice meaningful roles

 

Kenny’s shower head broke off in his apartment. His girlfriend who lives with him demanded that he do something about it and threw it at him. He brought it in and put it on my desk demanding that I do something about it.  First I coached him through the process of calling his manger with him on the phone talking but that got nowhere. Then we got in my car and I coached him through the process  of actually getting a replacement part at the hardware store.  Once again, he did the talking while I stood by his side giving him hints. He screwed the shower head back on himself. He wrote a letter to the manager, enclosing a copy of the bill, to get the money back sitting at my desk going over it step by step.

10)   Building personal growth and responsibility – Helping members understand and move through normal stages of life (e.g., prolonged adolescence, first parenting, mid-life crisis, empty nest syndrome), building self- responsibility (learning cause and effect, not blaming others), building self- efficacy (building the ability to positively impact one’s life), empowering members

Andy was offered a catering job with the Village Deli on a Saturday for four hours, but that was also the day his case worker was taking some members on an outing to Universal Studios. Andy was torn between fun and responsibilities. While another immature member urged him to go to Universal Studios with them and just have fun, I helped them both see how cancelling out on his boss at the  last minute would make him a less responsible employee and that fun has to scheduled around work.

11)   Community integration – developing and facilitating members’ connections beyond mental health and social services (Taking a member to a Mommy and Me group, helping a member to join a bowling league, creating a calendar of low-cost community events), helping member to discover niches, roles, and opportunities in the community, promoting being a good neighbor and citizen, helping member to invest in and give to community in positive ways, helping the member to learn to give to others

Francis had been raised Catholic, but hadn’t been back to Church in many years while she’d been on the streets and using drugs and prostituting.  Now she was clean, but felt too ashamed to return to

 

Church. I connected her up with another staff member who goes to Catholic Church regularly and he agreed to go with her and just sit in the back together during services to see how it felt.

12)   Community development – making the community a better place for people with mental illnesses, increasing tolerance and acceptance of mental illness, reducing segregation, reducing stigma, developing welcoming hearts in the community, building connections with other community social causes

The East Village Association arranged for a community clean-up day. A group of members and staff came in together as a Village team to help this neighborhood effort.

13)   Promoting self reliance, separation from services, and graduation – building financial independence (getting off SSI and Section 8), obtaining private insurance, preparing for graduation, facilitating relationship changes with staff, finding and providing opportunities to give back to others still struggling, developing self-advocacy skills, developing friendship skills

When Kathy called asking for my advice in her problem with her boyfriend, instead of giving her advice, I helped her explore who else she had in her life whose advice she could rely on, so she wouldn’t need me anymore.

87ARecoveryCultureProgressReport

welcome-to-hell

also, shop!

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Filed under Mental health recovery, Mental Hell Treatment, Oregon State Hospital, wellness and systems change

Day Off

As a State employee I have the perk of getting tomorrow off without pay (part of the Furlough Day program to cut budget deficits). I decided to take today off as well, using a vacation day, to make a 4 day weekend.

Yay!

Anyway, I have lots of stuff to do over the weekend- more than I could do in 2 days. We have a guest arriving from out of town- a long-term guest- and we’re turning part of the garage into a bedroom. There is still much to do and she arrives in a week.

Today I’ll just share some pictures, maybe another thing or two.

The pictures below are from National Geographic, they are free desktop images. You can find these and more at this place. Click for full size then right click to save.

This one makes me think the little guy is saying, “What in the heck has happened to my neighborhood?!”

For my next trick- courtesy of Goopymart

Nature is amazing, eh? This is from the Guardian:

The oldest evidence of a fungus that turns ants into zombies and makes them stagger to their death has been uncovered by scientists.

The gruesome hallmark of the fungus’s handiwork was found on the leaves of plants that grew in Messel, near Darmstadt in Germany, 48m years ago.

The finding shows that parasitic fungi evolved the ability to control the creatures they infect in the distant past, even before the rise of the Himalayas.

The fungus, which is alive and well in forests today, latches on to carpenter ants as they cross the forest floor before returning to their nests high in the canopy.

The fungus grows inside the ants and releases chemicals that affect their behaviour. Some ants leave the colony and wander off to find fresh leaves on their own, while others fall from their tree-top havens on to leaves nearer the ground.

The final stage of the parasitic death sentence is the most macabre. In their last hours, infected ants move towards the underside of the leaf they are on and lock their mandibles in a “death grip” around the central vein, immobilising themselves and locking the fungus in position.

“This can happen en masse. You can find whole graveyards with 20 or 30 ants in a square metre. Each time, they are on leaves that are a particular height off the ground and they have bitten into the main vein before dying,” said David Hughes at Harvard University.

The fungus cannot grow high up in the canopy or on the forest floor, but infected ants often die on leaves midway between the two, where the humidity and temperature suit the fungus. Once an ant has died, the fungus sprouts from its head and produces a pod of spores, which are fired at night on to the forest floor, where they can infect other ants.

Scientists led by Hughes noticed that ants infected with the fungus,Ophiocordyceps unilateralis, bit into leaves with so much force they left a lasting mark. The holes created by their mandibles either side of the leaf vein are bordered by scar tissue, producing an unmistakable dumb-bell shape.

Writing in the journal, Biology Letters, the team describes how they trawled a database of images that document leaf damage by insects, fungi and other organisms. They found one image of a 48m-year-old leaf from the Messel pit that showed the distinctive “death grip” markings of an infected ant. At the time, the Messel area was thick with subtropical forests.

“We now present it as the first example of behavioural manipulation and probably the only one which can be found. In most cases, this kind of control is spectacular but ephemeral and doesn’t leave any permanent trace,” Hughes said.

“The question now is, what are the triggers that push a parasite not just to kill its host, but to take over its brain and muscles and then kill it.”

He added: “Of all the parasitic organisms, only a few have evolved this trick of manipulating their host’s behaviour.

Why go to the bother? Why are there not more of them?”

Scientists are not clear how the fungus controls the ants it infects, but know that the parasite releases alkaloid chemicals into the insect as it consumes it from the inside.

On the subject of Zombies, Zombie nuts!

Saddest photo ever-

Unrelated nonsense-

At the place I work they are hiring a new Superintendent. I know some people who having worked in this place for many years are on the verge of quitting. I just hope this guy lives up to the hype.  I can hardly stand to lose more people who support the good things. So far, all the news is good. We meet him next week.

Bye for now,

-Rick

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Filed under animated gif, animation, macaques, Nature, Oregon State Hospital, pictures, Science

MacArthur Violence Risk Assessment Study

I work at Oregon State Hospital (OSH) in Salem, OR. It exists because in Oregon as well as most everywhere else, there is an assumption in the legal system (in society in general) that the people who have a mental health diagnosis are more prone to violence than others. This assumption is reflected in the functioning of the Psychiatric Security Review Board (PSRB), the primary instrument of oppression of those with a mental health diagnosis in this state.  This is a direct opposite to reality/ evidence. (See also reports here and here and here. Or here– or even here.)

The best research available is the The MacArthur Community Violence Study, a gigantic longitudinal project spanning several years and thousands of people. This study included 1,136 male and female civil patients between 18 and 40 years old. The project monitored violence to others every 10 weeks during their first year after discharge from a mental institution. Patient self-reports were augmented by reports from collaterals and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks.

The most comprehensive study ever done regarding mental health and risk of violence found that even among the “mentally ill” who commit violent crimes, the likelihood of that person committing further violence is considerably less than an individual who has no mental health diagnosis. For individuals who simply have a mental health diagnosis, the likelihood that they will commit an act of violence is substantially less than the average person.

(The MacArthur study is so named because major funding was provided by the John D. and Catherine T. MacArthur Foundation’s Research Network on Mental Health and the Law with a supplemental grant from the National Institute of Mental Health (grant # R01 49696) to interview the collateral informants.)

One factor is that many people who have behaviors labeled as mental illness have developed these symptoms as a result of (and a coping mechanism for) being victims of violence. Having a “mental illness” actually conveys a certain degree of immunity from any tendency towards violence.

The one variable that really messes up this finding is substance abuse. People who have both “mental illness” and active substance abuse are more likely to commit violent crimes.

Judging risk of violence by public opinion is as worthwhile as using your horoscope

It would make sense that if people have adequate support in their community they would be less likely to use alcohol or street drugs to self-medicate. In this way the mental health system as it exists in the United States today contributes to violence.

So- I propose that Oregon do the following:

  1. Reform the PSRB system- starting with the elimination of the PSRB.
  2. Eliminate the State Hospital (and quit building the new replacement facility- maybe the building could be turned into something else- another prison?).
  3. Use the money saved to create a system of community services that is fully funded, consumer driven and based on a compassionate, recovery oriented ethic.
  4. Create an emergency/ acute care system that is based on the Sanctuary model, that makes use of natural/ holistic medicine and provides a variety of choices in terms of treatment styles and settings.

Meanwhile, I won’t hold my breath. The public perception of those of us with “mental illness” is such that fear over-rides sense. A inmate escaping from the State Prison merits 2 inches of news space on page 6. A patient who leaves OSH (“absconds”) without PSRB permission is front page, lead story and a week of prominent follow-up articles.

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Filed under inhumanity, Mental Hell Treatment, Oregon State Hospital, wellness and systems change

Absolutely Beautiful, plus news clips

Cherry trees in bloom at Oregon State Hospital (click for full size, as usual)

Other news from OSH:

State Furloughs = Lack of Logic!

Controversial Ruling by PSRB!

Dying in Plain Sight!

Let the Feds Clean it Up!

Increased Federal Oversight Needed!

Maybe there are really serious problems!

Why Dr. Robinson didn’t come to work!

Duh!!! (Thanks, Gary)

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Filed under bees on cherry trees, Mental health recovery, Nature, Oregon State Hospital, pictures, politics

Mozart sandwich with Birthday Cake

I just had a birthday last week. I was born in 1955, 55 years ago.That makes me 5,555 years old! Below is a twenty dollar bill in circulation at the time of my birth.

(click for full size, as usual; you know I never skimp on picture size-always the biggest pictures here at moonsoup!)

Beatles-Birthday

I have a variety of things to share today. Music, pictures, animated gifs, personal history, stories from where I work, other things.

Enjoy! or not.

Okay, some of the Mozart promised in the title:

mozart-sinfonia_

concertante-allegro

mozart-snfonia_

concertante-andante

mozart-sinfonia_concertante-presto

So, this is an odd time of year for me. My birthday last weekend, April 11th will be my older son’s 25th birthday (he’s coming to visit from SF this weekend- riding the dog, ought to arrive by tomorrow morning), and smack in the middle of these things is the anniversary of my oldest/ youngest child’s death- April 6th. I often dread this time of year- if I’m going to be symptomatic mental health wise, this is the time I would do it. These days, however, I’m not expecting badness. She has mellowed in my heart. I experience her as a kind, gentle angel of death; reminding me of the preciousness in each moment. Thank you Erin.

Here’s a doodle by Andrew, the oldest living child,

and one of the most coolest people I know.

One of our cats- Blizzard, has been suffering from glaucoma for years, gradually going blind. Last month she had surgery to remove her eyes- it’s called “enucleation“. Anyway, these are some shots of her recuperation. By the way, she’s doing great. She’s way more comfortable and happy and since she’s been blind for a while she has no trouble finding her way around. My younger son paid for the surgery- over $1000- because he is also a really great guy. Blizz gets the cone off her head later today.

Here’s Blizzard today, sans cone head,

in the arms of my youngest son.

The Jupiter Symphony is one of my favorite Mozart compositions-

mozart-jupiter-allegro

mozart-jupiter-andante

mozart-jupiter-allegretto

mozart-jupiter-molto_allegro

I wrote a while back, I think, about the death of a patient at Oregon State Hospital where I work. The Oregonian newspaper just did it’s first major story about it (better late than never).

From the article linked above:

The body of Moises Perez, 42, was discovered in this bed located just to the left of the door of a room he shared with four other men. The Oregon State Hospital patient had been dead several hours before he was discovered during evening medication checks.

Below- some great pictures of/ from the ESO Paranal Observatory in Chile, high in the Andes. The top picture is a full-sky, 360 degree panorama. The other pictures are of the observatory itself in summer and winter.

Richard Harris is the state Director of Addictions and Mental Health. He wrote this to the Oregon Consumer Survivor Coalition, our primary collective voice as survivors of the Mental Hell treatment system. I don’t know if it’s serious or comic relief. Time will tell. Anyone can yak yak yak.

From: “Richard HARRIS” <richard.harris@state.or.us>
Date: 18 March 2010 12:14:23 PM PDT
Subject: Re: Consumer Voice—-REVISED MEMO

Revised

DATE:        March 18, 2010

TO:            All AMH Staff

FROM:      Richard L. Harris
Assistant Director

RE:            Consumer voice

Over the past several months I have had the opportunity to meet with
many people representing many mental health consumer groups. From
these meetings it has become clear to me that there is a need for
increased consumer voice within local and state government. Len and I
recently met with the Oregon Consumer Survivor Coalition (OCSC) and
together we have identified four ways by which consumer voice can be
amplified:

1.    Increased public education on addiction and mental health issues;
2.    Increased training for those providing addiction and mental
health treatment;
3.    Continued and increased peer support services and;
4.    Supporting and promoting an independent voice in the addictions
and mental health consumer community.

My initial commitment to increase consumer voice and to support and
promote peer delivered services will be for AMH to provide phone and
video support to the upcoming strategic planning summit sponsored by
OCSC. The summit will identify a clear pathway to establishing a
formal mechanism to support consumer voice statewide. In addition
Oregon’s Olmstead Plan calls for increased consumer participation in
all aspects of transition from residential facilities to independent
living with people having a key to their own home with access to
addiction and mental health services when needed.

To further consumer voice and increase consumer visibility in the
community, OCSC will reach out to the addictions community and attend
and participate in the OHA/DHS statewide budget forums scheduled
around the state later this spring.

These are important first steps in creating a solid foundation to
promote consumer voice and visibility within local communities and
local and state government. I look forward to continuing dialogue with
the OCSC and others to develop a highly visible and robust consumer
voice as part of AMH and the developing OHA.

Richard L. Harris
Assistant Director
Addictions and Mental Health Division
500 Summer St NE E-86
Salem, OR 97301-1118
richard.harris@state.or.us
Blackberry: 503-569-3183
FAX: 503-373-7327

Heads up: may contain graphic violence–

By the way, you can’t outrun a Samurai!

My personal favorite by Mozart, his unfinished “requiem”. This is the whole shebang, huge file, high quality-

Mozart_Requiem_July_4_1985

A couple weekends back my wife and I went hiking at Catherine Creek to look at the first wildflowers of spring. You get there by going to Hood River, Oregon, crossing the troll bridge (don’t look! you’ll turn to stone!) into Washington, driving east through the town of Bingen, Washington and at the second roadside lake take the old state road that climbs the hill. You’ll know you’re there when you get to it. There are a few waves of wildflowers that bloom and pass relatively quickly in the stony volcanic earth. By now there’s a whole new batch. By the middle of April they’ll almost all be gone. I hope we get back up there before the end of the season.

Mozart plays the bassoon!

mozart-bassoon_concerto-allegro

mozart-bassoon_concerto-andante

mozart-bassoon_concerto-rondo

Bye for now, have a great day.

-Rick


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Filed under animated gif, animation, cats, Family pictures, Free Music, Mental Hell Treatment, Mozart, mp3, Music, Nature, Oregon State Hospital, personal story, pictures, Ward F

Sunday Brunch

Appetizer

SorrentoRuins

layers

Playing with Hugh

Or, rather, hue (and contrast, and saturation etc.). All these taken in the past week or two. Click for real size, which is big, btw.

I call this one “very close to fall”.

near_fall

Oregon Rainforest- Silver Creek trail
Oregon Rainforest- Silver Creek trail

Ground Foliage
Ground Foliage
Looking Up

Looking Up

More woods in rain

More woods in rain

Bird, tower, moon- composit of several pictures

Bird, tower, moon- composit of several pictures

The J Complex (what's left of it) as envisioned by Prince

The J Complex (what's left of it) as envisioned by Prince

“General Pictures, Sir!”

above Oceanside near Tillamook

Palm.Bunny

pirate_storm-drain

baby

1991-kids_tow

kids_row

35 year old picture of me

35 year old picture of me

earth-sea-sky

sexyflower

I_am_Legion

From:

MindFreedom Oregon News Alert – Please Forward
http://www.mindfreedom.org/oregon

Descartes_mind_and_body

MindFreedom International News – 22 October 2009
Ray Alert #22 – Unite for Real
Mental Health Advocacy
http://www.mindfreedom.org/ray – please forward

Today is Victory Day for Ray Sandford!

No More Forced Electroshock for Ray, Ever!

Today, Ray Sandford of Minnesota phoned the MindFreedom office with
some very good news:

It is official.

After more than 40 involuntary, outpatient electroshocks (also known
as electroconvulsive therapy or ECT), Ray has won.

The court agreed to his change of guardianship. Ray’s new guardians
support his right to say “no” to intrusive procedures such as
electroshock.

Ray made this comment for MindFreedom International members and
supporters, who have backed his campaign for almost exactly one year.

“I’m a bit overwhelmed. This is wonderful! I’m very thankful. Without
your help I probably would still be sitting somewhere getting more
forced electroshock. So thanks a lot to and your group. Praise and
thank the Lord, amen!”

Said David Oaks, Director of MindFreedom International, “Ray’s courage
and laser focus led to a campaign that proves the ‘mad movement’ is
alive and well. The sheer level of people power had to break through.
I know some feel discouraged by the immense oppression of sanism.
Think of Ray. There is an ancient Persian saying: ‘No one is tired on
victory day!'”

THE SHORT STORY OF RAY’S VICTORY DAY

MindFreedom is encouraging all of Ray’s supporters to celebrate this
week, especially this Tuesday, 27 October 2009.

One year ago this week, on 27 October 2008, Ray Sandford first phoned
up the MindFreedom office. He had asked his local library about
organizations that support human rights in mental health. The
reference librarian gave him MindFreedom’s phone number.

Ray phoned up the MindFreedom office. He said that every Wednesday
morning
he was escorted from his group home to a hospital for another
involuntary forced electroshock, under court order.

MindFreedom International investigated and kicked off a public
campaign
that became global. Issuing 21 alerts, MindFreedom’s campaign
activated thousands of people who peacefully but passionately
contacted elected officials, held protests, mailed Ray stationery
supplies, won extensive media coverage, visited him, and much, much
more. At least one elected official said they felt ‘inundated.’

But MindFreedom also found that Ray’s oppression was systemic and deep.

MindFreedom volunteers identified and listed on the MFI web site more
than 30 agencies and individuals receiving taxpayer money to
supposedly help Ray. Only a few agencies helped Ray, and most actually
opposed his rights. Because MFI’s web site is so popular, many of
those who oppressed Ray can “Google themselves” and discover their MFI
listing near the top.

Ray’s last forced electroshock was on USA tax day, 15 April 2009.

By coincidence the 15th of April was also the date of the very first
forced electroshock, back in 1938 in Italy, when the subject cried out:

“Non una seconda! Mortifierel” which means in Italian, “Not another!
It’s deadly!”

On 13 May 2009, Ray was escorted all the way to a hospital bed. He was
prepped for another forced electroshock. Because of outrage, hospital
authorities
cancelled Ray’s shock at the last second, and he was sent
home.

More victories quickly followed.

Ray’s psychiatrist quit because he said his insurance company was
concerned about all the public attention. MindFreedom helped Ray find
a new psychiatrist supportive of Ray’s human rights.

Ray’s family joined in the campaign. MindFreedom organized a YouTube
video
with Ray and his Mom, begging for the shock to end. Ray’s
guardians, an agency under the Evangelical Lutheran Church in America
(
ELCA), tried to stop the video from going public, but it got ought.

Ray’s family found a better attorney. Ray found great pleasure in
firing his ineffective court-appointed attorney.

Several concerned Minnesota agencies formed an “ECT Work Group” to
change the law in Minnesota. Two MindFreedom representatives serve on
the committee, but are asking for more than just minor reform.

“SINGLE, SMALL VOICE IN THE FACE OF A MEDICAL GIANT.”

And today, Ray’s final victory is in place: Ray successfully replaced
his general guardians who had supported his forced electroshock.

One of Ray’s new guardians, Daryl Trones, announced:

“MindFreedom has just won a substantial victory! Today I received an
‘Acceptance of Appointment” from Ramsey County District Court
regarding the changing of guardianship for Ray Sandford. Ray no longer
will be subject to ECT treatments. The powers of Successor
Guardianship include the power to ‘withhold consent for treatment of
service, including  neuroleptic / psychotropic medications,’ under
Minnesota Statute 524.5-314.”

Daryl, Ray and his family want to thank all of Ray’s many supporters.

Said Daryl, “My appreciation to all the MindFreedom members and
volunteers and especially to David Oaks who orchestrated requisite
forces and passions to pull Ray Sandford from harm’s way. MindFreedom
now bas a successful case study outlining the necessary steps to
extricate persons subject to forced electroconvulsive therapy (ECT).
Congratulation to MindFreedom Staff and Members and most of all to Ray
Sandford who one year ago was just a single, small voice in the face
of a medical giant.”

Supporters should finally be able to postal mail to Ray Sandford
directly without delay.

You may postal mail your congratulations to Ray here:

Ray Sandford
Victory House
4427 Monroe St.
Columbia Heights, MN 55421-2880 USA

You can read the history of Ray’s successful campaign at:
http://www.mindfreedom.org/ray

free_your_mind_02_big

Utne Reader magazine periodically names “50 Visionaries Who Are
Changing Your World.”

A psychiatric survivor activist is named as one of these visionaries
in Utne’s November/December 2009 issue, which hits the stands now:

David W. Oaks, Director of MindFreedom International, an independent
nonprofit for human rights and alternatives in mental health.

Utne’s listing of David Oaks also zings ABC-TV’s recent national news
coverage of the “mad pride movement,” which has been widely criticized
by activists.

~~~~~~~~~~~

For Utne’s listing of David Oaks, and to make a public comment, go here:

http://www.utne.com/Science-Technology/David-Oaks-Director-MindFreedom-International.aspx

or use this link:

http://bit.ly/utne-oaks

~~~~~~~~~~~

For Utne’s entire list of 2009 visionaries, starting with the Dalai
Lama
who is on the cover, go here:

http://www.utne.com/Politics/50-Visionaries-Changing-Your-World-Hope-2009.aspx

or use this link:

http://bit.ly/utne-vision

~~~~~~~~~~~

Said David Oaks, “Utne is one of the few media leaders to acknowledge
the ‘mad movement’ to deeply change the mental health system. Utne’s
recognition is really of our whole movement’s vision. This shows we
are still connected to all the other movements for social and
environmental justice, just as when our movement first started. Can we
have a
nonviolent revolution now?”

eclipse_corona

Another Suspicious Death Inside Oregon State Hospital

According to the below MindFreedom Oregon Exclusive Report, another
psychiatric patient died inside Oregon State Hospital in
Salem, Oregon
under suspicious circumstances on Saturday, 17 October 2009.

The man — known here as “Patient M” — had apparently been
complaining repeatedly for a month about chest pain, which staff had
allegedly dismissed because of his psychiatric diagnosis. Instead of
medical care, staff reportedly just gave him more
psychiatric drugs.

After the patient died, the report says he was left undiscovered all
day by staff who were supposed to be checking on him regularly.

The below is based on several anonymous reports from patients on ward
50F with access to telephones, who took great risk to speak out.
Because of a long pattern of abuse and neglect in Oregon State
Hospital
(OSH), this information is offered immediately in the public
interest, but has not yet been investigated by authorities. Each
allegation needs to be investigated before confirmation.

At the bottom are ways you can speak out to demand an investigation,
and also demand support for a state-wide voice for Oregon’s mental
health consumers
and psychiatric survivors.

Patients supplying this news did not ask to be anonymous but patients
at OSH have reported retaliation for getting information out in
public. For example, this past week a minimum security patient was
allegedly moved, in shackles, to a more restricted area after he spoke
with Salem reporters about his lawsuit against Oregon State Hospital.

MindFreedom calls on the Governor, the US Dept. of Justice and the
media to immediately investigate the below allegations, especially the
RED FLAGS marked in this report.

~~~~~~~~~~~~

EXCLUSIVE REPORT to MindFreedom Oregon

“The medicine is not working.”

The Passing of “Patient M” on Ward 50F in Oregon State Hospital
(OSH)

Over one month ago, “Patient M” had a fellow patient — “R” — help
him write a special letter to the ward medical officer.

In the letter Patient M complained of his chest pain, stomach pain and
trouble breathing.

Instead of medical treatment for the chest pain, because of his
psychiatric diagnosis Patient M was given more psychiatric drugs as
staff felt he needed them, known in medicine as “PRN.” These
psychiatric drugs were often minor tranquilizers, usually Ativan
(lorazepam) or Klonopin (clonazepam). The psychiatric drugs were
administered whenever he complained of pain.

Two weeks ago, Patient M spoke directly to the Ward Medical Officer
and said that, “The medicine is not working.” He continued to complain
of chest and stomach pain with difficulty breathing. [RED FLAG] He
continued to be given “PRNs.” He was not given a pain reliever, heart
medication or any cardiac testing.

This past week, Patient M has told everyone on the ward who would
listen that he was in serious pain. Other patients were already very
worried about his health. He continued to receive tranquilizers when
he complained.

Last Thursday and Friday — 15th and 16th of October — were
particularly bad. [RED FLAG]

Patients say it’s important to know that it is policy that all
patients be checked for “location and condition every hour.” For
example, in a widely-publicized escape a month ago, staff had not been
checking on the patient.

Saturday morning, 17 October 2009, Patient M got up for breakfast, and
he was known as a man who never misses a meal. Some said eating seemed
to be his greatest enjoyment, and he was always the first person to
get his food. Because he is sloppy, he got his food delivered to him
outside the kitchen.

At 8:30 am he was given his morning meds. He told the nurse that his
chest hurt “really bad” and he had trouble breathing. He was given his
usual psychiatric drug PRN.

Patient M went to lay down.

A nurse checked at 9:30 am and saw he was lying down. He seemed okay.

Patient M resided in a very over-crowded room typical of the “50
building” at OSH. A short time later one of his roommates said his
eyes were rolled back. “But sometimes he sleeps like that” because of
the PRNs, said one roommate.

No staff checked his condition for the rest of the morning. [RED FLAG]

Lunch on 50F is served between 11 am and 11:30 am. Staff brought his
tray down to his room. They called his name and there was no response,
even though it is well known that he always eats. [RED FLAG] Staff
left, and took his lunch back to the kitchen.

Mid-afternoon a roommate shook his foot to see if he’d wake up. There
was no response. No staff looked in on him to check his condition all
afternoon. [RED FLAG]

Dinner time, 4:30 pm, staff called into his room to announce the meal.
No response. Patient M did not get up for food. Staff did not bother
to bring a tray down for him. No staff checked him.

His roommates complained of the stench of “shit” in the room. This
odor was probably from the natural course of a person who is lying
dead for hours as their bowels evacuate. Staff still stayed out. [RED
FLAG]

Finally, at 7:45 pm OSH medication staff went to his room to give him
his evening pills. This time he was checked. He was so dead cold, no
attempt was made at resuscitation. Some patients believe he was in or
past rigor mortis at this point.

Between 7:45 and 8 pm, patient eye-witnesses allege several things
happened. The room was sealed. Staff were called into what one person
called a “bubble” to speak privately.

Based on patient reports: “It was quiet for a few minutes. Then the
staff became very active. We could see through the nurses’ station
windows that they were handling documents, making photocopies. We
heard one staff say, ‘We’ll need six more of those.’ Then we could see
staff shredding originals of documents they had just photocopied. By 8
pm things had returned to normal. The body was carried out later.”

Over the weekend Patient M’s soiled bed and personal area were left as
is in the crowded room. “The smell was unbelievable,” said one witness.

On Monday morning, 19 October 2009, two days after the death, at the
ward meeting, patients complained about the unsanitary conditions in
this room. Staff took out the bed, bedding and sanitized the area. As
of that evening there was no counseling about the death, and no extra
help provided to other patients on that ward.

No memorial was suggested until patients brought it up at the ward
meeting.

Patients were questioned at the meeting about “What do you know?” and
“What will you report?” One patient referred to the meeting as an
“inquisition.”

Patients around the hospital heard about the death only by word of
mouth.

Many are reportedly saddened.

Because of the request by patients, a memorial is planned.

– end –

~~~~~~~~~~

ACTIONS * ACTIONS * ACTIONS

Please forward this alert to others who support human rights in mental
health.

The Governor has not responded to e-mails. Please telephone.

PHONE GOVERNOR TED KULONGOSKI AT (503) 378-3111

In a civil but strong way, in your own words:

1) Ask the Governor to personally investigate suspicious deaths at
Oregon State Hospital.

2) Ask the Governor to support the state-wide voice of mental health
consumers
and psychiatric survivors.

~~~~~~~~~~

BACKGROUND on OSH & MORTALITY:

Oregon State Hospital has a long history of suspicious deaths.

OSH is nationally famous when its secret discolored copper canisters
were revealed that contain the ashes of some 5,121 patients who died
between 1913 and 1971. The identification of many of the patients is
lost.

See the Time Magazine article on Jan. 2009 about OSH ash cans here:

http://www.time.com/time/arts/article/0,8599,1869177,00.html

For more photos of the canisters go to this web site from July 2009:

http://thephotobook.wordpress.com/2009/07/06/david-maisel-library-of-dust/

or use this link:

http://bit.ly/osh-ashes

Mortality and people in the mental health system continues to be a
national controversy today in the USA.

A major study by the National Association of State Mental Health
Program Directors showed that people who use the US
public mental
health system
die about 25 years earlier than the general public:

http://www.mindfreedom.org/kb/psychiatric-drugs/death

One possible reason provided in the study is the over-use of
psychiatric drugs, including multiple prescriptions, but this factor
is often omitted or downplayed by those in the mental health system
discussing these deaths.

Instead, the mental health system today is promoting “integration” of
physical and mental health as the answer to this mortality rate.
“Integration” is now a major buzz word in mental health.

Sound good?

Unfortunately, there’s no definition of this “integration.” Is this
the “integration” of psychiatric institutions into the community, as
mandated by the Olmstead Supreme Court decision? A draft of Oregon’s
plan to implement Olmstead does not emphasize the importance of
supporting the voice of
mental health consumers and psychiatric
survivors.

In some places this “integration” buzz word has simply meant increased
prescription rates of psychiatric drugs in clinics that had previously
focused on physical health. Sad about your heart condition? There may
be a
psychiatric drug prescription waiting for you, too.

People with psychiatric labels continue to be among the most
disempowered Oregonians.

How can this “power imbalance” change without a voice?

Since the exact month Governor Ted Kulongoski took office, Oregon
became one of the few USA states to provide zero — 0 — funding for
the state-wide voice of mental health consumers and psychiatric
survivors.  For more than seven years, there has been zero state
funding for any of those activities — a newsletter, conference,
office of mental health consumer affairs.

Nothing.

During tough times, people with psychiatric labels are supposedly hit
hardest. That’s when we should be supporting the voice of mental
health consumers
and psychiatric survivors the most.

However, apparently based on advice from his closest staff, Governor
Kulongoski continues to recommend zero for this state-wide voice each
budget.

You can read about the Governor’s legacy of “zero” for mental health
consumers and psychiatric survivors here:

http://www.mindfreedom.org/zero

~~~~~~~~~~

TWO ACTIONS:

1) PLEASE forward this covered-up news to all interested people.

2) PHONE GOVERNOR TED KULONGOSKI AT (503) 378-3111

Be civil and strong, ask for investigation of deaths at OSH, and for
his support of a state-wide voice for mental health consumers and
psychiatric survivors.

~~~~~~~~~~

ADDITIONAL ACTIONS:

US Department of Justice (DOJ) is supposed to be investigating Oregon
State Hospital
.

In your own words, ask that all appropriate results of investigations
by DOJ of OSH be made public, and also be provided to you.

You can e-mail DOJ here:

AskDOJ@usdoj.gov

Or for more DOJ contact info, go here:

http://www.usdoj.gov/contact-us.html

You can also e-mail or postal mail Governor Kulongoski, contact info
is here:

http://governor.oregon.gov/Gov/contact_us.shtml

Please also bring this to the attention of any interested media.

If you did not receive this alert directly from mindfreedom-oregon
news service, you can get on this free, public alert system here:

http://www.intenex.net/lists/listinfo/mindfreedom-oregon-news

For more info about MindFreedom Oregon go here:

http://www.mindfreedom.org/oregon

Update:

Autopsy was supposed to be done Friday- I have heard nothing. Key information would be stomach contents, since the hospital claimed he had all his meals that day (whereas eyewitnesses say he was left dead in his room all day).

Titan atmosphere

From Librivox- free audio books

(click to play)

A Century of Recorded Poetry, Vol 1, 01, Walt Whitman – America

A Century of Recorded Poetry, Vol 1, 02, William Butler Yeats – The Lake Isle Of Innisfree

A Century of Recorded Poetry, Vol 1, 03, William Butler Yeats – The Song Of The Old Mother

A Century of Recorded Poetry, Vol 1, 04, Robert Frost – The Road Not Taken

A Century of Recorded Poetry, Vol 1, 05, Robert Frost – Birches

A Century of Recorded Poetry, Vol 1, 06, Robert Frost – The Gift Outright

A Century of Recorded Poetry, Vol 1, 07, Gertrude Stein – If I Had Told Him A Completed Portrait of Picasso

A Century of Recorded Poetry, Vol 1, 09, William Carlos Williams – The Red Wheelbarrow

A Century of Recorded Poetry, Vol 1, 19, Langston Hughes – The Negro Speaks Of Rivers

communist_party

Have fun, be safe, eat as much candy as you want.

Leave a comment

Filed under CS/X movement, mindfreedom news, mp3, Oregon State Hospital, pictures, poetry

Yesterday and Today at Oregon State Hospital

467 Poisoned at Oregon State Hospital
November 18, 1942
One of the most tragic incidents in Salem’s history was the poisoning of nearly 500 patients and staff at the Oregon State Hospital, on the evening of November 18, 1942. Many who ate the scrambled eggs served for dinner that evening would later claim that they had tasted funny, some saying they’d been salty, others saying they tasted soapy. Within five minutes of consuming them, the diners began to sicken, experiencing violent stomach cramps, vomiting, leg cramps, and respiratory paralysis. Witnesses described patients crawling on the floor, unable to sit or stand. The lips of the stricken turned blue, and some vomited blood. The first death came within an hour; by midnight, there were 32; by 4 a.m., 40. Local doctors rushed to the hospital to help out staff doctors. The hospital morgue, outfitted for two to three bodies, was overwhelmed.
Eventually 47 people would die; in all, 467 were sickened. Though five wards had been served the suspect eggs, all the deaths occurred in four; in the fifth, an attendant had tried the eggs, found them odd tasting, and ordered her charges not to eat them.
Officials were baffled, and immediately focused on the frozen egg yolks which all the victims had been served, and which had come from federal surplus commodities. It was thought that the eggs might have spoiled due to improper storage, or even that they might have been deliberately poisoned by a patient who could have gotten a hold of a poison while on furlough. The biggest fear, however, was the fear of sabotage: with the country engaged in World War II, this possibility loomed large. Oregon Governor Charles Sprague ordered all state institutions to stop using the eggs. The federal government issued a similar order, and the Agriculture Department ordered an investigation into the handling of its frozen eggs.
But the eggs were part of a 36,000-pound shipment which had been divided between schools, NYA projects and state institutions in Oregon and Washington, 30,000 pounds of which had already been consumed with no ill effects. State officials confirmed that the eggs had been properly stored, and the president of National Egg Products Inc. pointed out that eggs bad enough to kill would be so obviously spoiled that no one would eat them.
The day after the poisoning, with dozens still ill, pathologists determined that the sickness and death had been caused by sodium flouride, an ingredient in cockroach poison; pathology reports showed large amounts of the compound in the stomachs of the dead victims. Five grams–the size of an aspirin–would have been fatal; some of the dead had eaten more sodium flouride than eggs. Cockroach poison was known to be available at the hospital, kept in a locked cellar room to which only regular kitchen employees had keys. State Police launched an investigation, and began interviewing staff and patients at the hospital.
Finally, several days after the poisonings, two cooks at the hospital, A.B. McKillop and Mary O’Hare, admitted that they knew what had happened, that they had realized soon after the symptoms had struck, but had not come forward for fear of being charged. McKillop took responsibility, saying he had been the one to send a patient trusty, George Nosen, to the cellar to get dry milk powder for the scrambled eggs he was preparing. He had given Nosen his keys to the cellar, and Nosen returned with a tin half-full of powder, an estimated six pounds of which were mixed into the scrambled eggs at McKillop’s direction. When people had begun getting ill, he had questioned Nosen about where he’d found the powder, and discovered he had brought roach poison.
Despite McKillop’s insistence that O’Hare bore no responsibility for the poisoning, and over the objections of the State Police, who had determined that the poisoning was accidental, District Attorney M.B. Hayden ordered both cooks arrested. A grand jury declined to indict them; the patient George Nosen was never charged. Considered by many of his fellow patients to be a mass murderer, he became something of a pariah at the hospital where he spent the rest of his life. Two brief attempts at life outside the institution failed, and he died at the State Hospital 41 years later, after suffering a heart attack during a fight with another patient.
Compiled and written by Kathleen Carlson Clements
Bibliography:
Capital Journal, November 19-December 1, 1942

Oregon State Hospital has been in trouble for some time.

This from 2004, Oregon Bar Association-

Oregon State Bar Bulletin — DECEMBER 2004
Parting Thoughts

State Hospital Needs Our Help
By Bob Joondeph

There is trouble at Oregon State Hospital. So what else is new? The Oregonian’s reports of sex-abuse and hush money in the 1990s may seem like old news, but the hospital’s problems are not: deteriorating buildings, some of which are over 100 years old; chronic over-crowding with patients sleeping in closets and seven to a room; chronic under-staffing with nursing, psychiatric and therapist positions remaining vacant for months and years. And don’t forget the 70-plus patients who have been found clinically ready to leave the hospital but can’t because of the lack of step-down community living arrangements. Despite recent efforts to bring relief, things are getting worse.

Why? One cause may be state budget cuts that have left thousands of Oregonians without community mental health and chemical dependency treatment. Another contributor may be Oregon’s methamphetamine epidemic that has created a new cadre of psychotic and neurologically damaged individuals. Some observe that Measure 11 has changed the calculus used by defendants who are deciding whether to assert an insanity defense. Traditionally, a successful insanity defense resulted in more time in custody. Now, due to longer sentences and the sanctions of prison discipline related to behavior problems, a defendant cannot count on a shorter ride in the custody of the Department of Corrections.

One tool that the hospital used for years to control its population was taken away by the Ninth Circuit Court of Appeals in Oregon Advocacy Center v. Mink, 322 F.3d 1101, (2003). ORS 161.370 requires defendants who have been found mentally incapable of facing criminal charges to be committed to a state hospital or released. It was the practice of OSH to refuse transfer of such inmates from jail for weeks or months in order to control the hospital census. The Ninth Circuit upheld Judge Panner’s determination that this practice violated the substantive and procedural due process rights of the inmates and his injunction requiring OSH to admit mentally incapacitated criminal defendants within seven days of a judicial finding of incapacitation. In is interesting to note that OSH still employs a similar tactic for inmates who are awaiting a determination of their fitness to proceed under ORS 161.365.

Whatever the cause, we do know that Oregon’s jails and prisons have recently been flooded with mentally ill inmates and that state hospital admissions of “criminally insane” patients have grown three times faster than planned. Despite the efforts of state and county officials to create new community placements with the money at hand, they are being overwhelmed by the numbers of new customers and hamstrung by the need to use scarce resources to maintain the crumbling infrastructure of Oregon State Hospital. (And no, the problem is not that Dammasch Hospital closed. We would have even fewer services available if Dammasch were still around.)

The solution? This is not a case of not knowing what to do. Nor is it a case of competing interests: staff working conditions, patient treatment and the public purse would all benefit from the changes suggested by the just-released report of the Governor’s Mental Health Task Force. Among key task force recommendations are the following:

  • The Legislature should appropriate sufficient funds to permit the orderly restructuring of Oregon State Hospital and the construction and operation of community facilities to support populations of individuals who will no longer be hospitalized.
  • Local mental health authorities with support from the state will continue to accept increasing responsibility for assisting individuals to leave state hospitals.
  • State and local mental health authorities will create a rolling three-year plan for the construction and operation of community facilities.

The good news is that the governor and the legislature have gotten the message. In November, the legislature’s Emergency Board permitted the shifting of funds within the Department of Human Services to support the creation of 75 new community placements for OSH patients and to go forward with a planning process for addressing the hospital crisis. The question remains whether the 2005 legislature will maintain its resolve to tackle the OSH problem in light of the massive budgetary shortfalls. Not doing so, to paraphrase hospital-speak, would constitute self-harming behavior.

The task force recommendations will take strong leadership to achieve. They will require a short-term influx of money to construct a smaller and/or refocused modern hospital and community facilities needed to accept the present residents of Oregon State Hospital. They will require collaboration among state agencies including the Department of Corrections and the Oregon Youth Authority to assure that acute psychiatric services are available for their inmates.

It is worth the investment. Transforming OSH and accompanying changes in how we use state hospitals will free our mental health system of a gigantic financial weight and allow the dedicated OSH staff to work in safer, more efficient environments. Patients will be safer and receive better treatment. The 25 percent of the state mental health budget that is dedicated to state hospitals will be more available to leverage federal matching funds. Compassionate care and community safety will be best realized by implementing a more modern, cost-effective approach to mental health treatment. The governor and legislature deserve our support to get this job done.


© 2004 Bob Joondeph

ABOUT THE AUTHOR
The author is the executive director of Oregon Advocacy Center.

Right about the same time as the article above, State Senator Gordly requested a Federal Investigation of the Hospital.

Another article made it to the blog  Alas, A Blog:

Rape and Abuse at Oregon State Hospital

Posted by Ampersand | October 15th, 2004

Sheelzebub at Pinko Feminist Hellcat comments on this Oregonian article, documenting a pattern of abuse and rape by Oregon State Hospital workers at Ward 40, a treatment center for children and teenagers. Even worse, the hospital had a pattern of hushing up these crimes.

The article itself is a litany of horrors, such as a fired hospital staffer using his knowledge of the hospital’s scheduling to kidnap and rape a teenager. (This same staffer apparently raped or molested five other patients; two later committed suicide). The most distressing thing for me, however, is the hospital staff’s apparent refusal to treat sexual abuse of patients as a serious problem. For example, regarding hospital employee and rapist/molester/abuser Ronnie LaCross:

On Valentine’s Day 1991, a day before [supervisor] Brakebill observed “No problems!” with LaCross’ behavior, the psychiatric aide, in violation of hospital policy, gave Darcey [a patient] a red and white teddy bear with a plastic tag that said, “I love you.”

Records show that staff confiscated the tag when Darcey used it to carve bloody wounds on her arms.

About a month later, two teenage patients demanded that staff stop LaCross from abusing Darcey. But hospital officials failed to take action.

The hospital waited almost three days before calling her caseworker at the state’s children’s services agency. The hospital did not inform police as required by law. After pestering the hospital for two days to report the suspected abuse, the caseworker called state police herself, records show.

Five months later, Mazur-Hart, the hospital superintendent, ruled that Darcey’s allegations were true. LaCross, who spent several months on paid leave, was eventually fired and convicted of second-degree sexual assault.

The girl who made the first complaint about LaCross more than a year earlier was named as an “additional victim” in police reports in the Darcey case. She told police that besides fondling her breast, LaCross had sex with her three times on the ward. LaCross was never charged in that case.

KATU’s story (based on the Oregonian’s reporting) includes this tidbit:

Records also suggest that one of the hospital’s whistle-blowers was demoted from his job as a mental therapist and made to scrub pots and pans in the hospital kitchen after he came forward in an affidavit saying he had warned the hospital about the ongoing abuse, The Oregonian reported.

The only reason most of this is known is that sealed court records from 1994 were misfiled in a public-records area. There’s good reason to worry that Ward 40 has continued to be a home for rapists, pedophiles and abusers since 1994. The Oregonian discovered seven cases of alleged child sex abuse in the last four years that were never reported to the chief DHS investigator.

Needed security measures that have become standard at other hospitals have not been taken:

A former worker who has since been convicted of attacking young boys, however, said the hospital was a pedophile’s dream.

In a letter to The Oregonian, Frank Milligan detailed a litany of oversight problems at the hospital, including “far too many blind corners” and a “lack of cameras or even simple surveillance equipment.”

“Should a staff member be so inclined, he/she need only wait for an emergency situation, or a patient to act out and draw the attention of the other staff, to take advantage of the chaos and slip away with a victim.”

Hopefully, the Oregonian article will be a start towards getting Ward 40’s appalling conditions fixed (or better yet, towards getting Ward 40 closed down and replaced with modern small-group homes). If you’d like to write Governor Ted Kulongoski a note asking him to take action, here’s his contact information.

oregon-state-hospital

Some useful links:

http://en.wikipedia.org/wiki/Oregon_State_Hospital

http://www.youtube.com/watch?v=jKEeavx3GfI

http://www.historycooperative.org/journals/ohq/109.2/brown.html

http://www.kirkbridebuildings.com/blog/oregon-state-hospital-the-library-of-dust

http://www.flickr.com/photos/photoinference/2994136725/

http://blog.oregonlive.com/politics/2008/01/feds_oregon_state_hospital_con.html

http://www.oregonlive.com/politics/index.ssf/2009/07/federal_investigators_return_t.html

http://www.statesmanjournal.com/article/20090920/NEWS/909200355/1001

last-J-tunnels

Special Master’s Report from last February

The Governor appointed someone to oversee the process of improving conditions at OSH- this is an excerpt, followed by a pdf  file of the full report:

Culture

Every organization develops its own culture; how it sees and responds to its world. The hospital is no different. Successfully changing the culture of this organization is the single most important factor in achieving the goal of establishing the Oregon State Hospital as a first rate hospital for the mentally ill.

For many decades the hospital has been under-funded, under-staffed, over-populated, under-managed, and housed in inadequate facilities. It is no wonder that over time it has become a highly calcified organization lacking in incentive to change and burdened by learned helplessness. It has been clear from working with a variety of people in the hospital that many problems have been well known and have existed for years with little or no attempt to solve them. There appears to never have been a culture in the organization that was supportive of people taking responsibility to do problem solving at the level where the problem is occurring.

Another aspect of the hospital culture that deserves mentioning is what I might call the “ward ” view as opposed to a “hospital” view. Largely, I believe, because of the original design of the hospital, staff and patients alike have tended to see each ward as a separate hospital and have tended to operate from that perspective. This has made the management of the hospital as an integrated whole a very difficult task. The centralized model for delivering treatment in the new facility should eliminate the “ ward” view and help facilitate the shift to a “hospital” view. This shift should enable the hospital as an organization to become much better managed and operated. This will be an extremely important transition and one that will be quite difficult for many in the hospital to make.

It also appears that the rather pervasive view of the hospital by staff has been to see it as a long term care facility instead of viewing it as an intensive treatment facility. These two different views produce two very different approaches to dealing with patients. The current view seems to be characterized by a general belief that most patients are going to be hospitalized for a long time and that there is no great urgency about moving them through treatment as rapidly as possible. The culture of the hospital needs to be one of viewing itself as an intensive treatment facility that is part of a treatment continuum. There needs to be an attitude by all management and staff and instilled in patients, that the hospital’s role is to complete their portion of the treatment of the patient as quickly as possible, consistent with best medical practice, so that the patient can move on to the next stage of recovery and return to the community as rapidly as possible.

These and many more hospital culture issues need to be identified, explored and new cultural norms created as needed to see that the whole atmosphere of the hospital promotes

the best possible treatment of patients in the least time necessary. The hospital needs to develop and implement a comprehensive, long term change plan to accomplish this cultural change. This issue of culture is one that will be a large component in a Request for Proposal (RFP) that is currently being drafted to bring professional consulting services to the hospital transformation project.

Download the full report: specialmastersreport

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I often wish that someone would make a serious effort to record the history of this place- from the patients’ perspective. I hear stories every day that would blow your mind. I heard about the story below from a patient who has been there for decades. He was not an eyewitness but he was around while some of the victims were still alive.

467 Poisoned at Oregon State Hospital

November 18, 1942

One of the most tragic incidents in Salem’s history was the poisoning of nearly 500 patients and staff at the Oregon State Hospital, on the evening of November 18, 1942. Many who ate the scrambled eggs served for dinner that evening would later claim that they had tasted funny, some saying they’d been salty, others saying they tasted soapy. Within five minutes of consuming them, the diners began to sicken, experiencing violent stomach cramps, vomiting, leg cramps, and respiratory paralysis. Witnesses described patients crawling on the floor, unable to sit or stand. The lips of the stricken turned blue, and some vomited blood. The first death came within an hour; by midnight, there were 32; by 4 a.m., 40. Local doctors rushed to the hospital to help out staff doctors. The hospital morgue, outfitted for two to three bodies, was overwhelmed.

Eventually 47 people would die; in all, 467 were sickened. Though five wards had been served the suspect eggs, all the deaths occurred in four; in the fifth, an attendant had tried the eggs, found them odd tasting, and ordered her charges not to eat them.

Officials were baffled, and immediately focused on the frozen egg yolks which all the victims had been served, and which had come from federal surplus commodities. It was thought that the eggs might have spoiled due to improper storage, or even that they might have been deliberately poisoned by a patient who could have gotten a hold of a poison while on furlough. The biggest fear, however, was the fear of sabotage: with the country engaged in World War II, this possibility loomed large. Oregon Governor Charles Sprague ordered all state institutions to stop using the eggs. The federal government issued a similar order, and the Agriculture Department ordered an investigation into the handling of its frozen eggs.

But the eggs were part of a 36,000-pound shipment which had been divided between schools, NYA projects and state institutions in Oregon and Washington, 30,000 pounds of which had already been consumed with no ill effects. State officials confirmed that the eggs had been properly stored, and the president of National Egg Products Inc. pointed out that eggs bad enough to kill would be so obviously spoiled that no one would eat them.

The day after the poisoning, with dozens still ill, pathologists determined that the sickness and death had been caused by sodium flouride, an ingredient in cockroach poison; pathology reports showed large amounts of the compound in the stomachs of the dead victims. Five grams–the size of an aspirin–would have been fatal; some of the dead had eaten more sodium flouride than eggs. Cockroach poison was known to be available at the hospital, kept in a locked cellar room to which only regular kitchen employees had keys. State Police launched an investigation, and began interviewing staff and patients at the hospital.

Finally, several days after the poisonings, two cooks at the hospital, A.B. McKillop and Mary O’Hare, admitted that they knew what had happened, that they had realized soon after the symptoms had struck, but had not come forward for fear of being charged. McKillop took responsibility, saying he had been the one to send a patient trusty, George Nosen, to the cellar to get dry milk powder for the scrambled eggs he was preparing. He had given Nosen his keys to the cellar, and Nosen returned with a tin half-full of powder, an estimated six pounds of which were mixed into the scrambled eggs at McKillop’s direction. When people had begun getting ill, he had questioned Nosen about where he’d found the powder, and discovered he had brought roach poison.

Despite McKillop’s insistence that O’Hare bore no responsibility for the poisoning, and over the objections of the State Police, who had determined that the poisoning was accidental, District Attorney M.B. Hayden ordered both cooks arrested. A grand jury declined to indict them; the patient George Nosen was never charged. Considered by many of his fellow patients to be a mass murderer, he became something of a pariah at the hospital where he spent the rest of his life. Two brief attempts at life outside the institution failed, and he died at the State Hospital 41 years later, after suffering a heart attack during a fight with another patient.

Compiled and written by Kathleen Carlson Clements

Bibliography:

Capital Journal, November 19-December 1, 1942

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Filed under Mental Hell Treatment, Oregon State Hospital, pictures

The New Max

new-maxSo, this is a view of the construction area on the site of the demolished sections of the old J Complex at Oregon State Hospital. Some parts that are not yet demolished are in the foreground. The walls coming up in back are going to be the “ABC” (Acute Behavioral Care?) section of the new hospital- corresponds with the current maximum security unit on 48B. If you click the pic it will bring up the full-res 8-megapixel shot. But here’s what’s even more cool- they have put up a webcam that refreshes every 15 minutes and shows various angles of the construction zone.

Go here.

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Filed under Mental Hell Treatment, Oregon State Hospital, pictures