Mental health success story One man shares his experience in the system

Mental health success story
One man shares his experience in the system

By Matthew Graham

The Clackamas Review, Oct 14, 2008, Updated Oct 14, 2008

With Ardenwald residents incensed over a proposed secure mental health facility in their neighborhood, we spoke with someone who’d been through the state’s mental health system and with the Psychiatric Security Review Board’s director to get an inside perspective on the facilities, their patients and how the system really works.

For seven years he thought someone was following him, trying to kill him. He thought his shoes, his shirt buttons and one of his teeth were bugged and that satellites were watching him.

Matthew Goss had been hit by a truck, causing “major head trauma,” and was suffering from extreme paranoia. He was devoutly religious and, after seven years of looking over his shoulder, decided he’d rather die and be with his lord than continue living under such duress.

“I was on a mission to die without actually pulling the trigger,” Goss said. “I decided if they’re having such a hard time killing me on the outside, I’ll go to prison where they can hire a person on the inside to kill me. So I robbed two banks, I told the ladies at the banks my license plate number and said I’d be at the First Round having a beer and that’s where the police got me, and that was the beginning of my recovery.”

Goss was sent to Sheridan Federal Penitentiary, but after realizing no one was going to kill him, he went to the prison’s doctor and told him his story.

“He said, ‘well here, take this med for your anxiety,’ so I took that med, and within a short time my mind started clearing up,” Goss said. “It was a miracle in my life. I started thinking rationally.”

Goss told his public defender about his head injury and mental problems and changed his plea to guilty except for insanity. He was transferred to the Oregon State Psychiatric Hospital.

“It was a time of healing,” he said of his 19-month stay there. “I built good relationships there with my treatment team and other patients, I got along well, I got a job.”

From there he was sent to a foster home, still under the Psychiatric Security Review Board’s (PSRB) purview, where he lived with other patients with mental disorders in a supervised setting.

“There was a 24-hour staff there,” he said. “There was a board that we had to sign in and out on, telling where we would be and at what time we would return. There was a lot of oversight.”

But Goss said the slightest slip-up could land a patient back in the hospital.

“Another guy got released from the Oregon State Psychiatric Hospital and he didn’t show up back at the house one night and the next day the cops came and arrested him and sent him back to the hospital,” Goss said. “That’s how strict they are. The PSRB does not screw around with anybody. They take this business very seriously.”

As Goss progressed from the state hospital to the foster home to eventually his own apartment at Chez Ami, a Clackamas apartment complex for the mentally ill, he gradually reintegrated into a normal life. He got a job doing landscaping and janitorial work, finally getting his herbicide, insecticide and fungicide license. He saved for a car and is driving again.

Goss said the state psychiatric system has helped him learn to live with his condition.

“A lot of people have a lot more active or persistent mental illness than I do, but I got on to a medical miracle drug that changed my life and I knew that I wanted to regain some of the respect that I’d lost in my family and my society, and so I was determined to become a different person,” he said.

He’s still working toward that, and it hasn’t been an easy path for him.

“When I got released I was frustrated because I couldn’t be as productive as I wanted to be, I was frustrated because I couldn’t drive, I knew that I had certain abilities and I wanted to reach my full potential,” he said. “Then I learned to live with those constraints, took it one day at a time. One day when the next door opens I’ll walk through it.”

Reviewing patients

For patients seeking conditional release from the state hospital to one of the residential facilities, there are four levels of review, said PSRB Executive Director Mary Claire Buckley. The state hospital has an internal review board comprised of psychologists, social workers, clinical directors and hospital administrators. If that board approves the conditional release, then Clackamas County Mental Health, the provider – in this case Columbia Care Services, Inc. – and finally the PSRB get to review the case.

Each of those boards and institutions has the right to refuse any given patient or, if they accept the patient, to set conditions on the release.

“The board wouldn’t even get to consider it if one of those said no,” Buckley said. “We’re not going to force a client on any community. That’s the beauty of the PSRB, that’s why it was designed. It used to be that the hospital staff decided.”

By law, a person found guilty except for insanity can’t be held in the state hospital system longer than the time they would have been sentenced had they not plead insanity. But if the hospital staff believes a person is unfit to leave the system at the end of that time period, the state can have that person civilly committed. The state then reviews that case every six months and can continue the commitment indefinitely.

But Buckley said most of the patients have no reason to stay in the hospital once they get proper treatment.

“These people aren’t by nature criminals, they aren’t by nature anti-social,” she said. “Most of our clients have a major mental illness that, because it was active at some point, resulted in these major crimes … The fundamental premise is that they committed their crime while their illness was active and if we have that under control,” they should be released.

Copyright 2008 Pamplin Media Group, 6605 S.E. Lake Road, Portland, OR 97222 • 503-226-6397

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PSRB Annual Performance Progress Report

LFO Revised Budget Form #107BF04c

Psychiatric Security Review Board
Annual Performance Progress Report (APPR)
for Fiscal Year 2005-06

Original Submission Date: March 16, 2007

2005-07 KPM# 2005-07 Key Performance Measures (KPMs) Page #
01 RECIDIVISM RATE – % of revocations of conditional release based on commission of felony 4
02 TIMLINESS OF HEARINGS – % of hearings scheduled within statutory timeframes 6
03 MAINTENANCE OF RELEASED CLIENTS – % of conditional releases maintained in the community per month 8
04 CUSTOMER SERVICE – % of customers rating their satisfaction with the agency’s customer service as “good” or “excellent”; overall customer service, timeliness, accuracy, helpfulness, expertise and availability of information. 10

Contact: Mary Claire Buckley, J.D., Executive Director Phone: (503) 229-5596
Alternate: Phone:

1. SCOPE OF REPORT
• The Psychiatric Security Review Board is consolidated into one program that effectively provides statutorily required hearings for adult clients and close supervision of those on conditional release in the community. Although a juvenile panel of the Board became effective January 1, 2007, the enabling statutes do not provide for the receipt of juvenile clients until July 1, 2007. Thus none of the current measures relate to any activity of the juvenile panel. However, performance measures specific to the operations of the juvenile panel will be developed and tracked for future reporting.

• The two aspects of the Board’s program, hearings and monitoring, are addressed by the four reported performance measures.

2. THE OREGON CONTEXT
As the State’s population continues to grow, so does the number of persons who require mental health services. When the demand for behavioral health services increases, but those necessary community services are reduced or eliminated or are not accessed for whatever reason, persons who are unsuccessful in managing their mental illness and unable to obtain needed help come to the attention of law enforcement personnel. In Oregon, the number of persons with mental health diagnoses involved in the criminal justice system has grown significantly as evidenced by the numbers housed in local jails and Department of Corrections’ institutions. Once charged with a crime, historically a small percent of defendants opt for the insanity defense and, usually by stipulation, are placed under the Psychiatric Security Review Board which is a national model for the management and treatment of insanity clients. In fulfilling its mandate the Board’s primary purpose is to protect the public. Thus it serves a critical societal need and contributes to the high-level outcome measure #64 of the Oregon Benchmarks – Adult Recidivism. Its work necessarily requires collaboration with a number of partners in both the criminal justice and mental health systems, including judges, district attorneys and defense attorneys as well as DHS’s Addictions and Mental Health Division and Seniors and Persons with Disabilities Division, Oregon State Hospital, local mental health authorities, county and community mental health agencies and other treatment and residential providers.

3. PERFORMANCE SUMMARY
The summary chart indicates that the Board is making progress on two measures; not making progress on one; and it is unclear on the remaining measure.
More specifically, the Board is making good progress in meeting or exceeding its target on two of its critical measures. However, the other long-standing measure regarding timeliness reflects a very concerning and disappointing result. Not only did the Board not make progress in this arena, but it took a serious nose dive.
Finally, it is too soon to gauge the Board’s progress in customer satisfaction as this is a new measure with results reported for the first time in 2006. However, the initial scores indicated areas that will need improvement.

4. CHALLENGES
Currently the Board is facing an unprecedented growth in the number of hearings it must hold. The Board projects a need for approximately 1000 hearings in the ’07-’09 biennium. Thus improving the timeliness of hearings despite the tremendous increase in demand for hearings will be the biggest performance challenge the Board faces in the next biennium. The reason is twofold: there is a limit to the number of hearings that members can realistically handle per hearing day and secondly, the Board is reliant on others including its clients’ psychiatrists and other treatment providers, be it those at Oregon State Hospital or in the community, to present the information required by the Board in a timely fashion so that Board initiated continuances are not necessary.

5. RESOURCES USED AND EFFICIENCY
The Board’s budget amount for the fiscal year, measured as one-half of its Legislatively adopted expenditure limitation is $424,732. The reported measure that reflects efficiency is #02, the percentage of hearings scheduled within statutory timelines. The Board also keeps two other efficiency measures for internal tracking and management use.

KPM #01 RECIDIVISM RATE –
% of revocations of conditional release based on commission of felony Measure since: 1992
Goal To protect the public
Oregon Context #64 – Recidivism Rate

Data source Agency records – affidavits in support of revocation order which outline reason for revocation. Done quarterly.
Owner Mary Claire Buckley, J.D., Executive Director – (503) 229-5596

1. OUR STRATEGY

The Board’s strategy is to maintain public safety by engaging in effective decision-making regarding appropriate placement of its clients and the subsequent monitoring of those living in the community. Its partners in this endeavor include DHS’ Addictions and Mental Health Division; Oregon State Hospital and a host of community agencies and treatment providers.

2. ABOUT THE TARGETS

The Board originally set its target at 0% based on its statutory mandate. However, after discussion with the Progress Board, it realized that that may have been a worthy goal but was unrealistic given this population so the target was adjusted. The target increased each year due to the anticipated rise in the number of clients that would be conditionally released in the community. Clearly the lower the actual percent, the better as the safer the community is. In 2005, the Board exceeded its target with a perfect rate of 0% for that calendar year. For 2006, its actual rate rose slightly based on one felony offense out of 54 revocations but still bested its target.

3. HOW WE ARE DOING

In 2006, the Board’s recidivism rate was 1.9%. This measure was below target as was the case in 2005. The general trend shows a continuance of positive performance in this arena.

4. HOW WE COMPARE

The Psychiatric Security Review Board is a unique model for the management and treatment of those who successfully assert the insanity defense. There are no public or private industry standards for this population. The State of Connecticut estabished a system modelled after, but not identical, to Oregon’s. It reports a rate of 0% although they have very few clients on conditional release in comparison – 22 of 161 vs. 351 of 726.
The Board would cite the Department of Corrections’ recidivism rate which is approximately 30% as the closest comparison to an agency in Oregon.

5. FACTORS AFFECTING RESULTS

Although it is the Board’s responsibility to make informed and effective decisions regarding the readiness of a client to return to live in the community without further violations of the law, it is extremely dependent on Oregon State Hospital staff to provide complete and accurate information on which to base those determinations. Further it has to provide the client the treatment and skills necessary to be successful in a community setting. In addition, the community agency must provide the structure, support and supervision necessary for a client’s successful reintegration.

6. WHAT NEEDS TO BE DONE

The Board and staff need to continue their successful efforts to assure public safety by demanding adequate and accurate information from Oregon State Hospital staff and community treatment teams on which they can base these critical decisions.

7. ABOUT THE DATA

The reporting cycle is based on a calendar year. However, the data is collected and tallied on a quarterly basis from the revocation orders issued by the Board. Any individual who commits a new felony offense while on conditional release would be automatically revoked. This information is highly reliable as an affidavit is required for each revocation which sets forth the reason for the revocation warrant.

KPM #02 TIMELINESS OF HEARINGS –
% of hearings scheduled within statutory timelines Measure since: 1992
Goal To review client’s progress in a timely manner and protect clients’ due process rights.
Oregon Context KPM #4 – Timeliness and Agency Mission

Data source Agency records – hearing dockets and client files with pertinent dates
Owner Mary Claire Buckley, J.D., Executive Director – (503) 229-5596

1. OUR STRATEGY

The Board’s intent is to set each client’s hearing within the required timelines set by statute. Staff maintain a running calendar outlining when each PSRB client’s particular hearing is due which is utilized to set the weekly Board docket.

2. ABOUT THE TARGETS

The Board adjusted this target as well because its original goal was far too ambitious given the reality of the hearing schedule. The Board reduced it to what was thought to be a more reasonable figure. In this situation, the higher the percent, the better the Board has done.

3. HOW WE ARE DOING

In 2006, the percentage of hearings held in the statutorily-mandated timeframes was 74%. This figure is woefully below the target and evidences a serious decline in this actual measure from previous years which were close to or better than the target.

4. HOW WE COMPARE

Once again, given the unique nature of the PSRB and its operations, the Board is not aware of any comparable public or private industry standards.
5. FACTORS AFFECTING RESULTS

The Board’s more recent targets reflect the fact that there will always be a small number of hearings that cannot be held in a timely fashion. However, that number is a far cry from the 26% that is indicated in 2006. The major factor contributing to this significant decline was the new Board’s position that it would not hold hearings on any patient without a current (within 21 days of the hearing date) progress note update from the Oregon State Hospital treating psychiatrist. That new policy initially resulted in more than 44 hearings being continued on the Board’s motion.
The other primary factor affecting this measure was the greater demand for hearings with only 65 budgeted hearing days on which to hold them. There is a limit to the number of full face-to-face hearings the Board can conduct in one day. The time it takes to hold a hearing varies widely depending on the client; the nature of the request; the number of witnesses; etc.

6. WHAT NEEDS TO BE DONE

Hospital staff have responded to the Board’s new policy so a decrease in continuances for that reason has already been noted by the Board and staff. However, an increase in budgeted hearing days would help with the other part of this problem. Further, staff will have to be even more mindful and somewhat ruthless in setting the docket with less regard to other considerations such as the short time an individual has been back in the hospital before a revocation hearing is held.

7. ABOUT THE DATA

The reporting cycle for this measure is the calendar year. However, the data is collected weekly and tallied on a quarterly basis from the calendar and computer reports generated that outline when each client’s particular hearing is due.

KPM #03 MAINTENANCE OF RELEASED CLIENTS
% of conditional releases maintained in the community per month Measure since: 1992
Goal To determine appropriate community placement and conditions of release so that a client is successfully reintegrated and public safety is maintained.
Oregon Context Agency mission and OBM #64 – Recidivism which may be impacted

Data source Agency records – revocation orders and monthly statistical reports
Owner Mary Claire Buckley, J.D., Executive Director – (503) 229-5596

1. OUR STRATEGY

The Board seeks to make appropriate decisions regarding community placement so that its clients remain on conditional release status and do not engage in criminal activity nor need to be returned to Oregon State Hospital.

2. ABOUT THE TARGETS

The Board lowered its target in this area due to the anticipated increase in the number of clients who would be on conditional release status this biennium. It was thought that with more clients in the community, it was likely that more revocations would occur which would reduce the number who stayed in the community. In this measure, the higher the number, the better the performance.

3. HOW WE ARE DOING

In 2005 the Board met its target and in 2006 the Board exceeded its target with an impressive 99% maintained.

4. HOW WE COMPARE

There are no relevant public or private industry standards related to this population with which to compare.
5. FACTORS AFFECTING RESULTS

Authorizing release to the community program and residential facility most fitting to a client’s needs is critical to the client’s success and the Board’s ability to meet its target in this area. Also continuous communication between the Board staff and treatment providers is essential. Community case managers must keep staff apprised of a client’s status so that the Board can intervene early in any difficulties that present themselves. The Board’s close supervision of its clients assists them to remain in the community. Access to alternatives to Oregon State Hospital such as residential alcohol and drug treatment programs or community hospitalization are an important resource for the Board to have available to reduce revocations.

6. WHAT NEEDS TO BE DONE

The Board and staff need to continue to provide whatever supports are necessary to maintain its clients in a community setting. This, in turn, requires DHS’ commitment to provide the financial resources necessary to access appropriate alternatives to State hospitalization.

7. ABOUT THE DATA

The reporting cycle is based on a calendar year. However, the data is collected and tallied on a quarterly basis from the revocation orders issued by the Board.

KPM #04 CUSTOMER SERVICE – % of customers rating their satisfaction with the agency’s customer service as “good” or “excellent”; overall customer service, timelines, accuracy, helpfulness, expertise and availability of information.
Measure since: NEW
Goal CUSTOMER SERVICE – To provide excellent customer service.
Oregon Context Agency Mission

Data source Results of survey of participants at Board’s Statewide training program
Owner Mary Claire Buckley, J.D., Executive Director – (503) 229-5596

1. OUR STRATEGY

To conduct a customer service survey to gain a sense of stakeholders’ satisfaction with the Board’s performance in the five listed domains. The Board will then review and act on the scores received.

2. ABOUT THE TARGETS

This is a new measure for the Board (baseline data has just been published in 2007) because only one survey has been conducted, we have not yet set targets on this initial data. Targets will be established as more data becomes available.
Higher percentages reflect higher satisfaction from our customers.

3. HOW WE ARE DOING

In 2006, 88% of respondents rated the Board’s quality of services as good or excellent. Given that this was the first attempt at surveying stakeholders, the Board had no idea what results to expect. There are certain categories – timeliness and availability of information which appear to need more focus by the agency so those percentages improve.

4. HOW WE COMPARE

There is no comparative data available.

5. FACTORS AFFECTING RESULTS

It is important to note the role the Psychiatric Security Review Board Plays in the lives of those responding to the survey. The Board is ultimately responsible for all decisions relating to a client’s placement, be it at the State hospital, in the community on conditional release or discharge.
As such, our customers, be it clients, hospital staff, community providers, persons in the criminal justice system, victims or members of the general public, often may not like the Board’s decisions, even if they are legally correct. This could affect the Board’s satisfaction ratings. Also our first survey did not reach a number of categories of stakeholders that should be solicited and did not include enough consumer/clients. This, too, is likely to affect the Board’s scores.

6. WHAT NEEDS TO BE DONE

The Board intends to broaden the spectrum of participants who receive its survey as well as engage in a greater effort to increase the response rate.
In the meantime, the Board will focus attention on the domains whose responses initially showed less satisfaction that others do so as to improve stakeholders’ opinions of the agency’s performance.

7. ABOUT THE DATA

The survey was conducted by agency staff in late 2006. It was sent to 168 individuals including Department of Human Services and Oregon State Hospital staff, community case managers, treatment and residential providers and consumers who had attended the Psychiatric Security Review Board’s two day statewide training program in the fall. We received 72 responses for a 43% response rate.
Results are retained by the agency and will be utilized by management to determine what actions should be undertaken to achieve improvement in certain areas.
The Board will conduct this type of survey on an annual basis from now on.

Contact: Mary Claire Buckley, J.D., Executive Director Phone: (503) 229-5596
Alternate: Phone:

The following questions indicate how performance measures and data are used for management and accountability purposes.
1 INCLUSIVITY
Describe the involvement of the following groups in the development of the agency’s performance measures. • Staff: As a small agency of 4 FTE, it was easy to involve staff in the process as all were literally at the table when our performance measures were initially developed in 1992. Since that time and throughout the modification of the performance measure system by the Progress Board, the Board and now 5 FTE staff have been engaged in the discussions related to the agency’s goals and what measures to utilize to demonstrate its performance.
• Elected Officials: Legislators’ provided input last Session by suggesting the removal of one measure from the external reporting process and utilizing it only for internal purposes.
• Stakeholders: Stakeholders’ opinions were solicited in meetings and individual conversations as well as to learn what they thought would be important to track and what outcomes they wanted the board to achieve.
• Citizens: The public as represented by the Legislature approved these performance measures during our budget hearing in the 2005 Legislative Assembly.
2 MANAGING FOR RESULTS
How are performance measures used for management of the agency? What changes have been made in the past year? Given that the Board’s primary purpose is to protect the public, the Board reviews the results to get a sense of the efficacy of its decision-making process at hearings.
The agency further assesses its monitoring function and compliance with its statutory mandates from this data. Depending on the results, the Board adjusts its procedures to improve the outcomes. Based on the results of the performance data collected, the agency has made efforts to improve outcomes in the areas where it fell significantly short of its target. In the past year the Board has increased the number of hearings scheduled per day to address the Board’s failure to provide hearings in a timely fashion for a significant percentage of clients.
3 STAFF TRAINING
What training has staff had in the past year on the practical value and use of performance measures? The Executive Director has attended the training sessions sponsored by D.A.S. and the Progress Board since the State implemented the performance measure system. She, in turn, shares the written materials received the other staff members and trains them in their use. Measures are calculated and reviewed quarterly to see what changes in operation might have to be implemented to improve measures that are wanting. Board members are also kept apprised as they recognize the value of performance measures in assessing the effectiveness of their work as well as areas of the agency’s functioning that might need additional resources when developing the Board’s budget.
4 COMMUNICATING RESULTS
How does the agency communicate performance results to each of the following audiences and for what purpose? • Staff: As noted above, staff review these measures quarterly to evaluate what operations might need to be adjusted to deal with any deficiencies that may be revealed. Board members are then informed as the adjustments usually affect their workload.
• Elected Officials: The Board communicates results to the Legislature through this Progress Board report as well as biannually in its budget preparation documents for review by the Department of Administrative Services , the Governor and ultimately by the Legislature and the public. The purpose would be to demonstrate how well the agency is carrying out its mission and statutory mandates.
• Stakeholders: The results are often cited in public testimony and presentations made by the Board and its Executive Director in various venues as well as at training seminars for all the various stakeholders in this system.
• Citizens: In citing the Board’s Key Performance Measure of recidivism and the percentage of those maintained on conditional release, the Board is often able to instill more confidence in a skeptical public and potential providers with these impressive figures when efforts are made to expand community resources and site residential facilities for P.S.R.B. clients.

Ex-state hospital worker sentenced in escape, smuggling

Ex-state hospital worker sentenced in escape, smuggling
Separate incidents in 2007 lead to four months in jail

By Ruth Liao • Statesman Journal
October 25, 2008

A former Oregon State Hospital employee will spend four months in jail for helping a patient escape and later smuggling drugs to another patient with whom she had a romantic relationship.

hosp
Bonita Tucker, 30, pleaded guilty Friday to second-degree escape, supplying contraband, delivering a controlled substance and possession of a controlled substance.

Circuit Judge Joseph Guimond sentenced Tucker to four months in jail and two years of probation.

“This was a blatant violation of a position of trust and which placed a great risk to the community,” Guimond said.

The convictions stem from two separate episodes in 2007, one when Tucker was employed as a mental health therapist with the state hospital and one that happened after she resigned from her job, said Marion County Deputy District Attorney Paige Clarkson.

Oregon State Police Detective Greg Withers gave testimony in court Friday about the investigation.

Tucker was convicted for aiding and abetting the escape of forensic patient Gino A. Puglisi, who escaped Feb. 14, 2007, after he cut through a security fence with bolt cutters. He was caught in Beaverton nine days later. Another patient, David Anderson, also was planning to escape but remained in the facility.

Tucker resigned from her job March 23.

Withers said investigators learned of the romantic relationship between Tucker and Anderson, including unconfirmed reports of Tucker flying to Texas and marrying Anderson by phone.

“It just fueled the fire,” he said. “She just wouldn’t give up.”

After Tucker had resigned from Oregon State Hospital, Anderson received a large FedEx package. When authorities inspected its contents, they found a large comforter with a small, six-inch plastic bag lined with morphine and amphetamine pills sewn inside a seam, Withers said.

The package recipient listed the name of a woman from Reedsport but included a 503 area code. Knowing that Reedsport’s area code is 541, Withers traced the package’s tracking number and found the Salem drop-off location where it was first taken. Withers then reviewed surveillance video of the FedEx business and was able to identify Tucker on the video tape.

Fingerprints also were found on the plastic inside the comforter, confirmed through Oregon State Police laboratory tests, Withers said.

Clarkson recommended a six-month jail sentence because of the severity of Tucker’s involvement.

Tucker’s retained attorney Keith Hayes asked the court not to impose jail time, but instead lengthen the amount of required community service hours.

In front of the judge, Tucker said she knew her relationship with Anderson was inappropriate, but she didn’t know why she continued it.

“I didn’t know what made me cross the line,” she said.

Tucker said she realizes now that Anderson was manipulative in persuading her to help with the escape and later smuggling in the drugs. She said she filed for a divorce and supports a court order that would bar contact with Anderson.

Tucker’s mother, Shirley Tucker, and Lakepoint Community Church pastor Sarah Page both spoke in support of Tucker.

As part of the conviction, Tucker also surrendered her certified nursing assistant’s license.

Guimond allowed Tucker to keep her driver’s license, instead of imposing a six-month automatic suspension required on most drug convictions.

But Guimond said he could not ignore the fact that she was a state employee paid to care for a vulnerable population.

“It gives me no joy to place you in jail at all,” he said.

Also on Friday, Anderson was convicted of second-degree escape and supplying contraband. Anderson already faces 47 months in prison after being convicted of using a minor in delivering drugs and identity theft while at the state hospital, Clarkson said.

Anderson was convicted and sentenced to 30 additional months in prison, to serve consecutively after he finishes his time under the Psychiatric Security Review Board. He declined to comment in court.

rliao@StatesmanJournal.com or (503) 589-6941

Portland Suicides Spike

Portland suicides spike
Posted by Mary Mooney, The Oregonian October 23, 2008 20:44PM

Nearly twice as many people have died by or attempted suicide in Portland’s downtown and west side this year, alarming police who are banding together with county mental health experts to figure out why, and how to get immediate care to those in crisis.
man
Caseworkers suspect that the bleak economy and reports of an upheaval in the local mental health system have intensified people’s sense of despondency, but they don’t know for sure.
Kraig Scattarella/The OregonianCentral Precinct Officer Betty Woodward successfully talked a suicidal man down from the railing on the west end of the Burnside Bridge on Jan. 7 during the weekday lunch hour.

“Does it concern us? Absolutely,” said David Hidalgo, senior operations manager for Multnomah County’s Mental Health and Addictions Services. “There’s a whole group of distressed individuals that we need to be able to make sure services are available to.”

The county intends to examine the cases further to figure out whether the people involved had been receiving care from local providers, or if a specific population has fallen through a gap.

“Are they in the system? Are they insured? Are they people who lost their jobs, or is it from general distress from the world we live in?” Hidalgo said.

Between Jan. 1 and Sept. 20, the Portland Police Bureau’s Central Precinct recorded 61 suicides or attempted suicides, compared with 33 during the same period a year ago. The precinct — which essentially covers the city’s core and west side — typically is the nexus for public suicides because of its high-rises and bridges spanning the Willamette River.

Stunned by the numbers, Police Chief Rosie Sizer and Central Precinct Cmdr. Mike Reese recently reached out to county officials to talk about what to do.

The result: Within the next month, Central Precinct police plan to start sharing their incident reports on every suicide attempt with the county so experts can provide follow-up care to people who survive.

“That hasn’t been done in the past,” Hidalgo said. “That’s a new link for us.”

Providing that support is crucial, said Dr. Kevin Smith, a psychiatrist at Oregon Health & Science University who spoke at a recent Portland forum on suicide. “If someone has prior suicide attempts, they have a history, and we know history repeats itself,” he said.
Westside
Throughout the county, the number of people who die from suicide has slowly risen over the past few years, but the statistics don’t reflect attempted suicides. This year’s westside spike is significant because the figures are more comprehensive and signal what could be more than an anomaly.

Reports earlier this year on the uncertainty of Cascadia Behavioral Healthcare’s financial stability might have stirred fear among mentally ill people, county officials and police said. In May, a $2.5 million government bailout lifted the state’s largest provider of mental health services from the brink of bankruptcy.

“That could be another contributor,” Hidalgo said. “Being the local mental health authority, one of the big things is that people need to know how to access care.”

Because of Cascadia’s financial crisis, the county transferred some clinics and services to other providers, but officials say in the end they lost no services.

The state’s Suicide Hotline has fielded a number of calls this year from people who are depressed, scared, living in their cars, lost their jobs and can’t afford rent.

“We’re definitely getting a spike in calls from people who are more concerned about issues impacting their everyday life,” said hot line director Leslie Storm. The line fielded 28,419 calls in 2007, up from 24,308 in 2006. As of Oct. 15 this year, 18,002 calls came in, and the count each month is growing, Storm said.

Increased collaboration

For help

• Oregon Partnership’s Suicide Prevention Hotline: 800-273-Talk
• Multnomah County Mental Health Crisis Line: 503-988-4888 or toll free 800-716-9769, available 24 hours, seven days a week
• Urgent Walk-in Clinic: Open 7 a.m. to 10:30 p.m., seven days a week, at 2415 S.E. 43rd Ave., use west entrance at Southeast Division and 42nd Avenue
• Project Respond mobile outreach: Available 24 hours a day, seven days a week; call county call center at 503-988-4888

In downtown Portland, the majority of the suicides and attempted suicides are very public. Dozens of businesspeople walking to their jobs or lunch, tourists staying at a downtown hotel and security officers posted outside the Central Library have seen people leap from buildings or bridges. Some observers have required counseling of their own, left traumatized from seeing jumpers fall to their deaths.

A 54-year-old man who suffered from bipolar disorder jumped off a downtown parking garage at Southwest Ninth Avenue and Morrison Street on a weekday morning in early March, narrowly missing pedestrians as he fell to his death.

Last month, a 38-year-old woman who had complained her insurance no longer covered her medication jumped to her death from the same downtown parking garage in the middle of the afternoon. A security official at the Multnomah County Central Library was the first on the scene.

Portland Officer Betty Woodward, who patrols downtown and was among the first Portland officers trained in crisis intervention, said the increased collaboration between police and county experts will be a “huge step forward.”

Often, police call an ambulance and the survivor goes to a hospital, but the officers aren’t privy to what happens next. Woodward said she’s tried to “hunt down” a person’s doctor or caseworker, but it’s not easy, and most officers don’t have time to do that. This is where the county plans to step in under the new plan.

Reese, the Central Precinct commander, has asked Cascadia mental health workers to address his officers at roll calls and is reminding dispatchers to send crisis intervention officers to suicide calls.

“We want officers to be aware that this is going on, and know what services are still in place that they can refer people to,” he said.

Woodward has successfully talked suicidal people off bridges, but also has lost people she tried to persuade not to jump. The calls take a toll on officers, she said.

“When you arrive to a call, and it’s too late, I don’t have good words for that,” she said. “You don’t even get to try. You can’t do anything. It’s horrible, pitiful, an absolute waste.”

— Maxine Bernstein; maxinebernstein@news.oregonian.com

Mental patients forced to go elsewhere after Cascadia clinic fire


Mental patients forced to go elsewhere after Cascadia clinic fire
Posted by Scott Nelson, The Oregonian October 21, 2008 17:57PM

More than 500 mental-health patients will have to go elsewhere for service after a fire destroyed part of a Cascadia Behavioral Healthcare clinic in Northeast Portland last night.

No one was injured by the blaze at Cascadia’s Garlington Center on Northeast Martin Luther King Jr. Blvd., but authorities say it appears to have “suspicious” origins. The cause of the fire that officials say began sometime before 9:52 p.m. is under investigation.

“It’s very important that we get it back up and running,” said Cascadia chief executive Derald Walker. “A lot of the people we serve live in this general area.”

An outcry of public support helped keep the center’s doors open after it nearly shut down this year in the face of severe financial problems at Cascadia.
pt.garlington.6-30-08.ob.071.jpg
The center had staff on hand today to help people who showed up for services and telephoned other patients, sending them to Cascadia Plaza about four miles away, Walker said. The Garlington Center served 525 clients, he said.

When the center will again be able to serve patients is unknown. Walker said officials today were still assessing the extent of the damage.

Fire officials estimate $200,000 worth of damage to the structure and an additional $400,000 to the building’s contents.

Walker said that as much as one-third of the building was badly burned, and that smoke damaged other areas. The fire destroyed Cascadia’s main computer, housed at the Garlington Center, but Walker said patient records weren’t lost because the hard copies survived. With the server destroyed, Cascadia cannot use its electronic medical records system and automated billing system until the arrival of a replacement that Walker expected by the week’s end.

The clerical area received the brunt of the damage, Walker said, with computers, copy machines and other business equipment burned in the flames.

“We will take precautions to make sure anyone connected to the Garlington Center who needs services will have a way to get them until it can be repaired,” Multnomah County Board Chairman Ted Wheeler said in a statement. “Given the economic crisis, these are anxious times for everyone. We will make every effort to make sure clients don’t fall through the cracks. Services will not be interrupted.”

— Desiree Aflleje; desireeaflleje@news.oregonian.com

Prosecutors, defense: Man police say killed adoptive dad is insane

Prosecutors, defense: Man police say killed adoptive dad is insane
PAGNAM
By Alex Wood
Journal Inquirer
Published: Thursday, October 16, 2008 10:18 AM EDT
State prosecutors agree with Brian E. Pagnam and his lawyers that Pagnam should be acquitted of murdering his adoptive father in their Enfield home in December 2006 on grounds of “mental disease or defect” — a defense still commonly called insanity.

Nevertheless, under state law, Pagnam will have to go on trial for the murder of his father, Robert John Pagnam, a retired correctional officer who was bludgeoned to death at age 85 in the home they shared at 195 N. Maple St.

The trial is scheduled to begin Oct. 27 in Hartford Superior Court. Pagnam, who is balding and has grown a bushy black beard since his arrest, appeared in shackles Wednesday in Hartford Superior Court and opted to be tried by a three-judge panel rather than a jury.

He seemed cooperative, even eager, as he answered questions from Judge David P. Gold.

An acquittal by reason of insanity wouldn’t mean that Pagnam, 41, would go free immediately.

If the three-judge panel acquits him on that basis, Gold told him, it could commit him to the custody of the state’s Psychiatric Security Review Board for up to 60 years, the maximum sentence for murder.

He could be confined to a mental hospital throughout that period, although the board also can take steps to reintegrate him into the community when and if it feels it is safe to do so.

Release from custody isn’t automatic even when a commitment to the board’s custody expires. A judge can extend the commitment upon finding that an acquitted person “remains mentally ill and dangerous,” prosecutor Vicki Melchiorre said.

Under questioning by the judge, Pagnam said he understood that he could remain committed for the rest of his life.

Because the two sides agree on the appropriate outcome, Pagnam’s trial will be less adversarial than a typical criminal trial, Gold told him.

As a result, the judge added, public defenders Sara L. Bernstein and John DelBarba may allow testimony to be offered that ordinarily would be prohibited by a defendant’s constitutional right to confront the witnesses against him.

Presumably that means some evidence will be presented through hearsay testimony. For example, a police officer might be permitted to testify to what a witness had said so that the witness wouldn’t have to testify or an autopsy report might be put into evidence in lieu of testimony by a medical examiner.

Pagnam also agreed Wednesday that either or both of two semi-retired “judge trial referees” assigned to Hartford Superior Court, Joseph Q. Koletsky and John F. Mulcahy Jr., can sit on the three-judge panel.

An elderly neighbor couple discovered Robert Pagnam’s body on Dec. 8, 2006, when they arrived at his house to take him to lunch. One of the neighbors, William Bailie, called 911 to report that there was a man on the floor, then turned the phone over to Brian Pagnam who told the dispatcher that his father was dead.

“He was murdered,” Brian Pagnam said. “He was neutralized.”

“I’m the one who neutralized him,” Pagnam said during the same recorded call, which was played at a preliminary hearing in the murder case in July 2007. “I have the Federal Bureau of Investigation coming.”

Pagnam later gave written statements to an Enfield police detective.

In the first, he said he found his father dead on the floor of the bedroom, then took his father’s car and drove to New Haven, “to the FBI or the Secret Service to report the incident.”

In a subsequent statement, Pagnam described planning and carrying out the killing of his father. He said he had put garbage bags in a drawer around 6 p.m. the day before “for the purpose of the killing/neutralization of Robert.”

He said he put on rubber gloves, got a garbage bag, went to his father’s bedroom, where the older man lay asleep on his bed, then hit him eight times in the face. He said he pulled his father off the bed, put a trash bag around his head “and wrapped it tight.”

He said he then stomped on his neck three times with his right foot.

“Robert didn’t fight at all,” he said. “Not a word.”

http://www.journalinquirer.com/articles/2008/10/16/news/doc48f74ca69a8c4459736188.prt

Copyright © 2008 – Journal Inquirer

Mental health success story

Mental health success story
One man shares his experience in the system

By Matthew Graham

The Clackamas Review, Oct 14, 2008, Updated 6.8 hours ago

With Ardenwald residents incensed over a proposed secure mental health facility in their neighborhood, we spoke with someone who’d been through the state’s mental health system and with the Psychiatric Security Review Board’s director to get an inside perspective on the facilities, their patients and how the system really works.

For seven years he thought someone was following him, trying to kill him. He thought his shoes, his shirt buttons and one of his teeth were bugged and that satellites were watching him.

Matthew Goss had been hit by a truck, causing “major head trauma,” and was suffering from extreme paranoia. He was devoutly religious and, after seven years of looking over his shoulder, decided he’d rather die and be with his lord than continue living under such duress.

“I was on a mission to die without actually pulling the trigger,” Goss said. “I decided if they’re having such a hard time killing me on the outside, I’ll go to prison where they can hire a person on the inside to kill me. So I robbed two banks, I told the ladies at the banks my license plate number and said I’d be at the First Round having a beer and that’s where the police got me, and that was the beginning of my recovery.”

Goss was sent to Sheridan Federal Penitentiary, but after realizing no one was going to kill him, he went to the prison’s doctor and told him his story.

“He said, ‘well here, take this med for your anxiety,’ so I took that med, and within a short time my mind started clearing up,” Goss said. “It was a miracle in my life. I started thinking rationally.”

Goss told his public defender about his head injury and mental problems and changed his plea to guilty except for insanity. He was transferred to the Oregon State Psychiatric Hospital.

“It was a time of healing,” he said of his 19-month stay there. “I built good relationships there with my treatment team and other patients, I got along well, I got a job.”

From there he was sent to a foster home, still under the Psychiatric Security Review Board’s (PSRB) purview, where he lived with other patients with mental disorders in a supervised setting.

“There was a 24-hour staff there,” he said. “There was a board that we had to sign in and out on, telling where we would be and at what time we would return. There was a lot of oversight.”

But Goss said the slightest slip-up could land a patient back in the hospital.

“Another guy got released from the Oregon State Psychiatric Hospital and he didn’t show up back at the house one night and the next day the cops came and arrested him and sent him back to the hospital,” Goss said. “That’s how strict they are. The PSRB does not screw around with anybody. They take this business very seriously.”

As Goss progressed from the state hospital to the foster home to eventually his own apartment at Chez Ami, a Clackamas apartment complex for the mentally ill, he gradually reintegrated into a normal life. He got a job doing landscaping and janitorial work, finally getting his herbicide, insecticide and fungicide license. He saved for a car and is driving again.

Goss said the state psychiatric system has helped him learn to live with his condition.

“A lot of people have a lot more active or persistent mental illness than I do, but I got on to a medical miracle drug that changed my life and I knew that I wanted to regain some of the respect that I’d lost in my family and my society, and so I was determined to become a different person,” he said.

He’s still working toward that, and it hasn’t been an easy path for him.

“When I got released I was frustrated because I couldn’t be as productive as I wanted to be, I was frustrated because I couldn’t drive, I knew that I had certain abilities and I wanted to reach my full potential,” he said. “Then I learned to live with those constraints, took it one day at a time. One day when the next door opens I’ll walk through it.”

Reviewing patients

For patients seeking conditional release from the state hospital to one of the residential facilities, there are four levels of review, said PSRB Executive Director Mary Claire Buckley. The state hospital has an internal review board comprised of psychologists, social workers, clinical directors and hospital administrators. If that board approves the conditional release, then Clackamas County Mental Health, the provider – in this case Columbia Care Services, Inc. – and finally the PSRB get to review the case.

Each of those boards and institutions has the right to refuse any given patient or, if they accept the patient, to set conditions on the release.

“The board wouldn’t even get to consider it if one of those said no,” Buckley said. “We’re not going to force a client on any community. That’s the beauty of the PSRB, that’s why it was designed. It used to be that the hospital staff decided.”

By law, a person found guilty except for insanity can’t be held in the state hospital system longer than the time they would have been sentenced had they not plead insanity. But if the hospital staff believes a person is unfit to leave the system at the end of that time period, the state can have that person civilly committed. The state then reviews that case every six months and can continue the commitment indefinitely.

But Buckley said most of the patients have no reason to stay in the hospital once they get proper treatment.

“These people aren’t by nature criminals, they aren’t by nature anti-social,” she said. “Most of our clients have a major mental illness that, because it was active at some point, resulted in these major crimes … The fundamental premise is that they committed their crime while their illness was active and if we have that under control,” they should be released.