Documentary provides insight and explores mental illness at Oregon State Hospital

By Michelle Cole, The Oregonian, Portland, Ore.

June 25–The latest film about Oregon’s infamous state mental hospital contains scenes from Hollywood’s “One Flew Over The Cuckoo’s Nest,” but the stories it tells are real.

“Guilty Except for Insanity” is a 90-minute documentary offering viewers a chance to get to know three men and two women who are patients at the Oregon State Hospital. It chronicles the haunting events that landed them in the hospital, what life is like on the ward and just how difficult it is to get better and get out.

The film started as a class project for Portland State University psychology professor Jan Haaken, who turned more than two years and 70 interviews into a documentary slated for its Portland premiere Sunday night.

Haaken talked with The Oregonian Thursday about the film, including her plans to do a final edit in response to the feedback she gets from Sunday’s audience. Here is condensed version of that interview:

The five patients you featured have interesting yet terrible stories how did you choose them?

I wanted ethnic diversity and gender diversity. I found that over half of the patients we approached wanted to have their story told. Those stories, in one way or another, involve people whose lives had fallen apart quite a bit before the state steps in — and we step in with a heavy boot.

What did you learn from making this film?
I started thinking the hospital was an evil place. I don’t any more. I see these places as shock absorbers in a very troubled system.

During the time you were making this documentary, there were a number of controversial events, yet you don’t mention the patient who was dead in his bed for hours before staff noticed or the ongoing U.S. Department of Justice investigation. Was that on purpose?
Yes. I wanted to focus on the people in the hospital and those who carry out the work.

What do you want Oregon viewers to take away from your documentary?
The film is different from social-problem documentaries in that it doesn’t direct you to do a particular thing at the end or offer a clear resolution in terms of who the bad guy is.

People carry these images of the “criminally insane,” I’m hoping people will see more of the complex humanity.

Have the patients and staff seen this film and will any of them be there for the Portland premiere?
Yes. All five of the featured patients will be with me and taking questions and comments from the audience.

— Michelle Cole

Documentary Website: http://www.guiltyexcept.com/

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Burley
Three weeks after he was shot during a traffic stop, Portland Officer Christopher Burley said he’s not angry at the man who shot him but wishes he could have gotten the mental health he needed before their encounter.

“The community as a whole failed Mr. Otis,” said Burley, referring to Keaton Otis, the mentally ill man who shot him during a traffic stop. “I think it’s something we can all learn from.”

Burley, 31, a five-year member of the Portland Police Bureau and member of its Hotspot Enforcement Action Team, spoke about the May 12 shooting at East Precinct, alongside team Sgt. Don Livingston and Officer Ryan Foote. Foote drove Burley to the hospital in a police car.

Burley was struck by two bullets in the upper, inner thigh groin area that went through muscle tissue and exited, and remarkably did not strike any major arteries.

Yet on the ride to the hospital in the back of a police car, Burley thought, “Is this the end of my police career? Is my life going to be different forever?”

He worried that his mother in Boise, Idaho, his hometown, would find out about the shooting from news reports.

“I was upset that I hadn’t put a plan together,” he said.

And, images of a man who’d been shot 8 months earlier at The Orient bar and was walking around with a cane and braces on his leg, went through his mind.

Burley was released from the hospital two days later. Initially, he said he walked with a waddle, but his stride has returned. He looked physically strong and fit today, dressed in khaki pants and a black Gang Resistance Education and Training shirt.

Ten days later, he joined his GREAT students, who were painting over graffiti in Southeast Portland. He said he’s thankful for the support from friends, family, students, and even from a few he’s arrested who have reached out to him.

Mostly, he’s thankful he’s alive and takes pleasure in even the most mundane pursuits – such as mowing the lawn of his Portland home.

“If I hadn’t been as fortunate ….I might not even be there to mow my yard,” he said.

The officers have returned to administrative duty, after a debriefing last night with the Traumatic Incident Team and fellow team members, and meetings with counselors. Members of the HEAT team involved in the incident are likely to remain off the street for about 30 days.

Burley, who has taught Gang Resistance Education and Training at Floyd Light Middle School, attended his students’ graduation earlier this morning. His students presented get well cards they made for him.

Sixth grader Emily Nelson called Burley “awesome,” and described him as “kind and caring.”

Burley was shot as he was struggling to pull motorist Keaton Otis, 25, from a Toyota Corolla and Otis yanked his arm away. Three other officers fired their Taser at Otis, but the stun gun shots weren’t effective. Police said Otis reached across the passenger seat and grabbed a 9mm pistol from the glove compartment.

Burley, who was standing by the Toyota’s driver’s door, told detectives he heard another officer shout “he’s going for something” and said he saw Otis reach into a Crown Royal bag. He said he stepped back and heard two pops and felt a burning pain. Burley fell to the ground.

“It was scary as I fell,” he recalled. “Do I have the use of my legs?” He wondered.

He moved his legs a bit and thought to himself, “OK, this is good.”

He crawled and pushed himself toward a curb as he continued to hear gunshots and radioed he’d been shot.

Had he not heard another officer warn him that Otis was reaching for something, Burley suspects he likely wouldn’t have backed up and his head might have been in the line of fire.

“I was looking for a lot of blood,” he said. When he didn’t see any, “I felt relief again.”

Foote helped drag Burley to a police car. Sgt. Livingston, who initially thought Burley had been killed when he saw him drop, checked on Burley in the back of the police car.

Burley remembers that moment.

Chris Burley, shot in both legs during a traffic stop last month that ended with the shooting death of Keaton Otis, and some of the kids he mentors for the Portland Police Bureau’s GREAT program from Floyd Light Middle School. Burley talked about the shooting today during a news conference.”I felt like I was back being a 4-year-old and your dad arrives at the scene…it’s OK, everything is going to be alright now,” Burley recalled.

Livingston said he felt responsible, and described how scary it was to see one of the officers on his team drop to the ground after getting shot.

Foote said he was frustrated he couldn’t find Burley’s injuries and called the drive to the hospital one of the scariest moments of his life. People along the sidewalks were pointing to his passing police car, motioning that he was going the wrong way. ” If they only knew,” Foote thought.

Burley said he harbors no anger against Otis.

“I was frustrated that Mr. Otis had decided he didn’t want to cooperate with what we were doing,” Burley said. But he added, “It saddens me that Mr. Otis died.”

He says he’s aware Otis’ family had tried to get Otis committed, but couldn’t prove he was a danger to himself or others.

“The community as a whole failed Mr. Otis,” Burley said. “He deserved resources.”

Burley, who previously taught high school physics and math in Chicago before becoming an officer, said he decided to speak out to draw attention to the crises on the streets.

“It was an opportunity to encourage the community to come together and assist those people who are in crisis.”

— Maxine Bernstein
Source: http://www.oregonlive.com/portland/index.ssf/2010/06/portland_officer_chris_burley.html

A mental health system still strapped in restraints


The Oregonian Editorial Board
Oregon State Hospital patients and staff remain locked in a “culture of despair” even as a new hospital rises and the state acts to reverse decades of neglect

Just outside the brick walls of the Oregon State Hospital, where 550 construction workers are building the nation’s newest mental hospital, there’s hammering, heavy machinery and hope.

Inside those walls, though, nothing seems to be working. There’s a growing number of patient assaults, more injuries, greater use of seclusion and restraints, more grinding despair.

How could this be happening? Didn’t the state decide four years ago to spend more than $450 million to replace the wreck of a state hospital that provided the stark backdrop to the movie “One Flew Over the Cuckoo’s Nest”? Didn’t it commit more than $60 million, even during these hard times, to add more than 500 new hospital employees? What about all those promises of a modern, compassionate system of mental health?

It’s not here yet. None of it. The new building on the Salem campus remains a work in progress. Scores of new staff, especially nurses, have arrived, but furloughs ordered across state government wreaked havoc on hospital staffing, and required more than 5,000 hours of overtime in the past month alone. Meanwhile, vulnerable, volatile patients remain crammed four or five to a room in soon-to-be-abandoned buildings.

It’s still a mess, this mental health care system in Oregon. That much was obvious in two legislative oversight hearings in Salem last week. There’s still twice as many criminally insane patients locked in the hospital as the decrepit facility was designed to hold.

Moreover, there’s been no change in state policy that prompts the Psychiatric Security Review Board, the mental health equivalent of the state parole board, to keep patients locked in the hospital for years, even decades, after they could be safely released to far less expensive community mental health facilities. If that policy isn’t changed, within a decade the new hospital will be so overwhelmed by the criminally insane that it will no longer have space for civil commitments of the mentally ill.

You get the sense that Oregon legislators keep waiting to hear that when it comes to mental health, their job is done. But mental health is a linked system, and it’s only as strong as its weakest links. For now, that’s a shortage of community beds and the policy that sends far too many mentally ill criminals to the hospital and never lets them out.

Legislators and Gov. Ted Kulongoski need to agree on this: No more staff furloughs at the state hospital. With the new budget shortfall announced last week, it’s likely that state employees will be sent home more days over the next year. That can’t happen again at the hospital. It caused too much stress and led to too much unrest among patients and too much expensive, exhausting overtime for staff.

Like its patients, the state hospital needs a real fighting chance to get better. The first 120 beds in the new hospital will open late this year, and the remaining 500 will come on line late next year. It will be safer for patients and staff. There will be more privacy, more places to walk, exercise, blow off steam. There will be more green space, more vocational activities. There will be air conditioning and a roof that doesn’t let rain drip, drip, drip into plastic buckets.

Yes, it’s just a building. Yes, it’s what goes on inside those walls that matters. And yes, it was painful to hear a patient tell legislators the hospital is enveloped in a “culture of despair.”

But better days are coming to Oregon’s mental health system and the patients and families it serves. Of course, one can’t see them from the barred windows of the hospital, which is as overcrowded and violent as ever. Yet there’s real change going on out here, where construction crews are working, where more hospital staff are being sought, where new community facilities are opening, where lawmakers vow to re-examine laws that keep patients locked away. The work is far from done, but there’s reason for hope.

Source: http://www.oregonlive.com/opinion/index.ssf/2010/05/a_mental_health_system_still_s.html

Mental health care provider returns to profitability and starts building a cash reserve

Walker
Cascadia Behavioral Health recovers from near collapse
Mental health care provider returns to profitability and starts building a cash reserve

Portland Business Journal – by Courtney Sherwood Business Journal staff writer
Cathy Cheney | Portland Business Journal
Under Derald Walker’s leadership, Cascadia Behavioral Healthcare quietly turned itself around.

Two years after a financial meltdown nearly destroyed Multnomah County’s safety net for the mentally ill, the nonprofit at the center of the crisis has rebounded.

Cascadia Behavioral Healthcare Inc. is a shadow of its former self, and will bear the burden of its April 2008 near collapse for many years. Even at half its former size, however, the Portland nonprofit remains a key component of the county’s safety net.

It returned to profitability in March. CEO Derald Walker, appointed in the midst of the crisis to turn Cascadia around, hopes to build a $500,000 cash reserve by early 2011.

Two years ago, these results seemed inconceivable.

Cascadia Behavioral Healthcare runs clinics for people struggling with addiction, offered counseling to people with severe mental illness and housed poor people with mental illnesses.

But in spring 2008, poor bookkeeping put all that at risk.

State Medicaid officials had ordered Cascadia to repay $2.7 million when the nonprofit could not provide documents backing previous years’ claims. Capital Pacific Bank had demanded repayment of a $2 million loan.

Leslie Ford, who had been CEO since Cascadia Behavioral Healthcare was founded through the 2002 merger of several smaller nonprofits, had been forced out. Two consecutive chief financial officers hired to turn Cascadia around had quit, after declaring the company’s books a mess and uncovering still more liabilities.

By summer 2008, it appeared as though Cascadia Behavioral Healthcare’s programs would be dismantled and farmed out to other nonprofits.
Instead, the nonprofit is paying down its debt

“They still have to watch their pennies,” said Kathy Tinkle, business services director for Multnomah County Human Services. “But they’ve made significant progress.”

Under Walker’s leadership, Cascadia obtained a $2.2 million loan from Multnomah County and the state. It negotiated its Medicaid assessment down to $1.2 million, payable over five years.

It also relinquished its role as Multnomah County’s pre-eminent mental health care provider by transferring several of its programs to other area nonprofits in order to cut expenses.

In August 2008, Lifeworks Northwest took over Cascadia’s Gresham clinic and Central City Concern took control of a downtown clinic at Southwest 12th and Stark streets. Luke-Dorf took control of Bridgeview, a residential treatment center.

Surrendering these programs cut Cascadia’s expenses, and the nonprofit cut costs still further by consolidating office space and leaving administrative jobs unfilled.

By drawing down the county-state loan, Cascadia invested in a $250,000 medical billing system aimed at further improving the nonprofit’s finances. The system prohibits Cascadia from submitting incomplete Medicaid claims, so that it can never again be reimbursed without adequate documentation, Walker said.

These cuts are paying off for the organization, but they have also left Cascadia much smaller.

It lost $2.1 million on revenues of $55.9 million in the year ending June 30, 2008, and lost $514,000 on revenues of $42.5 million the following year. Walker expects to end this fiscal year with a surplus of at least $200,000 from a budget of $38 million.

In 2008, Cascadia provided about 80 percent of Multnomah County’s mental health services. Now it provides only 32 percent of these services.

Meanwhile, county mental health officials have undergone their own transformation aimed at avoiding more surprises like the April 2008 Cascadia meltdown.

“We have realized that we can not be in a situation where we are so dependent on a single agency,” Tinkle said.

County mental health leaders now meet quarterly with their largest nonprofit contractors, and monthly with Cascadia, to track the performance health of the nonprofits that they fund.

Jason Renaud, volunteer and secretary of the board of the Mental Health Association of Portland, applauded Cascadia Behavioral Healthcare’s turnaround, and the county’s renewed oversight.

But he also lamented a mental health system that faces stagnant funding and growing demand.

Cascadia’s front-line workers, in particular, have borne a difficult burden through this transformation.

They have not received pay hikes since 2008. With a recent increase in the portion that many pay for health insurance, a number are now taking home less than they did two years ago.

Walker also cut vacation days.

A new program that manages counselor productivity can allow some employees to boost take-home pay if they increase billings as a share of total hours worked. Though many workers have embraced the program, others grumble on the growing emphasis on money in a caring profession.

Since the nonprofit’s fiscal crisis, employees have had to accept paper checks because Cascadia does not have enough of a cash buffer to implement a direct deposit system.

But unlike the crisis of two years ago, these are challenges that observers expect Cascadia Behavioral Healthcare to survive.

“Unfortunately, any nonprofit with the county is in this boat,” Tinkle said. “Our dollars aren’t growing as fast as our personnel and expenses.”

csherwood@bizjournals.com
503-219-3420

Shenkman considering using insanity defense

By Karen Florin Day Staff Writer
Results of mental evaluation awaited

The attorney for Richard J. Shenkman is considering an insanity defense and will make a decision once he receives a report from a doctor who is evaluating his client.

Shenkman, 61, is facing a slew of criminal charges related to his divorce from ex-wife Nancy Tyler, which police said turned violent on several occasions. In March 2007, he allegedly burned down Tyler’s house in Niantic. In July 2009, police said he kidnapped his ex-wife at gunpoint and held her hostage in his South Windsor home. He torched the home after Tyler escaped, police said.

Shenkman may pursue the insanity defense in the hostage case, which is being heard in Hartford Superior Court. During an appearance Thursday, defense attorney Hugh Keefe said he would be receiving a report from the doctor who is evaluating Shenkman’s mental condition and would notify the court before Shenkman’s Aug. 26 court date if he plans to pursue the “not guilty by reason of mental disease or defect” defense. Should Shenkman pursue the insanity defense, the state may want to order its own psychological evaluation, according to proscutor Vicki L. Melchiorre.

To be found not guilty by reason of mental disease or defect in Connecticut, a judge or jury must determine the defendant “lacked substantial capacity, as a result of mental disease or defect, either to appreciate the wrongfulness of his conduct or to control his conduct within the requirements of the law.” Once that finding has been made, the person is committed to a mental facility – usually the Whiting Forensic Institute in Middletown – and is under the care of the Psychiatric Security Review Board.

Also Thursday, Judge David P. Gold authorized the release of $37,500 put up as collateral for bail by Shenkman’s brother in one of the divorce-related criminal cases. Tyler, who has not been able to collect $180,000 that a judge ordered Shenkman to pay her as part of the divorce proceedings, had objected last month to the release of the money. Melchiorre said she spoke to an attorney for Mark Shenkman, who confirmed that the money belonged to Mark Shenkman and not his brother, “even though it is being funneled to (Richard),” Melchiorre said.

New London judge Susan B. Handy revoked Shenkman’s bail in the Niantic arson case following last summer’s hostage incident. In Hartford his remaining bonds are $12.5 million for the hostage case and $100 cash for an earlier case alleging he violated a protective order that required him to have no contact with Tyler.

k.florin@theday.com

Source: http://www.theday.com/article/20100528/NWS02/305289886/-1/NWS

Bratcher stays at OSH

By SCOTTA CALLISTER

SALEM – Jessie L. Bratcher will remain at the Oregon State Hospital, the state Psychiatric Security Review Board (PSRB) has decided.

Bratcher’s confinement was the subject of an April 28 hearing before the PSRB, the state panel that now is in control of his fate.

A Grant County jury last December found Bratcher guilty except for insanity for the shooting death a John Day man, Jose Ceja Medina, in 2008. He was turned over to the jurisdiction of the PSRB for life.

Bratcher was diagnosed with post traumatic stress disorder (PTSD) stemming from his military service in Iraq.

The hearing in April was his first session before the review board. The board routinely sets hearings in such cases every two years, but Bratcher also has the right to request a hearing as often as every six months.

Grant County District Attorney Ryan Joslin, who attended the hearing, said the board had three questions to consider: Does Bratcher still have the mental disease or defect, PTSD? When the condition is active, is he a threat to the community? And could he be safely monitored in the community, rather than in the hospital?

The board said yes to the first two questions and no to the last, ruling that Bratcher should remain confined to the state hospital.

Markku Sario, Bratcher’s attorney, was seeking – at trial and before the PSRB – to have his client sent to New Directions, a secure treatment facility that specializes in veterans with PTSD. The founder of the Los Angeles-based facility for veterans even testified for the defense in Bratcher’s trial.

However, Sario said there seem to have been some changes in the management of the program since then, and he was surprised when New Directions notified the PSRB that Bratcher had not been analyzed or assessed for admission.

Sario said he’s looking into the situation, and he will continue to press for Bratcher to be sent to New Directions or some other PTSD program. He noted that the state hospital has no program focusing on PTSD.

Meanwhile, he said Bratcher is doing well at the hospital in Salem, attending group counseling and working on stress reduction techniques. His symptoms are “in remission,” Sario said.

“He’s very invested in his treatment,” he said.

Sario said that with many more Oregon veterans coming home with PTSD, after serving the nation in the Middle East, specialized programs are going to be a critical need.

source: http://www.bluemountaineagle.com/Main.asp?SectionID=1&ArticleID=23943

Still Crazy after All These Years

Paul Simon, the poet laureate of my generation, penned this phrase in his 1975 hit album of the same name. In 1843 Daniel McNaughton, in a misguided attempt to shoot Robert Peel the British Prime Minister, wounded his secretary, Edward Drummond, who died shortly after. The case spawned the first rules to apply when an accused claimed insanity as a defense to criminal conduct. The first pronouncement was, not surprisingly, known as the McNaughton Rules.

McNaughton was found “not guilty by reason of insanity” and ordered to a mental hospital for treatment. The theory behind the rule was that mental disease had robbed the accused of the ability to reason and distinguish right from wrong.

The House of Lords set forth the rule, first indicating that in criminal trials the sanity of the accused is presumed. A legal presumption requires a jury to first accept the premise as a fact. Presumptions are rebuttable, however. Under McNaughton, “the jurors ought to be told in all cases that every man is presumed to be sane, and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved to their satisfaction; and that to establish a defence on the ground of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong.”

Today the defense is codified in statutes in most states, particularly Connecticut. In recent news reports, attorneys for a man accused of murdering a Wesleyan University student have recently filed notice they intend to use the defense. Notice of the defense must be given to the prosecutor who then can seek an examination of the accused to rebut the defense.

Connecticut General Statutes, sec. 53a-13 provides: “(a) In any prosecution for an offense, it shall be an affirmative defense that the defendant, at the time he committed the proscribed act or acts, lacked substantial capacity, as a result of mental disease or defect, either to appreciate the wrongfulness of his conduct or to control his conduct within the requirements of the law.”

The burden of proving the defense and the nature of the proof needed are formidable tasks for an attorney. The defense will not apply where the mental deficiency results form the ingestion of alcohol or drugs. No will it apply to repeated anti-social behavior or compulsive gambling.

As an affirmative defense the burden rests upon the defendant to prove the defense by a preponderance of the evidence. Remember, in a criminal trial the state has the burden to prove guilt by proof beyond a reasonable doubt. In contrast, the “preponderance of the evidence” is a lesser standard which we see in civil trials. We illustrate the difference by asking jurors to imagine the scales of justice in equipoise, balanced equally. If a party tips the scales, even slightly, in its favor by its proof then it has satisfied the “preponderance” standard.

Until recent years Connecticut juries were never told the probable outcome of a verdict of Not Guilty by Reason of Insanity. They were left to speculate than an accused may end up walking the streets again. Now they are informed of the process of evaluation and commitment for treatment in a secure facility.

Release after such a finding has become increasingly more difficult. In 1975 Matthew Quintiliano, a 14 year veteran of the Stratford Police Department, shot and killed his first wife. Acquitted by reason of insanity he was released shortly after when it was found that he was “no longer a danger to himself or others.” He remarried and in 1983 murdered his second wife.

In another noteworthy case an acquittee housed at Connecticut Valley Hospital was on furlough walking the streets of Middletown when he killed a young child. Another acquittee, Leslie Turner, had been released after doctors testified that he was controlled on anti-psychotic medication. His mental disease was not cured. On his release he failed to take his medication and relapsed, killing his grandmother.

These instances have led to a very strict review by the Psychiatric Security Review Board (PSRB) before an acquittee can be released, especially, if like Paul Simon says he’s “still crazy after all these years.”

Rich Meehan is a senior partner in the law firm of Meehan, Meehan & Gavin, LLP, Bridgeport, Conn. For more information on Rich or his firm go to http://www.meehanlaw.com or http://www.ctdentalmalpracticelawyer.com, or e-mail Rich at rtm@meehanlaw.com

Source:http://blog.ctnews.com/meehan/2010/04/30/still-crazy-after-all-these-years/