The Mental Health Minute

Articles and news about mental health issues

California overhauls mental health department

Here is an article from MercuryNews.com that talks about a change in the way mental healthcare will be handled in an attempt to balance the budget.  Once again, staff to patient ratios become a focus and in this article the California governor wants mental health to be staffed in such a way as to cut staffing patterns by up to one-third of the staff.  The pilot program proposes to put more psychologists and psychiatrists with the aggressive patients, which is nice, but those are not the people who will be dealing face-to-face with the aggression.  They will be sitting in the nurse’s station during most emergent situations.

Here’s some of this article.  I suggest you click over to read the full article if this story scares you as much as it does me.

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By JUDY LIN Associated Press
Posted: 12/12/2011 11:52:37 AM PST
Updated: 12/12/2011 04:52:14 PM PST

SACRAMENTO, Calif.—California has begun transitioning its mental health services program to concentrate care on the most serious patients residing in state mental hospitals and prisons, but the cost-cutting move is raising concerns about patient care from state workers.The state announced last week it will hand off more responsibility for public mental health programs to counties as part of Gov. Jerry Brown’s ongoing push to move services to California’s local governments. The administration says the reorganization will allow the state to form a new Department of State Hospitals that focuses exclusively on 6,300 patients in state hospitals and prisons.

“We think that as a package we’re providing a set of proposals that saves money but doesn’t change the quality of care and also increases safety,” Department of Mental Health acting-chief deputy director Kathy Gaither said in an interview Monday.

Earlier this year, state mental health officials assigned a committee to come up with a plan to improve care and safety while also finding places to cut costs within the state’s mental hospital system. The committee returned with a blueprint for overhauling the department’s policies and procedures. It cuts 346 positions in the current year to save $122.6 million and eliminates 620 positions to save $193 million next year.

The administration says it does not plan layoffs because many of those positions are already vacant or can be done through attrition.

The department currently has a $1.3 billion general fund budget.Safety Now!, a coalition of psychiatric technicians, physicians and other state hospital workers, warns that the plan would reduce staffing ratios by nearly one-third.

“It is clear that only short-term monetary goals are driving the state’s decision to cut staff,” Stuart Bussey, a doctor and president of the Union of American Physicians and Dentists said in a statement. “We know that if treatment staff are cut, patient safety will certainly deteriorate further, and assaults will increase—and that will ultimately cost the state of California more money in lawsuits than these proposed cuts will save.”

The new structure reduces patient-to-staff ratios, a move state officials say is needed to cut down on the use of overtime and contract staff—the two single biggest drivers of increased hospital spending. The department plans to modify staff levels based on the patients’ needs, putting more psychologists and psychiatrists with the most serious and aggressive patients and fewer with the more stable patients.

This week the Department of Mental Health will start with a pilot program at Atascadero State Hospital to treat its most aggressive patients together. If successful, that approach could expand to the state’s four other mental hospitals, Metro, Napa, Coalinga and Patton, along with two psychiatric programs at Vacaville and Salinas Valley state prisons.

Felisa Hamman, a nurse at Atascadero State Hospital, said it’s good the state is testing out the enhanced treatment unit, but she worries about other patients with personality disorders who have assaulted staff…[read more]

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December 18, 2011 Posted by | Mental Health | , , , , , | 1 Comment

Stigma Influences Seeking Mental Health Care

Here is an article I found on BrainBlogger that I thought was a good article and so I am reposting it here.  Please visit the original site because I found many really great articles there about mental health issues.  Leave them a comment and tell them I sent you when you go.  Won’t you leave me a comment, too, and tell me what your thoughts are on this topic?

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By | Editor Shaheen E Lakhan

Stigmatization of mental health disorders leads to a decreased quality of life, missed opportunities, and lost independence for the affected individual. A new study reports that stigmatization also determines if and when people will seek mental health care for themselves.

A large population-based survey in Finland evaluated the stigmatizing attitudes about mental illness and the use of mental health services. The study used a questionnaire to explore participant’s beliefs about mental illness. They were asked to respond “yes” or “no” to a variety of statements, including “Depression is a sign of failure,” “Mental health problems are a sign of weakness and sensitivity,” and “Depression is not a real disorder.” Other questions reflected participant’s desire for social distance from others affected by mental illness, as well as attitudes toward antidepressant medication. Respondents also reported their own experiences with depression. In total, nearly 5200 people aged 15 to 80 years old completed the survey.

Stigma is a complex concept that can be divided into three main categories: perceived public stigma (the general belief that people with mental illness are stigmatized by society), personal stigma (an individual belief about mental illness), and self-stigma (an individual’s view of his own mental illness). These attitudes and beliefs are closely related to people’s knowledge and education about mental health and treatments and services for mental illnesses.

Overall, people with depression reported more social tolerance of mental illness and held more positive beliefs about antidepressant medications compared to people without depression. People with more severe depression were more likely to seek healthcare compared to those with mild to moderate cases of depression. The study showed that stigmatizing attitudes do not prevent care-seeking behavior among people with depression, but the depression must be severe enough to overcome the social and self-stigmatization…[read more here]

 

 

July 21, 2011 Posted by | Mental Health | , , , , , | 8 Comments

Special training helps city police respond safely to mental health emergencies

Werner Erhard and Associates v. Christopher Co...

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Here is a great article that talks about training for police to better respond to psychiatric emergencies.  I love the idea.  Where I have a problem is that there is funding for this training at at time when mental health services are being cut right and left.  It is great to have better educated police dealing with psychiatric patients in distress, but, if you read this article, the focus is on trying to keep psych patients out of jail.  To do this, there have to be options available for treatment; with the current cuts that may not be an option.

Please read this article and leave me a comment about your thoughts on this topic, won’t you?  Even though this article is about New London, CT; I feel this information is applicable to the entire country because we are all dealing with cutbacks and changes in our state and local areas because of the budget shortfalls.  CIT teams are remarkable and they certainly are worth having, but what do you do with the patient when all the beds are shut down?

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By Karin Crompton

Publication: The Day

Published 04/24/2011 12:00 AM
Updated 04/24/2011 01:06 AM

Early one Friday night last November, Renee Beaulieu had a family emergency.

Her stepdaughter, nearly 50 years old and a longtime alcoholic with bipolar disorder, was screaming at Beaulieu and her husband. A family discussion about entering treatment had turned into an argument and then into a one-way outburst of rage.

Beaulieu, who had anticipated the potential for conflict when her stepdaughter had come asking for help, remembered what a hot-line counselor had told her: She could always call 911.

At first put off by the idea, Beaulieu learned from the counselor that New London’s police department was trained to respond to such calls. She dialed, said she needed help with crisis intervention, and 10 minutes later two cruisers pulled up, minus the lights and sirens but accompanied by a social worker.

“It was like, a traveling social worker? Social workers make house calls?” Beaulieu said during a phone interview last week.

New London was the first police department in the state to employ a Crisis Intervention Team, or CIT, to help officers respond to calls involving people with mental illness. The city last year received about 500 calls for response to people in psychiatric crisis, according to Deputy Police Chief Marshall Segar.

Beaulieu credits city police for their handling of the incident, in which her stepdaughter, who was sober at the time, calmed down and agreed to enter treatment.

Segar said about 20 officers in New London have been trained in the CIT program, as well as a number of dispatchers. One result of the de-institutionalization of people with mental illness, Segar said, is that “law enforcement has now become the front line in dealing with people in crisis.”

First developed in Memphis, Tenn., in 1988, the CIT program trains police in the unique techniques involved in such calls. Training results in fewer injuries to officers and the people in crisis, less need for lethal force, a decrease in involuntary commitments and a reduction in officers’ time off patrol, according to the Connecticut Alliance to Benefit Law Enforcement (CABLE).

One of the program’s main goals is to prevent the unnecessary arrest and incarceration of people who belong somewhere other than prison.

“In general, there just seems to be way too many persons with mental illness taking up extra prison beds in our state,” said Mike Lawlor, a former state representative who is now the undersecretary for criminal justice policy and planning at the state Office of Policy and Management.

Lawlor said one of the reasons is that prevailing theory holds that the only way to get treatment for some people is to have them arrested and sent to jail. While that might be partly true, he said, it is expensive – about $100,00 per year per inmate, Lawlor said – and ineffective.

Crisis intervention offers a different approach.

“Part of the solution to the problem is to get police and prosecutors to make different decisions, but also a very big part of it is to make sure there are other options – not just in theory but in practice,” said Lawlor, who called New London a pioneer.

“There are ways to handle these folks without tying up a prison bed. It requires us to make sure the options are there and to make sure the criminal justice system is ready to make more targeted decisions regarding who gets arrested and prosecuted.”

Training in New London

About 30 police departments have CIT policies and another 30 are creating them, according to CABLE. The program is mainly funded by the state and overseen by the state Department of Mental Health and Addiction Services.

Former New London police Capt. Kenneth Edwards oversees the statewide training, which occurs up to five times a year. A five-day, 40-hour training program will take place at Mitchell College in June.

Training includes classroom work, role playing and “experiential learning.”

Officers listen to voices on an MP3 player, an exercise intended to mimic what a person in the midst of a psychotic episode may be hearing. The officers are given jobs to do, routine tasks like going to a store or processing a transaction at a bank.

“The officers really feel it’s quite an eye-opener in terms of understanding that perhaps when a person isn’t responding to you right away, it may not be because they’re being defiant,” said Louise Pyers, the executive director and founder of CABLE. “It may be because they’re just not hearing you.”

In 2002, New London was sued by the daughter of a man who had died five years earlier after a scuffle with police.

Police confronted Edward J. Nolan, a schizophrenic who had been in and out of the former Norwich Hospital, after receiving a report that he had been acting strangely. Nolan faced off with five New London officers in a boxing stance; he began yelling, kicking and punching at them and eventually lunged for an officer’s gun.

Nolan died of a heart attack. Several officers suffered minor injuries.

A nine-member federal jury awarded $100,000 to his daughter, according to a story in The Day in 2002, after finding that the officers violated Nolan’s civil rights and used excessive force.

Police maintained they did nothing wrong in subduing Nolan, saying he died because he had a weak heart and had stopped taking medication for his schizophrenia, which brought on a psychotic rage.

Segar, the deputy police chief, said New London’s decision to implement the CIT program was “policy-based” and not based on specific incidents.

More than 800 police officers statewide have gone through the training since the mental health agency took over after an initial federal grant.

A survey of four of the “biggest” departments, which included New London, found that 1,500 people were diverted into mental health services rather than the prison system in one year, according to Pyers.

Still, 18 percent to 20 percent of the state’s 17,600 prisoners have “significant mental health needs,” according to the state Department of Correction. Those range from a need for medication to remain stable to more serious mental health issues, said spokesman Brian Garnett.

That figure is up from 13 percent to 15 percent a decade ago.

“It’s probably a couple of things,” Garnett said. “One is more people with those needs are coming in and probably some of it is better assessment methods than we’ve used in the past.”

Social workers in cruisers

An officer’s response to a call involving a person with mental illness can be somewhat antithetical to techniques they have learned.

“It is different from the training they get in the academy, where they’re trained to have a command presence,” Pyers said. “A person with mental illness sees that, and they become frightened, much more frightened, and that’s where problems happen.”

Officers will often use a softer voice, arrive quietly on scene without lights and sirens and use different de-escalation tactics than they would with the general public.

“Nine times out of 10, a police officer, just by virtue of what they’re wearing – the uniform, the gun, the radio, all of that – can instill fear in a person with mental illness,” Pyers said. And when the fear factor rises, their ability to comply with commands (is impaired) … especially if they think (police are) going to take them away and lock them up and throw away the key.

“And as a result of that, sometimes a person might start either pushing back or resisting the officer’s advances in terms of getting them under control.”

Tabatha Maiorano and Jeff Watson, social workers from the Southeast Connecticut Mental Health Authority, are assigned to the New London, Norwich, Waterford and Groton City police departments.

Maiorano said they spend most of their time with New London and Norwich departments, spending four out of their five workdays out in the community in cruisers.

The social workers ride with officers on their shifts, checking in on people and responding to whatever calls the officer goes to. Maiorano rotates her schedule to include day, evening and weekend shifts.

“That kind of gives us a range of being able to be there during different or off times,” she said, “when facilities are closed or private places are closed and officers have trouble getting ahold of clinicians.”

Maiorano said referrals for mental health services have gone up as a result of the program, either from the social workers meeting new people at a scene or because officers…[read more]

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April 25, 2011 Posted by | Mental Health | , , , , , | 1 Comment

Texas cuts force police to care for mentally ill

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Here’s an article from Chron: Texas AP News that I just had to post here.  As a psychiatric nurse currently working in the state of Texas, this article was of some interest to me personally and professionally.  Texas is not known for its generosity in dealing with mentally ill people; so it seems that the current budget crisis is a perfect opportunity for the Texas government to squeeze even more out of this pocket–maybe even to rip this pocket out of the budget totally.

The current trend to “criminalize” the mentally ill is not okay.  Police do not have the time or the skills to deal with psychotic and delusional persons.  The police are trained to prevent crimes and not to assess a persons mental status.  My fear is that with police having to deal more and more with the mentally ill, there will be more accidental shootings or even more intended shootings.  Suicide-by-cop seems to be an acceptable method of committing suicide in the population I treat.

Please read this article and let me know your thoughts on this topic.  I am frightened for my patients and for the state of mental health care in my state.

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By SOMMER INGRAM
© 2011 The Associated Press

March 13, 2011, 10:27AM

AUSTIN, Texas — In a state that offers meager funding for mental health, law enforcement officers across Texas have performed the duties of psychologists and social workers — roles they have neither the training nor the manpower to bear.

The Texas Legislature, which has never been generous to mental health clinics, has further withered services under the strain of a strapped state budget, and as a result, police and sheriff’s departments say the number of mental health calls they respond to is snowballing.

And thanks to a new $27 billion budget crisis, it may only get worse.

Initial proposals would cut services provided by the Texas Department of State Health Services by 20 percent, making it more likely for mentally ill Texans to end up in emergency rooms, having mental breakdowns or being thrown behind bars.

“We’re about to see huge setbacks. I think we’re going to get slaughtered,” said Leon Evans, chief executive of Bexar County Mental Health Care services. “We’ve been developing some tools so people don’t have to go to the hospital and prison. But I think all these programs that are very effective, that help to reclaim lives, are at risk.”

Experts say slashing mental health funding will have a painful and resounding effect across Texas when the mentally ill can’t access the treatment and medication they need to function.

“What’s happening is the criminalization of mental illness,” said Polly Hughes, public policy chair of National Alliance on Mental Illness. “It shifts the responsibility of taking care of mental illness to the counties and officers who are already stretched thin.”

Community services such as clinics, crisis hotlines and outpatient treatment are critical to keeping the mentally ill out of state institutions and jail.

The shortage of mental hospital beds means officers often have to drive a mentally ill person hundreds of miles to the next open bed.

“What we’re facing in 2011 are law enforcement officers as de facto social workers and jails becoming asylums,” Houston Senior Police Officer Frank Webb said. “Police officers are responding to more mental illness than social workers.”

Jails are packed with mentally ill Texans who most often haven’t committed a violent crime, but cycle endlessly through the system for minor violations, costing taxpayers thousands of dollars.

Texans with a serious mental illness are eight times more likely to be incarcerated in jails than treated in hospitals, according to the National Alliance on Mental Illness. A community health care program costs $12 per day to care for a patient, compared to $137 per day to incarcerate them, the group said.

Dallas County Sheriff Lupe Valdez said mentally ill inmates cost the county the most money, with more than a third of the county jail’s 6,000 inmates requiring mental health services. The cost of housing and providing care for these inmates was nearly $19 million in 2010.

As the seventh largest in the country, the jail is already dealing with limited resources and overflowing cells.

“If community mental health services don’t get the money they need, we’re going to end up being mental health institutions. In fact, we’re already there,” Valdez said. “If we start overloading the system, we’re not going to have what we need to take care of them.”

The stream of people into jail is continuous because it’s easier to get arrested than get treatment, Webb said.

Mental health cases are becoming so prevalent that departments across the state and nation have made …[read the rest of this article here]

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April 4, 2011 Posted by | Mental Health | , , , , , | 6 Comments

States slash $1.8 billion in mental health funds since 2009

Here’s an article I found that shows how serious the situation is becoming in the state of Mental Health Care in our country.  We cannot afford to sit by and allow these cuts to continue.  Becoming an ostrich and sticking our collective heads in the sand does not fix the problem.  The mentally ill are in every community across the world and they rarely receive the help they need.  There is such a terrible need for outpatient services in our communities to actually help our mentally ill live lives of productivity instead of lives of frustration and violence.

I hope this article from USAToday is interesting to you and helps you to see the enormity of the existing problem.

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By Sophie Terbush, USA TODAY

Since 2009, state legislatures have cut $1.8 billion in non-Medicaid mental health spending, according to a report released today by the National Alliance on Mental Illness.

Vital services cut include community- and hospital-based psychiatric care, inpatient housing and access to medications for tens of thousands of adults and children living with serious mental illnesses, the report says. Deeper cuts are projected for 2011 and 2012.

“On any given day, half the people with serious mental illness in this country receive no treatment,” says Michael Fitzpatrick,

executive director of the alliance. “If you don’t have the ability to do early intervention and public education so family members, the public, police and college administrators understand what mental illness is and how to get treatment, there’s a price to pay.”

Fitzpatrick adds that the shooting of U.S. Rep. Gabrielle Giffords, D-Ariz., in Tucson has put the spotlight on the public mental health system. One important lesson learned, he says: “Get people into treatment when they need it.”

One in 17 Americans lives with a serious psychological disorder such as schizophrenia, major depression or bipolar disorder, according to the report. About one in 10 children live with a serious disorder.

The cuts from state general funds for mental health services amount to 40% of total spending, the report says.

States cutting the most of mental health budgets: Kentucky (47.5%), Alaska (35.0%), South Carolina (22.7%) and Arizona (22.7%).

But 18 states increased mental health spending, the report notes. Adding the most was Oregon, with a 23.2% increase ($71 million from 2009-2011). Others ranged from 20.9% in North Carolina and 11.2% in Idaho to 0.2% in Florida.

Services cut in 2010 include emergency hospital treatment, long-term hospitalization, clinic services and crisis intervention programs.

Law enforcement, judges and emergency rooms are becoming the front-line responders for people in crisis. “If you look at who’s in county jails and juvenile facilities, many have a mental health diagnosis,” Fitzpatrick says. “If you don’t have services available in their community, there are unintended consequences.”

For people with mental illness, the emergency department of a hospital can be an access point into the health care system, says Sandra Schneider, president of the American College of Emergency Physicians in Washington, D.C.

“Already in emergency departments, patients are waiting days and weeks to get a bed in an inpatient facility,” she says.

With fewer places for patients with mental illness to go, “while they’re not receiving psychiatric care, they are often sedated, wandering around in the emergency department waiting for the proper facility to open up a bed,” and the first available bed may be hundreds of miles away from the patient’s home, she says.

March 14, 2011 Posted by | Mental Health | , , , , , , , | 3 Comments

It’s everyone’s problem to solve

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Here is an article about unfortunate events at a mental health complex in Milwaukee.  I say “unfortunate” in that this is a totally preventable event.  However, for those involved, this event is life shattering and traumatizing.

Mental health patients and staff should, at all times, know that they are safe from exploitation and safe from physical assault.  Without safety, how do you ever expect to deliver any treatment?

We often read about violence and sexual abuse that occurs in mental health situations.  It is unforgiveable to have a staff member taking advantage of a patient; just as it is unacceptable for a staff member to be attacked by a patient.

The article below is interesting in that it is written by the director of NAMI Greater Milwaukee.  Please read this article and let me know what you think.

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When asked, regarding the Milwaukee County Mental Health Complex, “what has to happen now?” and “who is accountable?” the answers are far from simple.

As the director of NAMI Greater Milwaukee, which is the local affiliate of the National Alliance on Mental Illness, and as a Milwaukee County resident, my answers to these two questions are as follows: What has to happen now, first and foremost, is that all individuals seeking and receiving treatment at the Mental Health Complex need to be safe and need to be receiving therapeutic and recovery-focused treatment.

All employees need to be assured safety as well as receive ongoing comprehensive training regarding hospital regulations, procedures and recovery models of care. Individuals with a history of sexual assault need to be effectively monitored for the safety of patients, staff and also to ensure that therapeutic and recovery-focused care can be provided to those patients with a history of sexual assault.

Milwaukee County employees with a history of sexual misconduct need to be removed from the system of care. The State of Wisconsin’s Department of Health Services needs to increase its monitoring and oversight role, and the appropriate accreditation of the facility needs to be expedited, which will require technical assistance to implement safety and recovery-focused systems of care.

The county executive and County Board along with the State of Wisconsin needs to appropriately fund a system of mental health care that is long overdue for increases in funding, rather than decreases and mere maintenance of funding for both inpatient and community mental health services.

Last but certainly not least, area private hospitals need to greatly increase their role in providing mental health treatment by both increasing inpatient mental health beds and by increasing their funding for proactive recovery-focused community mental health services.

As a community, we need to start looking at whether having a large mental health complex is the best approach for providing mental health treatment for Milwaukee County residents.

We need to consider establishing community mental health treatment centers in several locations of our county that can provide culturally appropriate mental health services. These facilities should have the capacity to treat individuals in need of acute mental health treatment as well as individuals needing a mental health assessment and the capacity to connect or reconnect individuals to mental health services in a welcoming, safe and recovery focused environment.

The lack of insurance that covers mental health treatment is another primary reason that leads to underfunded and unsafe mental health services. Far too often, people end up in the Mental Health Complex because they do not have insurance or the type of insurance accepted by private hospitals.

The stigma associated with mental illness is the No. 1 reason that people in need of mental health services do not seek treatment. The general population needs to know that people with a mental health diagnosis are more likely to be victims of violent crimes than perpetrators and that violence by individuals with mental illnesses is no greater than those without a mental illness.

Mental illnesses are medical conditions that affect our brain functioning and thought processes. Mental illnesses are not a flaw in an individual’s character, and they are not the fault of the individual who has the illness. With access to appropriate mental health education and treatment, people can live a life of recovery by managing their illness just as a people with diabetes are able to manage their illness.

It is hopeful that there are many initiatives and partnerships currently working to ensure that the quality of our mental health and substance abuse systems of care are increased, including the recent County Board appointment of a Community Advisory Council to ensure a broad range of expertise and voices are included to assist with the issues of safety and treatment at the Mental Health Complex.

To answer the question “who is accountable?” as cliché as it may be, we all need to be held accountable. From the county executive and the staff at the Mental Health Complex, the State of Wisconsin’s Department of Health Services, area private hospitals, mental health providers and mental health advocates, including each and every one of us residing in Milwaukee County.

One in every four individuals will experience a mental illness at least once in their lifetime. People with mental illness are our mothers, fathers, brothers, sisters, grandparents, children, veterans, neighbors, co-workers, teachers, lawyers, government officials and ourselves, and if we all don’t do a better job of making sure that our mental health services are funded adequately and provided appropriately, we will continue to have series of articles that we should all be ashamed of.

Peter Hoeffel is the executive director of NAMI Greater Milwaukee, which is the local affiliate of the National Alliance on Mental Illness.

You can read the original article here

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August 31, 2010 Posted by | Mental Health | , , , | Leave a comment

Thousands strain Fort Hood’s mental health system

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Since I used to work at Darnall Army Hospital and lived in Killeen, TX for a while, this article was of interest to me.  However, I would hope that this article would be of interest to others because our troops are being affected mentally and physically by years and years of fighting two separate wars concurrently.  We need to be doing more to help these men and women who are willing to “give all” to do what their country expects of them.  Soldiers don’t make the wars, they just go where they are sent and do what they are told.  We need to be concerned for these people if and when they are allowed to return to “normal” lives again–how will they handle the transition and how will they relate to people that have not had the same experiences?

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By Gregg Zoroya, USA TODAY
FORT HOOD, Texas — Nine months after an Army psychiatrist was charged with fatally shooting 13 soldiers and wounding 30, the nation’s largest Army post can measure the toll of war in the more than 10,000 mental health evaluations, referrals or therapy sessions held every month.

About every fourth soldier here, where 48,000 troops and their families are based, has been in counseling during the past year, according to the service’s medical statistics. And the number of soldiers seeking help for combat stress, substance abuse, broken marriages or other emotional problems keeps increasing.

A common refrain by the Army’s vice chief of staff, Gen. Peter Chiarelli, is that far more soldiers suffer mental health issues than the Army anticipated. Nowhere is this more evident than at Fort Hood, where emotional problems among the soldiers threaten to overwhelm the system in place to help them.

Counselors are booked. The 12-bed inpatient psychiatric ward is full more often than not. Overflow patient-soldiers are sent to private local clinics that stay open for 10 hours a day, six days a week to meet the demand.

“We are full to the brim,” says Col. Steve Braverman, commander of the Carl R. Darnall Army Medical Center on the post.

PTSD: Hundreds of soldiers incorrectly dismissed
BUREAUCRACY: Benefits process streamlined for vets with PTSD

That doesn’t even count those soldiers reluctant to seek care because they are ashamed to admit they need help or the hundreds who find therapy outside the Army medical system, Braverman and other medical officials say.

Officials worry the problems may worsen — for the military and the country.

“If Fort Hood is representative of the Army — and 10% of the Army is assigned to Fort Hood — then if you follow the logic, our numbers should be scalable to any other post in the country,” says acting base commander Maj. Gen. William Grimsley.

“I worry that if we don’t see this through the right way over the long haul … we’re going to grow a generation of people 10 or 15 years from now who are going to be a burden on our own society,” he says. “And that’s not a good thing for the Army. That’s not a good thing for the United States.”

Statistics provided to USA TODAY by Fort Hood commanders show the explosion of mental health issues here:

•Fort Hood counselors meet with more than 4,000 mental health patients a month.

•Last year, 2,445 soldiers were diagnosed with post-traumatic stress disorder (PTSD), up from 310 in 2004.

•Every month, an average of 585 soldiers are sent to nearby private clinics contracted through the Pentagon’s TRICARE health system because Army counselors cannot handle more patients. That is up from 15 per month in 2004.

•Hundreds more see therapists “off the network” because they want their psychological problems kept secret from the Army. A free clinic in Killeen offering total discretion treated 2,000 soldiers or family members this year, many of them officers.

•Last year, 6,000 soldiers here were on anti-depressant medications and an additional 1,400 received anti-psychotic drugs.

“I don’t think we fully understand the total effect of nine years of continuous conflict on a force this size,” Chiarelli says, reacting to those statistics.

“Those numbers are pretty staggering,” says Kathy Beasley, a health care executive with the Military Officers Association of America. She wonders what will happen when those soldiers leave the military. “Do we have the supply and the people in our systems to take care of that?”

Every time more counselors are hired here, their schedules immediately fill up with patients. “It’s almost like a Field of Dreams,” Braverman says, referring to the famous line from the 1989 film about a baseball field on an Iowa farm that spontaneously draws crowds. “If you build it, they will come.”

‘Life can slowly slip away’

Staff Sgt. Josh Rivera came back from his third tour in Iraq this year eager to save his marriage.

“When a soldier is constantly gone and actually fighting, not just deploying and sitting in an office, life can slowly slip away,” says Rivera, 32, a native of the Bronx, N.Y.

IN KENTUCKY: Losses mount at Fort Campbell, Ky.

Thirty-nine cumulative months of war had left him distant from his family and confused about his role in their lives, Rivera says. All that made sense was the infantry, which he loves. Rivera resisted seeing a counselor until his marriage was in real trouble, he says.

The Army therapist who met with Rivera and his wife, Julie, gently guided them back to basics — what brought them together 10 years before, why each mattered to the other and what they wanted out of life, the couple say.

Chaplains provide marriage counseling, but for soldiers who want to see a licensed marriage counselor, the base’s social work department has two, each with a caseload of 60 couples, says Lt. Col. Nancy Ruffin, department director.

She has to refer some troubled marriages to private clinics, and not all the soldiers are willing to do that, Ruffin says.

The demand for other types of counseling also far exceeds supply. There are not enough social workers to treat soldiers suffering the emotional effect of sexual assault. Ruffin says she has one social worker, who is handling 50 cases.

Fort Hood has an intensive, three-week therapy program, followed by eight weeks of group therapy, for soldiers suffering stress-related issues, including post-traumatic stress disorder. It has a waiting list of 80 soldiers.

The child and adolescent psychiatric services at Fort Hood handle more than 1,000 visits, assessments or counseling sessions with military children each month, up from about 800 in 2004. It refers about 30 overflow cases off base each month, up from zero in 2004, the base statistics show.

Fort Hood has one of the most robust mental health programs in the Army. It has 171 behavioral health providers and 28 new hires are on the way, says Lt. Col. B. Kirk Phillips, a psychiatrist and director of mental health care at the Darnall medical center. This is up from about 50 mental health workers in 2004.

Because of war and deployments, not only are there more soldiers suffering emotional problems, they are sicker than ever and require more counseling sessions, Phillips says. Even after the latest round of hiring, Phillips says, a recent internal analysis showed the mental health staff will need an additional 58 counselors to meet the demand.

Suicides outpacing 2009

Despite the increase in mental health resources, there have been 14 confirmed or suspected suicides among Fort Hood soldiers this year. That figure outpaces 2009 and matched each of the three worst years for suicides in recent base history, 2006-2008. In June, the Army recorded 32 suicides overall, the highest monthly total since it began keeping records.

Army Sgt. Douglas Hale Jr., 26, was one of the most recent Fort Hood suicides.

On July, 6, Glenda Moss received this text message from Hale, her son: “i love u mom im so sorry i hope u and the family and god can forgive me.”

Her son had tried to kill himself in May. She feared he might try again. She immediately called the Army and then drove the 90 minutes from her home in King, Texas, to the base.

It was too late. Hale had walked into a restaurant across Highway 190 from Fort Hood, asked to use the bathroom, locked the door and shot himself in the head with a newly purchased handgun, according to a police report. He was removed from life support a few days later.

Moss knew her son was very troubled. When his second combat tour to Iraq ended in 2007 after 15 months, he was diagnosed with PTSD and severe depression, began drinking heavily, saw his marriage disintegrate and, finally, left the base without permission last year.

He was brought back to Fort Hood in May after being taken into custody by police in King for being absent without leave, his mother said. He attempted suicide in his barracks that month.

The Army sent him to a psychiatric hospital in Denton, Texas. Army doctors told him “we don’t have enough people here (at Fort Hood) to help you,” his mother recalls.

A statement released by Fort Hood in response to questions about Hale’s case says, “Space and staff shortages prevent us from treating all our patients on post. While it is our intent to treat patients within our facilities, the reality is we cannot at the present time.”

Base officials declined to discuss the specifics of Hale’s case while an Army investigation continues.

Moss says her son seemed to be in good spirits after leaving the Denton hospital following a month of treatment in June. He spent the July 4th weekend at his mother’s home before she drove him back to Fort Hood on July 5.

Moss says the Army can do more to watch over troubled soldiers like her son. “They need to do as much as they can to stop this, because if they don’t, the Army’s going to be responsible for a lot more (suicides),” she says. “I don’t want another family to have to deal with what I went through.

‘Stigma was still a problem’

After the mass killings in November, Fort Hood launched a campaign to gauge the psychological health in the community. The goal was to see how many people needed help, whether they were getting it and how many counselors were needed. Part of the effort was an online, confidential survey in February to get soldiers’ views. Troops were offered incentives such as a day off from work to participate. More than 5,000 responded.

One in four said they would be viewed as weak, treated differently or harm their careers if they admitted suffering emotional issues, says Col. William Rabena, who led the campaign. The attitude was particularly strong among majors, lieutenant colonels and full colonels.

“Stigma was still a problem,” Rabena says. [read the rest of this article here]

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August 26, 2010 Posted by | Mental Health | , , , , , | 7 Comments

Nurses fear even more ER assaults as programs cut

As a nurse, I was naturally interested in this article.  However, I feel that violence is increasing across the entire spectrum of healthcare and more people should be alarmed by it.  My mother used to tell me, “Don’t bite the hand that feeds you”.  It seems that this could be rephrased to say, “Don’t injure the hand that is trying to help you”.

As more and more budgets are being cut, mental health patients are left with fewer and fewer options.  Most go into the ER and the hospital systems, but some still go into the police/prison systems.  We all need to tell our congressmen and our state representatives that mental health issues will not go away just by taking away the funding to deal with it.  If anything, the problem will snowball and become too big to deal with if left untreated.

This is an article I found in Google News, so please feel free to go there and read more or even leave a comment.

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By JULIE CARR SMYTH (AP) – 20 hours ago

COLUMBUS, Ohio — Emergency room nurse Erin Riley suffered bruises, scratches and a chipped tooth last year from trying to pull the clamped jaws of a psychotic patient off the hand of a doctor at a suburban Cleveland hospital.

A second assault just months later was even more upsetting: She had just finished cutting the shirt off a drunken patient and was helping him into his hospital gown when he groped her.

“The patients always come first — and I don’t think anybody has a question about that — but I don’t think it has to be an either-or situation,” said Riley, a registered nurse for five years.

Violence against nurses and other medical professionals appears to be increasing around the country as the number of drug addicts, alcoholics and psychiatric patients showing up at emergency rooms climbs.

Nurses have responded, in part, by seeking tougher criminal penalties for assaults against health care workers.

“It’s come to the point where nurses are saying, `Enough is enough. The slapping, screaming and groping are not part of the job,'” said Joseph Bellino, president of the International Association for Healthcare Security and Safety, which represents professionals who manage security at hospitals.

Visits to ERs for drug- and alcohol-related incidents climbed from about 1.6 million in 2005 to nearly 2 million in 2008, according to the federal Substance Abuse and Mental Health Services Administration. From 2006 to 2008, the number of those visits resulting in violence jumped from 16,277 to 21,406, the agency said.

Nurses and experts in mental health and addiction say the problem has only been getting worse since then because of the downturn in the economy, as cash-strapped states close state hospitals, cut mental health jobs, eliminate addiction programs and curtail other services.

After her second attack in a year, Riley began pushing her hospital to put uniformed police on duty.

The American College of Emergency Physicians has recommended other safety measures, including 24-hour security guards, coded ID badges, bulletproof glass and “panic buttons” for medical staff to push. Detroit’s Henry Ford Hospital is among hospitals that have had success with metal detectors, confiscating 33 handguns, 1,324 knives, and 97 Mace sprays in the first six months of the program.

But there are practical and philosophical obstacles to locking down an ER. Bellino and others say safety begins with training health care workers to recognize signs of impending violence and defuse volatile situations with their tone of voice, their body language, even the time-outs parents use with children.

He said nurses, doctors, administrators and security guards should have a plan for working together when violence erupts. “In my opinion, every place we’ve put teamwork in, we’ve been able to de-escalate the violence and keep the staff safer,” he said.

Also, he and others said it is important to combat the notion among police, prosecutors, courts — and, at times, nurses themselves, who are often reluctant to press charges — that violence is just part of the job.

“There’s a real acceptance of violence. We’re still dealing with that really intensely,” said Donna Graves, a University of Cincinnati professor who is helping the federal government study solutions.

Robert Glover, executive director of the National Association of State Mental Health Program Directors, said economic hard times are the worst time for cuts to mental health programs because anxieties about job loss and lack of insurance increase drug and alcohol use and family fights.

“Most of them, if it’s a crisis, will end up in emergency rooms,” he said.

Vermont nurse David DeRosia, who has been attacked at work, said patients want McDonald’s-like fast service even when they visit busy emergency rooms. When they don’t get it, some lash out.

“They want to be able to pop in and get what they need immediately, when the emergency department has to see the sickest patients first,” he said. “There are many people who have unrealistic expectations they can get whatever they want immediately, and it isn’t a reality.”

What has heightened fears among nurses and other health professionals is that attacks have become more violent, Graves said. “What’s bringing attention to it now is the type of violence: the increase in guns, in weapons coming in, in drugs, the many psychiatric patients, the alcohol, the people with dementia,” she said.

Twenty-six states apply tougher penalties for assaults against on-the-job health care workers. A renewed push to stiffen punishment began the Emergency Nurses Association reported last year that more than half of 3,465 emergency nurses who participated in an anonymous, online survey had been assaulted at work.

“It came as news to me that they are one of the most assaulted professions out there,” said state Rep. Denise Driehaus, who is pushing tougher nurse-assault penalties in Ohio.

Yet bills making an assault on a nurse a felony instead of a misdemeanor failed in North Carolina and Vermont during sessions that just ended, and Virginia shunted its proposal to a state crime commission.

Rita Anderson, a former emergency nurse who pioneered efforts in New York in 1996 to make it a felony to assault a nurse, said resistance is often strong — among both nurses and law enforcement officials.

In 1999, after her jaw was dislocated by a 250-pound teenager, Anderson pursued charges under the state law she had worked hard to pass. She said police were surprised a nurse would press charges against a patient, and prosecutors were skeptical of the case.

“It doesn’t matter if you’re drunk or you’re on drugs or you’re in pain,” she said. “That doesn’t give you the right to hit another person.”

Seattle ER nurse Jeaux Rinehart had learned to get outside fast to avoid kicks, spit, scratches and punches on the job at Virginia Mason Hospital. Then one day in 2007 Rinehart didn’t move quickly enough and a junkie who had entered the ER in search of a fix smashed him in the face with a billy club. Bones broken, Rinehart sucked meals from a straw for weeks.

“A thing like that sticks in your mind to the point where it’s always there, it’s always present,” Rinehart said. “I’m on heightened alert a hundred percent of the time.”

Rinehart was attacked again in July. An intoxicated patient punched and spit on him, then threatened to come back with a gun and kill him. He is pursuing felony charges.

___

Online:

Emergency Nurses Association: http://www.ena.org

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August 11, 2010 Posted by | Mental Health | , , , | 2 Comments

Report: ‘Stigma’ at State Department for those seeking mental health treatment

Seal of the United States Department of State.
Image via Wikipedia

This article is from the Washington Post and describes the changes or lack of changes in the way the State Department treats those who seek mental health services.  After reading this, it seems that nothing has changed.

Read this article and see if you agree with me.  Let me know, won’t you?

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Josh Rogin

Foreign Policy
Thursday, August 5, 2010

The State Department is moving to improve how it handles mental health services for employees coming back from high-stress or high-threat postings, but there’s still a great deal of stigma attached to seeking this kind of help and the department needs to do more, according to a new internal report.

“Employees believe there is still a significant stigma attached to seeking mental health assistance,” the State Department Office of Inspector General (OIG) said in a report released last week. The OIG called on State to remove the stigma by issuing a high-level statement encouraging returning diplomats to use the mental health tools at their disposal.

State has been ramping up its efforts, including creating the Deployment Stress Management Program in the Office of Medical Services, and increasing the number of mental-health professionals at the ready. There is also a consultation and interview process called the “High Stress Assignment Outbrief” for when Foreign Service officers get back from the field, but less than 60 percent of those returning from Iraq and Afghanistan go through it. For other high-stress postings, the usage rate is much lower.

There are also more social workers and psychiatrists than ever at the embassies in Baghdad and Kabul, but according to the OIG it’s unclear whether there are enough. The report recommends the department survey the war zones to see if diplomats’ mental needs are being adequately addressed.

Sometimes, simply letting officers know their time abroad was appreciated can go a long way, according to the OIG.

“Some returnees felt a lack of recognition for their service,” the report stated. “The Department could consider such steps as certificates of recognition from the Secretary or more meetings between returnees and senior officials at the Department and posts.”

Here’s the link to the original article.

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August 6, 2010 Posted by | Mental Health | , , , , | 2 Comments

Girl, 16, dies during restraint at an already-troubled hospital

This is a tragic story and this death is totally unacceptable.  The problem here is that there usually are not enough staff to spend the time you really need to spend with adolescents.  The adolescent patient is very time-consuming, as they are not adults and do not fully understand the situations they find themselves in.   They rarely think before acting and sometimes they choose to act out instead of thinking.  Dealing with adolescent psychiatric patients can be both a blessing and a curse.  In my ten years working with this population, I have seen many, many success stories.  Yet it is the near-misses and the actual misses that I actually remember vividly.  Although I have never been a party to any teenager getting injured, I know that it does happen.  What do you think about this story?  Let me know if you have any information to share on this topic, won’t you?

My heart goes out to all the people involved in this tragic loss.  The child will never live her life, the family will never get to integrate her into their midst, the people who were charged with keeping her safe will have to live the rest of their lives knowing that they failed and in failing cost a young girl her life.

This article is from the St. Louis Today website.  Please visit the original article and leave them a comment if you feel like it.

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BY BLYTHE BERNHARD • bbernhard@post-dispatch.com > 314-340-8129 AND JEREMY KOHLER • jkohler@post-dispatch.com > 314-340-8337 ©2010, St. Louis Post-Dispatch | Posted: Sunday, August 1, 2010 10:00 am |

The charge nurse found Alexis Evette Richie alone in a small room at SSM DePaul Health Center, motionless and sprawled facedown on a bean bag chair.

Minutes earlier, the 16-year-old foster child had tried to hit, scratch and bite staff members in the adolescent psychiatric ward. Two aides grabbed her arms and took her down a hall and into a small room called the “quiet room.”

They held her facedown in the chair while a nurse injected a sedative into her hip. Alexis continued to struggle and then went limp.

The nurse and the two aides left without checking her pulse or making sure she was breathing.

Charge nurse Iris Blanks checked on her minutes later and didn’t think Alexis looked right. An aide helped Blanks roll the girl over. Alexis wasn’t breathing. Her pulse was faint.

It was 12 minutes after she stopped moving before anyone tried to revive Alexis. By then it was too late.

“Why did they leave her like that?” Blanks wailed over the phone to her daughter that night, according to a police report.

The “little girl,” she said, “didn’t have to die.”

The medical examiner agreed, concluding that Alexis had suffocated on the bean bag chair. Her death on Oct. 26 was ruled a homicide.

Alexis’ death came less than two years after the Bridgeton hospital had been warned by the state and federal regulators that patients weren’t safe. In January 2008, a patient with doctor’s orders for constant supervision died alone after five days in seclusion. That led to a state inquiry that uncovered instances of improperly secluding and restraining patients and failing to report deaths to authorities.

A health inspector was already investigating an operation in which a urologist removed the wrong kidney from a patient.

Last week, officials with SSM Health Care, the St. Louis-based corporation that operates DePaul and several other hospitals, said they could not speak about specific patient cases because of federal privacy laws. “The desire to defend ourselves and paint an accurate and full picture does not outweigh our patients’ right to privacy,” they said in a statement.

They said safety is the first and most basic promise that they make to patients and cited the training throughout SSM that empowers all employees to protect patient safety.

In early 2008, DePaul was required to explain to state inspectors how it would improve patient safety.

It satisfied the state by passing a full inspection. Its written improvement plan included suspending certain surgeries until surgeons earned proper credentials. DePaul also promised to continuously monitor patients in seclusion and make sure all its behavioral health employees were trained in first aid and restraining patients.

As is the case in most instances when hospitals are found to be unsafe, nothing was done to alert the public.

Even though DePaul had updated its safety procedures, many things went wrong the night Alexis died. Patients held facedown need extra care to make sure their breathing isn’t constricted, according to standards established by a national group that credentials hospitals. Failing to check on a patient after giving a sedative is a breach of basic care because the drugs can slow a patient’s breathing.

A state health inspector especially wanted to know what caused the 12-minute delay before CPR was started on Alexis.

“I don’t think they knew what to do,” one aide said.

The government found — again — that DePaul patients were in immediate jeopardy. A federal agency placed a three-paragraph legal notice in the Post-Dispatch classified section indicating that DePaul was scheduled to be “terminated” from the Medicare program because it was “not in substantial compliance with Medicare Conditions of Participation.”

There was no explanation of why.

And, once again, neither the state nor the hospital alerted the public that inspectors had determined DePaul patients might be in danger.

Errors unreported

At least two of these episodes at DePaul were so-called “never events” — a list of 28 serious errors or incidents that the health care industry agrees should never occur at a hospital, from baby abductions to wrong-site surgeries.

How often these occur nationwide is unknown. Only about half the states, including Illinois, mandate reporting of never events to state authorities.

Missouri does not, but hospitals can voluntarily report to the Missouri Center for Patient Safety, a nonprofit group in Jefferson City created to study never events. It plans to release general figures on medical mistakes — without naming hospitals or doctors — sometime next year.

Even among states that require hospitals to report never events, compliance is spotty. A report by the U.S. Inspector General for the Department of Health and Human Services in 2008 acknowledged that many errors go unreported.

Missouri health officials in the past year have found 11 cases of hospitals with such serious problems that patients were considered to be in immediate jeopardy.

While those inspection reports are public records, they are difficult to access.

The state is too strapped for cash to put its inspection reports online, said health department spokesman Kit Wagar.

It’s another way that Missouri patients are in the dark. Earlier this year, the Post-Dispatch highlighted failures of hospitals to report when they discipline doctors. Reporting of serious disciplinary actions is mandatory, yet the newspaper found just eight reports a year by Missouri hospitals, a number experts said was low.

Some states provide much more detailed information about problems at hospitals. California and Minnesota — two states that require hospitals to report never events — publish reports online that name the hospital and infraction.

“If you have routine regular public reporting, I do think that builds public trust,” said Louise Probst, executive director of the St. Louis Area Business Health Coalition, which represents local employers’ interests in the health care debate.

SSM executive Robert G. Porter said in an interview Thursday that the company would support an effort such as Minnesota’s in which there is open sharing of information by all hospitals, so long as it didn’t create a culture where people were afraid to report mistakes.

“If health care workers were fearful that any mistake they made would be automatically publicly scrutinized, what incentive would they have to openly and honestly report errors — or even near errors — so that we can learn from them and improve?” SSM said in its statement.

Becky Miller, who directs the Missouri patient-safety nonprofit group, said the issue is also about lawsuits. “A lot of these safety issues can be very litigious events, so there is a reluctance to openly talk about them and to report them,” she said.

The federal agency U.S. Centers for Medicare and Medicaid Services, or CMS, investigates most cases of an unexpected patient injury or death reported to it.

The agency’s website, Hospital Compare, has some information for patients but none about never events.

CMS has the authority to cut off federal funding to any hospital that fails to fix a serious problem, essentially shutting it down.

It rarely wields that power. Each year, CMS cuts off two to four hospitals out of more than 6,000 nationwide. No St. Louis-area hospital has ever been terminated, according to CMS; DePaul came close after Alexis’ death.

Five days in seclusion

When a patient dies during or soon after being secluded or restrained at a hospital, it’s a red flag that could signal negligence. That’s because those patients need constant supervision for their protection.

Hospitals must report the deaths to CMS as a condition of participating in Medicare and Medicaid. But DePaul didn’t report two such deaths in January 2008.

Few details are available about one of them: the death of an 87-year-old cardiac patient who had been in wrist restraints, according to an inspection report.

The second death involved a patient who was supposed to get continuous, one-on-one supervision in a room apart from other patients.

On the fifth day of seclusion, an aide reported seeing the patient, who had a history of seizures, “slithering around on the floor like a snake” and falling when he tried to stand up, according to the health inspector’s report. When the shift ended, the aide reported that the patient was asleep.

No one checked for at least 12 minutes after the aide left. A staff member on rounds found the patient dead on the floor.

The aide who had been monitoring the patient later told an investigator that it wasn’t the first time that a patient needing “one-to-one” monitoring had gone unsupervised. A nurse said the staff was short because of budget cuts.

Investigators warned that DePaul psychiatric patients were in “immediate jeopardy.” In addition to the failures involving the two deaths, the hospital did not always document reasons for restraining patients and did not always check the vital signs of restrained patients as required.

The hospital promised to review all restraint episodes every week and retrain its staff on restraints.

In their statement last week, SSM officials said they “regularly monitor and review our staffing levels to ensure we are providing safe patient care.”

A troubled life

Alexis was abused and abandoned in her short life.

Her medical and foster-care records indicate that after Missouri child-welfare officials removed her from her home at age 7, she bounced around foster homes and institutions.

Around age 11, she tried to kill herself by running into traffic. She was admitted to DePaul on Oct. 16, 2009, after stabbing a teacher at Evangelical Children’s Home with a pencil.

In therapy at DePaul, Alexis said she knew she needed to behave. She wanted to go home to her foster family in time for her 17th birthday on Nov. 4.

She could be cheerful and attentive — but was often angry or tearful, according to the records. Being around younger girls would trigger flashbacks of when she was 7 and a family friend sexually abused her.

She was constantly seeking attention, primarily from boys, and was often defiant to staff.

Staffers sometimes encouraged other patients to ignore her — a therapeutic tactic.

Nurses and aides sedated and restrained her several times during her 10-day stay.

The day before she died, Alexis removed a screw from a window panel in the nursing station, taunting workers with it. She wouldn’t calm down. An aide named Leon Harriel held her down. She got shots of two drugs, Ativan and Geodon, according to her medical records.

After she quieted, Alexis was asked whether she felt safe while she was restrained.

“Safe,” she answered.

The next night, when Harriel told Alexis to go back to the girls hall for bedtime, she cursed him and said, “I’ll kick your ass.”

He told her he was going to get a shot to calm her down. That made her angrier.  [read more here]

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August 5, 2010 Posted by | Mental Health | , , , , , | 1 Comment