Resources Page

I have added some agencies to a new resources page (tab is located at the top) on my blog home page. If you have or know of an agency that would like to be added to it please send me an email.

Mental Health Care in Idaho Prisons

The basic idea behind the article is to imagine this scenario "the Director of the agency you are interning for wants to run for political office this year. She needs to know the full story on the issue of mental health care in Idaho prisons, which will come up on the campaign trail. She has asked you to develop a written briefing on the issue, as well as make a suggestion on what side of the issue she should take. If you do a good job she will hire you to help with her campaign, as well as be on staff if she wins." 

                                                                    Introduction: Issue, Policy, Problem:  

“ At any given time in many states, one in six ( a rate three time higher than the general population) inmates are suffering from a serious mental disorder such as schizophrenia, bipolar disorder, or major depression” (Cassel, 2007) During the 1980s and early 1990s, the pace of deinstitutionalization accelerated as states realized they could save funds by closing hospital beds. In 1955 there had been 558,239 patients in the state mental hospitals; by the end of 1994, this figure had decreased to 71,619, meaning that 87 percent of the hospital beds had been closed. The fate of the discharged patients was not seen as a concern to politicians or local law enforcement officials. (Torrey, 2010) Many correctional officers and prison administrators are ill equipped to work with mentally ill prisoners. Correctional officers come into the correctional field expecting to deal with prisoners but are undertrained and under educated when it comes to dealing with serious mental illnesses.

In 2008 a state prison warehouse that Gov. C.L. "Butch" Otter wanted to turn into a 300-bed facility to house people the state deems too dangerous to themselves failed to come to fruition. Instead this warehouse was turned into a facility called Correctional Industries, a self-sustained shop that trains offenders in medium and lower level custody the ability to learn a marketable trade. Correctional Industries employs staffers to teach skills like carpentry, metal working and print services. The items that are built here are sold to the private sector for profit and the money generated is used to fund the program. While a very innovative way to generate money using the prison population, it still does not address the growing population of inmates who need psychiatric help. Instead of a dedicated facility, inmates with mental illnesses are housed in administrative segregation at the Idaho Maximum Security Institution. If they are violent or have violent tendencies they are placed in individual cells and are allowed out only one hour a day in segregated recreational yards that are 10’ by 10’ chain linked “cells”. It is important for Idaho to embrace a methodology of recovery and fund the building of a mental health facility that is staffed by those trained to deal with serious mental illness. Not to simply lock them away in a cell and hope that by medicating them they will simply be “out of sight, out of mind”.  In this analysis the scope of the issue will be identified as well as the impact this topic has on our community and state. It will also address several methods that can be implemented to provide a continued quality of life for those diagnosed with mental illness as well as move the care of mentally ill people from the hands of the Idaho Department of Corrections to the hands of trained professionals.

                                                                                           History and Scope of Issue:

     When the government began closing state-run hospitals in the 1980s, people with mental illness had nowhere to turn; many ended up in jail. With the lack space in hospitals the county jails and state prisons had no other choice but to become the default treatment center. (Staff, 2011) Prisons are overcrowded and the United States has seen a dramatic increase in incarceration rates in both state and federal institutions 2,019,234 people were incarcerated in U.S. prisons and jails by mid-2002. The federal prison population increased by 8,042 persons – 5.7%, between 2001 and 2002. State prison populations increased by 12,440 people – 1%- between 2001 and 2002. Local jail populations increased by 34,235 people – 5.4% between 2001 and 2002. Between 1995 and 2002 the average increase in the incarcerated population per year has been 3.8 % overall – 8.1% for federal prisons.
     But this is not a new issue, in 1841, Dorothea Dix brought to the Massachusetts Legislature attention that the sick and insane were "confined in this Commonwealth in cages, closets, cellars, stalls, pens! Chained, beaten with rods, lashed into obedience." After touring prisons, workhouses, almshouses, and private homes to gather evidence of appalling abuses, she made her case for state-supported care. Ultimately, she not only helped establish five hospitals in America, but also went to Europe where she successfully pleaded for human rights to Queen Victoria and the Pope. (US History, 2012)
        In 1841 Dr. John Galt took over the superintendence of the Eastern State Hospital in Williamsburg, Virginia, the first publicly supported mental state hospital. It was a triumph for the time because it was the first publicly supported hospital dedicated to the sole treatment of the mentally ill.  Dr. Galt, a pioneer in his time in the treatment and the rehabilitation of those suffering from psychological disorders introduced Moral Management Therapy This taught, as Dr. Galt said, that the mentally ill "differ from us in degree, but not in kind" and are entitled to human dignity. Dr. Galt introduced therapeutic activities and talk therapy. He was probably alone among contemporary asylum superintendents to advocate that the psychiatric hospital undertake in-house research and claimed to treat African-American patients on an equal footing with whites. Dr. Galt used restraint very sparingly (one year restraining none) and sought a calming medication to replace restraint. He dispensed opium liberally to patients in a foreshadowing of our twentieth century neuroleptics. In 1857, Dr. Galt was the first to advocate deinstitutionalization and community-based mental health care. Dr. Galt and Eastern State Hospital introduced all the components of the modern psychiatric hospital -human dignity for the mentally ill, therapeutic activities, talk therapy, calming medication, in-house research, deinstitutionalization, and community-based mental health care. (Eastern State Hospital, 2012)
      With these great advances in the care of those with mental illnesses seen almost 141 years ago, the United States and Idaho have regressed greatly due to simply put money. In the 1970 and 1980’s Ronald Reagan was governor of California he systematically began closing down mental hospitals, later as president he would cut aid for federally-funded community mental health programs. It is not a coincidence that the homeless populations in the state of California grew in the seventies and eighties. The people were put out on the street when mental hospitals started to close all over the state. (Fabian, 2004)
                                                                             Perspectives & Analysis of Policy:
      Idaho currently has two psychiatric hospitals State Hospital South in Blackfoot which provides inpatient treatment for adults and children. The hospital works in partnership with families and communities to enable clients to return to community living. The second state hospital is State Hospital North located in Orofino which is a 55-bed psychiatric hospital that provides treatment for adults in psychiatric crisis. The hospital is intended to be of short to intermediate duration with the objective of stabilizing presenting symptoms and returning the patient to community living in the shortest reasonable period of time. The commonality of these hospitals is to provide treatment for short durations of time and get them back into the community, a Band-Aid to the real problem, consistent care and consistent treatment.
      The economic downturn has made an impact on the state of Idaho and the mass unemployment has exacerbated and caused deep cuts in the economic support of public money to the care and treatment of those with mental health issues. Gov. C.L. "Butch" Otter recommended budget for the Idaho Department of Health and Welfare's mental health services division during the next fiscal year, which begins July 1, is about $32.4 million. That's down 4.6 percent from the current fiscal year and a full 19 percent less than in 2008 two years after he took office. The division of Health and Welfare has laid off or left unfilled 35 full-time positions to assist adults with mental health problems, and another 14 positions to help Idaho youth. About 450 people in the past year have been referred to out of state mental health programs or to private providers amid the staffing cuts and budget holdbacks in 2009 and 2010. (Bonner, 2011)  Idaho is sending its problems to other states instead of helping them here and allowing them to re-integrate back into society. When those who commit crimes can’t be sent away they are placed in the Idaho Department of Corrections prison system where the state becomes responsible for their daily needs.
                                                                               Impact of Policy & Analysis:
     Currently, Idaho has no published policy on the treatment of those with mental illnesses. Idaho uses many out of state resources to minimize the cost of dealing with the mentally ill. An example can be drawn from the use of the Oregon’s suicide hotline. Since Idaho does not currently have a hotline, people in crisis are directed to call the Oregon help center. Why? Simply put the state government does not have any financial obligation nor does it need to provide trained counselors or professionals to staff a state center. The State of Idaho provides state funded and operated community based mental health care services through Regional Mental Health Centers (RMHC) located in each of the seven geographical regions of the state.
                                                                Judgment:
      The idea of deinstitutionalizing mental health care and the treatment of those who suffer from mental disorders was a well-intentioned idea, the failure to provide outpatient care that revolved around the idea of recovery and the ability to return and function in society is easily one of the biggest failures of the 20^th century. Today, in many states including Idaho, the continuation of closing hospitals or limiting the number of beds by administrators and politicians are creating a problem that they either do not want to face or chose not to care. In many cases it is easy to point out problems but a harder task to offer suggestions that will change the direction social services will provide those who need the help. There are many possibilities that politicians and administrators can look at. Some of these are:

1)      Use and incorporate outpatient treatment: In order to ensure that those individuals diagnosed with a serious mental illness get the treatment they need to not return back to jail, prison or hospitals the implementation of an outpatient treatment facility is necessary. An outpatient treatment facility would provide a legal base for providers to ensure that selected seriously mental ill patients follow through with prescribed medication and treatment plans in order to remain in the community.

2)      Use Mental Health Courts:  Mental illness is a substantial contributing cause to crime in Idaho. Crimes committed by persons suffering from mental illness cause substantial losses to persons and business throughout the state and endanger public safety. In addition, millions of dollars are spent each year on the incarceration, supervision and treatment of mentally ill offenders; Mental health courts in Idaho and other jurisdictions that closely supervise and monitor mentally ill adult and juvenile offenders can oversee their treatment are an innovative alternative to incarceration for certain offenders. Such courts, which can be operated in conjunction with drug courts, have provided a cost-effective approach to addressing the mental health needs of offenders, reducing recidivism, providing community protection, easing the caseload of the courts, and alleviating the problem of increasing prison, jail and detention populations. The goal of mental health courts is to reduce the overcrowding of jails and prisons, to reduce alcohol and drug abuse and dependency among criminal and juvenile offenders, to hold offenders accountable, to reduce recidivism, and to promote effective interaction and use of resources among the courts, justice system personnel and community agencies. (State of Idaho Judicial Branch, 2012)

3)      Shift state fund:   Idaho has the capability to require all county departments of mental health, such as the Department of Health and Welfare, to pay IDOC for all cost associated with treatment of seriously mentally ill prison inmates. This would ease some of the problems IDOC has faced financially over the last few years. As of FY11 the Idaho Department of Corrections (IDOC) has had to handle multiple adversities that have resulted in staff furloughs (un-paid time off), a 23% correctional officer turnover rate and the costs associated with initially training correctional officer at the Peace Officer Standards and Training academy. To illustrate the low priority that Idaho places on the care and rehabilitation of those with mental disorders one needs only to look at Key Strategic Initiatives for FY12 (Correction, 2011) listed on their website. These initiatives are listed in order of importance as stated by IDOC administrators:

1. Reduce staff turnover

2. Population management through the Manage All Populations (MAP) group

3. Substance use disorder services implementation

4. Sex Offender Management Board implementation

5. Secure mental health facility development

6. Management and leadership development

7. Commitment to Quality, quality assurance initiative

4)  Reform treatment laws: Begin with developing and implementing a mandate that provides dedicated treatment for offenders and those individuals that are incarcerated with serious mental disorders. This policy can focus on treatment interventions that can be based on need for treatment standards rather than on dangerousness. The idea of this is to allow mentally ill individuals the ability to seek treatment before they commit a crime, not after. (Torrey, 2010.

There are no guarantees that those incarcerated with serious mental illness will receive any treatment beyond that which is required by federal law. Nor is there any guarantee that by providing treatment in state hospitals will prevent recidivism, crime or even rehabilitation. But the state of Idaho owes it to its citizens to protect them while maintaining the human dignity for the mentally ill. Those with mental illness live in our communities, they shop at our stores, and they may even live next door to you. It is important to provide a way for them to receive the help they need before they commit a crime or become dangerous to those around them.

Military Suicide: Help for Families Worried About Their Service Member

By Alexandra Sifferlin

In this week’s TIME cover story, “One a Day” (available to subscribers here), journalists Mark Thompson and Nancy Gibbs explore why suicides among the U.S. military have reached crisis levels. Every day, one active-duty service member dies by his own hand, the authors note: “The U.S. military seldom meets an enemy it cannot target, cannot crush, cannot put a fence around or drive a tank across. But it has not been ale to defeat or contain the epidemic of suicides among its troops.”

The specific triggers for suicide are unique to each soldier. Each person deals differently with the stresses of war, frequent deployments, separation from family, death of comrades. Many contend with depression and post-traumatic stress upon returning home. There are several programs and support lines for these soldiers, but it also helps for their immediate families to remain vigilant and to monitor their behavior. Even still, many service members fall through the cracks.

Below is what we hope is helpful advice for military spouses, who want to know what warning signs to look for in their service member and how best to handle severe situations. One immediate sign, say experts, is a pervasive sense of uselessness, a feeling that they no longer belong. “What we learn from our families [who lost service family members to suicide] and what they saw in their loved ones, is behavior [in which they] pulled back and felt they were not able to be a useful part of unit that relied on them,” says Bonnie Carroll, founder and chairman of the Tragedy Assistance Program for Survivors, or TAPS, a non-profit that supports those who have lost a loved one in the military. “These men and women need to know they are still a part of a unit at home and overseas.”

Here, experts offer more answers to common questions that military families face when a loved one shows signs of trouble:

What are the signs of suicide risk to look out for?
There are many signs of suicide, says Kim Ruocco, director of the suicide prevention programs at TAPS. Some key warning signs to look out for:

• Hopelessness and saying things like “This will never get better”
• Helplessness and saying things like “I can’t do anything about this”
• No longer finding joy in things they once enjoyed
• Angry outbursts and increased agitation
• Sleeplessness or oversleeping
• Lack of appetite or increased appetite
• Withdrawal from friends and family, or suggestions that family would be better off without them
• History of suicide attempt and history of depression
• Post-traumatic injury

Warning signs of suicide that call for immediate attention:

• Talking about or making plans to take his or her own life
• Putting personal affairs in order
• Giving away personal possessions
• Obsessing about death
• Abusing drugs or alcohol
• Acquiring or obtaining access to lethal means (prescription drugs, weapons, etc.)
• Engaging in out-of-the-ordinary or risky behaviors

“You should always ask someone if they are thinking of killing themselves and if they are, do not leave them alone, escort them to help, take them to a doctor at primary care, behavioral health or the emergency room,” says Ruocco. “Sometimes a person will deny thinking of suicide despite warning signs. These people should also be considered high risk and be taken for immediate evaluation.”

Whom should I contact if I’m concerned about my loved one?
The first person to speak with is your loved one. Ask your he or she is feeling, says Eileen M. Lainez, a spokeswoman for the U.S. Department of Defense. For example: Do you feel as if you could harm yourself? How often are you having those kinds of thoughts? Do you have a plan to harm yourself?

“Keep track of all conversations with a service member who expresses any indication that he or she could harm him or herself, or is experiencing unique or intense stressors,” says Lainez.

There are several 24/7 service lines open to family members who have immediate concerns:

• Military Crisis Line: Dial 800-273-8255 (press 1 for military) or visit the crisis line online, which provides a chat and text service for veterans (see below) and active duty members
• Veterans Crisis Line: Visit Veterans Live Chat or call 800-273-TALK to talk with a crisis counselor
• DCoE Outreach Center: Visit Real Warriors Live Chat or call 866-966-1020 to talk with a health resource consultant
• Military OneSource: Call 800-342-9647 for one-on-one counseling or visit online
• Do not hesitate to call 911 in an emergency

Should I alert the military if my loved one is showing signs of suicide at home?
Anyone concerned about a service member for any reason should not hesitate to contact that service member’s supervisor, commander, any health-care provider or a chaplain. “If the family member is looking for behavioral health support, information or resources, they should contact [these individuals]. The earlier an adjustment or behavioral health issue is identified and addressed, the more likely a positive outcome will result,” says Lainez.

Is there anything I shouldn’t do?
Don’t be afraid to be proactive: Ask your loved one questions about suicidal thoughts or plans, and do not hesitate to get help. “Suicidal thoughts can be a medical emergency. Someone who has been thinking about suicide over time can lose the ability to control the impulse. Put aside fears of betraying your loved one or ruining his [or her] career and chose to save his [or her] life,” says Ruocco.

Should I be more concerned if my loved one has been overseas for several tours, or less concerned if he or she hasn’t?
There are many factors associated with suicide, which make it difficult to point to any one factor as a root cause. Currently, there is no evidence directly linking the number of deployments to an increased risk of suicide. Any warning signs of suicide should be taken seriously, regardless of the number of times the service member has been deployed overseas.

“Combat exposure can increase risk for suicide, especially if the service member was exposed to trauma or suffered a concussive injury,” says Ruocco. “However, about half of our service members who die by suicide have never deployed, so the fact that they have not deployed should not be a reason to not seek treatment.” The 2010 Department of Defense Suicide Event Report found that indeed half of all service members who died by suicide during 2010 had never been deployed to Iraq or Afghanistan.

What can I do to support my soldier and help prevent suicide risk?
Real Warriors, a campaign started by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) to promote recovery and resilience among returning service members, suggests that you encourage and help your loved one do the following:

• Cut back on obligations when possible and set reasonable schedules for goals
• Consider keeping a journal to express pain, anger, fear or other emotions
• Avoid isolation — get together with buddies, commanding officers, family, friends or other members of the community regularly
• Stay physically fit by eating healthy foods and getting enough sleep
• Stay motivated by keeping personal and career goals in mind
• Use relaxation techniques to help manage stress
• Stay organized by keeping a daily schedule of tasks and activities

There are plenty of mental-health resources out there, but here are a few we highly recommended for service members and their families:

• U.S. National Suicide & Crisis Hotlines: http://suicidehotlines.com/national.html
• U.S. Army Suicide Prevention: http://www.armyg1.army.mil/hr/suicide/
• Real Warriors suicide prevention: http://www.realwarriors.net/family/support/preventsuicide.php
• U.S. Department of Veterans Affairs suicide prevention: http://www.mentalhealth.va.gov/suicide_prevention/
• Tragedy Assistance Program for Survivors, for families who have lost a loved one in uniform to suicide: http://www.taps.org/survivors/survivor.aspx?id=6320

Read the full TIME cover story, available to subscribers here.

Battling BARE

Found this on Facebook from a group called Battling BARE . I think it is great that people are becoming more attentive towards our soldiers and the invisible wounds they suffer from.

 

Broken by battle,
Wounded by war,
My love is FOREVER.....
To this I Swore,
I will quiet your silent screams,
... Help heal shattered souls, Until once again MY LOVE,
You are Whole.......
 

 

On another note I have been receiving some great e-mails from friends throughout the community on my educational and professional endeavors and I just want to thank you all for all the support and encouragement each of you give me. Trust is something that veterans do not give very lightly because it is something that is earned through sharing hardships and building a bond that is forever. Somehow I think that the VA has forgotten this. Trust is what I am going to bring to my community of Veterans here in Boise. Trust that someone cares and someone really wants to see them get better.

 

I was talking with a real good friend of mine this weekend and he brought up a great point about the need to communicate and I began to think about how Veterans who may have never met before can meet for the first time and just start talking. I think it is great and I enjoy every person that I meet and try and encourage and support wellness.

 

Although times are trying for some do not forget that you have a friend here in the Gem state that is willing to listen to you.

 

 

WRAP for Veterans and People in the Military

The process of recovery begins with you, but you don't have to do it alone!!!

I am currently attending a program that will certify me to conduct the Wellness Recovery Action Plan (WRAP) for veterans I serve.

If you are on active duty, in the reserves, or have been in the military, you may be having a hard time coping with the hardship, trauma, and loss related to military service and being involved in war-related activities. You may have feelings and experiences that are extremely upsetting, feelings that keep you from being the way you want to be and doing the things you want to do. In addition, things may be happening in your life that are difficult to deal with. Family members and friends, who don’t understand what you are experiencing and why you are behaving the way you are, may not know how to respond or how to help. Some may try to help and others may turn away. You may feel like the situation is hopeless - that you will never feel well and enjoy life again.
The Wellness Recovery Action Plan can help you in the process of recovery, of getting well and staying well, and of assisting you in becoming who you want to be and making your life the way you want it. It will also be helpful to you in adapting to any challenges you have in your life like chronic illness, serious disability, being on active duty, or dealing with extreme loss or grief.

This online version of the Wellness Recovery Action Plan (WRAP) is specifically oriented for people who are in the military or have been in the military. There are video clips with Mary Ellen Copeland talking to veterans as they are developing their WRAPs. This WRAP is private and can be accessed at any time. You can make changes to it whenever you want and e-mail it to anyone you choose. WRAP can help with coordinating daily living as well as larger issued like depression and PTSD. This version of WRAP is very convenient for military personnel and is friendly, easy, and empowering. https://wrap.essentiallearning.com/Default.aspx?ReturnUrl=%2f

After my certification I hope to begin providing classes specifically for veterans in Idaho that will help them develop a personal WRAP as well help them start down the road of recovery.

Call me at Riverside Rehab, Inc. (208) 853-8536 and I will help you with your WRAP in my veteran services department.

Did you know that:

• More than 42 million American men and women have served in a time of war
• Current Projected U.S. Veterans Population: 23,442,000
• There are between 529,000 and 840,000 veterans who are homeless at some time during the year, that’s 23% of the homeless population
• 89% of homeless veterans received Honorable Discharges
• 33% of homeless veterans served in a war zone
• Each year between 375,000 – 600,000 homeless veterans receive no assistance
• 6 million veterans are living with a disability
• 45% of veterans need help finding a job
• 37% of veterans need help finding housing
• Number of Veterans with for Post Traumatic Stress Disorder (as of 09/30/08): 342,624

IF you dream it WILL they come?

In an effort to continue to serve my fellow veterans I have been afforded an opportunity that I do not think many veterans or people in general get.
I have been offered the opportunity to open a department at the company I work for Riverside Rehab., http://www.riversiderehab.net/ that deals directly with veterans and links them to community resources such as housing, health care, employment assistance, financial resources and advocacy. The primary purpose is to prevent homelessness, hospitilization, or incarceration.
Most importantly it will bridge the gap between the VA and the veterans home since I can see the veteran every week for regular sessions. I can contuing to supplement the care that the VA is able to provide. With such things as Reduced Rate Counseling, Medications Managment, Finanacial / Payee Services and Targeted Service Coordination.

I am excited about taking on this endevor and I am also hestitent because I have never attempted something like this before. But if I have learned one thing from the military it is to "never quit" and to "never leave a fallen commrade". I hope that I can help my fellow warriors, as well, as make this a success venture.

Military instructor suspended over Islam course

WASHINGTON | Wed Jun 20, 2012 10:58am EDT

WASHINGTON (Reuters) - The instructor of a college course that taught top military officers the United States was at war with Islam has been relieved of teaching duties and the course ordered redesigned to reflect U.S. policy, a military spokesman said on Wednesday.

The elective course at the National Defense University's Joint Forces Staff College included a slide that asserted "the United States is at war with Islam and we ought to just recognize that we are war with Islam," Pentagon officials said in April as they launched a review of the course.

Colonel David Lapan, a spokesman for the chairman of the Joint Chiefs of Staff, said on Wednesday a review of the course found that "institutional failures and in oversight and judgment" led to the course being modified over time in a way "that portrayed Islam almost entirely in a negative way."

"The inquiry recommends the course be redesigned to include aspects of U.S. policy and reduce its reliance on external instruction," Lapan said in a statement. It also recommended improving oversight of course curricula.

"The elective course's military instructor has been relieved of his instructor duties until his permanent change of station, which was previously planned for 2012," Lapan said.

The inquiry also recommended a review of actions by two civilian employees of the staff college to see if disciplinary action was warranted. A second military officer will receive administrative counseling, Lapan said.

General Martin Dempsey, chairman of the Joint Chiefs, ordered the review of the course on Islam and military education in general after a soldier complained about the content of the course entitled "Perspectives on Islam and Islamite Radicalism" at the Joint Forces Staff College in Norfolk, Virginia.

Navy Captain John Kirby, a Pentagon spokesman, said in April that Defense Secretary Leon Panetta was deeply concerned about some of the materials being taught in the course, such as the slide suggesting the United States was at war with Islam.

"That's not at all what we believe to be the case. We're at war against terrorism, specifically al Qaeda, who has a warped view of the Islamic faith," Kirby said.

Discovery of the course material embarrassed the military at a time when U.S. officials were trying to mend U.S. ties with the Muslim world following a spate of incidents in Afghanistan, including the burning of copies of the Koran and pictures showing U.S. soldiers posing with corpses of Afghans. (Reporting by David Alexander; Editing by Vicki Allen)