Finally....

So after 15 months of waiting I am finally being seen and scheduled for appoinments through the VA. This has been a long year, with some good and some bad twists. But more to follow on that I have an appoinmnet to get too!!

Need some research help from you!!!

I am currently conducting research on a question regarding the effectiveness of pre / post deployment psychological assessments performed by the military for one of my graduate classes at the University of Southern California and I could use some help from those voices tat have gone through it like myself. I want to make sure that my experiences are similar or different from your. The last post deployment brief I went through was in June 2011 so I know some things may have changed since my retirement, which is why I am asking for your help.

My question is:

"Are the current pre-deployment / post-deployment psychological screenings effective in identifying mental health problems in Soldiers?"

I would like your opinion and what you think should be changed to make it better. If you know or have access to any empirical research / or any research on the subject PLEASE forward it too me.

 

Thank you all and I will post this research after I complete it on the blog.

 

 

A Letter Home



CPT John Hallett Afghanistan 2009

 

SPC Dennis Williams, Driver Afghanistan 2009

I wanted to share with all of you a letter I wrote to Cynthia on 18 September 2009. About three weeks after the death of my Company Commander Captain John Hallett, his driver SPC Dennis Williams, our Battalion Physicians Assistant CPT Cory Jenkins and our Battalion Senior Medic SFC Ronald Sawyer.

SFC Sawyer with his niece Emma and his 20 month old son Daniel
picture courtesy of Iraqiwarheros.com

    "Just wanted to write you a letter and say I love you and miss you very much. Things are going good here and I don't want you to worry. I remember you told me I could write you about things here that were happening and how I felt during the situation and the things I did. Well I figured that now would be a good time to tell you about something. It is therapeutic right?

I have been reading a lot going to bed around 0100 or 0130. It is funny how when I am home I never really buy anything for myself and now that I am in Afghanistan I am Amazon biggest customer. I always have that feeling that I should read all the books I can in case, well, you know.

I wanted to write you and tell you about what happened on 25 August. This is probably the hardest thing I have had to do, actually write to you about it.

The patrol we were on went to the Shah Wali Kot district center to do a Key Leader Engagement with he leaders then conduct an assessment of the medical clinic in the village. We left that morning at 0800. I had two medics in my MRAPand cross loaded CPT Jenkins and SFC Sawyer into CPT Hallett's Stryker. We departed the FOB and headed north to Shah Wali Kot. When we got there I got out with CPT Hallett and we talked a little bit (he was sick) as we walked up to the district center to meet with the police chief and ask about the clinic that was about 1/2 mile away. We left and went to the clinic and we were there for about hour. During this time CPT Jenkins and SFC Sawyer look at the facility and even treated a few people that were there.

CPT Cory Jenkins

As we mounted back up to head to the Forward Operating Base (FOB) I had move forward in my MRAP and got onto the road. We had 2 Mortar vehicles, the HHC commander, my vehicle and CPT Halletts vehicle so five total vehicles. 51 was already ont he road and pushed forward, the road was very narrow and the strykers could not pass me so I called CPT Hallett and said the order of movement would be 51, me, HHC 6, A66 9CPT Hallet's vehicle and 52 picking up the rear. We left and headed to the OB. As we were driving I heard a big "Boom" and the radio came to life. HHC 6 called me and said "IED hit" I immediately looked in the rear view mirror and saw a huge pillar of smoke rising in the air. I immediately told my driver to turn around and drove past HHC 6 towards the the vehicle that was hit by the IED. I saw it was A66. The scene was horrific the vehicle was flipped over and the back end now faced the direction we were traveling.

Out of the back door I could see a leg hanging out like someone was lying down in the back. I dismounted and ran to the vehicle. I did not know if anybody was with me but I knew we had little time if we were going to save anyone. My biggest fear was that it was going to explode. In retrospect I should have been worried about the enemy ambushing us with small arms fire. But I did not think about it. I ran up to the vehicle and the fire inside was spreading and the smoke was rolling out of the vehicle. I got inside and someone was yelling for help. I could not see any further than about 2 inches in front of my face. I was choking from the smoke and could feel the fire on my face. I heard someone yelling and could see SPC Pannel crawling through the smoke towards me his head was bleeding so I grabbed his vest handle and pull him out of the stryker. At this time SPC Chaney (my company medic) and SSG Banuelos (my HQ PSG) took care of him and began to take off his gear. I went back to the stryker to find my friend and commander CPT Hallett.

I saw an arm under the back part of the Stryker and knew that was CPT Jenkins. I got back into the Stryker now with SSG Banuelos with me and the .50 cal rounds were now starting to cook off and we could hear them exploding outside the Stryker. SSG Banuelos and I tried to get SFC Sawyer out of the vehicle but the fire was intensifying and I knew that it would be only minuets before the AT-4 (Anti-Tank Missile) would explode causing in effect more casualties. So I pulled everyone back away from the vehicle. I was mad because I could not find CPT Hallett............

SPC Pannell was air medevac'd I I helped carry him to the bird shielding his face from the flying debre and placed him on the bird.

When I got back I started to think about what happened and that CPT Hallet's vehicle was in the spot of the convoy I was supposed to be in. I feel bad like maybe I had something to do with this tragic event and was the cause of many deaths that day. I gathered the company and told them the news as I fought to hold back my tears. After things had settled down I sat and watched while members of the company started to pack up CPT Hallet's belongings, my thoughts went to his new born daughter that he was talking about at dinner the night before.

I can't explain how I felt losing my friend. How helpless I felt watching that Stryker burn and knowing my friend and other Soldiers were in it. I still think about this at night went it is quiet and I know that I could not have saved them without jeopardizing the lives of even more Soldiers. Did I do the right thing? Did I do EVERYTHING I could? I have held my feelings in for this long and try to remain strong and focused for the Soldiers and the leaders of the company, but I never thought it would be this hard again. After Iraq and all the fighting we did in Mosul I thought I had become hardened by battle but the feelings just resurface with every death.

But I am doing it baby and I could not have asked for a better group of Soldiers and Leaders. I just wanted to write you and let you know what happens and courage our young men display every day they are here. The impossible tasks that they are asked to perform everyday. But they put there fears aside and continue the mission.

Even through this ugliness goes on I still know that I have an angel waiting for me at home. I want you to know that I WILL be home soon and give hugs and many kisses.

Gene

This is a letter I know that there were many hero's that day and I write this a tribute to all of those involved. Thank you all for letting me tell you about an event I still think of everyday.

LT Kim XO, me, and CPT Hallett NTC

   

The first of many but a life time of memories

In December of 2008 I was given the privilege to be promoted to First Sergeant and given the equal privilege to be placed as an Infantry First Sergeant to my friend Captain John Hallett In A Company 1st battalion, 17th Infantry. Being the new "kids on the block" to some other seasoned command teams we shared a command vision that helped us become successful in combat and to overcome some very trying times in our deployment.
I remember John calling me on a Saturday and asking me to meet him at a Denny's in Lakewood for breakfast so that we could discuss our plans for training and to share our philosophy of leadership. I will talk more about John later. In this post I just wanted to share a remembrance of SGT Troy O. Tom.


SGT Tom was one the first Soldiers I met when I toured the company my first day and I just remember his huge smile. A soft spoken leader who rarely raised his voice because his actions spoke even louder. He led by example and touched many of us with his genuine concern and love of his Soldiers and the respect of his leaders.

SGT Tom was killed on August 18, 2009, he would be the first Soldier that A Company 1-17th would lose during the deployment. 3rd Platoon "Dirty Pirates" were attached to another company in the Arghandab Valley. I rememeber sitting down to write his mother a letter, one of the hardest things I have had to do.

SGT Tom thank you for you service and you will never be forgotten...Attu 7

Xavier Mascare–as/The Daily Times; Army Sgt. Troy Orion Tom's mother accepts the flag that was covering his casket from Brig. Gen. Kurt Story on Wednesday at the burial at Farmington's Greenlawn Cemetery following his memorial at the Farmington Civic Center.

Xavier Mascare–as/The Daily Times



SGT Tom being carried to his final resting site.Xavier Mascare–as/The Daily Times

Military bonds draw veterans to mental health jobs

As a graduate student working towards my Masters Degree in Social Work degree I can honestly say that I truely want to help Veterans and their families. I also believe that it is important that a Vet help a Vet because there is a common bond between the two "SERVICE". I am reminded of a saying that "For those who fought for it, freedom has a taste the protected will never know." 

1SG Gene Hicks Helmand, Afghanistan

 By Maria LaMagna, Special to CNN

(CNN) -- Things probably should have turned out differently for Samantha Schilling.  The stories she tells have dark beginnings and could have had, under different circumstances, dark endings -- as so many stories for those in the military do. Schilling, now 31, served in the U.S. Navy from 1999 to 2003. She was never deployed but worked as an information systems technician at Naval Station Norfolk in Virginia.

Several of her friends were killed during the 2000 al Qaeda bombing of the USS Cole in Yemen, which left 17 dead and at least 37 injured. Some of the injured were transferred to her base in Norfolk. Many of the survivors suffered from mental trauma after the bombing. One of them, a man who had been aboard the ship, attacked Schilling and attempted to rape her. That assault drove home the impact that active duty had on her colleagues' mental state. "I experienced military sexual trauma, and that just inspired me," she said. "Coming back into civilian life, you're not the same person you were in the military. ... You carry with you all these burdens, all these stressors."  

Schilling was released from service with an honorable medical discharge in 2003. Since that time, she has taken on a personal mission to help others who need counseling after military service. She's nearly completed a masters in a joint military psychology and neuropsychology program at the Adler School of Professional Psychology in Chicago and plans to finish her doctorate degree in 2015.
"I'm determined to be able to be helpful to others," she said. "Helping others helps me. ... I think therapy can help people adapt to civilian life again instead of maladapt. People who have PTSD and other (issues) can maladapt and cause trouble in the civilian world."

It's no secret the U.S. military has struggled to adequately support its troops after they leave active duty.

A large number of service members suffer from post-traumatic stress disorder (PTSD). An estimated 11% to 20% of veterans returning from the Iraq and Afghanistan wars suffer from the condition, according to the U.S. Department of Veterans Affairs.

That's between 220,000 and 400,000 of the 2 million troops deployed since the September 11 terrorist attacks.

A new study shows that only about half of U.S. service members deployed to Iraq and Afghanistan diagnosed with PTSD received any treatment for it.

And statistics from the U.S. Department of Veterans Affairs show that about 18 veterans commit suicide every day.

The VA has stepped up efforts to expand care and recently announced plans to hire 1,600 more mental health professionals and 300 support staff members to help meet the increasing demand for services.
But some former active-duty service members aren't waiting for help to arrive. Veterans have turned to psychology to become mental health professionals, and they're filling in gaps in veteran care that government and civilian efforts have left open. And while they are still rare, programs to train them are slowly emerging at universities and nonprofit organizations around the United States.
                                           "It's just going to increase and increase"

Born a year ago with funding from the Department of Veteran Services in Massachusetts, a program through the Massachusetts School of Professional Psychology called Train Vets to Treat Vets has recently picked up steam. It has several goals: mentoring new veterans, providing services to at-risk and homeless veterans, and educating the public about ways they can help.

"As the stigma (of seeking professional mental health treatment) breaks down more and more, and more veterans are willing to come into treatment, (the need) is just going to increase and increase," said Robert Chester, 25, who served in the National Guard for six years and became a student at the Massachusetts School of Professional Psychology.

"That's why we want to get more veterans into mental health, both to break down the stigma and get more clinicians out there."

Chester is now an admissions assistant at Train Vets to Treat Vets.

Starting the program was a joint effort between the Massachusetts Department of Veterans' Services and veterans (Chester and colleagues Greg Matos and Norman Tippens) who are also students at at the school.

"We, as the veteran students, wanted to see that we could create more of a military cohort at our school," Chester said. "We really wanted to put something together where we can help our fellow veterans by providing mental health services in that specific way."

Since the program's start, Chester has fielded e-mails every day from veterans who want to get involved. Six will enroll in the school's fall class.

Massachusetts School of Professional Psychology President Nick Covino says the idea for the program came from a Latino mental health program the school began about eight years ago.

"It was clear that folks who wanted to talk about emotional issues ... want to talk about emotional issues with somebody that understands their culture and probably want to do it with somebody that's from their culture," Covino said. "It was a natural extension to think about returning veterans."

Having student veterans in the program has been beneficial not only to the veterans it has helped but to non-veteran graduate students who want to specialize in veteran care.

From casual conversations to exchanging papers and working on doctoral projects together, a collaboration between veteran and non-veteran students is "radically changing the academic culture of our learning community," Covino said.

                                                            Laptop battlefield

Leaning over an occasionally beeping laptop in a downtown Chicago office building, Robert Kyle rolls up the sleeves of a blue button-down shirt to reveal heavily tattooed forearms. On one, a drawing that looks like the Grim Reaper. On the other, columns of initials. There are so many, his arm is more ink than skin. He explains that they're the initials of friends who died alongside him while deployed in Afghanistan and Iraq. There are 53, he says. But there are more to add he hasn't gotten around to yet.

Kyle, who goes by his first and middle name online for security reasons, has his own set of challenges. At 26, he has survived three deployments and sustained a traumatic brain injury. He enlisted in the Army when he was 17 and served from 2003 to 2009.

Although he still carries burdens from his deployment, since his return, he hasn't forgotten about his military family. Some, he knows personally; others, he's only met through that beeping laptop. He has dedicated his life to helping veterans connect to one another and improve their mental health.

Kyle works as a peer coach at Vets Prevail, a free online forum and multistep mental health program. It was founded in 2009 by a small group of professionals, almost all of them veterans.

While working as a peer coach, Kyle is pursuing a graduate degree in psychology from DePaul University.

Six salaried professionals work at Vets Prevail, as well as three peer coaches who directly interact with veterans online. Although the peer coaches are not doctors, they complete a training process, and most important, Kyle says, they have all served on active duty.

"When they hear that you have done what they've done, (veterans) tend to open up more than someone that has never been in a combat zone. That opens a little more trust," Kyle says. "Veterans are doing this for veterans."

Kyle retired from service in 2009 after his injury and went back to school, earning a degree in psychology from Lees-McRae College in North Carolina.

Since that time, he has worked to develop Vets Prevail. Now, more than 8,000 veterans from about 5,000 ZIP codes turn to the site to chat and learn coping mechanisms, and membership is rapidly increasing.

Justin Savage, a 32-year-old Army veteran who works as the head of program development for Vets Prevail, says a large part of that success is the users' assurance that the experts on the other side of the computer screen are speaking their language.

"We live and breathe accountability," said Savage, who returned from Iraq in 2005. "Having vets do it really brings a new level."

                                                                         "A really good fit"

It makes sense that veterans would want to become mental health professionals, psychologist Joe Troiani says. In a military culture built on camaraderie, the desire to help a fellow veteran is natural and powerful.

Troiani, an associate professor at the Adler School of Professional Psychology, where Schilling is a student, is also a retired Navy commander and is determined to ensure that veterans get the help they need.

"If I was in trouble, I could pick up the phone and call some of my veteran friends," Troiani said. "You and I could have served together, and I have your back, you have my back. If something happens to you, I'm going to make sure that your family is taken care of."

The Adler School offers training for a new post-doctorate specialty called "military clinical psychology" and since the program's start two years ago has trained about 20 students per class. The need is greater, but 20 is the cutoff to ensure the best training, Troiani says.

Entering the mental health field can be "a really good fit personality-wise" for veterans, says Bret Moore, a former active-duty Army psychologist who completed two tours in Iraq.

"(Service members) want to protect and help people get through difficult times," Moore said. "That's really what a psychologist does: helps people who are more vulnerable, or not as strong in a certain sense, get through difficult times."

Taking responsibility for another human life is a familiar duty for veterans, Covino says.

"To have been in situations where they've needed to rely on judgment and develop a capacity for reflection, an ability to act autonomously and courageously. ... Those are qualities of character you can't teach," Covino said.
                                                               "They haven't experienced it"

Jon Neely, a 45-year-old living in Springfield, Illinois, has been using Vets Prevail for several months and says he logs on for about an hour every week, though when he first began using it, he logged on every day. Neely served in Kosovo from 1999 to 2000 and retired from the military in 2005.

"All too often, you go seek help from somebody that is book-learned, but they don't understand," he said. "They don't know. To me, getting help or seeking help from a non-veteran is like going to a marriage counselor that has never been married. They know all the book knowledge, but they haven't experienced it."

Sarah Bonner, 31, an Air Force veteran who was medically discharged from Ramstein Air Base in Germany in 2006, is an active user of Vets Prevail. She says that talking to a "like-minded" person is what has kept her coming back to the site.

She has bonded with the peer coaches, to whom she refers by their first names like friends, in a way she did not expect.

"There were a couple times recently, I was at a really low point," she said. "I was angry, and I wasn't holding back with what I said. They don't care. If I want to cuss out and threaten to punch something, they might say, 'Let's think of softer things than the wall to punch.' ... They let you talk about the stuff that's ugly."

                                                              "Why did all of us serve?"

Training veterans to treat other veterans does involve some risk, Chester says. If veterans are not stable themselves, they should not treat others as mental health professionals. For that reason, it can be a good idea for them to work with a psychologist even while they administer care to others.

There is so much training and hands-on experience involved in a post-doctorate program that it is highly unlikely a veteran who is still feeling unstable would make it all the way through, Troiani says. Rarely, but occasionally, a veteran will say, "This program is not a good fit for me," he says.

But if it is a good fit, the results can be rewarding.

"Why did all of us serve if not for each other?" Kyle asked. "Just because we're not in the military any more, it doesn't mean we are no longer brother and sister. It's a bond we'll have for the rest of our lives."

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.