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MindFreedom's dialogue with to Lane County about data on mental health.

In November 2007, MindFreedom leaders Ron Unger and David Oaks appeared before the Lane County Board of County Commissioners to make a request for data about empowerment, self-determination and coercion in the mental health system in Lane County. All five of the County Commissioners said they found the request reasonable, and that they would like to put these issues on the agenda. MindFreedom Lane County submitted a request for this data on 28 November 2007 to Al Levine, manager of Lane County Mental health, and Rob Rockstroh, director of Health & Human Services for Lane County. Update: 21 February 2008 the first data was sent by Al Levine to MindFreedom Lane County.

Update 21 February 2008:

The first data has arrived from Al Levine, manager of Lane County Mental Health, here is his e-mail:

    Date:     February 21, 2008 1:18:14 PM PST

David, here is some data I have gathered that you requested. This is for the last full fiscal year (July 1,2006 - June 30, 2007). I am working on data for current year to date.

In this timeframe 633 emergency holds were placed (causing someone to be admitted psychiatrically as a danger to self or others) in one of the regional acute facilities. Most were placed at the Johnson Unit, but when it is full arrangements are made to admit clients to out of area hospitals (Good Sam in Corvallis, Mercy in Roseburg-now closed, Salem Hospital, Bay Area Hospital in Coos bay, St. Charles in Bend, or one of the Portland hospitals).

There were a total of 3730 bed days (an average length of stay of 5.9 days). Of these 633 involuntary admissions, only 66 resulted in a Civil Commitment( or roughly 1 in 10), which means that the other 9 in 10 either improved to the point they no longer met criteria or they agreed to continue treatment voluntarily. This % of commitments to holds has been a pretty stable number over many years (approx. 10% of holds go to commitments).

I do not have data on the number of committed patients who had medication overrides and am not certain that Sacred Heart keeps that data, although I have requested it. I have also requested data on Seclusion and Restraint, which they will provide by mid March. I can report that they reported to me that they have gone a year without any episodes of restraint use and are into the fourth month I believe without any episodes of seclusion.

I will report the full data as I get it.


- end -

Below is the note with initial request for data sent on  28 November 2007

Hi Al and Rob,

Attached is the same request for information that David and I presented
to the county commissioners this morning, with the one difference being
that the requests on this copy are numbered (David thought that would
make it easier to refer to them.)  Al, I know we talked about this
before in general, but I wanted you to have this more specific request.

It would be great if we could have some kind of response from the county
(if only to state where you might be in the process of collecting data,
or a statement of your intentions, or whatever) by the time of the Opal
Network meeting on January 29, 2008.  Thanks for your consideration of
this matter!

I'm copying this to Peter Sorenson and Bill Dwyer, as well as to David,
so they also have the numbered copy.

Ron Unger

[coordinator, MindFreedom Lane County]

MindFreedom Request for Information

How often does coercion happen in mental health treatment in Lane County, and how many people are affected?

Why MindFreedom desires this information to be public:  If coercive treatment is occurring more frequently than is absolutely necessary to prevent imminent danger to self or others, then most of us can agree that this is a serious problem.  Coercive mental health treatment deprives individuals of their civil rights, and also frequently results in trauma which in turn exacerbates mental health problems.  One way to insure that coercion is kept to a minimum is simply to measure it, and make the results public.  Measurement means increased scrutiny, and procedures with the potential of doing damage deserve a high degree of scrutiny.  Such measurement would also facilitate monitoring the effectiveness of the implementation of any alternatives to coercive treatment which the county might employ in the future.

Types of events to measure, for each year, for all of Lane County (this would best be broken down for each facility in which these types of event occur.)

(Note:  MindFreedom understands that some individuals in Lane County are experiencing forced mental health treatment under the supervision of the Psychiatric Security Review Board, due to crimes they have committed in the past.  The issues involved in these kinds of cases are somewhat different, and therefore MindFreedom is not requesting statistics on the type of treatment these individuals are experiencing at this time.)

1    Number of total days of involuntary commitment
2    Number of individuals experiencing 1 or more days of involuntary commitment
3    Number of individuals from Lane County sent involuntarily to the state hospital
4    Number of hours individuals spend in involuntary seclusion (being locked in a room)
5    Number of individuals experiencing involuntary seclusion
6    Number of hours individuals spend in some form of restraints
7    Number of individuals experiencing some form of restraints
8    Number of days during which individuals are forcibly medicated
9    Number of individuals experiencing forced medication
10    Names of medications used in a forcible manner, with what frequency
11    Number of days during which individuals are placed on conditional releases, outpatient commitments, or trial visits.
12    Number of individuals placed on conditional releases, outpatient commitments, or trial visits.

We are asking the Commissioners to takes steps to insure that this information is collected and made public.  This would represent an important, objective step toward insuring the quality of mental health services in Lane County.  Thank you for your consideration of this matter!

- end -

The next day, 29 November 2007, Al Levine wrote back the following, agreeing to provide some of the data within the suggested time frame:

On Nov 29, 2007, at 8:48 AM, LEVINE Al wrote:

Ron, I can supply some of this data by the timeframe you indicate. I may
also be able to get some of the seclusion and restraint data. I
seriously doubt I can get the data on the details around specific
medications administered involuntarily, as that is not typically
collected by inpatient units and would have to be extracted from the
in[patient records at considerable cost. While I can certainly get you
data on number of emergency "holds" (involuntary hospitalizations) and
number of commitments, trial visits, admits to the State Hospital (all
are essentially involuntary in that a person either must be committed or
under a guardianship to be admitted these days and some data on episodes
of seclusion and restraint at the JU (possibly including average time in
seclusion or restraint). That data is to be presented at the Acute Care
Council meeting in January. I am committed to get you as much of this
data as I can. What is also true is that we do not forcibly medicate
individuals who are under commitment in the community (on trial
visit/conditional release). If someone refuses medications who is in
that status, they face the threat of having to be returned to the
hospital, which I suppose is a form of coercion, but are never forcibly
medicated as outpatients. Due to the acute shortage of inpatient beds,
the truth is that the only folks who do end up being placed back in the
hospital are those that meet criteria for an emergency hold anyway
imminent danger to self or others. Simply refusing meds does not get
you into a hospital bed. Al

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Paula Joan Caplan, PhD

Paula Caplan, PhD: Psychologist, author, playwright and activist who is challenging the harm caused by psychiatric labeling. Paula is a long-time member of MindFreedom International. Author of 12 nonfiction books. Her latest book, "When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans," uncovers the way too many people traumatized by war are told that that makes them “mentally ill.” Her book won the 2011 American Publishers Award for Professional and Scholarly Excellence (PROSE Award) in the Psychology category.
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