NAMI | Community

A full 40-hour week of Crisis Intervention Training (CIT) classes and MH site visits twice yearly give law enforcement officers an inside view of mental illness and how it is treated within Clackamas County.

Clackamas County Sheriff, Craig Roberts, invites representatives of all police departments in Clackamas County to take a full week off from their official duties to attend in-depth classes and meet people with mental illness when they were not in crisis. Ten deputy sheriffs and officers from most county police departments participated.

Most of the teaching sessions are presented by staff from Clackamas County Mental Health department. Participants are advised how to approach and treat a person in a mental health crisis in order to promote calm and avoid escalating the situation. The In Our Own Voice presentation persons in recovery from mental illness in which they spoke of their times in crisis and encounters with law enforcement, as well as their subsequent recovery to productive lives, is always well-received.

Site visits include treatment facilities, group homes and apartments. The entire group visits Portland Oregon State Hospital and Hooper Detox Center in Portland.

As a final exam, members of In A Different Light theater troupe provide vignettes of their dark days as the officers apply new skills learned during the training in interacting with them. The officer graduates will wear special CIT pins identifying them as being specially trained to work with persons having a psychiatric crisis and will be called for back-up in such incidents. Each CIT graduate and instructor also receive a NAMI silver ribbon pin during the graduation ceremony. Families are advised to mention that there is an existing mental health condition when calling 911.

MENTAL HEALTH COURT MEETS TREATMENT REQUIREMENTS, NOT JAIL TIME by John Humphreys , CCMH, Judge Robert Selander & Judy Redler-Winter

Based on successful models in other parts of the country, Mental Health Court has been operating within Clackamas County since late 2001. Persons charged with a misdemeanor crime who are also known to have a diagnosis of mental illness can request their attorney to negotiate with the District Attorney’s office for a transfer to Mental Health Court. Criteria for consideration are the presence of a mental illness, willingness to participate in appropriate treatment, and a belief by the Court that if the individual is offered mental health treatment, the likelihood of committing further crimes is diminished. Once accepted, the enrollee’s treatment is monitored on behalf of the Court by Clackamas County Mental Health Center staff, who report to the Judge. Acting on this information, the Mental Health Court Judge will counsel the enrollee to remain committed to treatment and to avoid the commission of new offenses. In some instances, the plea will not remain on the records of those who successfully meet Mental Health Court conditions. In all instances, the Court endeavors to emphasize mental health treatment instead of traditional justice system consequences such as jail time, formal probation, fines and fees.

MHC is held twice monthly at the County Court House on Main Street in Oregon City. It is usually a crowded court room with many persons presenting their initial case or returning to check in with the Judge on the progress they have made. Judy Redler Winter spent over two engrossing hours watching the proceedings and came away with some encouraging observations of the operations. The Judge was extremely respectful of the clients, addressed them as “Mr. ---“ often gave some sage advice such as “Don’t make decisions if you don’t

want the consequences.” The Judge was very clear and direct in his statements to the clients, “No self-medicating with alcohol or drugs or you will be sent directly to jail.” “Before you accept a guilty plea, I want you to be aware of your rights, have no coercion and be very clear about the consequences.” He often addressed returning clients with personal comments and question on how they were doing. Participation in Mental Health Court includes a probation period (typically one to two years) and the following stipulations:

2-Take meds, if prescribed; do not discontinue without discussing with prescriber

At every session of Mental Health Court, NAMI-CC Volunteer is present handing out NAMI-CC brochures to family members and friends accompanying the accused persons to court. The Court welcomes attendance by family members or those functioning as advocates or supports for Court enrollees. The Court will make time for advocates or support persons to address the Court, if they have relevant information. Locally compiled statistics point to the success of this model.

Based on an interview with Melinda Mowery, Jessica Leitner, Senior Program Manager and Jan Miller, CCCH/NAMI-CC liaison by Judy Redler.

An entirely new focus in the approach to treatment of mental health issues has emerged in Clackamas County. All proposed innovations are now being viewed through the lens of what specific and individual steps can be taken to assist each client in recovering a lifestyle based on their own wishes, not on what "the system" deems they need.

Each individual is interviewed by a care-coordinator (no longer called a case manager) to determine interests, goals and dreams. Dollars that would have been spent on isolated programs or classes are now allocated for the individual to direct along their personal lines of interest or need. Recognizing that for many people, some type of productive activity is much more healing than only recreational types of ventures, an emphasis has been placed on this. Finding one's"niche" in life and working to achieve personal goals have become keys to recovery from the depths of mental illness.

Rather than setting up classes, programs or activities aimed at providing daily activities in an environment far removed from the rest of the community, the focus is now reintegration into the community. Instead of providing an isolated pool table at Hilltop as in years past, the care-coordinators assist persons wishing to play pool to seek this activity in the community.

Many persons who have been supported through Clackamas County Community Health ( the merger of Mental Health and Public Health) over the years have rebelled at the strict, limited program formats offered them and have left the system and make their own way in the world. It is now recognized that the need and desire for integration in the community is far more healthy and staff are assisting persons with integration through more creative, individualized plans, rather than insisting on compliance with an artificial program which may not be satisfying to an individual.

Several organizations have evolved to assist persons with mental health issues realize their goals, share their success and use their talents. Many of these organizations are peer-run and inspired such as the Safe Haven drop-in center which provides a place to meet several times a week and is in the process of developing new opportunities, such as Peer-to-Peer support groups and young adult evening activities. Another such organization is Empowerment Initiatives, Inc. designed to assist persons to obtain help in realizing individual needs and hopes. There is an opportunity for assistance in re-entry into the job market through Community Solutions: Working for Independence. The In a Different Light theater troupe was a pioneer in offering an opportunity for talented persons to exercise their creativity. In Our Own Voice: Living with Mental Illness speakers' bureau offers another avenue to dignity and contribution to the community. The realization has come that no one group fits all and each must be born of the desire and needs of individuals who wish to participate in them. These groups all offer bridges for integration back into the community for persons who must daily battle for their personal stability, dignity and usefulness. In coming issues, many of these parallel programs will be reported upon in more depth.

MORE PRISONERS IN OREGON ON PSYCHOTROPIC MEDS by John Kerr, Clackamas County MH Specialist currently working with inmates at the Clackamas County Jail

A study conducted by the Department of Justice in 2000 reports 1 in 10 inmates take psychotropic medications and their findings suggest the rates are 1 in 5 in Oregon (along with Hawaii, Maine, Montana, and Nebraska).

In the 1960’s, hospital rates for the mentally ill were estimated to be approximately 339 per 100,000. Currently, the rates are 29 people per 100,000. With the advent of hospital closures and downsizing, the expectation was society would benefit through cost savings by having fewer hospitals by treating individuals on an outpatient basis rather than by maintaining people in the hospital. Not only was this a more economically viable solution, available data at the time suggested improved clinical outcomes with outpatient treatment versus inpatient treatment. Unfortunately, funding did not follow individuals from the hospital to the community. Due to difficulty with housing, mental health budget cuts and various and sundry social ills that eclipse the problem of the mentally ill, it has become common knowledge that our prison system has become the default inpatient treatment locus for the acutely mentally ill. Jails and prisons have become the nation’s front line mental health provider.