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When helping the mentally ill, solutions start at home

Mail Tribune - 11/15/2017

Nov. 15--Donald Richardson Jr. was trying to fall asleep when he saw a disembodied eyeball.

"Picture a bloodshot eyeball with thousands of fingers swarming and picking at it," he says. "I got up and went out and had a cigarette and tried not to panic. I knew it wasn't real -- or at least that there was a majority chance it was not real."

Richardson has bipolar disorder and schizoaffective disorder, leaving him prone to mania, depression, hallucinations and delusions.

After an attack against his father that resulted in misdemeanor charges, he entered Jackson County's Mental Health Court, which tries to divert qualifying defendants with mental illness from the criminal justice system.

While some of Richardson's hallucinations are frightening, others are more benign, like the time he saw a cat coming out of a shoe. He says his hallucinations are like conscious dreaming.

"When I saw the cat hallucination, it was fascinating and sad at the same time because it's something I'll have to deal with the rest of my life," he says.

In addition to seeing things that aren't there, Richardson also experiences auditory hallucinations.

"Hearing voices is one of my big things. I hear voices pretty much all the time," he says. "When I'm taking a shower or bath, I'll hear a voice say, 'Why are you naked? You're not supposed to be naked outside!' Every time I hear it, I think, 'OK. I'm pretty sure I'm in the shower.'"

Richardson says he has learned not to engage with the voices.

"I can at any point talk to them. I try never to do that," he says. "I don't want to give them recognition. I don't want to give them power. The more attention you pay to something, the more power it has over you."

Richardson, who lives with his father, says another tactic for dealing with the voices is to focus on making video game tutorials. The more he hones in on a mentally engaging activity, the more the voices retreat.

Participants in Mental Health Court must stay on their medication, abstain from drugs and alcohol, attend counseling and court meetings and complete other requirements on the path to graduating from court.

Richardson is learning to analyze his emotions and cope with his hallucinations. He said the whole Mental Health Court team is committed to helping him.

"It's made me realize it can be fought -- but it's like pushing a rock up a hill," he says. "Having people who are willing to help me is awesome and new."

Richardson, 36, first started experiencing symptoms of anxiety, paranoia and confusion in his early 20s.

A roommate taking psychiatric courses pointed out he might have serious mental problems. When he lived in California, he was an inpatient at a mental health facility, but says it was like being in a factory.

"I'm very impressed with Oregon. I've only been here a year-and-a-half, but from a mental health standpoint, it's amazing," he says.

A new path

Jackson County Circuit Court launched its own Mental Health Court in 2015, modeling it after programs in other parts of the state and nation.

A decades-long move to downsize state psychiatric hospitals in America has contributed to a rising population of mentally ill people in jails and prisons.

Serious mental illness has become so prevalent in jails and prisons they are now commonly called "the new asylums," says the national Treatment Advocacy Center.

Nearly 10 times as many people with severe mental illness are behind bars than in state-level psychiatric hospitals, the center says.

Jackson County Circuit Judge Lisa Greif, who presides over Mental Health Court, says the court is part of an effort to stop people from cycling through jail, the streets, local emergency rooms and Asante Rogue Regional Medical Center's behavioral health unit, which provides short-term inpatient psychiatric care.

"We've seen a lot of success," she says. "We've seen people who have been either homeless or close to homeless find stable housing. We see people who have been stabilized on their medications that are no longer getting arrested all the time or going to the behavioral health unit. We've seen some good, long-term stability."

On a recent day in court, Greif praises Richardson for his progress, which includes complying with treatment, attending recovery meetings and taking part in activities at Compass House, a supportive clubhouse in Medford for people dealing with mental illness. She offers him his pick from among gift cards to local retailers and restaurants.

"Here's your certificate. Here's your gift card. Enjoy. You've earned it," Greif tells him as the audience applauds his success.

Greif says Mental Health Court requires a team approach. It has representatives from the Jackson County District Attorney's Office, the public defenders office, law enforcement, Compass House, the National Alliance on Mental Illness of Southern Oregon, drug treatment providers, organizations that coordinate Oregon Health Plan benefits and more.

Richardson says team members genuinely care about him. Before he started Mental Health Court, he expected a punitive environment, not the supportive, caring atmosphere he found.

"I come every Tuesday and it's been a good part of my week because people want to help me," he says. "Before, I was ignoring the problem and not letting people know. My fear was that acknowledging the problem would make it worse and talking about it would make it worse. I didn't want to talk to counselors. I feel comfortable with people in the courtroom. I trust them to help me."

Greif says mental illness afflicts people of all ages, genders and walks of life, including veterans and those with college degrees and career success.

To graduate from Mental Health Court, participants must make progress toward continuing their education or employment, even if that means volunteer work for some. They also complete a "giving back" project. One woman with a graphic design background created brochures and a logo for Compass House. Another put together a list of resources in the community for people who need help.

"It's neat to see the projects they do because you can see they put a lot of heart into them," Greif says.

Because of the time it takes to interact with each participant, Mental Health Court is limited in the number of people it can accept. It currently has 11 participants, but likely will reach -- and exceed -- its 15-person capacity soon. Greif says she will let the number of participants go beyond 15 for a brief period because three people are expected to graduate shortly.

Although Mental Health Court can make a dent, she says more services are needed locally to help the mentally ill.

"I think it's part of the solution," Greif says.

Local resources

The state of Oregon is putting more money into local services, in part because of a settlement it made with the federal Department of Justice over institutionalization and incarceration of the mentally ill. The settlement calls for the state to meet benchmarks for shorter and shorter stays at the Oregon State Hospital.

"People who come back to the community are not as stable as they used to be," says Jackson County Mental Health Crisis and Outpatient Services Manager Rick Rawlins.

Long-term inpatient care isn't necessarily beneficial for everyone. Some patients, especially kids, are exposed to new negative behaviors inside facilities and copy those behaviors, says Mental Health Division Manager Stacy Brubaker.

"People are best treated in their own community with their own support systems," she says.

Mental Health offers assertive community treatment to some mental health clients, especially those who are leaving inpatient care or as an alternative to being sent to the Oregon State Hospital. Clients get help from a skills trainer, case manager, employment specialist, therapist, nurse, peer specialist and addiction specialist. The team approach is expensive, but not as costly as a stay at the Oregon State Hospital.

"It's sometimes called a hospital without walls. It's the highest level of outpatient treatment in the community," says Doug Huston, assertive community treatment and forensics team manager. He is also the county's liaison to Mental Health Court.

Although some patients resist treatment, the team works to build rapport. Some clients are homeless, while others live in motels, with family members, in adult foster homes or independently, Huston says.

The county's Early Assessment and Support Alliance helps young people age 15-25 when they first begin experiencing psychosis, which interferes with the brain's ability to process information. Subtle signs in the beginning can include a reduced ability to filter out unwanted information. Later symptoms can include hallucinations, delusions and paranoia.

The goal is to intervene early and help young people succeed in school, at work and in life.

Mental health professionals are embedded in Jackson County's jail, probation and parole programs and transitional work center for inmates. Because of funding cutbacks, the county had to end a new initiative to embed mental health workers with police departments. Most of the law enforcement agencies in the Rogue Valley have taken part in training to help officers aid mentally ill people they encounter, according to Mental Health.

Mental Health also provides walk-in crisis services to everyone regardless of their insurance status during business hours at 140 S. Holly St., Medford. The crisis telephone line is always available by calling 541-774-8201.

Local organizations involved with mental health plan to build a crisis resolution center in Jackson County. The center will care for sub-acute patients, providing a level of care below that offered at RRMC's psychiatric unit.

Patients at such centers typically stay for three to seven days, or up to two weeks, according to JCMH.

A push for prevention

In recent years, the Oregon Legislature has invested million of dollars in community-based mental health services, says Mike Morris, behavioral health policy administrator for the Oregon Health Authority.

He acknowledges many family members of severely mentally ill people are frustrated the state's commitment standards make it hard to force someone into longer term treatment.

"From the state's perspective, it's a very difficult issue to walk that line between protecting someone's civil rights and protecting people with mental illness from themselves and protecting the community. It's difficult to achieve that balance," Morris says.

But he says there was a time in the nation's history when it was too easy to hold mentally ill people against their will at state psychiatric hospitals.

Oregon's goal is to provide community-based services that reduce the need for treatment in hospitals and cut down on the number of mentally ill people held in jails and prisons, Morris says.

Juliet Britton, executive director of the state Psychiatric Security Review Board, is also an advocate of expanding community-based services.

The board oversees clients who have been judged guilty except for insanity, including Pedro Sabalsa-Mendez, who was found guilty of murder except for insanity in August after stabbing Avi Feldman to death in Ashland last year. He is being held at the Oregon State Hospital.

Britton says the criminal justice system ends up being the fall-back option when there isn't enough mental health care in communities.

"Well-funded community intervention is critical to avoid some of these crimes," she says. "My board often says, 'We wish we didn't have any clients.'"

-- Reach staff reporter Vickie Aldous at 541-776-4486 or valdous@mailtribune.com. Follow her at www.twitter.com/VickieAldous.

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(c)2017 the Mail Tribune (Medford, Ore.)

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