Sunday, December 30, 2012
Tuesday, October 30, 2012
At jail, a rising tide of suicide | The Columbian
At jail, a rising tide of suicide | The Columbian
an article about a jail taking steps to be safer for folks at wits end. The Sheriff is adding on-site psychiatry and additional on-site mental health care to the mix of facility changes. This article presents some positive steps toward curbing a negative, and all too common, problem. If only for practical reasons (of risk management for the jail/county) and not for the greater reason of respect for human life, these are steps to be encouraged.
an article about a jail taking steps to be safer for folks at wits end. The Sheriff is adding on-site psychiatry and additional on-site mental health care to the mix of facility changes. This article presents some positive steps toward curbing a negative, and all too common, problem. If only for practical reasons (of risk management for the jail/county) and not for the greater reason of respect for human life, these are steps to be encouraged.
Wednesday, October 17, 2012
Thinking about police shootings in the Autumn sun
Here in western north Carolina the clouds are scurrying off the dance floor and the sun is lighting up the autumn color. Glorious! The extension burst until spring's pastels. I do miss this time of year in this setting.Because I can't enjoy anything without being a "negative nellie" (or whatever the masculine version of that phrase is) I immediately starting ruminating on death and destruction....
An article in today's CNN headlines recalls the tragedy of a young man killed by campus police. Its hard times all around in south Alabama. Can this be used to change policy and training? There's a good question.
Unfortunately I have only more questions. Like, who tracks police shootings and what does the data show? I am interested in this topic because I wonder if there are ways to train officers to increase the compassion of their interactions with the public, even an aggressive and potentially dangerous public. This interest is not just about police; the general public has an anti-authority bent--it takes two to tango, they say.
Hell, if I could be "king of the world" I would like to reduce competition in favor of cooperation. Following the Buddha more couldn't hurt anyone, except those who want to destroy. But, alas, I'm just a guy.
A website with a law enforcement POV with a newsfeed for police involved shooting is PoliceOne. It looks like a good source for cops to support each other, find training & tips, and preview gear. Not quite what I was looking for, but interesting as a presentation of that POV. It reminds me to be sensitive to the complexities that law enforcement (and military) personnel attend to in the performance of their duties.
The data I'm interested in may not exist, if this story from 2001 remains relevant. "[A] provision in the 1994 Crime Control Act requiring the Attorney General to collect the data and publish an annual report on them, statistics on police shootings and use of nondeadly force continue to be piecemeal products of spotty collection, and are dependent on the cooperation of local police departments. No comprehensive accounting for all of the nation's 17,000 police department exists."
In a late 2011 news story there is the appearance of no change:
"The nation's leading law enforcement agency collects vast amounts of information on crime nationwide, but missing from this clearinghouse are statistics on where, how often, and under what circumstances police use deadly force. In fact, no one anywhere comprehensively tracks the most significant act police can do in the line of duty: take a life.
"We don't have a mandate to do that," said William Carr, an FBI spokesman in Washington, D.C. "It would take a request from Congress for us to collect that data.
Congress, it seems, hasn't asked."
Consider a report about a LAPD unit that investigates police shootings "to insure that investigations of police shooting incidents are full, fair, objective, independent, and timely".
Title:Implementation and Possible Impacts of Operation Rollout
Author(s):C D Uchida; L W Sherman; J J Fyfe
Date Published:1981
Here's something I didn't expect to find: A map from the conservative Cato Institute noting entitled Botched Paramilitary Police Raids. The map shows incidents where law enforcement actions resulted in the injury (or death) of an innocent solely due to action based on incorrect information. I.e, raiding the wrong home looking for suspects. The map was created to accompany the report Overkill: The Rise of Paramilitary Police Raids," by Radley Balko.
The issue is sensitive. And important.
Auroraadvocate.com - Kaleidoscope: 'Moral treatment' was Athens asylum concept
Auroraadvocate.com - Kaleidoscope: 'Moral treatment' was Athens asylum concept
this news story presents some history of mental health treatment in 19th and 20th century America (specifically Ohio). The author enjoys learning about the history of old buildings and that led to this presentation about The Ridges at Ohio University -- once the Athens Lunatic Asylum.
The Thomas Kirkbride plan was based on the "moral treatment" model of psychiatry and advocated for by Dorethea Dix. Patients came to live at the facility's idyllic setting. They joined in the operation of the campus's self-sustaining farm-like methods.
[side note: the wikipedia article on Ms Dix is out-of-date. It mentions that the hospital in Raleigh NC named for the advocate is "scheduled to close in 2010". That event has now happened. Dorethea Dix Hospital was replaced by Central Region Hospital in Butner NC.]
I found the article a nice quick introduction to the history of mental health reforms in the US, as well as an interesting look at the why's and how's of some old buildings. Too often both these topics are neglected in this world of auto-refresh. Very refreshing distraction....
this news story presents some history of mental health treatment in 19th and 20th century America (specifically Ohio). The author enjoys learning about the history of old buildings and that led to this presentation about The Ridges at Ohio University -- once the Athens Lunatic Asylum.
The Thomas Kirkbride plan was based on the "moral treatment" model of psychiatry and advocated for by Dorethea Dix. Patients came to live at the facility's idyllic setting. They joined in the operation of the campus's self-sustaining farm-like methods.
[side note: the wikipedia article on Ms Dix is out-of-date. It mentions that the hospital in Raleigh NC named for the advocate is "scheduled to close in 2010". That event has now happened. Dorethea Dix Hospital was replaced by Central Region Hospital in Butner NC.]
I found the article a nice quick introduction to the history of mental health reforms in the US, as well as an interesting look at the why's and how's of some old buildings. Too often both these topics are neglected in this world of auto-refresh. Very refreshing distraction....
Saturday, October 6, 2012
Outcomes and payment models in crisis intervention
Here are a few notes and reflections about some of the things I'm thinking about today.
Since this an interesting and timely topic (and I can write what I want in this space) let me opine also.
Capping payments (e.g., per member/per month model) is designed to allow providers flexibility in treating patients. A real plus of this system is that it allows budgeting to be based in reality. When you know your income resources can be allocated. The risk for providers is in managing the patient load by balancing the number of patients and the amount of care provided. Too few patients is risky for returning unearned funds, too many patients is risky for resentment and burnout. One other downside is the disconnect between each of the three poles: patient, funder, and provider.
Fee-for-service is designed to control costs using market factors. This system allows folks to buy whatever services they think they want/can afford. One risk is that patient's are often rely on their provider(s) (and marketing companies) for recommendations about health related purchases. A real plus is theoretical flexibility in provider and service selection. This system is favored by those who want to be rewarded directly for the number (and quality) of the services they provide.
Obviously, each model has benefits based on point of view.
So, I'm working in a crisis stabilization unit/detox at a standalone psychiatric hospital and I'm in a doctoral program in counselor education. I keep turning over what I'm doing and how I'm going to graduate. The answer is to write up what I'm interested in; what I'm interested in is usually whatever I'm doing. In this case I am interested in evaluating my presentation materials: what material is best to present to patients in withdrawal/early recovery with a 7-10 day average length of stay?
This isn't what brought me to school, but is a familiar idea. And a good one to keep in my back pocket. The patients are post-crisis intervention, so part of the evaluation could include the relationship of initial assessment/presenting problem to the admitting diagnosis and the discharge plan. How is the patient better prepared to return back to their environment after the intervention?
Treating Complex PTSD
I started out today reading about complex PTSD and DESNOS (Cloitre et al 2011). [quick rabbit trail: The layers of the crisis intervention field are deep. Makes me wonder about the history of the field and how it would be constructed.] The purpose of the article is to present a model for treatment of complex PTSD based in best practices. The authors explore how to treat the problem and in what order. Task 1: is "patient safety, symptom stabilization, and improvement in basic life competencies"; Task 2: "the exploration of traumatic memories for the purposes of first reducing acute emotional distress resulting from the memories and then reappraising their meaning and integrating them into a coherent and positive identity." Education about trauma, mindfulness & meditation, and symptom management CBT (cognitive behavioral treatment) seemed to rank pretty high as useful interventions.Payment for Services
From there I jumped to a discussion at Shrink Rap about the pros & cons of capitated fee structures versus fee-for-service. The commentators quickly began promoting the Canadian healthcare system and calling each other names. Result: no decision.Since this an interesting and timely topic (and I can write what I want in this space) let me opine also.
Capping payments (e.g., per member/per month model) is designed to allow providers flexibility in treating patients. A real plus of this system is that it allows budgeting to be based in reality. When you know your income resources can be allocated. The risk for providers is in managing the patient load by balancing the number of patients and the amount of care provided. Too few patients is risky for returning unearned funds, too many patients is risky for resentment and burnout. One other downside is the disconnect between each of the three poles: patient, funder, and provider.
Fee-for-service is designed to control costs using market factors. This system allows folks to buy whatever services they think they want/can afford. One risk is that patient's are often rely on their provider(s) (and marketing companies) for recommendations about health related purchases. A real plus is theoretical flexibility in provider and service selection. This system is favored by those who want to be rewarded directly for the number (and quality) of the services they provide.
Obviously, each model has benefits based on point of view.
Reflection
Prominently, outcomes and evidence-supported (based?) treatments are themes relative to both discussions. For a behavioral health care system to be most useful a requirement that patients can judge providers equally while providers can rely on treatment models.So, I'm working in a crisis stabilization unit/detox at a standalone psychiatric hospital and I'm in a doctoral program in counselor education. I keep turning over what I'm doing and how I'm going to graduate. The answer is to write up what I'm interested in; what I'm interested in is usually whatever I'm doing. In this case I am interested in evaluating my presentation materials: what material is best to present to patients in withdrawal/early recovery with a 7-10 day average length of stay?
This isn't what brought me to school, but is a familiar idea. And a good one to keep in my back pocket. The patients are post-crisis intervention, so part of the evaluation could include the relationship of initial assessment/presenting problem to the admitting diagnosis and the discharge plan. How is the patient better prepared to return back to their environment after the intervention?
Wednesday, October 3, 2012
The Shooter: how did that happen?
This post is a quick review of a news item I found while surfing the web. The topic concerns crisis workers greatly, not least because of the balance between the rights of people and protection of the community. Mental illness is often viewed with fear, specifically because of events like the one that prompted this article.
Shootings expose cracks in US mental health system
is an Associated Press article I viewed in the Fargo Inforum, an online news source. The article discusses some of the issues involved with persons with mental illness that go on to harm others. The basis for the article is an interview with the parents of a fellow who killed some co-workers and himself a week before.
Point 1: the families of persons with mental illness suffer as much as the person. This is a truism that goes unrecognized by many crisis interventionists. [In fact, that might be a good question for an attitudinal survey of crisis workers: "how important are family services?".] One support mentioned is a "free, 12-week course for loved ones of people with mental illness" in the Minneapolis area. The local NAMI chapter is very involved with the family.
The NAMI Information HelpLine is an information and referral service which can be reached by calling 1 (800) 950-NAMI (6264), Monday through Friday, 10 am- 6 pm, Eastern time.
Point 2: The history of forced treatment is contentious.
"A successful patients’ rights movement in the 1970s made it difficult — and illegal in some states — to force a person into treatment unless he or she was homicidal or suicidal. Dr. Darold Treffert, a Wisconsin psychiatrist, coined the phrase “dying with their rights on” in 1974, after collecting stories of people who didn't qualify for involuntary commitment and later killed themselves
In the years since, 41 states have added “need for treatment” standards to their laws that allow more individuals to be placed into court-ordered treatment programs. Minnesota is not among them."
Point 3: Recovery is possible. The article closes with presentation of two successful professionals that learned to manage their disease and are now living "normally".
Shootings expose cracks in US mental health system
is an Associated Press article I viewed in the Fargo Inforum, an online news source. The article discusses some of the issues involved with persons with mental illness that go on to harm others. The basis for the article is an interview with the parents of a fellow who killed some co-workers and himself a week before.
Point 1: the families of persons with mental illness suffer as much as the person. This is a truism that goes unrecognized by many crisis interventionists. [In fact, that might be a good question for an attitudinal survey of crisis workers: "how important are family services?".] One support mentioned is a "free, 12-week course for loved ones of people with mental illness" in the Minneapolis area. The local NAMI chapter is very involved with the family.
The NAMI Information HelpLine is an information and referral service which can be reached by calling 1 (800) 950-NAMI (6264), Monday through Friday, 10 am- 6 pm, Eastern time.
Point 2: The history of forced treatment is contentious.
"A successful patients’ rights movement in the 1970s made it difficult — and illegal in some states — to force a person into treatment unless he or she was homicidal or suicidal. Dr. Darold Treffert, a Wisconsin psychiatrist, coined the phrase “dying with their rights on” in 1974, after collecting stories of people who didn't qualify for involuntary commitment and later killed themselves
In the years since, 41 states have added “need for treatment” standards to their laws that allow more individuals to be placed into court-ordered treatment programs. Minnesota is not among them."
Point 3: Recovery is possible. The article closes with presentation of two successful professionals that learned to manage their disease and are now living "normally".
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