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Mental health access a challenge

Columbia County takes an integrated approach to serving its population


by: SUBMITTED PHOTO - SUBMITTED PHOTO Judy Thompson (second from left) and Teri Robinson of the Columbia County NAMI affiliate promote their fundraising walk during their holiday event, Christmas for Consumers. One night late last summer, Judy Thompson saw the gleam of a police badge through her living room window. She answered the door to find St. Helens Police Officer Jon Eggers following up on a report that she and her husband, Bob, were dead in their home.

The call had come from Longview, Wash., where Judy’s son Alton lived and had phoned in his concerns. In a sense, the confusion was easy enough to explain to the officer: In the past year, Alton has also complained of being controlled by a grid, and occasionally, by magnets. At times he identifies himself as an employee of NASA.

In 1999, Alton had the first “break” that would lead to a diagnosis of bipolar schizophrenia.

A heavy sense of sadness settled between Judy and Eggers as she explained her son’s inaccurate report to the police.

“Eggers had gone to school with Alton,” Judy said, recalling the police officer’s look of shock. “He said, ‘I’m so sorry.’”

Alton was “at the top of his game” when he first showed symptoms of mental illness at the age of 29. There was talk of the successful laser operator making partner at his company when he abruptly announced to his mother that he was God.

When Alton and Judy’s other son, Brian, crossed the threshold into their mid-20s, Judy had felt a sense of relief. Her sons’ biological father had long struggled with what had always been explained away as alcoholism, and was eventually called “the family curse.”

But Alton’s sudden spiral was fairly textbook: There were episodes of standing on rooftops, and a lack of sleep. He had delusions of mind-reading.

With Alton’s insurance options exhausted, Judy and her husband found themselves paying about $1,000 out of pocket each month for his medication, much of it experimental. Once, when faced with a $539 charge for a 30-day supply of Seroquel, Judy recalls fighting back tears and instead paying for the three pills that would get Alton through the weekend.

Six months passed and Alton returned to work, but only briefly. One of his counselors recommended that Judy begin applying for Social Security benefits on Alton’s behalf — a process Judy described as “very humiliating.”

It was a three-year endeavor and required Judy to hire an attorney. It took two attempts to secure Alton’s benefits. But most upsetting to Judy was the realization, “This means he’s not going to get better.”

Local (rural) resources

Columbia County has been designated as one of the state’s rural areas, meaning it lies more than 10 miles out from an urbanized area with a population of 40,000 or more.

The Oregon Office of Rural Health was established in 1979 to address the risk of underserved populations outside of the state’s urbanized areas. Its partnership in 1989 with Oregon Health and Science University strengthened the organization’s ability to identify and respond to the specific needs of more widely dispersed rural populations.

Columbia County Mental Health serves much of the county’s mental health needs, funded largely by Medicare and state money earmarked to cover indigent patients.

CCMH Director Roland Migchielsen acknowledges the barriers to proper mental health treatment in the area. But he argues there are considerable advantages to the rural model.

“I think since we are a little bit smaller-scale and in a county where everybody knows everybody, we have great relationships with each other,” he said. “It’s easy to pick up the phone and advocate for your clients. We build bridges so that people don’t fall through the cracks.”

This has involved increased collaboration with the school district, and development of the school-based health systems.

There are currently two such centers in the county: Sacagawea Health Center, sponsored by Legacy Health, and Rainier, sponsored by Columbia Health District, with a third location scheduled to open in Vernonia next year.

Each center is open Mondays, Tuesdays and Thursdays, with a mental health therapist in the office for each of those days. Services are available at no cost to school-aged children in the district.

Police involvement

Another agency that finds itself frequently collaborating with CCMH is the Columbia County Sheriff’s Office, which manages operations at the county jail.

Deputies are trained to look for signs of mental distress even from the time of booking, said Undersheriff Andrew Moyer.

The arresting officer will ask if the suspect has any kind of suicidal history. If a suspect seems suicidal, deputies place a hold on him and take him to CCMH.

“We don’t even let them come into our facility until they’re cleared by a doctor,” Moyer said. “Then all throughout their stay at our facility, whether (it’s for) one day or closer to a year, we look for those types of signs when they have a court date.”

Moyer says they pay attention to what happens at that court date.

“And some of that leads to just a conversation, which sometimes helps the inmates out,” he said. “Sometimes it’s, ‘How about we call CCMH and have them come see you?’”

The legal end

On the judicial level, Columbia County has received considerable praise for its treatment of both defendants and potential parolees who present signs of mental disorders.

A handful of Oregon counties offer mental health treatment courts that involve collaboration between judicial staff, behavioral experts and probation officers to assess whether in some cases, mental health issues factor into an individual’s criminal behavior.

In many such cases, an individual is given the option to adhere to a recommended course of treatment either in lieu of prison time or to mitigate a parole violation.

Columbia County does not offer its own treatment court. These courts can demand considerable docket time and court resources. But even absent the program, Columbia County Circuit Court Judge Ted Grove has earned the admiration of some prominent treatment court judges, like Clatsop County’s Cindee Matyas, who called him one of her role models.

Grove said when it comes to sentencing, “You consider what is going to best protect the community and either reform or maintain the individual’s mental health,” acknowledging that mental illness can either cause or increase the severity of criminal behavior.

He has been known to require regular court check-ins from those who have committed only misdemeanors, but “who have shown a history of being noncompliant.”

“You can require them to come into court every three weeks to keep them engaged with treatment,” Grove said.

NAMI

Judy admires Grove, describing him as someone who has a vested interest in the success of the people who pass through his court.

And Judy is well acquainted with the difficulties of confronting mental illness in the courtroom: Alton has been in jail eight times since last October, she says. He is currently in Columbia County Jail, where he is refusing to take his medication.

“I’m just waiting to be blindsided beyond belief,” Judy said.

To help her cope with the persistent worry about Alton’s well-being, Judy became involved with a local chapter of the National Alliance on Mental Illness, an organization that acts as both an advocacy group for mental health consumers and as a support network for those impacted by mental disorders.

Judy realizes her concern isn’t just for her son’s welfare, but for the community as well. She feels compassion for law enforcement officers, who are so often on the front line of confronting mental illness in the community. NAMI has paid to send six Columbia County officers to Crisis Intervention Training in Clackamas, a 40-hour program focused on “police response to people with mental illness.”

A cornerstone of NAMI’s support philosophy, as Judy explains it, is “We know we didn’t cause it, we can’t cure it, we can’t control a loved one.”