Self-Injury/Cutting: Part 2


Taken from the  Mayo Clinic  which is located   HERE.


Your first appointment may be with your family doctor, another primary care doctor, a school nurse or a counselor. But because self-injury often requires specialized mental health care, you may be referred to a mental health provider for evaluation and treatment.

What you can do
To help prepare for your appointment:

  • Make a list of symptoms you’ve had, including any that may seem unrelated to the reason for the appointment.
  • Note your key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins, herbs or supplements that you’re taking.
  • Take a family member or friend along, if possible, for support and to help you remember information.
  • Be ready to provide accurate, thorough and honest information about your situation and your self-injuring behavior.

Prepare a list of questions to make the most of your time with your doctor. Some basic questions to ask your doctor include:

  • What treatments are available? Which do you recommend for me?
  • What side effects are possible with that treatment?
  • What are the alternatives to the primary approach that you’re suggesting?
  • Are there medications that might help? Is there a generic alternative to the medicine you’re prescribing?
  • What should I do if I have an urge to self-injure between therapy sessions?
  • What else can I do to help myself?
  • How can I (or those around me) recognize that things may be getting worse?
  • Can you suggest any resources that would help me learn more about my condition and its treatment?

Don’t hesitate to ask questions any time you don’t understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions about your self-injuring and emotional state, such as:

  • When did you first begin harming yourself?
  • What methods do you use to harm yourself?
  • How often do you cut or injure yourself in other ways?
  • What feelings and thoughts do you have before, during and after self-injury?
  • What seems to trigger your self-injury?
  • What makes you feel better or worse?
  • Do you have social networks or relationships?
  • What emotional issues are you facing?
  • How do you feel about your future?
  • Have you had previous treatment for self-injury?
  • Do you have suicidal thoughts when you’re feeling down?
  • Do you drink alcohol, smoke cigarettes or use street drugs?


Although some people may ask for help, sometimes self-injury is discovered by family members or friends. Or a doctor doing a routine medical exam may notice signs, such as scars or fresh injuries.

There’s no specific diagnostic test for self-injury. Diagnosis is based on a physical and mental evaluation. A diagnosis may require evaluation by a mental health provider with experience in treating self-injury. A mental health provider may also evaluate you for other mental illnesses that may be linked to self-injury, such as depression or personality disorders. If that’s the case, evaluation may include additional tools, such as questionnaires or psychological tests.


There’s no one best way to treat self-injuring behavior, but the first step is to tell someone so you can get help. Treatment is based on your specific issues and any related mental health conditions you might have, such as depression.

Treating self-injury behavior can take time, hard work and your own desire to recover. Because self-injury can become a major part of your life and it’s often accompanied by mental disorders, you may need treatment from a mental health professional experienced in self-injury issues.

There are several treatment options for self-injuring behavior.

Known as talk therapy or counseling, psychotherapy can help you identify and manage underlying issues that trigger self-injuring behavior. Therapy can also help you learn skills to better manage distress, help regulate your impulsiveness and other emotions, boost your self-image, better your relationships, and improve your problem-solving skills.

Several types of individual psychotherapy may be helpful, such as:

  • Cognitive behavioral therapy, which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
  • Dialectical behavior therapy, a type of cognitive behavioral therapy that teaches behavioral skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others.
  • Psychodynamic psychotherapy, which focuses on identifying past experiences, hidden memories or interpersonal issues at the root of your emotional difficulties through self-examination guided by a therapist.
  • Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression, and improve your general well-being.

In addition to individual therapy sessions, family therapy or group therapy also may be recommended.

There are no medications that specifically treat self-injuring behavior. However, your doctor may recommend treatment with antidepressants or other psychiatric medications to help treat depression, anxiety or other mental disorders commonly associated with self-injury. Treatment for these disorders may help you feel less compelled to hurt yourself.

Psychiatric hospitalization
If you injure yourself severely or repeatedly, your doctor may recommend that you be admitted to a hospital for psychiatric care. Hospitalization, often short term, can provide a safe environment and more intensive treatment until you get through a crisis. Day treatment programs also may be an option.


You can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care tips:

  • Stick to your treatment plan, including keeping psychotherapy appointments and taking prescribed medications as directed.
  • Keep your doctor or mental health care provider’s phone number handy, and tell him or her about all incidents related to self-injury.
  • Appoint a trusted family member or friend as the person you’ll immediately contact if you have an urge to self-injure or if self-injuring behavior recurs.
  • Take appropriate care of your wounds if you do injure yourself or seek medical treatment if needed — call your relative or friend for help and support.
  • Don’t share instruments used for self-injury, which raises the risk of infectious disease.
  • Ask your doctor for advice if you have sleep problems, which can significantly affect your behavior.
  • Learn how to include physical activity and relaxation exercises as a regular part of your daily routine.


If you or a loved one needs help in coping, consider the tips below. If there’s a focus on thoughts of suicide, you or your loved one can call the National Suicide Prevention Lifeline 24-hour crisis line at 800-273-8255 (800-273-TALK).

Coping tips if you self-injure

  • Recognize the situations or feelings that might trigger your desire to self-injure. Make a plan for other ways to soothe, distract or get support for yourself so you’re ready the next time you feel that urge.
  • Connect with others who can support you so that you don’t feel alone. For example, reach out to a family member or friend, contact a support group or get in touch with your doctor.
  • Learn to express your emotions in positive ways. For example, to help balance your emotions and improve your sense of well-being, become more physically active, practice relaxation techniques, or participate in dance, art or music.
  • Avoid alcohol and illegal drugs. They affect your ability to make good decisions and can put you at risk of self-injuring.
  • Avoid websites that support or glamorize self-injury. Instead, seek out sites that support your recovery efforts.

Coping tips if your loved one self-injures

  • Get informed. Learning more about self-injury can help you understand why it occurs and help you develop a compassionate but firm approach to helping your loved one stop this harmful behavior.
  • Try not to judge or criticize. Criticism, yelling, threats or accusations may increase the risk of self-injuring behavior.
  • Let your loved one know you care no matter what. Remind the person that he or she is not alone and that you are available to talk. Recognize that you may not change the behavior, but you can help the person find resources, identify coping mechanisms and offer support during treatment.
  • Share coping strategy ideas. Your loved one may benefit from hearing strategies you use when feeling distressed. You can also serve as a role model by using appropriate coping strategies.
  • Find support. Consider talking to other people who’ve gone through the same thing you’re going through. Share your own experiences with trusted family members or friends and keep in close touch with the professional taking care of your loved one. Ask your friend or loved one’s doctor or therapist if there are any local support groups for parents, family members or friends of people who self-injure.
  • Take care of yourself, too. Take some time to do the things you enjoy doing, and get adequate rest and physical activity.


There is no sure way to prevent your loved one’s self-injuring behavior. But reducing the risk of self-injury may include strategies that involve both individuals and communities — for example, parents, schools, medical professionals, supervisors, co-workers and coaches:

  • Identify people most at risk and offer help. For instance, those at risk can be taught resilience and healthy coping skills that they can then draw on during periods of distress.
  • Encourage expansion of social networks. Many people who self-injure feel lonely and disconnected. Forming connections to people who don’t self-injure can improve relationship and communication skills.
  • Raise awareness. Adults, especially those who work with children, should be educated about the warning signs of self-injury and what to do when they suspect it. Documentaries, multimedia-based educational programs and group discussions are helpful strategies.
  • Promote programs that encourage peers to seek help. Peers tend to be loyal to friends even when they know a friend is in crisis. Programs that encourage youths to reach out to adults may chip away at social norms supporting secrecy.
  • Offer education about media influence. News media, music and other highly visible outlets that feature self-injury may nudge vulnerable children and young adults to experiment. Teaching children critical thinking skills about the influences around them might reduce the harmful impact.

Self-Injury/Cutting: Part 1

Taken from the Mayo Clinic  which is located   HERE.


Self-injury, also called self-harm, is the act of deliberately harming your own body, such as cutting or burning yourself. It’s typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration.

While self-injury may bring a momentary sense of calm and a release of tension, it’s usually followed by guilt and shame and the return of painful emotions. And with self-injury comes the possibility of more serious and even fatal self-aggressive actions.

Because self-injury is often done impulsively, it can be considered an impulse-control behavior problem. Self-injury may be linked to a variety of mental disorders, such as depression, eating disorders and borderline personality disorder.


Signs and symptoms may include:

  • Scars, such as from burns or cuts
  • Fresh cuts, scratches, bruises or other wounds
  • Broken bones
  • Keeping sharp objects on hand
  • Wearing long sleeves or long pants, even in hot weather
  • Claiming to have frequent accidents or mishaps
  • Spending a great deal of time alone
  • Pervasive difficulties in interpersonal relationships
  • Persistent questions about personal identity, such as “Who am I?” “What am I doing here?”
  • Behavioral and emotional instability, impulsivity and unpredictability
  • Statements of helplessness, hopelessness or worthlessness

Forms of self-injury
One of the most common forms of self-injury is cutting, which involves making cuts or severe scratches on different parts of your body with a sharp object. Other forms of self-harm include:

  • Burning (with lit matches, cigarettes or hot sharp objects like knives)
  • Carving words or symbols on the skin
  • Breaking bones
  • Hitting or punching
  • Piercing the skin with sharp objects
  • Head banging
  • Biting
  • Pulling out hair
  • Persistently picking at or interfering with wound healing

Most frequently, the arms, legs and front of the torso are the targets of self-injury because these areas can be easily reached and easily hidden under clothing. But any area of the body may be used for self-injury. People who self-injure may use more than one method to harm themselves.

Because self-injury is often an impulsive act, becoming upset can trigger an urge to self-injure. Many people self-injure only a few times and then stop. However, for others, self-injury can become a long-term, repetitive behavior.

Although rare, some young people may self-injure in public or in groups to bond or to show others that they have experienced pain.

When to see a doctor
Getting appropriate treatment can help you learn healthier ways to cope.

  • Reach out for help. If you’re injuring yourself, even in a minor way, or if you have thoughts of harming yourself, reach out for help. Any form of self-injury is a sign of bigger issues that need to be addressed. Talk to someone you trust — such as a friend, loved one, health care provider, religious leader or a school official — who can help you take the first steps to successful treatment. While you may feel ashamed and embarrassed about your behavior, you can find supportive, caring and nonjudgmental help.
  • Emergency help. If you’ve injured yourself severely or believe your injury may be life-threatening, call 911 or your local emergency services provider.

When a friend or loved one self-injures
If you have a friend or loved one who is self-injuring, you may be shocked and scared. Take all talk of self-injury seriously. Although you might feel that you’d be betraying a confidence, self-injury is too big a problem to ignore or to deal with alone. Here are some options for help.

  • Your child. You can start by consulting your pediatrician or family doctor who can provide an initial evaluation or a referral to a mental health specialist. Don’t yell at your child or make threats or accusations, but do express concern.
  • Teenage friend. Suggest that your friend talk to parents, a teacher, a school counselor or another trusted adult.
  • Adult. Gently encourage the person to seek medical and psychological treatment.


There’s no one single or simple cause that leads someone to self-injure. In general, self-injury is usually the result of an inability to cope in healthy ways with psychological pain related to issues of personal identity and having difficulty “finding one’s place” in family and society. The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality.

Through self-injury, the person may be trying to:

  • Manage or reduce severe distress or anxiety and provide a sense of relief
  • Provide a distraction from painful emotions through physical pain
  • Feel a sense of control over his or her body, feelings or life situations
  • Feel something, anything, even if it’s physical pain, when feeling emotionally empty
  • Express internal feelings in an external way
  • Communicate depression or distressful feelings to the outside world
  • Be punished for perceived faults


Certain factors may increase the risk of self-injury, including:

  • Being female. Females are at greater risk of self-injuring than males are.
  • Age. Most people who self-injure are teenagers and young adults, although those in other age groups also self-injure. Self-injury often starts in the early teen years, when emotions are more volatile and teens face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
  • Having friends who self-injure. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
  • Life issues. Some people who injure themselves were neglected, or sexually, physically or emotionally abused, or experienced other traumatic events. They may have grown up and still remain in an unstable family environment, or they may be young people questioning their personal identity or sexuality.
  • Mental health issues. People who self-injure are more likely to be impulsive, explosive and highly self-critical, and be poor problem-solvers. In addition, self-injury is commonly associated with certain mental disorders, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
  • Excessive alcohol or drug use. People who harm themselves often do so while under the influence of alcohol or illegal drugs.


Self-injury can cause a variety of complications, including:

  • Worsening feelings of shame, guilt and low self-esteem
  • Infection, either from wounds or from sharing tools
  • Life-threatening problems, such as blood loss if major blood vessels or arteries are cut
  • Permanent scars or disfigurement
  • Severe, possibly fatal injury, especially if you harm yourself while under the influence of alcohol or illegal drugs
  • Worsening of underlying issues and disorders, if not adequately treated

Suicide risk
Although self-injury is not usually a suicide attempt, it can increase the risk of suicide because of the emotional problems that trigger self-injuring. And the pattern of damaging the body in times of distress can make suicide more likely.

If you, your friend or a loved one is having suicidal thoughts or is in emotional distress, get help right away. Take all talk of suicide seriously. Here are some options:

  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.
  • Seek help from your doctor, a mental health provider or other health care professional.
  • Reach out to family members, friends, teachers or spiritual leaders for support.

If you think your friend or loved one is in immediate danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call for emergency help or take the person to the hospital, if you can safely do so. If possible, take away any tools used for self-injury.


Rick Warren Gives First Sermon After Son’s Suicide

Taken from  ABC News Which is located   HERE.

Pastor Rick Warren, returning to his Saddleback Church pulpit for the first time since his son’s suicide, said today he hoped to be able to remove the stigma that is attached to a person suffering from mental illness.

Dressed in a black T-shirt and jeans, Warren preached a sermon focused on how he and his family had struggled to help his son Matthew through his illness, and how they have struggled to deal with their loss since his suicide in April.

Warren, the author of “The Purpose Driven Life,” said the sermon was to be the first in a series titled, “How to Get Through What You’re Going Through,” which, “will show you how the Bible can bring you comfort and encouragement.”

He and his wife Kay Warren walked out to a standing ovation after being absent for four months since the suicide of their son Matthew Warren, both appeared to fight back tears as they greeted the audience.

Warren first thanked his staff, fellow pastors and family before starting his sermon.

During the sermon Warren deconstructed the stages of grief he experienced after his son’s death and said he had spent 27 years praying for “God to heal [his] son’s mental illness.”

“It was the number one prayer of my life,” Warren said.

Throughout his sermon Warren talked in more detail about the toll mental illness had on Matthew Warren, describing his son having a “tender heart and tortured mind.”

At the end of the sermon Warren said he wanted to help remove the stigma of suffering from a mental illness.

“In any other organ of your body breaks down there’s no stigma,” said Warren. “But if your brain doesn’t work, why are you ashamed of that?”

Warren said for the next six weeks he would give sermons about different stages of grief and would talk more about how his faith helped him after his son’s death.

He also said the church would offer support groups for people suffering from mental illness.

Warren’s son committed suicide in early April after what the pastor said at the time had been a lifelong battle with mental illness.

“No words can express the anguished grief we feel right now,” Warren wrote April 6 in a letter to his 20,000-strong congregation. “Our youngest son, Matthew, age 27, and a lifelong member of Saddleback, died today.”

Warren wrote that his son was “an incredibly kind, gentle, and compassionate man.”

“But only those closest knew that he struggled from birth with mental illness, dark holes of depression, and even suicidal thoughts,” Warren wrote. “In spite of America’s best doctors, meds, counselors and prayers for healing, the torture of mental illness never subsided.”

Warren gained international fame for his 2002 bestseller, “The Purpose Driven Life.”

Since Warren’s first public service on Easter Sunday in 1980, Saddleback Church has grown into a church with more than 200 ministries.

In his 1995 book, “The Purpose Driven Church,” Warren shared the principles that led to the success of Saddleback. The follow-up, “The Purpose Driven Life,” catapulted him into the world spotlight and has sold tens of millions of copies.

According to the Saddleback website, “The Purpose Driven Life” is the best-selling non-fiction hardback book in history.

Prove Me Now: Streams In The Desert, July 27th, 2013

Prove me now  Malachi 3:10

What is God saying here but this: “My child, I still have windows in Heaven. They are yet in service. The bolts slide as easily as of old. The hinges have not grown rusty. I would rather fling them open, and pour forth, than keep them shut, and hold back. I opened them for Moses, and the sea parted. I opened them for Joshua, and Jordan rolled back. I opened them for Gideon, and hosts fled. I will open them for you–if you will only let Me.

On this side of the windows, Heaven is the same rich storehouse as of old. The fountains and streams still overflow. The treasure rooms are still bursting with gifts. The lack is not on my side. It is on yours. I am waiting. Prove Me now. Fulfill the conditions, on your part. Bring in the tithes. Give Me a chance.

I can never forget my mother’s very brief paraphrase of Malachi 3:10. The verse begins, “Bring ye the whole tithe in,” and it ends up with “I will pour” the blessing out till you’ll be embarrassed for space. Her paraphrase was this: Give all He asks; take all He promises.”
–S. D. Gordon

The ability of God is beyond our prayers, beyond our largest prayers! I have been thinking of some of the petitions that have entered into my supplication innumerable times. What have I asked for? I have asked for a cupful, and the ocean remains! I have asked for a sunbeam, and the sun abides! My best asking falls immeasurably short of my Father’s giving: it is beyond that we can ask.
–J. H. Jowett

All the rivers of Thy grace I claim,
Over every promise write my name.

(Ephesians 1:8-19).


Praise & Worship: July 26th, 2013

Song List

1.  Your Beloved-  Vineyard

2.  Hallelujah-  Three Talented Girls

3.  Grace Flows Down-  Christy Nockels

4.  Sometimes Alleluia-  Chuck Girard

5.  In The Night My Hope Lives On-  Andrew Peterson

6.  The Light Of That City-  Brooklyn Tabernacle Choir

7.  The Lord Is Gracious And Compassionate-  Kathryn Scott/Vineyard

8.  The Wonder Of Your Cross-  Robin Mark

9.  Broken Hallelujah-  Mandisa

10.  Love Me-  jj Heller

11.  When I Am Afraid-  Laura Hackett











ACLU Uncovers Increased Proportion Of Mentally Ill Inmates In Solitary


Taken from  the  Denver Post  which is located   HERE.

Nearly 90 Colorado prisoners with serious mental illness were locked in solitary confinement this year — and many had been there for at least four years — despite legal and expert recommendations that prisons stop “warehousing” the mentally ill in 23-hour-a-day isolation.

An 18-month study by the ACLU of Colorado also found the proportion of mentally ill prisoners held in solitary confinement increased from 2011 to 2012, even as the state prison system decreased the overall number of inmates in solitary.

Prisoners with moderate to severe mental illness now make up the majority of those in solitary, also called “administrative segregation,” according to the report, obtained by The Denver Post and to be released Tuesday. The 87 prisoners with serious mental illness in solitary have diseases including schizophrenia and severe depression.

There were 684 prisoners in administrative segregation as of June 30,, or 3.9 percent of the inmate population, according to the corrections department.

One reason so many mentally ill inmates are in solitary is that the Colorado prison system has a severe shortage of psychiatrists, falling well short of national recommendations, according to the report.

“It is clear that one of the Colorado Department of Corrections’ methods of managing the scores of mentally ill prisoners under its charge is to confine them in administrative segregation,” says the report, “Out of Sight, Out of Mind.”

“We have not seen a commitment from the department that says ‘we agree we need to move all seriously mentally ill prisoners out of solitary confinement,’ ” said Mark Silverstein, legal director for the American Civil Liberties Union of Colorado. “We will continue to press the Department of Corrections.”

Corrections officials said they had not reviewed the report and would not comment specifically on its findings. But the state prison system has made dramatic improvements in the last year in the way it handles mentally ill prisoners, and those improvements are only beginning to emerge in statistics, they said.

The state started a residential treatment program inside Centennial Correctional Facility in Cañon City in January, shutting down a prior program that treated mentally ill prisoners while they were held in solitary confinement. The old program had a success rate of just 27 percent, according to the ACLU’s report based on corrections data.

In the last two weeks, corrections officials moved an additional 18 mentally ill prisoners from the Colorado State Penitentiary to the residential treatment program, said Kellie Wasko, director of clinical and correctional services. The 240-bed treatment center now has about 200 inmates, who are supposed to progress from level one to level eight before they are released or sent back to another prison.

The latest prisoners sent to treatment had been “refusers,” Wasko said, but were persuaded by staff to go. “We are certainly not going to go into a cell and hold them down and force them to go to the treatment program,” she said. “They were people that have a major mental illness. That doesn’t mean that they are not of their right mind. These guys can still make choices for themselves.”

Wasko said there likely will remain a small percentage of prisoners with serious mental illness in solitary confinement. These are the inmates who, even when they are stabilized with medication, have a “dangerous, disruptive, violent criminality” that is dangerous to the rest of the prison population, she said.

The ACLU’s study — based on inmate interviews, prison documents and redacted mental health files — found the out-of-cell therapy time for prisoners at the state’s new treatment center is not much longer than the average therapy time for prisoners treated while in solitary confinement.

Mentally ill prisoners new to the treatment center spent an average of 14 minutes per week out of their cells in therapy, the ACLU found. Prisoners who graduated to level two were out of their cells 55 minutes per week for therapy, the ACLU found.

Corrections officials said they do not force prisoners to participate and that it often takes a few weeks for inmates transferred to the treatment center to engage in therapy. An inmate who spent 14 minutes in out-of-cell therapy time in a week might have been offered six hours, Wasko said.

The state prison system has a major shortage of psychiatrists and psychiatric nurses, making it difficult to increase therapy time.

The corrections department has 11 psychiatrists and was given the legislative funding to begin hiring 13 additional psychiatrists this month. Even if the department fills all of those positions, it still falls short of the nationally recommended guideline of one psychiatrist per 150 inmates.

With the additional hires, Colorado would have about one psychiatrist per 166 inmates.

“We have a shortage,” Wasko said. “It’s difficult to maintain clinicians. The unknowns of corrections are not real appealing to some people.”

The ACLU argues that seriously mentally ill prisoners should have at least 20 hours of out-of-cell time per week, including 10 hours of therapy.

The report cites legal and expert opinions across the country, including in California, Pennsylvania and Wisconsin, that have forced prisons to stop putting mentally ill prisoners in solitary.

“We have never had occasion to operate a maximum security prison, but I do know this issue has come before the courts across the country — prisons have complied with those orders. They do find a way,” Silverstein said.

In one 2013 case, the U.S. Department of Justice investigated the use of solitary confinement at the Pennsylvania State Correctional Institution and determined that prolonged confinement of mentally ill prisoners was cruel and unusual punishment.

Researchers have found that in some cases, the health of mentally ill prisoners deteriorates further with solitary confinement. A 2012 statement from the American Psychiatric Association said “prolonged segregation of adult inmates with serious mental illness, with rare exception, should be avoided due to the potential for harm to such inmates.”

The association defined “prolonged” as more than three or four weeks.

The ACLU cites cases of seriously mentally ill inmates attempting suicide, attacking others, eating feces and banging their heads against walls.

Solitary statistics

  • In March 2013, the state prison system held 87 seriously mentally ill prisoners in solitary confinement. Among those, 54 had been there longer than one year and 14 had been there longer than four years.
  • In 2012, the average length in solitary for mentally ill inmates was 16 months.
  • Solitary confinement costs about twice as much as general population housing.
  • From June 2011 to June 2012, the percentage of prisoners in solitary confinement who are mentally ill grew from 46 percent to 58 percent.
  • About one-third of inmates in the Colorado prison system have psychiatric needs.
  • From 2011-12, the state prison system decreased the percentage of prisoners held in solitary from 6.8 percent overall to 4.6 percent.As of June 30, the percentage was 3.9 percent.Sources: ACLU of Colorado report “Out of Sight, Out of Mind” and Colorado Department of Corrections


Psychiatric Emergency Room A ‘Bottleneck’ For Mental Health Care

Taken from  Minnesota Public News Radio  which is located   HERE.

One of the busiest entry points into Minnesota’s mental health system is the psychiatric emergency room. Sometimes they walk in off the street or are brought in by police or EMS. Nearly always they are in need of treatment for mental illness.

On a relatively serene Monday morning, MPR’s Tom Crann spoke with Hennepin County Medical Center psychiatrist Dr. Kathleen Heaney, who described what it’s like in a psychiatric emergency room that is an important place for mental health services, one that is often over burdened.

Below is a transcript of their conversation, edited for length and clarity.

Dr. KATHLEEN HEANEY: We are the bottleneck and the canary in the mine, you might say, of our disintegrating mental health system. It was quiet today, but there are some weekends when every room is full, the emergency room is trying to send us more people, the police are bringing us more people, and we are unable to move people out of here. So it can be problematic at times.

TOM CRANN: The thing we often hear about emergency rooms for physical health is that there is a large segment of the population who uses this as primary care, because they don’t have other options, they don’t have insurance. So something happens, they come to the emergency rooms. Are you seeing that happen in mental health as well?

HEANEY: Yes, we will see people here who come to us — frequent-flyers is the word we’ll use — and we can see that they failed multiple appointments out there in the community, but they come here for their med refill. A lot of people can use us if they are seeking shelter, want to hide out from somewhere. So our job is to sort out and make sure that our limited resources go to the individuals that really need it.

CRANN: When I hear you talk about the intake process, it seems like there’s a judgment that has to happen fairly early on about the patient, especially to decide to hold them here. How quickly is that decision made?

HEANEY: Well, if someone’s throwing a chair through the glass triage out there, that decision is made rapidly. I’m being somewhat facetious, but the behavior can bespeak to whether they need to stay or go.

But, when an individual walks up to that triage desk, the nurse checks their vital signs, starts to get history to find out why they’re here. The nurse asks them some questions, asks them if they’re suicidal, if they feel if they want to hurt anybody, are they having voices or hallucinations, and if there’s negative to all those things, then that person would not be held here.

But if a person seems to potentially be a danger to themselves or others, talking about wanting to kill themselves or saying that they think that Martians are making them dinner that evening, these would give us pause to evaluate further. It doesn’t mean we absolutely put them on a hold right then, but we would have to consider keeping them here longer so that we could see what’s happening, what’s going on.


CRANN: You’re saying that this is an acute psychiatric facility and yet it’s being fed in different ways: From people who are using it as routine mental health, to law enforcement not knowing what to do with somebody. Is that a sustainable model for mental health treatment?

HEANEY: Places that do not have acute psychiatric services have big problems, nationally, because people that have mental health problems are flooding medical emergency rooms, and they don’t know what to do with this or how to handle it. It’s a huge problem.

This hospital is lucky, and I believe my colleagues, the emergency room physicians across the hall, very much appreciate us because they can send all their problems to us. This is rare nationally.

The business that we’re in is we’re dealing with the untouchables. I don’t say that in a derogatory way. But, these people in mental illness historically were considered demonized, or they were locked away. But now, after deinstitutionalization, which is a good thing, all these people who are unable to care for themselves or get access to their medication are wandering around homeless.

CRANN: Sounds like there’s an issue occasionally of what people might call outside of your discipline a “revolving door.” Is there a problem with patients that come in who really should be in other more chronic situations who are using this acute facility too often?

HEANEY: That’s exactly right. It can be difficult to make these determinations. Because we are expected, who work in this field — and we’re aware of this because of the events that have happened over the past few months with shootings and so forth — is that people think that the mental health providers are god, and that we can protect everybody and predict everything. And that’s not true.

So, we do the best we can to determine if someone is a potential danger to themselves or others. But we certainly cannot predict what’s going to happen all the time.


CRANN: You bring up an interesting question there: often when we hear the debate about violent crime, gun crime, everyone says, “Well, we need to make sure that we’re treating the mental health aspect of this.” And as someone who does this in an acute facility like this, what goes through your mind when you hear that argument being made politically?

HEANEY: I wish that they would spend more money in building and developing resources for the mentally ill and people who have chemical use disorders. It’s very easy to point fingers and say, “Oh, as long as we find out everybody who’s mentally ill, then the world will be safe.”

But, every human being is capable of doing something and be temporarily out of their mind, whether it be drugs or terrible shock or whatever. Obviously there’s degrees, there’s levels of degrees. But the thing is, it’s not so easy to say, “Oh we’ll take care of the mental illness and register everybody and then everything will be safe.”

Those people who are saying that should spend more time building facilities and putting money into the care of our mentally ill instead of dismantling it.