Steve Watson, .JoEl|sn Friday, August so. 2013 2:35 PM RE. 6 hour rule violations Molly I do want to pull these cases and look at them. I might add, that i'I'oseeutms don't have to do VUPS on all these crises and they could take then: into court and tight the ease anyway. I hope that when 2: case is volunlnrily zlisitiissezl and someone is still dangerous to self or otliens, the family is being told they can always call us and we can come out again. While I know there is variation among rwuirs, I don't believe it is as much as We read every case in CCS so have a good feel for whirl mi. DMIIP is doing. Often the evidence or lack Uf(wi!li or without a witness statement) or poor quality of the witness leads to decisions being made one way or the mm, not DMHP vuriatimt, I see that you do understand the number of cases we have to evaluate as we are the litigation protector (or pemeivcd that way) for many hospitalslist is to run numbers onwhiclr hospitals are re 'ring to us and what our rate of detention is from each. That will give me a good indication of who is over using us. It is not one avenue for solution. I wish we could have more staff, but have been firmly told from all the way up the food c.ha.in that more stall" will not be granted. By the first OIZOI4 We will be giving up all cotnmunity based crisis outreach and moving that to another type of crisis team outside our ofliee. That may reducasome demand. Not sure how much. 7 In theoldcn days we used to screen out referrals. I don't like to do that, but we may need to 'start taking ainnch tighter stand on who we screen in for acceptance to evaluate. Anyway, thanks for writing hack. Stay in touch. I'll have a supervisor look at the cases and see what they think. JoEllen From: mol1ymcn@u washirrgtorredu Sent: Friday, August 30, 2013 2:24 PM To: Watson, JoEllcn Subject: RE: 6 hour rule violations Thanks for the quick response I do agree that front line staff put enormous pressure on DMI-1Ps to evaluate EVERYONE. Social Workers and Doctors talk about "liability" as ifthey have all been sued. Just last week, I had a patient named -1 taken to NW Hospital. Social Worker Ann Drummond insisted on referring Mrs. 'for evaluation. I told her that she really didn't met criteria because Mrs.-- daughter said she would take her in and she had money, was eating, etc. The only problem is that she kee oing hack to the house she thinks she owns. Ann insisted on the referral and of course, Mrs. was not detained. Perhaps more education for frontline staff is the answer, perhaps better phone screening might would help. I think the inconsistaneies in how detain people is somewhat at fault. As staff members, we pray for those "certain that are more likely to detain people, This "hope" causes people to refer some patients who the system would screen out if there was more 's is why Anne me to write Em Affitlnt/it on MI. -- ltiitl two pntient with 6 limit' i-tile and-- 1 inst got out oflzlil with Felony Assault 3 conviction after he crtu:kocl npeti his lnothefs sltu with it no hummer. Not the til" person you want slipping through the cracks. And, he would have. if his patients hadn't been paying me privately to lnakr sure he stayed on the Lu. 1 convirioetl him to stay despite this violation, not be convinced to stay in the hospital. He was release on the 6 hour ttitlny. His parents sic in the Support 'lhey are that its will go . habit to his opt and lock them out lie is emaciated, rlisurgmiized and mimic. He may also be facing - eviction ifhis ntenltil health problems continue to disrupt the cotiiplex he lives in. rin not asking you to investigate these cases. 1 just wanted to put some stories to the names. We are all in the business of he! ping people with mental illness. I think you will agmc that i-timing ACUTE PATIENTS on llour rule violations is adding insult to injni-y. lwould suggest that we accept the reality of the situation, we have. People will continue to refer patients, inappropriately or not. When you have detained someone with REAL, ACUTE needs, we should be able to keep them and treat then. The solutions {or now seems to me to add more staff and fill the PERSONEL GAP which results in the 6 hour rule violations at this little. Then probleimsolve and move forwalrl with mots cuntpruhensive plan I am hoping to be part of the solution. Molly McNamara, LICSW The above email may contain patient identifiable or confidential information. Because email is not secure, please be aware of assoei The information is intelldod for the individual rlanted above. If you am not the intended recipient, any disclosure, copying, tiisttihu On Fri, 30 Aug 2013, Watson, JoEllen wrote: Thank you Molly for your letter of concern. Do you have data on how frequently this is happening? We usuiilly receive communication from the Prosecutors when this ooclus. Please let me know more specifics as supervisors pull cases to look at the time lines and also discuss with Prosecution to ensure that hospital ERs ate documenting appropriately. That being said, the number of from hospitals has been overwhelming, especially for patients who have medical complications and may or may not be experiencing a mental disorder that can be treated appropriately with an ITA hold. owovcr, medical staff don't feel they have other options but to refer for civil commitment. There has ltlways hcen pmpensily of ER to refer patients that may not meet ITA criteria but that the ED is about releasing without 3 DMHP evaluation first. These types of 1'eferri1ls have also been increasing. My point is that the entire system can best be served by referrals for patients who really do need civil commitment and treatment when all less restrictive options will not suffice. Ifwe were able to see patients who truly need civil commitment as their only option for treatment, I believe we would have less problems meeting the statutory timeliucs. I will talk. with Anne Misuta about the dismissals. In the meantime ifyou have a specific case you would like me to exploit; please call me with the patient; (si) name and I can have a supervisor review tosee ;what happened. - Mydirect line is 8 I . ?--??Original T-"rem: Sent: I-iriday, Aiigtist 30, 2013 1:22 PM i . To: Amnon Cc: Watson, .loEl-len Subject: 6 hour rule violations Dear Amnon and oEllen, . My name is Molly McN.amara._ I feel compelled to express the heartfelt pain that is experienced in our community when patients are released by the ITA Court on the 6 hour rule violation. . I am a Social Worker both inpatient at Harborview Medical Center and in private practice. I also facilitate a NAM1 support? group for family members of patient. As staff members and relatives ofpeople with mental illness, we are overwhelmed by the current state of the mental health system. Currently the most painful problem seems to stem from the nurnber of6 hour rule violations. ask that you focus efforts on solving this problem as soon as possible. - If there is anything staff members or family members can do to advocate for a solution, please don't hesitate to let me know. Molly McNamara, LICSW (206) 375-0727