Virginia Senator Deeds Stabbed by Son (…And How it Could Have Been Avoided)

Virginia Senator Creigh Deeds was Stabbed by his 24 year old son Austin (Gus) Deeds  who then killed himself with a shotgun at their rural home just West of Charlottesville, Va.. Austin Deeds had just been ‘psychologically’ evaluated just hours before at Bath Community Hospital under an Emergency Custody Order (ECO). The ECO is only good for 4 hours with a possible 2 hour extension if ordered by the magistrate.  Hospital staff stated, working within the maximum 4 hour window, they were unable to find a treatment facility to address Austin Deeds’ psychiatric needs despite several hospitals reporting they did in fact have availability.

Here is some analysis/questions from someone (me) that’s been in this profession for years. I also provide some ideas of solutions if you know of someone struggling with a similar situation:

1. Diagnoses: If the hospital was looking for a treatment facility this means that something the evaluator found indicated Austin was either a threat to himself or others or needed a a level of medical intervention not available at the current hospital. I’m also thinking about the type of evaluation that was conducted and why it was even done at BCH, what the evaluator’s credentials are, and how it was reviewed with Austin and his family. 

2. Discharge: If there were no options (which there clearly were), I wonder if and how the hospital communicated their findings from the evaluation as well as their concerns about safety to the parents and authorities. I’m also wondering what kind of discharge meeting took place. When a client is stepping down from a hospital or residential setting, we always facilitate a comprehensive treatment team meeting to talk about discharge so everyone leaves understanding what the next steps are – action steps. When we work with families struggling with similar issues, we don’t wait for the hospital to give updates. But as mental health professionals, we are able to navigate the bureaucracy much easier and get clear answers much faster. 

3. Responsibility: Providers, whether big hospitals or little, ole’ therapists, have an ethical and legal responsibility to communicate to authorities if a patient is in eminent danger. So who is responsible here? If you ask the hospital, they’ll probably point fingers until the next news cycle. If you ask an attorney, they’ll go through the policy and procedures for the hospital regarding intake, evaluations, referrals, discharge, etc. and anyone of making decisions in that chain could be liable.

4. Intervention (Placement Options): The hospital staff at BCH clearly did not consider referring outside of the traditional placement list (psych beds at hospitals). It’s unlikely that it was due to financial constraints and certainly not due to a lack of treatment centers as some have speculated (Yes, there are certainly a lack of medicaid-funded psych units in VA). There are facilities all over the country that are extremely well-equipped to accept, stabilize and work with patients just like Austin. Most hospitals, though, follow a tired, out-dated protocol of calling three near-by psych hospitals to find out if they have a bed avail. If they here no at all three, patient is discharged with a list of therapists to contact to set up an appointment. Sound ridiculous? You’re right. 

5. Solutions: In my humble opinion, Austin would be alive today if earlier intervention had been provided by a treatment team including a psychologist, psychiatrist, therapist, and case manager. The psychologist provides the initial psychological evaluation to identify the issues, what is causing them, and create a specific list of interventions for the rest of the team. The psychiatrist (though in limited supply in Bath Co, VA) performs an initial psychiatric (medical/medication) evaluation and identify what, if any, medication is necessary to compliment any individual counseling being performed. The therapist provides weekly counseling either in-office or in the family’s home to address areas identified within the psychological evaluation. The case manager is the project manager for everyone and is on-call 24/7. This person also facilitates regular treatment team meetings to ensure updates are provided to the family and all professionals. For instance, if the therapist starts seeing signs of bizarre thinking patterns which are historically correlated with dangerous behavior, the case manager can alert the rest of the team and monitor the client more closely while also increasing the frequency of support. If a higher level of care (ie. psychiatric hospitalization) is recommended by any member of the team, the case manager not only identifies a placement but completes all intake paperwork. The case manager also provides psychoeducation to the family to help them understand the client’s diagnoses and what they can do to most effectively support him. 

If you or someone you know is in a similar mess, do not assume your local hospital has the expertise to handle the situation. Contact a mental health professional to find services that can manage the entire project from assessment to placement to discharge and aftercare. 

Boot Camp and Therapeutic Wilderness Programs: Part 1: History, Myths and Reality

Ahhh, the boot camp. Good ‘ole fashioned behavior modification through discipline, intimidation and fear. It was the era of Tough Love. The boot camp’s sordid history stems from our collective belief that all kids need when they’re acting out is an experience more like what the military provided (past tense is key here since the military no longer uses ‘boot camp’ tactics in basic training – They found it to be counterproductive). What may come as no surprise is that these bastions of verbal ballistics just were not (…and continue not to be) effective.

Once associated almost exclusively with the initial weeks of military indoctrination, the term “boot camp” has, in recent years, come to be adopted by programs that want to emphasize the rapidity and intensity of their experience.

From computer boot camps (become a certified systems engineer in one week!) to fitness boot camps (10 sessions to a Bigger, Stronger you!) to weight loss boot camps (shed those pounds in a fraction of the time!), the boot camp phenomenon seems to be particularly appropriate for the members of today’s overscheduled, not-a-moment-to-waste society that need their butt kicked.

But while many so-called boot camps are actually little more than sped-up seminars, the intense, intimidating, and “in your face” philosophy (think the first hour of the film “Full Metal Jacket”) still permeates at least one type of non-military boot camp: the juvenile boot camp for troubled teens.

A Rigorous Road to Redemption?

The boot camp approach began to cross over from the military world to the civilian population in the early 1980s, when boot camp programs were created as alternatives to incarceration for certain adult and juvenile offenders.

According to the Office of Juvenile Justice and Delinquency Prevention, the first boot camp for adult offenders was established in Georgia in 1983. Two years later, Orleans Parish, Louisiana, became home to the first juvenile boot camp.

According to information on the OJJDP website, most juvenile boot camps (and the majority of boot camps for adult offenders) feature the following components:

• Boot camps almost always include rigorous physical conditioning and other forms of physical labor.
• An emphasis is placed upon discipline, which is usually enforced through a military-like code of rules and regulations.
• Teen boot camp participants usually have been convicted of nonviolent crimes, or have been referred to the boot camp by parents in an effort to curb unhealthy and illegal behaviors.
• Teen boot camps are usually intense short-term experiences (rarely lasting longer than six months) after which the troubled teen is returned to the community.
• Depending upon the nature of the boot camp, the teen may be required (or encouraged) to submit to a post-camp supervision program or enroll in an aftercare program.

More Boot Camps for Teens in Trouble

In the early part of the 1990s, OJJDP provided funding for a pilot program consisting of three juvenile boot camps – one each in Cleveland, Ohio; Mobile, Alabama; and Denver, Colorado. Information provided by the National Criminal Justice Reverence Service (NCJRS) indicates that these three OJJDP-funded teen boot camps were “designed to address the special needs and circumstances of the adolescent offender.”

The NCJRS website provided the following details about these three juvenile boot camps:

• The OJJDP’s juvenile boot camps were designed for a target population of adjudicated, nonviolent offenders under the age of 18.
• The pilot boot camps for teens included highly structured, three-month residential programs that were followed by six to nine months of community-based aftercare.
• During the aftercare period, youth who had completed the juvenile boot camps were to pursue academic and vocational training or employment while under intensive, but progressively diminishing, supervision.

Though the juveniles who completed these pilot program boot camps were found to have improved in certain academic areas, an OJJDP “Lessons Learned” document reports that the teen boot camps had no impact on reducing recidivism rates (that is, decreasing the odds that a juvenile would re-offend after completing the boot camp):

The pilot programs, however, did not demonstrate a reduction in recidivism. … In Cleveland pilot program participants evidenced a higher recidivism rate than juvenile offenders confined in traditional juvenile correctional facilities.

It should be noted that none of the sites fully implemented OJJDP’s model juvenile boot camp guidelines, and that some critical aftercare support services were not provided.

This observation was echoed in a 1996 report (Boot Camps for Juvenile Offenders: An Implementation Evaluation of Three Demonstration Programs) that was prepared for the National Institute of Justice:

What appeared to be a promising prognosis at the conclusion of boot camp disintegrated during aftercare. All three programs were plagued by high attrition rates for noncompliance, absenteeism, and new arrests during the aftercare period. …

In all fairness to the programs, aftercare was particularly affected by unexpected cuts in Federal support. … However, at this juncture it does not appear that the demonstration programs solved the problem that typically plagues residential correctional programs: inmates who appear to thrive in the institutional environment but falter when they return home.

‘Therapeutic’ Boot Camps for Troubled Teens?

Though the boot camp model appears to have been less than successful in its efforts to effect long-term positive change among adjudicated young people, this failure has not stopped the concept from spreading. For example, a number of private programs continue to market teen boot camp services to parents who are concerned about their children’s behavior.

Why do boot camps remain an attractive option for some parents? The National Institute of Justice’s 1996 Boot Camps for Juvenile Offenders report indicates that this popularity may be due in large part to certain media-fueled attitudes about the power of “getting tough” with troubled teens:

• In addition to their considerable popularity within the correctional system, boot camps have demonstrated extraordinary appeal to the general public.
• Experts on boot camp programming nationwide note that boot camps are a “natural” for media coverage, which tends to focus on the programs’ disciplinary aspects and appeals to “get tough” sentiments.
• In a culture where many people view military service as a formative experience, the public also seems to intuitively grasp the rehabilitative rationale for the programs.

An alternative to the juvenile boot camp approach can be found in therapeutic wilderness programs for troubled teens, which emphasize non-abusive techniques while still providing a series of challenging opportunities through which struggling teens can develop valuable skills, communication strategies, and self-esteem.

Emphasizing responsibility to oneself and one’s family and community, and providing a significant therapeutic component, strong family involvement, and considerable aftercare support services, wilderness programs for troubled teens are founded upon the philosophy that teen mental health challenges are not “quick fix” problems.

Unlike the top-down control that is a hallmark of the juvenile boot camp approach, wilderness programs for troubled teens help participants identify their own problems, take responsibility for their past failures and frustrations, and decide that they want to make healthy changes.

New Generation Using Wilderness – Not Brutality

Thanks to visionaries that saw the benefits of using wilderness and adventure as a context, strategy, metaphor and intervention for behavioral, mental health and substance abuse issues, we have seen a significant move away from the Boot Camp to the Therapeutic Wilderness Program. Some of the big names in the field started with Kurt Hahn (1886-1974) who started Outward Bound, then decades later we saw the influence of Larry D. Olsen and Ezekiel C. Sanchez at Brigham Young University; Nelson Chase, Steven Bacon, and others at the Colorado Outward Bound School; Rocky Kimball at Santa Fe Mountain Center.

This pivot away from Boot Camp and towards therapeutic intervention led many programs to adopt the very successful recipe of a series of tasks that are increasingly difficult in order to challenge the patients; teamwork activities for working together; the presence of therapist as a group leader; and the use of an evidence-based (eg. CBT) therapeutic process such as a journal or self-reflection.

Next Time: A look at some of the types of therapeutic wilderness programming being offered and what the research says.

What to Do if You Think Your Child Might be Dangerous

We are all heart-broken over the gun violence in Newtown, CT at Sandy Hook Elementary School. Many of us are questioning gun laws and wondering about mental health support in our country. Before we dive into our what-to-do list, lets examine a few numbers since this is also a time when our fear is not necessarily congruent with actual threats.

So how do kids actually die in the U.S.?

Total number of hyperthermia deaths of children left in cars, 2012: 29

Total number of choking deaths under age 10 each year: 80

Total number that die from child abuse each year: 1,825

Total number that die from unintentional accidents each year: 1,466

Total number from gun shots each year: 2,900

So what can you do if you believe your child is at risk for becoming violent?

1. Consult a Counselor: A good counselor can help parents process their concerns and also provide individual work with the child. They can teach anger management, distress tolerance and many other important coping skills. Expect to spend $100-200/hr and attend 1-2 times per week. 

2. Consult a Case Manager: They can help you identify all the different treatment options. So often, parents have no idea what is out there and how to access help. Parents mistakenly believe it’s either individual counseling or an ER visit. A skilled and experienced Case Manger will help find someone to conduct an assessment, list possible interventions and help with all the paperwork and phone calls. This is typically the absolute best use of money and time for parents. Expect to spend $200 for a consultation and $100-200/hr for ongoing help. 

2. Meet with the School: Schedule a meeting immediately with the school counselor, teachers, the school psychologist and assistant principle. If you do not have a Case Manager in place to facilitate this meeting, make sure you communicate that the goal of the meeting is to understand what your child’s behavior is like at school, share your concerns, and make sure that everyone involved in your child’s life is aware and looking for signs of distress. Expect to spend about 3-4 hrs per month with the school via email, phone or in-person. 

3. Get an Evaluation: This is something your counselor or Case Manager can help start. It can be a confusing and overwhelming process if you do not know the right questions to ask and expectations for the evaluator. We recommend only using a licensed psychologist for evaluations. Expect to spend $1000-5000 for the evaluation and for it to take about 6 hrs. 

4. Don’t Put Off Getting Help: It’s one thing to put off washing your car or scrubbing the guest bathroom toilet. This is something you do not want to wait on. Worst care scenario is that you get an evaluation completed, consult with a Case Manger and meet with the school – and nothing happens. Or wait. Is this actually the best case scenario? Ultimately, we can never know what we really avoided. It’s also tempting to see kids display some weird behavior and blow it off. Don’t. Ask them what’s going on and how (not if) you can help. Give them the option of talking with someone at school or that new counselor you found. Get help and support now. You can always get rid of the professionals when things are stable. Expect to have professionals involved 6-12 months.

Please, do not wait. Fonthill Counseling offers complimentary consults and there are many other case management and counseling agencies that may do the same in your area. A good agency will not try to sell services and will be honest with how to help and what you may need. Whether you think your child may have autsim, aspergers, conduct disorder, bipolar or depression – ask a professional for insight and analysis on your options. You are not alone.