Five elopements or walkouts of mentally ill patients from the Guam Behavioral Health and Wellness Center this year have been investigated, and prompted policy reforms at the center, officials said.<\/p>\n
GBHWC Deputy Director James Cooper-Nurse told the Pacific Daily News that internal investigations and procedural reforms began after the second elopement, weeks before a disability watchdog\u2019s July 9 public statement about the incidents.<\/p>\n
Elopements occur when patients leave a psychiatric or health facility without permission or proper supervision, often due to a serious mental illness and\/or diminished capacity to make safe decisions.<\/p>\n
The five elopements triggered a public warning and \u201cgrave concerns\u201d from the federally mandated watchdog Guam Legal Services Corporation\u2013Disability Law Center, GLSC-DLC.<\/p>\n
The watchdog accused the GBHWC of failing to prevent repeated incidents involving patients under 72-hour involuntary psychiatric holds over a lack of formal policies and oversight.<\/p>\n
It said the GBHWC \u201chas disregarded a pattern of repeated elopements and failed to address its practices that put the lives and safety of individuals who need help at risk and in harm\u2019s way.\u201d<\/p>\n
Cooper-Nurse said GBHWC Director Carissa Pangelinan clarified the cases involved individuals under 72-hour involuntary psychiatric holds, and not general crisis stabilization patients.<\/p>\n
\u201cSo actually, after that second incident, director had asked me to go ahead and convene our internal investigation, which I had done,\u201d Cooper-Nurse said. \u201cIn the process of that internal investigation, we\u2019ve already been identifying some of those areas that we need to improve and some of those areas where we need to either create new policy or modify existing policy.\u201d<\/p>\n
Guam\u2019s federally mandated Protection and Advocacy agency for individuals with serious mental illness since 1999, the GLSC-DLC, said the five incidents involved patients previously assessed as dangerous to themselves or others or as gravely disabled.<\/p>\n
It said the GBHWC lacked formal, written procedures for preventing or responding to elopements, failures that could result in injury or death.<\/p>\n
\u201cGBHWC practices and lack of preventive guidelines and action toward elopements should be unacceptable in our community of Guam,\u201d the watchdog said.<\/p>\n
Cooper-Nurse said the GBHWC is finalizing written policies and expects them to be ready for review by this week.<\/p>\n
Dry-run drills are scheduled, he said, and the agency is coordinating with the Guam Police Department and other key partners to tighten safety protocols and improve intake and detention processes.<\/p>\n
\u201cThe process itself is written already. Now it\u2019s more about formatting and making sure that everyone\u2019s trained on it,\u201d he said.<\/p>\n
Transition period<\/p>\n
A procedural gap the GBHWC is addressing is the transition period between a patient\u2019s arrival and formal admission, Cooper-Nurse said.<\/p>\n
\u201cPart of what we\u2019re uncovering is a big sort of gap area is in the transition from when someone is bringing an individual to the department for an assessment for a 72-hour involuntary hold, and then actually them getting into the building,\u201d Cooper-Nurse said.<\/p>\n
He said some of the interim procedures have to do with \u201clooking at shortening or reducing that transition time and also creating that safe, comfortable environment\u201d not just for the GBHWC consumers, but for its staff and \u201cwhoever it is that\u2019s bringing the individual in.\u201d<\/p>\n
Mobile crisis teams began community outreach in March, around the time the elopements occurred, Cooper-Nurse said.<\/p>\n
He added that staff members are revisiting partner organizations to explain what the new procedures mean in practice.<\/p>\n
Key partners include GPD, Guam Memorial Hospital, Guam Regional Medical City, U.S. Naval Hospital and private clinics.<\/p>\n
\u201cAccording to the law, anyone can petition for a 72-hour hold,\u201d Cooper-Nurse said. \u201cThe biggest partners we see that are involved in escorting or bringing an individual here have been the police, GMH and GRMC.\u201d<\/p>\n
Despite public criticism from GLSC-DLC, the GBHWC has not received lawsuits, legal claims, or official liability notices related to this year\u2019s elopements.<\/p>\n
\u201cWe have not received any,\u201d Cooper-Nurse said. \u201cThe complaints we\u2019ve received, if it can be considered a complaint, is this discussion with Guam Legal Services. We consider Guam Legal Services a partner in this.\u201d<\/p>\n
Cooper-Nurse described the legal and ethical complexity involved in enforcing involuntary psychiatric holds while protecting civil liberties.<\/p>\n
\u201cWhat the 72-hour hold amounts to is our ability to take a person\u2019s civil rights away and detain them involuntarily,\u201d Cooper-Nurse said. \u201cThat doesn\u2019t feel very safe for folks. The goal is always to reduce the amount of seclusion and restraint and to really offer as much as possible, caring, treating environment where people have a choice in their health care.\u201d<\/p>\n
When it came to patients who exhibit violent behavior or are unresponsive to care, he said they may meet the legal threshold of being \u201cgravely disabled,\u201d which qualifies them for involuntary detention.<\/p>\n
\u201cThose would fall into the gravely disabled category, which then they would…that is another sort of criteria that our provider [uses] to determine an involuntary hold,\u201d Cooper-Nurse said.<\/p>\n
He added that final admission decisions must be made by licensed mental health professionals following proper assessments.<\/p>\n
\u201cOur providers still need to assess them and determine that they meet that criteria to be involuntarily held,\u201d Cooper-Nurse said. \u201cThat transition time… is the procedural piece that we need to shore up.\u201d<\/p>\n
Reducing stigma<\/p>\n
As new protocols take effect and training continues, Cooper-Nurse said the center remains focused on building public trust and reducing stigma around behavioral health care.<\/p>\n
\u201cPart of our role is to de-stigmatize mental health and behavioral health,\u201d he said. \u201cThis is a safe facility, and we really do want to ensure that there\u2019s this de-stigmatized notion that coming to this building means you\u2019re going to be detained. Yes, we have that ability in the most severe cases, but we also have a lot of voluntary health care services that people can [access].\u201d<\/p>\n
Sen. Chris Barnett also inquired with the GBHWC, and inquired whether legislative support is required to improve patient safety, secure additional resources or fortify the center\u2019s compliance efforts.<\/p>\n
\u201cI am prepared to assist,\u201d the senator said, adding that the purpose of the inquiry is not to assign fault \u201cbut to ensure that the public systems tasked with caring for our most vulnerable residents are operating within the bounds of applicable laws, federal program standards, and clinical best practices.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Five elopements or walkouts of mentally ill patients from the Guam Behavioral Health and Wellness Center this year…\n","protected":false},"author":2,"featured_media":262050,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4317],"tags":[105,3462,218,12,16,15],"class_list":{"0":"post-262049","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-mental-health","8":"tag-health","9":"tag-local","10":"tag-mental-health","11":"tag-news","12":"tag-uk","13":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114846963132185963","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/262049","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=262049"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/262049\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/262050"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=262049"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=262049"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=262049"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}