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Legislation Addresses Outpatient Treatment

Saturday, November 10, 2018

In late October, Governor Wolf signed House Bill 1233 establishing a framework for assisted outpatient treatment in Pennsylvania.

This legislation seeks to develop a new avenue for needed court-ordered outpatient treatment in addition to existing avenues of involuntary evaluations, hospitalizations, and outpatient commitments.

The bill's primary sponsor was Representative Tom Murt of Hatboro, a strong mental health advocate. In introducing this legislation, Rep. Murt's intent was to put a pathway to needed care in place before an individual with serious mental illness became a potential danger to himself or to others. This has become known as Assisted Outpatient Treatment. Over 40 states now have similar legislation.

The new law amends the Mental Health Procedures Act of 1976. It creates a process for mandated outpatient care for persons felt to be at risk of rehospitalization, incarceration, or harm to self or others because of not maintaining indicated mental health treatment.
Counties have the option of implementing AOT.

The PA Department of Human Services is developing regulations, policies, and procedures for use by counties. The Montgomery County Office of Mental Health is currently reviewing the legislation.

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Herbie And His Almost Admittance To MCES

Sunday, November 4, 2018

Herbie, the intrepid stigma fighting and suicide prevention promoting VW bug and his faithful companion and reviver, Gabe Nathan have been by MCES many times. In September, they wanted to make a special appearance during Suicide Prevention Month.

Just parking out front would have limited Herbie's visit to our staff and passersby. Herbie and Gabe thought our patients would enjoy spending some time with the little guy and hearing Gabe deliver their anti-stigma and pro-suicide prevention message. Herbie would drive into our patient courtyard so patients could come down, meet him, and speak with Gabe.

Two sets of large steel double doors open our patient courtyard to a rear parking area. Herbie has a narrow beam, so bringing him in that way seemed feasible. Alas, the tape measure said otherwise. Save for a few fractions of an inch, we might have succeeded. Instead, Herbie will visit our inpatients via video at some point and make a live appearance at Carol's Place.

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Former MCES Staff Member Writes Article On Suicide Risk Assessment

Thursday, November 8, 2018

We often share news of articles published by our staff. This month we are pleased to share an article by a former staff member. Chris Mamrol, BSN, RN, CPPS, coordinated our performance improvement activities. Chris is now a Patient Safety Liaison with the Pennsylvania Patient Safety Authority (PSA).

The PSA is an independent state agency that works to reduce and eliminate medical errors by identifying problems and recommending solutions. They review and report on incidents involving patient injuries at hospitals and other health care facilities. The PSA staff help providers develop safe practices and procedures.

Chris is a strong supporter of suicide prevention. He has made a number of presentations on this topic for our staff. In an article in the October 2018 issue of the PSA Advisory, Chris identifies some of the most common problems in identifying and evaluating suicidal intent. Chris draws observations from data from the PSA's Patient Safety Reporting System and the professional literature.

We recommend his article highly to providers serving persons who may be at risk of suicide.

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MCES Leads Discussion On Preventing Post-Discharge Suicides

Friday, September 7, 2018

A major suicide prevention concern at MCES and other psychiatric hospitals is the risk of suicide among patients after discharge.

Studies have found the suicide rate to be high for the first thirty days after discharge and particularly for the first two weeks. Cases where patients have taken their lives within days of discharge are not uncommon.

Factors contributing to this risk include the impact of life stressors that may face patients on return to the community, recurrence of psychiatric or substance use related symptoms, inability to access outpatient providers, and not following aftercare treatment plans.

Some patients may find less support when they return home than they received in the hospital where support and oversight are available 24/7.

MCES staff discussed these issues at three full morning continuing education programs for 120 licensed social workers and counselors and other behavioral health professionals this month. The presentations highlighted the importance of pre-discharge suicide risk assessments, identifying support resources for patients, instructing families on ongoing suicide risk and how to access crisis intervention services if need.

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MCES Promotes Mental Health And Suicide Prevention

Sunday, October 7, 2018

During September, MCES staff participated in local events to promote mental health care and suicide prevention.

On Saturday, September 8, MCES had an information resource table at the East Norriton Community Day 2018 at the Standbridge Street Park. Many residents from the township and adjacent communities stopped by to learn more about MCES's services and get answers to questions on dealing with mental health crises and thoughts of suicide.

On the evening of Tuesday, September 11, MCES was part of a panel discussion of suicide prevention at the Conshohocken Community Center. Panelists included government officials, representatives of community services and suicide prevention programs, local police, and persons who had survived suicide attempts.

The panel took questions from the audience on suicide risk factors, warning signs of possible suicidal behavior, talking to someone who might be suicidal, and, most importantly, how to get help when confronted with a suicide emergency.

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MCES Program Gets Attention From Australia

Sunday, October 7, 2018

Over the years, MCES programs have drawn interest far from Montgomery County. A recent example occurred this month.

MCES was among the first in this area to incorporate the services of Certified Peer Specialists into its programs, and one of the first to give peer specialists a support role on a psychiatric inpatient unit. In 2008, this role was expanded to include suicide prevention.

Two peer specialists facilitated a weekly inpatient suicide prevention support group, provided one-to-one suicide prevention counseling to inpatients, participated in suicide prevention training for providers and police officers, and developed a self-help, personal suicide prevention plan for consumers. These activities were the subject of an article in a national behavioral health publication and an MCES publication entitled "Suicide Prevention for Peer Specialists," which came to the attention of researches at the Centre for Mental Health at the University of Melbourne in Victoria, Australia.

The researchers are looking at programs to prevent suicide through the provision of peer-support delivered by peers with lived experience of suicide. Information on MCES's efforts in this area will be part of the study.

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CDC Data Shows Suicide Rates Increased In 44 States

Sunday, October 7, 2018

In June 2018, the Centers for Disease Control and Prevention (CDC) released data from 27 states by the National Violent Death Reporting System.

This data is gathered from death certificates, coroner/medical examiner reports and law enforcement reports.

During 1999-2016, suicide rates increased significantly in 44 states with 25 states experiencing increases of greater than 30 percent. Adults aged 45-64 had the largest absolute rate increase from 13.2 per 100,000 persons in 1999 to 19.2 per 100,000 in 2016 and the greatest number of suicides (232,108) during the same period.

Relationship, substance use, health and job or financial problems were among the circumstances contributing to this increase in suicides nationally.

Firearms were the most common method of suicide overall (48.5%) Fifty-four percent of decedents did not have a known mental condition.

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MCES Offering Suicide Prevention Week Activities

Monday, July 23, 2018

MCES will observe National Suicide Prevention Week 2018, September 9 to September 15, with a full morning of education on reducing suicide risk in patients discharged from medical and psychiatric inpatient stays and from Emergency Departments, Crisis Centers, and similar settings. The first days and weeks after leaving a psychiatric hospitalization are a period of very high suicide risk even for patients who were not suicidal at admission.

The program is primarily intended for licensed social workers (LSWs and LCSWs) and licensed professional counselors (LPCs) who work in emergency departments, medical units, and other care settings that refer patients to us for psychiatric evaluation and hospitalization as indicated.

The PA State Board of Social Work and Professional Counselors approved the program for 3.25 continuing education (CE) credits. Attendance may be opened to other professionals depending on registrations or another session may be scheduled later in September.

For more information and to register contact Tony Salvatore at

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MCES Welcomes Director of Nursing

Monday, July 23, 2018

Marilyn Callaway, MBA, BSN, RN, was welcomed to MCES in June as director of nursing. Marilyn has over 15 years of experience in behavioral health including working with patients in a wide variety of settings.

Her work includes acute and chronic mental illness, dementia, substance use and intellectual disabilities.

Marilyn has a BS in Psychology from Ohio State University, a BS in Nursing from Drexel University and an MBA from San Francisco State University.

Marilyn supervises over 120 full and part-time staff across three shifts in the Nursing Department at MCES. This includes Nurse Managers, our psychiatric nurses, our nursing specialists in education, risk management, crisis, and infection control, and our psychiatric techs.

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Farewell Building 50...The Name That Is

Monday, July 23, 2018

"Building 50" was the numerical designation of our main building when it was a Norristown State Hospital facility.

When we moved here in 1988, the Building 50 sign was out front (it is still there behind some bushes) and it was cast in concrete over our front door, which is now now covered by an MCES banner.

Many of the NSH sites had formal names. Yet most became known by their numbers. For example, the Regional Forensic Center is referred to as Building 51. That convention came to affect us at Building 16, our former, home, and followed us here.

Perhaps our original corporate name, Montgomery County MH/MR Emergency Services was too much of a mouthful. In any case, even when we adopted our present name, which readily lent itself to the less cumbersome MCES, Building 50 stuck.

Our staff and just about everyone else who has any dealings with us continue to use it daily. Curiously, Circle Lodge has never be known as "Building 15" despite always operating in a former NSH facility. Perhaps the fact that their initial residents were recent NSH patients compelled them to separate their identity from the state hospital as much as possible. Whatever the reason, we should have stemmed this usage long ago.

Building 50's historical institutional utilization, as part of NSH and later the county prison for women, coupled with our location, which leads some to think that we're part of the state hospital, does not support or relate our crisis intervention and emergency mental health mission to the communities we serve. Actually it stigmatizes us because nothing about us is institutional, except the architecture and we do all we can to minimize that.

So when we answer the phone saying "MCES" or "emergency services" we will gently clarify who we are to callers asking for "Building 50." We will similarly respond to visitors who come into our foyer and ask our crisis staff "Is this Building 50?"

We know that it will take some work to undo 30 years of misidentification but we are up to it.

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WLVT Reports On Law Enforcement Training

Wednesday, June 20, 2018

MCES was the first organization in the country to train members of law enforcement on how to work with individuals in a mental health crisis. Hundreds of officers go through the training each year.

Reporter Harri Leigh of WLVT recently took a look at the three-day training. Click here to watch her report.   

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Suicide Prevention's Perfect Storm

Saturday, June 16, 2018

By Tony Salvatore

For a change, everybody's talking about suicide and suicide prevention. Almost 50,000 people die by suicide every year in the US. Soon suicide will claim more American lives than were lost in more than a decade of combat in Viet Nam. Strangely, not too much talk about that.

So what did it take for suicide to be the topic du jour in the mass media, social media, and around the water cooler? All it took were two very newsworthy suicides involving very well-known people occurring days apart and the release of a report by the Centers for Disease Control and Prevention (CDC) indicating that the US suicide rate has been climbing since 1999 and that it's taking lives in demographics not affected in the past.

Suicides of people of note do unfortunately happen from time to time but not usually in small clusters and the CDC and other federal agencies do release reports on US suicides with some regularity. However, the government reports on suicide are rarely highlighted and the talk about the latest celebrity suicide generally subsides in a few days – as it should. Regrettably, public interest in suicide prevention tends to wane just as fast.

Sadly, most of the attention that suicide prevention's getting will have little lasting effect. To be sure, some people will make donations, some will insert "#suicideprevention" to their social media posts for a bit, others will register for the next suicide prevention awareness event, usually a walk or run, in their town, and those inclined to "do something" will take a suicide prevention training or join a local task force if there's one.

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MCES Offers Tips For Post-Discharge Suicide Prevention

Thursday, April 12, 2018

A major focus of MCES's Suicide Prevention Program is to reduce the risk of suicide among discharged patients, particularly those returning to community settings.

Many studies have shown that the 30 days after leaving a psychiatric hospital is a period of very high suicide risk for persons with serious mental illness.

MCES performs pre-discharge suicide risk assessments and offers both patients and family members information regarding suicide prevention. MCES is now initiating post-discharge suicide prevention at the "front door" by providing family members with a copy of "Suicide Risk After Discharge: What Family Members Need to Know." The new trifold summarizes the nature of suicide risk in patients after hospitalization, warning signs, and what to do.

Click here to download "Suicide Risk After Discharge"

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MCES Crisis Residential Program Turns 20

Friday, April 27, 2018

In a former farmhouse on the western edge of Norristown, lives are rebuilt. Men and women come to the farmhouse, the home of Montgomery County Emergency Service's Crisis Residential Program (CRP), to get back on their feet.

The CRP Program offers short-term, supportive treatment in a home-like environment for individuals 18 or older who need care in other than inpatient or outpatient settings. Experienced mental health professionals are on site around the clock.

CRP is still sometimes referred to as the "Ranch House" because that was the architectural style of its first home on the grounds of the Valley Forge Medical Center where it opened in 1998. In 2006, it moved into its present quarters.

CRP is an important part of MCES's continuum of crisis services. It serves persons who need short-term residential to rebuild their community living resources. CRP also aids in community reintegration, when appropriate, after an inpatient stay.

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Suicide Prevention Needs Assessment Beginning Soon

Monday, May 21, 2018

Suicidal persons make up a large portion of those we serve through our hotline, crisis center, EMS, and inpatient unit. MCES has been a leader in suicide prevention in Montgomery County and contributed significantly to it getting started in the region. Now we are taking a look at what may be needed to enhance suicide prevention resources in the county.

MCES's inpatient program is a nonprofit psychiatric hospital. The Affordable Care Act mandates that nonprofit hospitals do a community health needs assessment every three years for their primary service area. Our next one will be carried out this spring and will focus on suicide prevention needs in the county.

The assessment will involve a survey, review of available statistics and input from community groups. The findings will be the basis for an "Implementation Strategy" highlighting unmet needs that we can address. The Montgomery County Suicide Prevention Task Force is cooperating with this project and will use our results to shape a county suicide prevention strategy.

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Suicide Prevention