The stabbing death of a mental health worker has put the spotlight on the safety of home visits.
Jennifer Warren, 38, was killed Sunday while delivering medication to a patient in St. Helens, Ore., ABC affiliate KATU reported. Warren worked for Columbia Community Mental Health, which provides in-home counseling and medication management for people with mental illness.
"She was a real good worker," Columbia Community Mental Health's director Roland Migchielsen told KATU. "We had her for 10 years, and this is a devastating loss."
The suspect, 30-year-old Brent Redd, was taken to a hospital and treated for injuries, KATU reported. Police would not say whether Redd's injuries were self-inflicted or the result of a struggle with Warren but did say he'd called 911 to report what he'd done.
In 2007, Redd was found not guilty by reason of insanity for the attempted murder of his mother. He was sentenced to 20 years under the jurisdiction of the Oregon Psychiatric Security Review Board, a sentence he started serving in Oregon State Hospital. But in 2010, the board granted Redd conditional release into community care.
"Public safety is the first concern of the Psychiatric Security Review Board," Mary Claire Buckley, executive director of the board, said in a statement Sunday. "Today's tragic incident is the first time in 34 years when any client under the board's jurisdiction has been alleged to have committed a violent act of this nature."
Because of patient confidentiality laws, the nature of Redd's mental illness is not known. His family told KATU he had been taking antipsychotic and antidepressant medications, but that the doses had been scaled back for an upcoming surgery.
"Given his past history of violence, that could certainly have put him at an increased risk of becoming psychotic and violent again," said Dr. Ken Robbins, clinical professor of psychiatry at the University of Wisconsin-Madison.
Robbins, who is not involved in Redd's treatment, said courts are usually reluctant to release people who commit violent crimes into the community.
"Presumably, he had received treatment that made mental health professionals believe he was no longer at risk for violence," he said, adding that the continued treatment would have been one of the conditions for Redd's release. "If the antipsychotic and antidepressant medications that had treated his illness were being decreased, one would have to anticipate he might become more unstable, more dangerous."
Robbins said violence is a rare but real risk for mental health workers doing home visits.
"If someone is going to visit someone with a history of psychiatric illness and a history of violence and it's unclear whether they've been compliant with their medications, one obviously has to be very vigilant," he said, describing how workers are trained to look for signs of anxiety. "But the signs can be very hard to read, and these unfortunate instances have nothing to do with a particular mental health worker's skills."
Jerome Fesler, whose wife delivered medication to Redd before quitting over fear for her safety, said workers should be sent on home visits in pairs.
"They should double them up," Fesler told KATU. "They should have someone else. They should be working in pairs, plain and simple. You know, two people is always better than one. You've got someone there that if something does happen. They can call for help."
Robbins believes there is safety in numbers, but that extra workers can also trigger anxiety in patients.
"If you have too many people show up, it can feel crowded and threatening, and you may actually precipitate violence," he said. "On the other hand, there are safety reasons you may want to have two or three people along. You have to think through the pluses and minuses."
More than 400 of the 615 people currently under Oregon's Psychiatric Security Review Board jurisdiction live in the community, according to the board. And since 1978, only 2 percent of the more than 1,400 people found guilty by reason of insanity supervised by the board have committed crimes again.
"You would think if someone committed a crime because they were psychotic, that once the psychosis is treated they shouldn't have to spend their life in a facility," said Collins. "At some point, it would make sense that conditional release be considered, assuming there's a way to make sure they stay on treatment that's working."