Found Safe NC - Shaylie Madden, 7-week-old infant, Biltmore Park in Asheville, 9 May 2019 *Arrest*

[annemc2]

A psychotic and actively homicidal person should immediately be transferred to any inpatient psychiatric hospital to be stabilized even if they are waiting for admission to a highly specialized unit.

Jails are notoriously understaffed when it comes to mental health care. Sometimes they will have a psychiatrist round on their patients only once a week or so because of budget limitations. (A psychiatrist friend of mine in Texas worked at a state prison and had to *bring his own toilet paper* for real).

I know in my area that patients who have committed crimes are languishing in jail only because of lack of beds at the state hospital. It's been in the press a bit lately. Obviously these people are uninsured or they would be transferred to any hospital that has an open bed.

Something strange is going on here. Has there been anything recently in the news regarding Krista's case?

edited to add: according to the article posted upthread by @Doghairrules

Maj. Frank Stout with the Henderson County Sheriff's Office said Madden "was placed under direct supervision/observation of our staff but not placed in the area nor the type clothing of a person on suicide watch."

Henderson County District Attorney Greg Newman said the first step would be for Madden to undergo medical evaluations, most likely first by a professional hired by her defense team and then by a state mental health specialist. The evaluations would "get some clarity as far as what's needed going forward," he said. "It would only be in the most extraordinary cases where somebody is released from custody to go to a hospital,” Newman said. “We’ve had that happen before, but it is very rare. And a judge, typically, has to make that determination. All the parties would have to be on board, and there would have to be some great reason to do that.” Krista Madden attorney: Incident came 'totally out of the blue'

I guess the grand jury is meeting soon? I would classify this as one of the more "extraordinary cases where somebody is released from custody to go to a hospital" if she is truly so psychotic that she thought she should kill her infant. If it were me I'd have a forensic psychiatrist in there so fast. I don't know if that's protocol, though.

sorry for the wall of text

 

[katydid23]

The defense team is trying to arrange for treatment for Krista Madden at a Chapel Hill facility that specializes in treatment of postpartum depression and related issues. Devereux said defense attorneys in such cases would typically seek a reduction in bond and a conditional release to such a treatment facility, not a return to her home before trial.

"If it is some sort of psychotic break, postpartum, we don’t want her around the kids, either," Devereux said. "She doesn’t want to be."
” Krista Madden attorney: Incident came 'totally out of the blue'

 

[Gunslinging Granny]

The defense team is trying to arrange for treatment for Krista Madden at a Chapel Hill facility that specializes in treatment of postpartum depression and related issues. Devereux said defense attorneys in such cases would typically seek a reduction in bond and a conditional release to such a treatment facility, not a return to her home before trial.

"If it is some sort of psychotic break, postpartum, we don’t want her around the kids, either," Devereux said. "She doesn’t want to be."
” Krista Madden attorney: Incident came 'totally out of the blue'

A psychotic and actively homicidal person should immediately be transferred to any inpatient psychiatric hospital to be stabilized even if they are waiting for admission to a highly specialized unit.

 

[katydid23]

"A psychotic and actively homicidal person should immediately be transferred to any inpatient psychiatric hospital to be stabilized even if they are waiting for admission to a highly specialized unit."

We do not know that the defendant is 'actively' homicidal or psychotic act this time. Nor do we know if she is currently being seen and assessed and treated. She may well be, according to what the DA said:

"Henderson County District Attorney Greg Newman said the first step would be for Madden to undergo medical evaluations, most likely first by a professional hired by her defense team and then by a state mental health specialist. The evaluations would "get some clarity as far as what's needed going forward," he said."

"It would only be in the most extraordinary cases where somebody is released from custody to go to a hospital,” Newman said. “We’ve had that happen before, but it is very rare. And a judge, typically, has to make that determination. All the parties would have to be on board, and there would have to be some great reason to do that.”


The family would not want to bail her out without having someplace ready for her to be admitted for treatment. I don't think it is as easy as you are making it out to be. How many places are going to green light the admission of a patient , currently in jail for a major violent crime?

I think they are following the process, step by step, as laid out by the DA, above. JMO

 

[Gunslinging Granny]

If her husband paid her $75,000 bail bond all he has to do is take her to the nearest ER and say, "My crazy wife is homicidal. She threw my baby down a cliff." The ER doctor at that point would have to keep Krista, and keep her safe from herself, until an inpatient psych bed was available. Krista would never have to go back to her house and wait for a psych bed because she demonstrated that she is homicidal.

Krista could be appropriately assessed, diagnosed, and started on treatment at any local inpatient psych unit while waiting for the "super dooper" 5 bed facility which may not have an opening for weeks.

Ask yourself why this isn't happening. You'd think her husband would be very worried that she is going to commit suicide in the jail. Today, it's VERY difficult to kill yourself in a locked psychiatric unit.

 

[katydid23]

If her husband paid her $75,000 bail bond all he has to do is take her to the nearest ER and say, "My crazy wife is homicidal. She threw my baby down a cliff." The ER doctor at that point would have to keep Krista, and keep her safe from herself, until an inpatient psych bed was available. Krista would never have to go back to her house and wait for a psych bed because she demonstrated that she is homicidal.

Krista could be appropriately assessed, diagnosed, and started on treatment at any local inpatient psych unit while waiting for the "super dooper" 5 bed facility which may not have an opening for weeks.

Ask yourself why this isn't happening. You'd think her husband would be very worried that she is going to commit suicide in the jail. Today, it's VERY difficult to kill yourself in a locked psychiatric unit.

OR, he could have hired a very good, experienced team of doctors, and have them visit her and assess her, where she is currently residing.

Maybe he does not feel comfortable, personally picking her up from jail and trying to talk her into going to a hospital?

We do not know what her family's strategy is, or what they are doing behind the scenes. But I don't think we should be judging them so harshly, without having all of the facts.

My younger brother was diagnosed as a paranoid schizophrenic. Even when he was not in distress, he was still very difficult to handle and could be quite stubborn.

 

[Gunslinging Granny]

There are ambulance services throughout NC. They pick up and deliver medical and psychiatric patients to hospitals.

 

[soap mama]

- plus she gave a description of the suspects- the man and woman with ski masks

Reminiscent of Susan Smith.

 

[Not a Belle]

If her husband paid her $75,000 bail bond all he has to do is take her to the nearest ER and say, "My crazy wife is homicidal. She threw my baby down a cliff." The ER doctor at that point would have to keep Krista, and keep her safe from herself, until an inpatient psych bed was available. Krista would never have to go back to her house and wait for a psych bed because she demonstrated that she is homicidal.

Krista could be appropriately assessed, diagnosed, and started on treatment at any local inpatient psych unit while waiting for the "super dooper" 5 bed facility which may not have an opening for weeks.

Ask yourself why this isn't happening. You'd think her husband would be very worried that she is going to commit suicide in the jail. Today, it's VERY difficult to kill yourself in a locked psychiatric unit.

Where I live, she would be held until deemed stable, which would happen before shift change in the ED, then would be sent home—or wherever she could go—pending bed availability at the state hospital. There are no psychiatric-hold beds in the hospital, so if she were going to be held anywhere, it would be jail, if they could/would take her.

In terms of length of stay, the average where I live is around five days, plus or minus two (and “plus” is rare). Going inpatient on a Friday means discharge Monday, maybe Tuesday, which means almost no actual treatment time, as little happens over the weekend. Inpatient admission has the goal of stabilizing acute crisis, not providing longer-term treatment; that happens outside the hospital.

 

[katydid23]

There are ambulance services throughout NC. They pick up and deliver medical and psychiatric patients to hospitals.

I don't understand why the harsh judgment of the family? I am sure they are doing the best they can under the circumstances. I know you think you have all the answers, but it might not be as easy as you think, to make things happen, the way you believe they will.

I do not believe he could drop her off at an ER and leave her there. We tried to get help for my brother, when he was having extreme mental health issues, and it very rarely worked out.

He was admitted into psych hospitals a few times, usually for 3 days or a week. He was arrested multiple times for disorderly conduct, or whatever they could come up with. But even when he was having auditory hallucinations, and was delusional, the ERs would not take him.

 

[katydid23]

There are ambulance services throughout NC. They pick up and deliver medical and psychiatric patients to hospitals.

The problem is, she needs to be admitted first.

 

[Not a Belle]

The problem is, she needs to be admitted first.

Exactly—a psychiatrist has to agree to admit before that happens. For a variety of reasons, this can take time, and sometimes there is no one willing to admit. It’s definitely not just a show-up-and-be-admitted deal.

 

[angelainwi]

I don't understand why the harsh judgment of the family? I am sure they are doing the best they can under the circumstances. I know you think you have all the answers, but it might not be as easy as you think, to make things happen, the way you believe they will.

I do not believe he could drop her off at an ER and leave her there. We tried to get help for my brother, when he was having extreme mental health issues, and it very rarely worked out.

He was admitted into psych hospitals a few times, usually for 3 days or a week. He was arrested multiple times for disorderly conduct, or whatever they could come up with. But even when he was having auditory hallucinations, and was delusional, the ERs would not take him.

If a family has resources like it would appear that her family does there would be no issue having her admitted to a facility that would accept private pay. It is understandable that Chapel Hill is the closest facility that specializes in post partum issues, however, there are other facilities in the nation that one of them should have an open bed. Keeping her in jail if she is suffering from PPD/PPP is a horrible option if there are other options available. Worse case they bond her out and pay for private care in their home or in a hotel. And even if they do not have the money liquid and available with the hubby's estimated income they could easily get a loan to cover her care. I pray that they figure out a placement for her soon. If they love her they will figure it out. It can be done. I help make crisis placements around the nation every day. There are beds available. You cannot always have the location of your choice, but no way would I ever advise a family to keep her in jail in this kind of situation.

 

[angelainwi]

Exactly—a psychiatrist has to agree to admit before that happens. For a variety of reasons, this can take time, and sometimes there is no one willing to admit. It’s definitely not just a show-up-and-be-admitted deal.

For most acute level private facilities admissions can be accommodated in 24 hours. If there is a will and there is money it can be done. I wish it was being done for her.

 

[Gunslinging Granny]

Where I live, she would be held until deemed stable, which would happen before shift change in the ED, then would be sent home—or wherever she could go—pending bed availability at the state hospital. There are no psychiatric-hold beds in the hospital, so if she were going to be held anywhere, it would be jail, if they could/would take her.

In terms of length of stay, the average where I live is around five days, plus or minus two (and “plus” is rare). Going inpatient on a Friday means discharge Monday, maybe Tuesday, which means almost no actual treatment time, as little happens over the weekend. Inpatient admission has the goal of stabilizing acute crisis, not providing longer-term treatment; that happens outside the hospital.

Can you share links for this info?

North Carolina, like every other state, has statutes related to psychiatric patients who are danger to themselves or others. These patients are NOT sent home at the end of the shift. They are involuntarily committed.
NC DHHS: Involuntary Commitments

 

[Gunslinging Granny]

The problem is, she needs to be admitted first.

What? Ambulance patients are not admitted to the hospital before they are transported to the hospital.

 

[Gunslinging Granny]

I don't understand why the harsh judgment of the family? I am sure they are doing the best they can under the circumstances. I know you think you have all the answers, but it might not be as easy as you think, to make things happen, the way you believe they will.

I do not believe he could drop her off at an ER and leave her there. We tried to get help for my brother, when he was having extreme mental health issues, and it very rarely worked out.

He was admitted into psych hospitals a few times, usually for 3 days or a week. He was arrested multiple times for disorderly conduct, or whatever they could come up with. But even when he was having auditory hallucinations, and was delusional, the ERs would not take him.

If your brother was not a threat to himself or others, the ER didn't have to keep him and involuntarily commit him. Krista threw her baby off a cliff (after turning off her location services on her phone). She demonstrated homicidal behavior.

 

[Not a Belle]

What? Ambulance patients are not admitted to the hospital before they are transported to the hospital.

Where I live, ambulances don’t transport for psychiatric admissions at all. Admissions to psychiatric hospitals absolutely happen prior to transport though. Either a doctor agrees to admit prior to transport, or it doesn’t happen.

 

[Not a Belle]

Can you share links for this info?

North Carolina, like every other state, has statutes related to psychiatric patients who are danger to themselves or others. These patients are NOT sent home at the end of the shift. They are involuntarily committed.
NC DHHS: Involuntary Commitments

I understand what you’re saying, and that may be the way it works there. That is not the way it works where I am, though written policies are similar.

 

[Gunslinging Granny]

Where I live, ambulances don’t transport for psychiatric admissions at all. Admissions to psychiatric hospitals absolutely happen prior to transport though. Either a doctor agrees to admit prior to transport, or it doesn’t happen.

You must live in a place with extremely inadequate healthcare or socialized medicine. In America, acute psychiatric hospitals have diagnostic evaluation centers which provide emergency and crisis intervention services including emergency evaluations. It's the standard of care.

Ambulance services receive government payments. They can't legally discriminate against psychiatric patients.