Gullo was being evicted at that time due to numerous complaints about threats and aggressive behavior which had employees of the hair salon in constant fear for their safety. Following Gullo’s arrest, Rogersville police seized several knives and swords from his apartment.
At the time Gullo, 33, still had charges pending from a 2015 arrest when he attacked five police officers who came to arrest him on a probation violation warrant.
In October, all charges from both arrests including five counts of assault were dismissed on the condition that Gullo receive a mental evaluation and adhere to the prescribed treatment.
According to Rogersville Police Department Assistant Chief Travis Fields, that evaluation consisted of a telephone interview with a clinician from Frontier Health, after which Gullo was released homeless.
On Dec. 9, Gullo was having dinner at his mother’s home in Rogersville when police received a complaint that he had threatened her with a knife.
His mother told police they were preparing dinner when Gullo became very upset and claimed that “the voices” were talking to him.
She stated that Gullo grabbed a steak knife and threatened to cut her face, and then he took her cell phone and left. He was later arrested and charged with aggravated assault and theft.
It’s the latest in a long list of arrests for Gullo, who is currently in the Hawkins County Jail awaiting another mental evaluation.
Fields told the Times-News last week he doesn’t believe Gullo belongs in jail. Instead, he thinks Gullo needs long-term psychiatric help.
“By the time he was released in October, he had served more than enough time in jail for those charges,” Field said. “We were trying to get his mental health evaluated and it kept falling through, and finally the judge said we’ll go ahead and get him set up for a committal and dismiss the charges. They took him to the (Hawkins County Memorial) hospital and they (Frontier) wouldn’t send anyone down there to talk to him. They called him on the phone, asked him a couple of questions. Whoever that mental health worker was just cut him loose.”
Fields said he and other RPD officers have been dealing with Gullo for more than a decade. Gullo has numerous arrests for assault, drug possession and public intoxication, and almost every time police take him in they’re in for a fight.
“If there was anybody in need of long-term mental health care, it’s him,” Fields said. “This is ridiculous that we can’t get this guy help. We’re trying to get him some help and we can’t. He keeps ending up in jail when he needs to be in a more structured mental health environment before he hurts somebody or gets hurt himself. It’s just frustrating.”
Fields added, “Through all this we’ve only charged him to try to get him help. Every time you deal with him you have to try to get him help. With his background, and knowing what everybody knows, what does it take to upgrade it to where they can’t do it over the phone? If you catch him at the right time, you’ll talk to him and he’ll sound like he’s got some sense. But there’s certain times when he’s off his medicine that he doesn’t do very well, and I guess they haven’t seen him during that time. The first thing we’re wanting is for them to go down and do these evaluations face to face. They need to spend a little bit more time with him than just a phone call, because, God forbid, if he gets out here and hurts somebody, that’s going to look bad on everybody.”
ROGERSVILLE — On the heels of Joseph Gullo’s latest arrest in Rogersville, the Times News contacted Frontier Health to ask a few questions about mental evaluations and what determines the level of treatment a patient receives.
Frontier Health provides a wide range of mental health services to the eight-county Northeast Tennessee region which includes Sullivan and Hawkins, and it also provides some mental evaluation services in Wise, Lee and Scott counties in Virginia.
Sherri Feathers is senior vice president of specialty services at Frontier Health, and Kathy Benedetto is senior vice president for children’s services, but also responsible for forensic and assessment division.
They are not legally permitted to discuss specific cases.
Hypothetically speaking, when you have a patient repeating a cycle of arrest and release over and over, who's responsibility is it to try to stop this cycle?
Benedetto: Many decades ago those were patients who were placed in hospitals, and perhaps treated for years and years. With the de-institutional movement, which has probably been going on for 30-40 years, we've reduced the number of psychiatric beds. We are trying to do community based treatment, and there are excellent community based treatments out there. For our patients who have severe mental illness, the medications have improved, and many of our patients do quite well on an outpatient basis. The challenge with that is, they have to keep their appointments, they have to be compliant with the medications, and often times it's a family member, a spouse, mother brother sister, who insists that they come in. Many of our patients get to point they know they need the treatment and they are compliant.
Some of our most challenging situations are patients who might go to the hospital, get assessed, get the treatment they need, get the medications they need, and then just don't do the follow up on an out-patient basis. We have very good resources to do follow-up and connect with those patients. Jail liaisons. Care managers who meet with patients in the home.
But, we do have a handful of patients, who with all those supports we provide, still refuse to come in, or think they're fine without their medication. Then we have a really challenging situation with the police, with the courts, and honestly, with our own treatment team, because we want our patients to follow our recommendations.
Is there a time when you say, this has gone on long enough, and this person needs to be committed?
Benedetto: We can only do that if they meet the criteria at that time to be committed because you're literally tasking someone's rights away.
Feathers: What we see with some of the chronically mentally ill, they may look fine at one moment, but in the next few days if they stop taking their medication they become very psychotic. At that time they're re-assessed by the Crisis Team and if they do meet criteria and they are considered to be a danger to the community, they would be committed and placed in a psychiatric location. But, hospitalization is short term. Their goal is to get people stabilized and to send then home with support and follow up care. We have a lot of folks who are chronically mentally ill who agree to go to group homes and they agree to those types of services. But sometime we send folks to group homes, and after a while they decide they want to leave. there are a lot of folks who are mentally ill, but they are not incompetent, so they can make their own decisions.
Benedetto: We have chronically mentally ill patients who take their mediation, learn to manage their symptoms, and function very well in their families, in their jobs, and in the community. We celebrate those.
What can be done about the patient who doesn't want help?
Feathers: That's a tough question. The most important thing for a person who is chronically mentally ill is support. Someone needs to reach out to that person and provide some support services. It's a tough situation because we often see folks who are homeless and chronically mentally ill, and they don't have the family and support.
Benedetto: We can't treat if they don't come, and they have to want to come. It's voluntary.
What can you learn from a mental evaluation?
Feathers: There are two different types of assessments we do. Our mobile crisis team sees folks in the community in emergency rooms, in doctor offices, and throughout the community. We see people who are in an immediate crisis. They may be suicidal. They may be homicidal. They may be in the community experiencing some psychosis that places them at risk to themselves and others.
We have licensed clinicians who are mandatory pre-screening agents, and they go out in the community and do assessments to determine if that person needs immediate, acute, short term psychiatric hospitalization. If they don't meet criteria for commitment to go into a psychiatric hospital, the emergency room doctor typically assists us with a recommendation for treatment. If we do send someone home and we don't send them to the hospital via emergency commitment, we immediately set them up with our out-patient services for an immediate appointment to get them some care.
Benedetto: We performed approximately 8,500 Mobile Crisis evaluations 2016-17 in the eight county region. That's up from 2015-16 when it was approximately 6,500, and the year before it was 6,400. Only about 50 percent of those who receive a Mobile Crisis Evaluation end up spending time at a psychiatric hospital such as Woodridge, Peninsula, or Moccasin Bend. Some of those who don't go to a hospital will go to an outpatient facility, detox, or they may go to our crisis stabilization unit.
What are the criteria for commitment?
Feathers: We're looking at all kinds of different things. We do a Columbia suicide assessment to look at past history, suicidal or homicidal attempts, past psychiatric history of psychosis. We speak to family members, we speak to the physician who is in charge of the case. We're also looking at medication, current psychiatric history, and we're assessing their living functioning to determine the proper level of care. Are they a danger to themselves, a danger to others, or a danger to the community.
What's the difference between assessments done by the mobile crisis team and a court ordered evaluation?
Benedetto: Frontier Health has a contract with the Department of Mental Health that provides support and funding for us to do limited forensic assessments. Those forensic assessments are limited to a pretty narrow scope of evaluation. For the most part those are ordered from the bench, from our judges, and when we get a court order for a forensic assessment, typically what they're asking for is criminal responsibility or competency to stand trial. Can the person participate in their own defense. Are they competent to stand trial. Those are done by psychologists, psychiatrists, and we are answering that specific question. That's no what kind of medication do they need to be on or what kind of treatment do they need. Those kind of things are done through our out-patient centers.
The level of care we're missing here is our outpatient centers because we can have a judge, an attorney, a physician, a school system - any number of people refer a patient to us, or the patient can refer themselves to us. I'm in trouble, I need help, what kind of services do you offer, and that's another kind of evaluation we offer on the out-patient side. The problem with that evaluation is it's typically voluntary. We don't mind at all if the judge orders those evaluations to happen. It's just for those evaluations to happen the patient must be willing to go through that.
Frontier Health has criminal Justice Liaisons in each of the jails in Northeast Tenn., and those liaisons typically work with the judges, the District Attorney, the defense attorney, the nurses in the jail - to identify those inmates who are at-risk, to be sure they are connected with services after they leave jail, tor prevent them from recidivating. the goal is to make sure their treatment is continued with outpatient services.
Can't you do both types of evaluation at the same time?
Benedetto: The courts are busy, and once in a while it could happen that we get the forensic assessment ordered, when really what they want to know is, what kind of treatment does this person need, and are they a danger to themselves or others. Do they need to go in the hospital. Those orders can be a little bit confusing at times depending on how they're written and what they receive.
Is there enough resources in this region to handle the volume of mental health care needed. Are you and other providers overwhelmed?
Benedetto: We have outpatient centers in all of out counties, and we have the ability to do assessments in those facilities and to provide a good workup for those patients. we do medication management, we have psychiatrists, we have psychiatric nurse practitioners, we have therapist, we have care manager, so we have those resources. I think we have enough resources on an outpatient basis. The demand is quite high, but we try to triage those patients and prove the best care we can to the people coming through the door. A challenging part of that is we have many referrals where an appointment is made and we never hear from them. They feel like they were patched up, everything is great, life goes on, and I don't need that anymore. One of the things were trying to do is address that stigma, and trying to teach not only our patients, but their family members that treatment is important, and compliance is important, just like it would be with diabetes or high blood pressure. We have tools and techniques that work but you have to take advantage of them.
We did have a spike this past year, attribute the spike to opioid epidemic.
The total number of outpatient adults see in 2016-17 in eight NE TN and Lee, Wise and Scott: 31,139.
Feathers: Due to the opioid epidemic we're seeing a lot of new folks who get to the point with their addiction that they're in crisis. They feel that if they don't get help they will kill themselves or they have no hope for their future and they know they need help. we have about 30 full time crisis staff members who operate around the clock 24/7. We have a 24 hour hotline and they dispatch the clinicians to complete the assessments. They are talking a lot about the opioid epidemic, and they are seeing more folks who are in need of treatment. We try to get those folks in for detoxification and residential treatment.
Is there a shortage of beds in psychiatric hospitals?
Feathers: That's a good question. When it comes to a psychiatric hospital what i say is, you can't plan a crisis. It seems to be either feast or famine. Every morning I get a copy of the waiting list that shows us where we have folks waiting to go to a hospital bed. There are some days the list is tremendously long and we may have 15-20 folks waiting to go to a facility. Then there are other morning when we have no one on the list. Crisis services are very unpredictable. We do keep our crisis stabilization unit full at all times. that's a 16 bed facility and we serve males and females there. Magnolia Ridge where we do detox and residential drug and alcohol treatment, we do have a waiting list there. While we have folks on the waiting list we serve those folks with our outpatient services.
Benedetto: It's very well recognized that homeless individuals are sometime folks who really need treatment for not only their mental health disorder, but maybe addiction. We talk a lot in our field about folks who perhaps started out with a trauma, with a mental health disorder,and end up medicating themselves with opioids or alcohol, or heroin, and end up on the street. We like to assess people early on, and we hope their they're going to be compliant with treatment. We know that treatment works. We know that there are patients who quite well on many of the medications out there for chronic mental illnesses.
Are there any statistics on the number of people who need help and aren't receiving it?
Benedetto: This is not a statistic we're particularly happy about, but about half of our patients who are discharged from psychiatric hospitals and referred for outpatient treatment - about half of them do not follow through. How many of those do well on their own? Maybe some. How many really need those medications to sustain a healthy lifestyle? Probably quite a few. Do they go to other resources? Maybe. Maybe not. But one thing that is particularly important to understand is, we're doing an awful lot of outreach for those individuals. If they don't show we are making a phone call, finding them in the home or community through our case management services, and trying to get the reconnected. So while I say its half, that's on the initial follow up from the hospital. We're working with the TennCare Bureau, we're working with out managed care organizations, other insurers, everything we can to keep people connected.
In light of the recent spike in your mental patient caseload, would you say the region is in a mental health epedemic?
Benedetto: I don't know if I would call it a mental health epidemic. I think we are seeing more people who have not reached out for treatment before. That's something we would have to monitor over time. Our numbers have goner up in this region, but i think numbers are going up all over the state and country, and that;s for a variety of reasons. At this point I'd be speculating, but i do think the opioid crisis has led to that number going up. That's a big part of the problem.
Does the ability to pay for mental health services play any factor into if a person receives treatment or not.
Feathers: Absolutely not. When the crisis team does an evaluation that doesn't play a role whether or not they commit a person to a psychiatric hospital at all. There's a contract for the uninsured that the Department of Health has with out local psychiatric hospital. The hospital is paid for services by the state Department of Mental Health.