Oregon State Hospital – and the state’s broader mental health system – is failing and unable to stop the cycle of people repeatedly not getting help until they be arrested, state lawmakers heard Thursday.
The challenges are countless: people often cannot access the care they need until they are arrested and sent to the public hospital, which can provide services to 758 people at a main campus in Salem and a satellite site. at Junction City. Meanwhile, counties often lack adequate resources to help those released from the public hospital, whether through housing options, treatment or both.
For Oregon, this is a growing crisis affecting members of the system and the communities to which they will return.
“The system is broken and I think that needs to be recognized,” Washington County District Attorney Kevin Barton said. Thursday, lawmakers on the House Interim Behavioral Health Committee. “The system fails on many levels.”
Now the state hospital is facing a federal court order that compels it to treat and release patients sooner when they face criminal charges – and send them back to their counties. The problem extends beyond the walls of Oregon State Hospital, the state-run residential mental health facility that serves people found by the courts to be in need of treatment so they can help in their own defense when facing criminal charges. This is because patients will return to their communities and continue to need resources.
Lawmakers want to hear solutions, Rep. Rob Nosse, D-Portland and committee chair, told the audience and speakers. Legislation is also in the works to address some of these needs – including bills to increase the number of certified community behavioral health clinics in a federal program and a bill to make it easier to run and build residential mental health facilities. Still, Nosse encouraged speakers to share their ideas with him.
The state hospital is asking lawmakers for $4.9 million so it can hire more people it says are needed to admit, treat and discharge patients faster.
The state had three months to get used to moving patients through the pipeline faster. On September 1, US District Judge Michael Mosman ordered strict limits on treatment: up to 90 days of treatment for those charged with misdemeanors, six months for non-violent crimes and one year for violent crimes. After that, the state psychiatric hospital is required to discharge patients into the custody of their counties. Previously, state law allowed treatment for up to three years, or when the patient was held for their maximum sentence if convicted.
At the heart of the dispute is a 20-year-old lawsuit centered on the plight of people facing criminal charges who are in jail because they can’t get prompt treatment. In that case, a court order asked the hospital to admit them within seven days of a judge’s decision that they needed mental health treatment to help with their defense. Disability Rights Oregon, then called the Oregon Advocacy Center, filed the original lawsuit with Metropolitan Public Defender, a nonprofit law firm that contracts with Oregon to provide public defense services.
They returned to court in 2019 after the state failed to consistently enforce the order. In December 2021, Oregon State officials and advocates agreed to hire an outside neutral expert to make recommendations to address the hospital’s capacity issues. The recommendations that followed included new timelines for treating patients. Outside expert Dr. Debra Pinals, director of the University of Michigan’s law, psychiatry, and ethics program, recommended shorter timelines to get people back up to speed — among other reforms.
State officials recognize that the system needs to be improved.
Nosse asked Patrick Allen, director of the Oregon Health Authority, if the state agreed that the judge’s order was a good idea.
“We’re running out of good ideas in this space,” Allen said, adding that the authority had accepted the outside expert and, in the face of the order, “it was a bit difficult to argue on that point.”
Nosse asked Allen what was needed to improve the situation.
“More of everything,” Allen said, adding that too many people end up in public hospitals after a 911 call and involvement with law enforcement.
In the short term, Oregon State Hospital is asking lawmakers to approve $4.9 million for 59 new positions for the remainder of the fiscal year, which ends June 30, 2022. The state hospital says that additional staff are needed due to increased patient turnover. – and accompanying clinical work within a shorter time frame – which accompanies the order.
New positions include staff providing security and transportation, social work, treatment and therapy services, and admissions and forensic assessment services. If this request is accepted, its estimated cost for the biennium 2023-2025 would be $15.5 million.
But state officials are more acknowledging the needs of the system. Those include more beds at the hospital level, but not necessarily at the state hospital, Allen said.
Marion County District Attorney Paige Clarkson said she is concerned about pending releases from the state hospital that involve people facing serious charges including arson, sexual abuse on children and assault. These people, Clarkson said, will return “unrestored and without a plan.”
“We just have more questions than answers,” Clarkson said.
Problems persist after a criminal case is over.
Grant Hartley is director of the Multnomah County Office of Metropolitan Public Defenders, which provides public defender services in the Portland area. Hartley said defendants who have their cases dismissed often end up with limited services.
Social workers and case managers often work “frenziedly” and can often only find inadequate placements that don’t help the person, Hartley said.
Emily Cooper, legal director of Disability Rights Oregon, told lawmakers the answer was not to warehouse people, but to establish longer-term community mental health services to keep people from returning to the system.
“We can’t get out of this,” Cooper said, adding that the public hospital is being misused as a “de facto detention center.”
“The hospital needs to go back to the way it was designed,” Cooper said.
She added that people in Oregon jails have died while awaiting treatment, four in Multnomah County and three in Washington County.
The people who die, Cooper said, are what “keep me up at night.”
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