Patients are entering and exiting Oregon State Hospital at a quicker rate than before to meet court-ordered deadlines on mental health treatment so they can defend themselves against criminal charges.
But the mental health system that cares for them when they leave the state-run residential psychiatric hospital is struggling to keep up with the increased demand for services, which can run from outpatient counseling to housing to keep them off the streets.
Oregon State Hospital is under a court order to treat so-called aid-and-assist patients between three months to a year, depending on the severity of the charges, to ensure that suspects don’t languish in jail. After years of litigation and input from an outside expert, the state hospital is now discharging most patients on schedule.
But many of these patients still need treatment after they leave the state hospital. And as a growing number of patients exit the state hospital, the responsibility to care for them shifts to community mental health systems run by counties or their contract providers. Community mental health programs can include outpatient services like counseling and therapy and residential care in facilities.
Community-level care is essential, providers say. When suspects don’t get the care they need, they can commit another crime, end up homeless or both. That’s why prosecutors, police and local officials are urging lawmakers to consider the needs of the entire system.
“I don’t want people to stay in the Oregon State Hospital just as much as you don’t,” Marion County Commissioner Danielle Bethell told a legislative panel on Wednesday. “But they also can’t just be walking around my streets decompensating and creating more crime. It’s not good for them and it’s not good for our neighbors.”
The number of people in community programs has increased statewide from 355 people in July 2022 to 630 people this September, said Cherryl Ramirez, executive director of the Association of Oregon Community Mental Health Programs. Those programs are funded by the state and other sources like federal grants.
As a result, the group is asking lawmakers for an extra $7.5 million annually so providers can hire more staff and pay for housing, Ramirez told the panel, the House Committee on Behavioral Health and Health Care.
Lawmakers won’t decide on the community mental health budget – and others – until the 2024 session. Rep. Rob Nosse, D-Portland and the committee’s chair, said it sounded like a reasonable request.
Local pressures
Outside the state Capitol, litigation is pending.
In September, Marion County sued the Oregon State Hospital and the Oregon Health Authority, which runs the facility, in Marion County Circuit Court. That lawsuit alleges the health authority has not provided the staff, resources and facilities necessary to treat defendants, as required by state law.
“No county commissioner in history has ever said the first thing they want to do when they can’t work with a partner is file a lawsuit, but we’re at a severe loss in our county,” Bethell said.
A federal court case filed in 2002 by disability advocates, including Disability Rights Oregon, was resolved with a decision that patients need to be admitted within seven days of a court order for treatment. Otherwise, they sit in jail. But the lawsuit continued after the hospital did not comply.
In that case, advocates and the state hospital agreed to work with an outside expert to treat suspects in a timely fashion. A federal judge determined that patients are to be treated and discharged within three months for misdemeanors, nine months for nonviolent felonies and 12 months for violent felonies.
In certain cases, prosecutors can ask for the person to remain in the hospital beyond the deadline if they face violent felony charges and there is a compelling public safety concern or need for hospitalization. A misdemeanor defendant can stay at the state hospital for up to an extra 30 days if they have a placement set with a community mental health provider.
Even so, people still exit the hospital and don’t get the community care they need, said Paige Clarkson, Marion County’s district attorney. They also don’t go to court because they aren’t competent to stand trial.
“We really find ourselves with some of these folks in what I’ve been calling a black hole of unserved people,” Clarkson said.
Oregon State Hospital drops wait times
The wait time for patients to enter the state hospital has dropped.
In September 2022, when the court-ordered treatment deadlines were set, patients waited an average of 35 days to be admitted. Now, the average wait is slightly more than six days, Dolly Matteucci, superintendent of Oregon State Hospital, told lawmakers. That means those patients spend less time in county jails waiting for hospital treatment.
The hospital is maintaining that level while the number of admissions has increased – from an average of about 70 people a month to 97, Matteucci said.
The majority of patients – nearly three-fourths – are discharged from the hospital before they reach the court-ordered limit and return to their communities, she said. And about 27% are discharged because they reached the time limit and can no longer stay at the hospital.
Matteucci said patients have higher needs than before though turnover among staff has slowed after a wave of retirements during the pandemic.
“They are doing their usual work and treatment and they’re doing it at a more vigorous pace,” she said.
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