The Oregon State Hospital – and the state’s wider mental health system – is failing and unable to stop the cycle of people who repeatedly don’t get help until they are arrested, state lawmakers heard Thursday.
The challenges are myriad: People often cannot access care they need until after they are arrested and sent to the state hospital, which can provide services to 758 people in a main campus in Salem and a satellite location in Junction City. Meanwhile, counties often lack the adequate resources to help people released from the state hospital, whether through housing options, treatment or both.
For Oregon, it’s a mounting crisis that impacts people in the system and the communities they will return to.
“The system is failing and I think that needs to be recognized,” Washington County District Attorney Kevin Barton told lawmakers on the House Interim Behavioral Health Committee on Thursday. “The system is failing on multiple levels.”
Now, the state hospital faces a federal court order that requires it to treat and discharge patients sooner when they face criminal charges – and send them back to their counties. The issue extends beyond the walls of the Oregon State Hospital, the state-run mental health residential facility that serves people deemed by courts to need treatment so they can aid in their own defense when they face criminal charges. That’s because the patients will return to their communities and continue to need resources.
Lawmakers want to hear solutions, Rep. Rob Nosse, D-Portland and the committee’s chair, told the audience and speakers. Legislation is also in the works to address some of those needs – including bills to expand 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 bring their ideas to him.
The state hospital is asking lawmakers for $4.9 million so it can hire more people it says are necessary to admit, treat and discharge patients more quickly.
The state has had three months to get used to moving patients through the pipeline quicker. On Sept. 1, U.S. District Judge Michael Mosman ordered strict limits for treatment: up to 90 days of treatment for people charged with misdemeanors, six months for nonviolent felonies and one year for violent felonies. After that, the state’s psychiatric hospital is required to discharge patients into the custody of their counties. Prior to that, state law allowed treatment for up to three years, or when the patient was held for their maximum sentence if they were found guilty.
At the heart of the dispute is a 20-year-old lawsuit centered on the plight of people facing criminal charges who are sitting in jails because they can’t get treatment promptly. A court order in that case called on the hospital to admit them within seven days of a judge determining they needed mental health treatment to aid in 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 comply with 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 problems. The recommendations that followed included new timelines for treating patients. The outside expert, Dr. Debra Pinals, director of the Program in Law, Psychiatry and Ethics at the University of Michigan, recommended tighter timeframes to restore people to competency – among other reforms.
State officials acknowledge the system needs work.
Nosse asked Patrick Allen, the Oregon Health Authority director, if the state agreed that the judge’s order was a good idea.
“We’re out of good ideas in this space,” Allen said, adding that the authority agreed to the outside expert and, when faced with the order, “it was a little bit difficult to argue that point.”
Nosse asked Allen what’s needed to make the situation better.
“More of everything,” Allen said, adding that too many people end up at the state hospital after a call to 911 and involvement with law enforcement.
For the short term, the Oregon State Hospital is asking lawmakers to approve $4.9 million for 59 new staff positions for the rest of the biennium, which ends June 30, 2022. The state hospital says the additional employees are needed because of the increased patient turnover – and accompanying clinical work in a shorter time frame– that comes with the order.
The new positions include staff who provide security and transportation, social work, treatment and therapy services and admissions and forensic evaluation services. If that request is granted, its estimated cost for the 2023-2025 biennium would be $15.5 million.
But state officials recognize the system’s needs more. Those include more hospital-level beds, but not necessarily at the state hospital, Allen said.
Marion County District Attorney Paige Clarkson said she’s concerned about pending releases from the state hospital that involve people with serious charges, including arson, child sex abuse and assault. Those people, Clarkson said, will return “unrestored and without a plan.”
“We simply have more questions than answers,” Clarkson said.
Problems persist after a criminal case ends.
Grant Hartley is director of the Multnomah County office of Metropolitan Public Defenders, which provides public defender services in the Portland region. Hartley said defendants who have their case dismissed are often left with limited services.
Social workers and case managers will often work “frantically” 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 that the answer is not warehousing people – it’s putting up more long-term community mental health services to keep people from cycling back into the system.
“We cannot build our way out of this,” Cooper said, adding that the state hospital is being misused as a “de facto detention center.”
“The hospital needs to get back to the way it was designed,” Cooper said.
She added that people in Oregon jails have died while waiting for care, four in Multnomah County and three in Washington County.
The people dying, Cooper said, are what “keeps me awake at night.”
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