Oregon State Hospital, the state’s closed psychiatric hospital, abruptly announced three weeks ago that, in response to a federal judge’s order, it would be returning more than 100 patients to their respective counties early.
Many patients at the facility face criminal charges and are detained until they are stable enough to stand trial.
In interviews, sources familiar with Oregon’s struggling mental health system said the new policy won’t fix the system’s longstanding shortcomings: There just aren’t enough treatment options. treatment for people with severe mental illness. The emergency release is the latest symptom of a system that critics say is grossly inadequate for the mental health issues facing Oregon.
Kevin Fitts, executive director of the Oregon Mental Health Consumers Association, said the early release was a “fiasco”.
“Where are these people going? There’s not enough capacity,” Fitts said. “I’m not talking about a small lack of ability. I’m talking about 20-30% of what is needed.
The hospital did not specify who it would release, which upset prosecutors.
“It’s the most absurd thing in the world that we don’t know,” says Washington County District Attorney Kevin Barton. “And not only that, they won’t tell us.”
Oregon is near the bottom of the rankings for state mental health outcomes. Here, getting arrested is the only way for people to get treatment. And, when people get out of the system, they are often arrested again.
“It’s like squeezing a ball,” Barton says. “The hospital was rushed, and it bursts on our side. But there is nowhere to put these people.
Jason Renaud of the Portland Mental Health Association supports the new policy but says it won’t fix underlying issues. “A percentage of these people who are released will be back in prison in a few weeks,” says Renaud.
When these patients slip through the cracks, they make disturbing headlines.
Take, for example, Terri Lynn Zinser, a 54-year-old woman who left Oregon State Hospital in April after a four-month stay. She was referred to a local treatment center, Unity Center for Behavioral Health, but left soon after. The county then lost track of her, according to court documents, before she was found curled up under the covers of a crib in a northeast Portland home last Tuesday. Zinser was charged with burglary and harassment and released.
The state’s mental health system has been decimated by the pandemic. In a presentation to lawmakers earlier this year by Steve Allen, the state’s director of behavioral health, one slide called the community residential bed losses “staggering.” Only 16 secure Level 1 residential treatment beds, the highest level of care available to returning patients, remain in Multnomah County.
During a taped call with county officials earlier this month, Allen struggled to answer questions about the implications of the new policy for public safety. His agency released written responses to questions from county officials and WW earlier this week.
But many questions, including the long-term effects of the policy, remain unanswered. Here are the ones that are.
Why is Oregon State Hospital doing this?
Too many people are so seriously mentally ill that they need to be hospitalized, but there are not enough beds. (The hospital’s capacity is currently 705 patients.)
For those accused of crimes, that means jail. Defendants can only be tried if they are stable enough to “aid and assist” in their own defence. During this time, they are waiting in prison for a bed to become available at the public hospital so that they can be treated.
This process can take months, which judges ruled unconstitutional. In 2002, Disability Rights Oregon obtained a court order requiring the hospital to admit people within seven days. For 15 years, the state fulfilled that mandate, until ‘drastic cuts’ to mental health services during the recession led to an increase in the waiting list, says DRO legal director Emily Cooper .
In 2019, the average wait time was 26 days.
“We continue to be terrified that there are people with mental illness who are waiting in prison for court-ordered mental health services who, if not suffer, die,” Cooper said. It evokes the death of Bryce Bybee, 22, who was waiting in the Washington County jail for a bed in the state hospital.
On August 29, U.S. District Judge Michael Mosman ordered state health officials to follow an outside consultant’s recommendation to address the backlog: release patients awaiting trial sooner. While state law previously required the hospital to discharge defendants within three years, the new order reduces that time frame to a maximum of 90 days for misdemeanors and one year for violent crimes.
The timelines bring Oregon in line with other states, Cooper says. “You can’t just lock people up in the public hospital and throw away the key.”
How many patients does the hospital plan to discharge, and when?
“About 120” patients were newly eligible for discharge at the time of ordering, according to the Oregon Health Authority. However, they will not all be released at the same time and counties will be given 30 days notice before they are released. The first batch of notifications came out last week.
Multnomah County got its first Friday, said Julie Dodge, acting director of behavioral health for Multnomah County.
She’s not concerned about the county experiencing a “rapid influx” of new patients, Dodge says. Still, it’s an unwelcome change for a system that’s struggling to house and care for the patients it already has, she adds. The county has only three beds available in its locked treatment centers.
“We’re in this perfect storm,” Dodge says. “It’s going to take time to fix that – and we don’t have time.”
Where will discharged patients go?
It depends, says Judge Nan Waller, who chairs the county mental health specialist court, which deals with such cases.
Depending on the circumstances, the defendants could be placed in “community restoration” programs or simply released. In extreme circumstances, prosecutors can ask that a defendant be declared “extremely dangerous”, and if a judge agrees, they will be returned to a public hospital. But, says Waller, it’s very rare.
The court is working with the county, nonprofit organizations and insurers to try to find the best treatment option in the community for each defendant. But there are not enough beds. And there is no obligation for residential treatment centers to take anyone in. This can make it difficult, if not impossible, to find placements for people with criminal histories of certain offenses, such as arson, Waller says.
“People end up on the street”
Why doesn’t Oregon just expand the state hospital?
This would require approval from the Oregon Legislature. The state recently opened several smaller “cottages” at the state hospital’s satellite location in Junction City. But, beyond that, “they have not expressed any interest in expanding the state hospital,” Behavioral Health Director Allen told county officials earlier this month. .
State Rep. Rob Nosse (D-Portland), who chairs the House Interim Committee on Behavioral Health, said expanding the hospital is not a short-term solution.
In the meantime, Nosse points to more than $1 billion in new funding for mental health care. But Nosse says it will take Multnomah County’s mental health system at least two years to catch up with demand.
While he wishes the county had more time to prepare, he understands the logic behind Judge Mosman’s order.
“It’s a big deal,” he said. “These people deserve to get through this system faster.”
OK, the state opens its checkbook. Where is all this money going?
Higher wages for workers who care for patients in the public hospital and other treatment facilities, on the one hand.
During the pandemic, many employees refused to report for work at the public hospital and officials were forced to call in the National Guard. During the summer, staff regularly work mandatory overtime, says David Lynch, a nurse at the hospital and president of the union.
When asked why it is difficult to recruit workers to fill these positions, Lynch has a simple answer: “violence”.
Earlier this month, Oregon Occupational Safety and Health announced it was issuing three hospital citations related to “workplace violence and injuries.”
Lynch says recent pay increases have helped, but the hospital’s new release policy has not.
“It will increase acuity,” he says, referring to the amount of attention patients need to keep themselves and staff safe. “There will be less time to stabilize them, and turnover will be more frequent.”
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