A necessary hospital – Governor backs Junction City mental health facility

From the Eugene Register-Guard, September 30, 2011

Gov. John Kitzhaber’s affirmation Wednesday of state plans to build a psychiatric facility in Junction City was pitch perfect, both in its recognition of the need for the new hospital and in its commitment to expanded community-­based health care.

Governor John Kitzhaber by Henk Pander

Governor John Kitzhaber by Henk Pander

As the governor reminded the packed crowd attending a town hall meeting, the state will need more secure psychiatric beds when its two smaller mental hospitals in Portland and Pendleton close in coming years.

The governor is right about that, even though some advocacy groups have questioned the need for the Junction City hospital. They argue that a new 620-bed facility in Salem will replace the capacity that will be lost when the current Oregon State Hospital is closed. They say the state should invest in community-based mental health services instead of building the Junction City facility. That, they say, would enable the state to keep patients in a setting that’s cheaper for taxpayers, that provides a less institutional environment and that keeps patients closer to families.

Hospital critics are on target about the importance of community-based mental health care, but they’re wrong in arguing that the Salem hospital will provide Oregon with sufficient capacity. As the governor noted, Oregon will lose space for 150 psychiatric patients in 2015 when two of Oregon’s smaller psychiatric hospitals, Oregon State Hospital in Portland and Blue Mountain in Pendleton, are closed. That’s when the 174-bed Junction City facility is supposed to come on line, providing the state with a modest net gain of 24 psychiatric beds to the state system.

Those beds play a crucial role in the state’s system, serving people with severe mental illness who require acute care. If insufficient hospital space is available, people with severe mental illness are pushed into community-­based residential centers, leaving less space for patients who need 24-hour treatment but can be cared for in non-institutional settings.

As previously noted in this space, that’s what’s happening now. Because the state lacks sufficient hospital space, facilities and programs that provide less-intensive mental health treatment are forced to deal with people whose illness is more severe than is appropriate for those services. Meanwhile, those who need secure psychiatric beds often must wait for months before there is an opening.

Yet Kitzhaber also was right to recognize the need for Oregon to transition to a mental health care system that is focused on community-based preventive care for most patients — and that could see the Junction City facility eventually transition into a prison that specializes in treating mentally ill inmates.

The move away from “big-box” psychiatric facilities to community-based care is also one for which the federal government has advocated, in particular the Obama administration. But that transition will take time. It’s one thing to talk about locating a network of 16-bed community mental health care facilities throughout Oregon; finding actual sites and cooperative communities is another matter.

Finding the money to expand community-based care also will be a daunting challenge at a time when the state faces major budget shortfalls. Oregon and other states already have learned the painful lesson of what happens when states find money by cannibalizing their hospitals.

An effective state mental health system provides a continuum of services ranging from hospitalization to community-based care. The governor has made clear that he recognizes the need for that continuum, and he should, along with the Legislature, stay the course on a new state hospital in Junction City.