From Go Local PDX, September 09, 2014

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The number of criminal suspects in Oregon deemed unfit to stand trial and then sent to the state mental hospital has almost doubled in the last four years and it’s costing the state millions.

Under Oregon law, if someone accused of a crime is unable to participate in their own legal defense because of a mental illness, they are sent to either a mental health facility in their own community or to the Oregon State Hospital, where they then receive treatment until they are fit for trial.

Increasingly, judges are using the latter option.

Between January 2010 and April 2014, the number of suspects sent to the Oregon State Hospital jumped from 88 to 151, according to the Oregon Health Authority.

“It’s not good practice. There’s really no evidence that that benefits people,” said Jason Renaud, spokesperson for the Mental Health Association of Portland.

Renaud said that many patients are sent to the state hospital for fairly innocuous infractions, such as shoplifting.

Almost half of all “aid and assist” patients, as they are called, are sent to the state mental hospital for misdemeanor and infractions, according to the healthy authority.
Cost run high

That comes at a high cost: $678.44 a day for an aid and assist patient to stay in the Oregon State Hospital. They make up about 20 percent of the population.

In 2013, aid and assist patients stayed a statistical mean of 71 days, costing the state roughly $48,000 a piece.

“Sending people to the state hospital is the most expensive option available, except for maybe the emergency room,” Renaud said.

State courts overwhelmed

Judge Julie Frantz oversees most of the aid and assistant felony cases that go through Multnomah County Circuit Court.

She said she can’t speak to courtrooms in other counties, but that in Multnomah County the mental health system is overwhelmed.

At the local level there is an enormous lack of services and support for people with mental illness, Frantz said, adding that too many people are walking a thin line that can be easy to fall off.

“There’s no funding for medication, for treatment, 24-hour clinics, housing,” Frantz said. “If someone is suffering from mental illness, then they lose their job, they might snap [and commit a crime.]”

But once they are in front of her, the defendant has to make a decision, whether to plead guilty, plead no contest or go to trial. If they can’t make that decision for themselves, and they pose a potential threat to the public, she has to do something with them.

At that point, she said, there are very few options left for them.

“County jails aren’t equipped to be mental clinics,” Frantz said. “The only alternative we have left is to send people to the state hospital.”

State slow on meeting goals

The state of Oregon had planned to move away from its reliance on the state mental hospital system.

Renaud [and Frantz] both point to a U.S. Department of Justice report that stated Oregon’s efforts to shift its mental health services towards smaller community-based care facilities has fallen flat.

“The data we have reviewed clearly shows that Oregon’s community services have not begun to expand,” reads the report. “That has led to a predictable result – Oregon is not yet transitioning to a community-based system.

“The State’s data reveals that funding for mental health services is not yet shifting away from costly restrictive institutional settings to more effective, less costly community settings.”

Frantz agrees that smaller more intimate care facilities would be less costly and would provide more support for defendants, but not enough of those facilities exist.

Marion County, which is home to the Oregon State Hospital, has taken a proactive approach to providing more community-based mental health services to people with an aid and assist status, said Bob Joondeph, executive director of Disability Rights Oregon.

Scott Richards, behavioral health division director for the Marion County Health Department, said state funding has allowed his agency to hire a clinician to treat some patients in a community-based setting.

That approach is cheaper than the state hospital and has another benefit, he said.

“I also think … that it makes more sense to not remove someone from the community they are going to live in if they don’t need to be,” he said.

Frantz pointed to places like Bexar County, Texas, as a place that was leading the nation in community-based care.

That said, the state of Oregon has already said it wants to move towards a more efficient and supportive system. It just hasn’t gotten there.

“The legislation passed,” Frantz said. “But it doesn’t appear the funding followed.”