Directive to continue addressing the statewide Aid & Assist crisis

Directive to continue addressing the statewide Aid & Assist crisis

To: Margie Cooper Stanton, Director, Health Systems, Steve Allen, Behavioral Health Director, Health Systems, Dolly Matteucci, Superintendent/Chief Executive Officer, Oregon State Hospital, Derek Wehr, Deputy Superintendent, Oregon State Hospital

From: Patrick Allen, Director, Oregon Health Authority

Date: June 7, 2019

Subject: Directive to continue addressing the statewide Aid and Assist crisis

Oregon continues to experience increasing numbers of defendants who have been deemed unable to aid and assist in their own defense. Currently, most of these defendants receive competency restoration services at Oregon State Hospital. However, Oregon State Hospital cannot continue to absorb patients at the rates that they are being sent by local courts and jails. We cannot compromise the health, safety and civil rights of our current patients by going above our managed capacity. This has created a statewide crisis that is impacting our local communities, judicial systems, county jails and community mental health programs.

While this is a statewide issue, the Oregon Health Authority must continue doing all it can to mitigate the amount of time defendants are waiting to receive the treatment they need. This directive outlines the steps and associated deadlines Health Systems and Oregon State Hospital will take over the next few weeks. Most of these efforts are already underway. Please report back on your progress and findings no later than Friday, Aug. 9, 2019.

Reduce the amount of time people are waiting for admission.

  • Prioritize Aid and Assist admissions within the OSH admission process. Due: July 19.
  • Ensure counties know how to expedite admissions for people with the highest need for immediate psychiatric treatment. Due: Aug. 2.
  • Reduce the length of stay for current patients to make room for new admissions.

  • Speed up the discharge process for patients who are not yet able to Aid and Assist but who no longer need hospital-level care. Due: Aug. 2.
  • Determine if additional full-time forensic evaluator positions are needed. Due: July 19.
  • Increase community services for those who do not need hospital-level care to divert them from the hospital.

  • Establish plans to increase the state’s capacity for community restoration services through $7.6 million received through the Aid and Assist Policy Option Package, if approved. Due: Aug. 2.
  • Establish plans to implement SB 24 and 25, if passed, to support community restoration and improve process efficiencies. Due: Aug. 2.
  • Assess the feasibility of using the Northwest Regional Re-entry Center and other regional residential centers to provide community restoration services. Due: July 26.
  • Explore other funding options for community restoration and diversion services, including funds left from the decommissioning of Dammasch State Hospital. Due: July 26.
  • Ensure existing community mental health program contracts support community restoration and diversion services. Due: Aug. 2.
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    Health Authority Outlines Plan To Reduce Delays At Oregon Psychiatric Hospital – June 8, 2019

    The Oregon Health Authority released a proposal Friday for how it will deal with the backlog of jail inmates trying to get mental health treatment at the Oregon State Hospital.

    Right now, there are 44 people who judges around the state have deemed in need of mental health treatment before they can aid in their own criminal defense. They’re waiting inside jails until they can get admitted to the state’s psychiatric hospital.

    In a two-page memo to staff, OHA Director Patrick Allen said they’re taking steps to reduce the time people are waiting to be admitted and speed up the discharge process for those who no longer need hospital level care. He also stressed the need for funding from state lawmakers for community based mental health services.

    The plan comes days before the state is due in federal court in Portland over the issue.

    Disability Rights Oregon and Metropolitan Public Defender have sued the state, arguing it’s violating a 2002 federal court ruling that said inmates found unable to aid in their own defense must be transferred to the state hospital within seven days.

    The plaintiffs argue that’s not happening and point to the dozens in jails waiting to be transferred.

    In an interview with OPB on Friday, Allen acknowledged the state is operating outside the seven day window outlined in the federal court case.

    “We’ve driven that number down to 21 days and that waiting list down from about 60 people to closer to 30-40 people,” he said. “So we’re making progress.”

    Allen said he can’t admit everyone because it would jeopardize the safety of his staff and possibly the other patients.

    Research has shown the longer people with mental illnesses stay in jail, the sicker they become.

    “There are a lot of studies out there that show that people with say schizophrenia that’s untreated for a prolonged period of time, it may permanently reduce their baseline functioning,” said Emily Cooper, legal director of Disability Rights Oregon.

    Mental health advocates say people in jail often don’t get proper treatment. Many jail and law enforcement officials agree.

    In a declaration filed Friday in the federal lawsuit, Washington County Sheriff Pat Garrett said inmates ordered to the state hospital routinely stay in his jail past the seven day window.

    “Some of these mentally ill inmates decompensate to the point where they refuse to shower or maintain basic hygiene, they smear human feces on the walls of their cell, they engage in more or less constant yelling or mumbling, they engage in self-harm or they simply withdraw to the point where they don’t eat, speak or respond,” Garrett said in federal court documents.

    Garrett said people with mental illnesses shouldn’t be in jail, but should be “humanely housed in a therapeutic environment where they can be appropriately treated by medical professionals.”

    House Majority Leader Jennifer Williamson, D-Portland, said lawmakers are looking at ways to prevent defendants with misdemeanors from going to the state hospital, saving the room for those with felonies.

    “It saves the state hospital beds for people who are truly dangerous,” Williamson said. “It solves the problem only if we fund community mental health providers who can address the needs of people who are accused of violations and misdemeanors.”

    Allen noted in his memo that OHA has asked the Legislature for $7.6 million to fund community health programs, so people could get treatment locally rather than having to go to the state hospital. Many counties in Oregon don’t have adequate mental health services, making the state hospital a court’s only option should they find someone unable to aid in their own criminal case.

    Long term, the state and mental health advocates said they’d like to see more options so fewer people with mental illness end up in jail.

    Cooper, with Disability Rights Oregon, said that’s in part what the federal lawsuit is about.

    “What we’re trying to do in this litigation is say, ‘No, we don’t even want someone to show up at the jailhouse door, we want them to be diverted from the correctional health system,’” she said.

    As for those who are languishing in jails right now, Allen said: “My heart goes out to them and I am doing everything that I can to get them into the hospital as quickly as I can.”

    That’s an argument a federal judge in Portland will weigh in on Tuesday.

    OHA sets deadlines to end patient space shortage at crisis-stricken Oregon State Hospital
    Salem Statesman-Journal, June 8, 2019

    The Oregon Health Authority has set deadlines intended to address the crisis at Oregon State Hospital hampering its ability to admit new mental health patients sent by court orders before the patients go to trial in criminal cases.

    OHA Director Patrick Allen announced the timetable Friday, which was sent to Gov. Kate Brown. The state hospital is at maximum capacity and has about 40 people waiting for admission.

    The state was held in contempt earlier this week by a Washington County court after it failed to admit four court-ordered “aid and assist” defendants within the required seven-day deadline.

    So-called “aid and assist” court orders account for more than 260 patients already housed at Oregon State Hospital. Local courts use the orders as a tool to commit defendants to the hospital so they can get treatment and become able to “aid and assist” in the defense of their pending criminal case.

    Allen’s memo directs hospital administrators to prioritize aid and assist cases within the hospital’s admissions process by July 19.

    “The state hospital cannot solve this capacity crisis on its own,” Allen said in a statement. “We look forward to working with legislators and local leaders to adopt more effective solutions that prevent people with mental illness from being arrested, keep them out of jail, divert patients who don’t need acute treatment from the state hospital and offer them housing and treatment in their communities.”

    By Aug. 2, the state has the goal of ensuring counties know how to expedite admissions for people with the highest need for psychiatric care.

    The hospital also has the goal of speeding up the discharge process for patients who are not yet ready to aid in their court cases, but no longer need hospital-level care. That deadline also is Aug. 2.

    Allen’s memo calls for establishing plans for increasing the state’s capacity for community services for people who don’t need hospital care. It also calls for developing new for funding options.

    In a statement, Gov. Brown said: “The steps outlined today by the Oregon Health Authority will help stem the capacity crisis at the Oregon State Hospital; but to truly solve this problem, we need to stop practice of criminalizing the homeless and mentally ill.”

    Brown also urged lawmakers to approve funding to expand housing and mental health treatment on the local level to curb homelessness and help people get into safe and stable homes.

    Lawmakers have been alarmed by the situation and are trying to address it with Senate Bill 24, which has passed the House. Lawmakers want to ensure that defendants get the mental health care they need and don’t fall through the cracks.

    The bill is now with the Senate. Brown said she’s been working with legislative leaders on amending Senate Bill 24 so that it will have “a meaningful impact on reducing court-ordered admissions to the State Hospital so that beds can be reserved for those most in need.”

    Lawmakers plan to have a conference committee and work on bill language that would restrict the ability of individuals facing misdemeanor charges to be sent to the hospital.

    Oregon House Majority Leader Jennifer Williamson, D-Portland, and Sen. Floyd Prozanski, D-Eugene, have called the situation “absolutely unacceptable.”

    The number of patients sent to the hospital to be treated and prepare to participate in their criminal trial has steadily grown.

    That group had an average daily population of 109.4 in 2012. Four years later, the average daily population was 218.7, the hospital said.

    Oregon State Hospital is operating with about 95% of beds filled instead of the industry standard of 85%, said hospital relations director Rebeka Gipson-King. That’s to accommodate more patients sent by the courts.

    As a result, most units only have one bed available for sudden and acute needs. At 95% capacity, the hospital has 632 beds for patients at its Salem and Junction City campuses.