From The Lund Report, May 17, 2011

Mental health advocates urge legislators to reform the Psychiatric Security Review Board

Mental health advocates, in alliance with patients at the Oregon State Hospital, believe House Bill 3100 doesn’t go far enough to reform the Psychiatric Security Review Board (PSRB), and are urging legislators to make significant changes.

They’re concerned about the “back door” at the Oregon State Hospital – how patients are assessed, treated, and eventually released once they’re sent there by the court system and the PSRB.

Chris Bouneff, the executive director of the National Alliance for Mental Illness in Oregon, described the changes in Senate Bill 420 and House Bill 2701 as “more comprehensive” and “more expansive” than House Bill 3100.

“[We] had no intention of resting on 3100,” Bouneff said. “It does so very little.”

As The Lund Report reported in an earlier story, that bill would require a state-certified psychologist or psychiatrist to evaluate people before they entered a guilty plea except for insanity. If they posed a substantial danger to others, those who committed misdemeanor crimes would be sent to the state hospital.

“I think [Senate Bill 420 and House Bill 2701] have the potential to transform our system,” Bouneff said.

Under Senate Bill 420, the Oregon Health Authority would have jurisdiction of patients at the state hospital. Now that authority rests with the PSRB, which is responsible for people who committed a misdemeanor or a felony, and have been found “guilty except for insanity.”

Of the 735 adults and 17 juveniles under PSRB’s jurisdiction in March, 344 people remain in the hospital, while the rest have been “conditionally released” to various community settings – supported housing and intensive case management.

Essentially functioning as a parole board, PSRB determines who enters the Oregon State Hospital, and when they leave.

By giving such jurisdiction to the Oregon Health Authority, “the hospital [would have] some control over who comes in and leaves,” Bouneff said. “Right now, they have no control.”

“It isn’t the board’s expertise to know when a person needs hospital-level care,” agrees Bob Joondeph, the executive director of Disability Rights Oregon. “What PSRB’s expertise is in is supervising people in community settings.”

House Bill 2701 requires the hospital superintendent to notify the PSRB when a patient is ready to be released, giving the board 60 days to do so. The Oregon Health Authority would be responsible for preparing treatment plans and clinical assessments, as well as determining appropriate timelines for such care.

“The idea behind both of these pieces of legislation is to create more movement where appropriate so that people don’t languish,” Bouneff said.

Currently, neither bill is scheduled for a hearing, which concerns advocates. Unless changes are made to the hospital’s back door, patients will continue to languish, Joondeph said. “It leads to hopelessness, and a level of despair that those folks are doing everything they’re supposed to do, and it never leads anywhere.”

Long hospitalizations

Bouneff and Joondeph are critical of the PSRB for keeping people in the state hospital even though they no longer need intensive care, treatment and 24-supervision.

“There are patients who are considered clinically ready for discharge who don’t need to be in the hospital, but are unable to leave,” Joondeph said. “They can spend months and years in there, frankly.”

The PSRB hearing process is slow and deliberate, Joondeph said, and numerous steps must be taken before someone can be conditionally released such as finding an appropriate community setting.

But such procedures result in an extremely low recidivism rate of 2.3 percent, meaning that few people commit new crimes after they’re released, said Mary Claire Buckley, the PSRB’s executive director.

Bouneff believes the PSRB is reticent to release patients because it’s “afraid of what happens if someone commits another offense. Unless the risk is zero, they hesitate to release someone.”

A lack of community resources impacts the PSRB

Buckley strenuously disagrees, and said “people should only be in the hospital for as long as necessary. We don’t deny that there are people right now who could be out.”

The timeline doesn’t solely depend on the PSRB but whether resources are available at the community level. “When community resources are made available to the board, the board conditionally releases people,” Buckley said.

Between 2003 and 2008, she said, the Addictions and Mental Health Division funded more community resources, which led to a 40 percent increase in the number of people who left the hospital. “That was a significant upsurge correlated directly with the increase in community resources,” she said.

By keeping people in the hospital long past the time they’re ready to leave, their lives essentially halt, said Joondeph. “People are institutionalized, and they are kept out of their community. Many patients feel frustrated by that.”

Senate Bill 420 Would Create a Dual System, Buckley Warns

Buckley has numerous concerns about Senate Bill 420, which, she said, could lead to many “unpredicted and unintended consequences.”

It would create a dual system, she said, by giving the Oregon Health Authority jurisdiction over people in the hospital while the PSRB would have authority for people who’ve been conditionally released. Because some people may need to be readmitted to the hospital, “people will be bouncing back and forth between the Health Authority and the board,” she added.

There’s also a potential conflict of interest “in having the same organization responsible for the budget and census” of the hospital also responsible for determining when someone is released. “The protection of the public will not be the primary concern,” Buckley said. “It’s not an independent review.”

Harris Mazaratto, who’s defended PSRB patients for the past 25 years and supports changes to the PSRB, agrees with Buckley. He called the legislation “a big gamble” because it doesn’t fully address what giving jurisdiction to the Health Authority would actually look like. “Will people be entitled to counsel? Who will be there on the board? Would it be just the superintendent? Who would pick these people?”

Letting the hospital decide who’s released may actually backlash for advocates. “This hospital has had some very conservative superintendents who were very fearful of any kind of liability and really went out of their way to discourage releases,” Mazaratto said.