Hospital Closing Would Accelerate State’s Direction on Mental Health

From the Lund Report, December 2016

It’s unclear if the Legislature will actually approve the closure of the Junction City as the same forces that won $130 million to build it over the concerns of the mental health community will fight to save it. But it’s possible it could be used as a prison hospital while patients are treated in the community with funding from Medicaid through CCOs.

By Chris Gray

The state would only be accelerating a direction that the state had already planned to go if Oregon moves forward with closing the Junction City hospital by summer 2018, according to a spokesman for the Oregon Health Authority.

“Prior to the opening of Junction City, the facility was described as a short-term solution for residential beds that would be alleviated as community-based treatment capacity increased,” explained Oregon Health Authority spokesman Robb Cowie.

Bob Joondeph, the director of Disability Rights Oregon, said the position of his organization felt validated. “We opposed it being built in the first place. We thought it was expensive and the wrong allocation of healthcare dollars,” he told The Lund Report. “The closure represents the direction that the state should be going.”

But Chris Bouneff, the director of the National Alliance for Mental Illness — Oregon, said it was hard to react to the announcement without knowing how serious Gov. Kate Brown was with the proposal.

“It’s not a surprise because as everyone predicted, building Junction City put the state in a precarious position financially that was not sustainable. It truly is something the state has to pay for itself,” he said — unlike other services for people with Medicaid, the bulk of which would be paid for by the federal government.

The state would save $34.5 million by closing the psychiatric hospital in June 2018, barely three years after the state spent $130 million in construction costs to open it.

The Junction City psychiatric hospital has 81 patients, including both civil commitments and people who have been convicted of crimes but for insanity.

Brown’s budget continues investments in the community mental health system first proposed by former Gov. John Kitzhaber, but the budget doesn’t include any new money specifically earmarked for mental health services.

The budget does keep the Medicaid program running at full strength, and since many people with severe mental illness qualify for the Oregon Health Plan, this could provide the means for funding necessary services for them through coordinated care organizations. Any services funded through Medicaid are primarily paid by the federal government, which refuses to pay for care in state institutions.

Aid & Assist Population Hits Record High

Meanwhile, the number of people that local authorities are shipping to the state hospital so they can be stabilized for trial hit a new record high in October, climbing to 241 after dipping below 200 people for most of the summer. Joondeph said 40 percent of these individuals are forced into the state hospital on misdemeanor charges, which are typically dropped when they do appear in court, only to be placed right back on the streets without connecting them with services.

Brown’s budget includes a number of heavy lifts besides the Junction City closure, raising the question of whether her proposals are at all realistic or just a conversation-starter.

Her healthcare policy advisor, Jeremy Vandehey, declined to be interviewed for this article.

Brown comes in with a mandate from her narrow but decisive 51-44 victory over Republican challenger Bud Pierce, but will serve just two years before having to appear before the voters again in 2018.

Her budget proposes just shy of $900 million in new revenues, including $35 million from tobacco taxes and $34 million in new liquor taxes.

At the same time, she wants to grow the state bureaucracies, adding 7 percent more employees at the Oregon Health Authority and 3 percent at the Department of Human Services. Salaries at the Oregon Health Authority have soared under Director Lynne Saxton by 29 percent since 2013.

Conservative editorial writers and leading Republicans such as Senate Minority Leader Ted Ferrioli, R-John Day, have blasted the governor for not taking up public pension reform, likely kicking that conversation to the Legislature where Sen. Richard Devlin, D-Tualatin, will have a tough job putting together a budget that can actually pass.

The budget disruptions are driven in part by a $1 billion reduction in federal spending for Medicaid, as the state is being asked up to pick up a greater share of the healthcare costs for low-income residents. Democrats and labor leaders asked the voters for a $5 billion corporate tax increase — Measure 97 — but were soundly defeated.

“The Governor proposed a balanced budget that was built on difficult choices,” Cowie added. “These choices are a product of the tight budget constraints the state is facing over the next two years.”

All revenue measures require 60 percent of legislators in each chamber, which Democrats cannot pass on their own. Opposition to the Junction City closure is also likely from labor groups and the legislators who built the hospital over the concerns of mental health advocates. Even opponents of the hospital’s construction, including Sen. Sara Gelser, D-Corvallis, wonder if closing the hospital in 2018 is moving too fast, according to the Eugene Register-Guard.

Prison Hospital Solution?

Bouneff said the Junction City hospital was always built as a way to provide jobs for people in Lane County — not because it was the best way to provide mental health treatment.

The state budget is also strained by increasing costs for the mass incarceration of its residents, caused by mandatory minimum sentencing laws such as Measure 11. Kitzhaber attempted to roll back some of those, but ran into opposition and the state will likely have to build more prisons.

It’s possible the Junction City hospital could be converted into a Department of Corrections hospital, which could save some of its 330 jobs while freeing up space in the existing prison network for new prisoners.

“Everyone’s saying it was a wasted investment — well, no, it was designed for multiple purposes,” Bouneff said.

Joondeph said the state also has up to 40 inmates being treated at the Behavioral Health Unit at the Oregon State Penitentiary in Salem. “These are the inmates with the most severe combination of mental health and behavioral challenges in the prison system,” he said. “There are over 200 inmates who are placed in specialized settings for mental health reasons and many, many more with mental health diagnoses.”

The state also has more than 900 inmates who are older than 60, many of whom will likely need long-term care and hospitalization before they’ll ever return to society.