From the Salem Statesman Journal, May 23 2009

New psychiatric facility alone can’t fix Oregon’s mental health system, advocates say

Construction will get under way next month on the first phase of a $280 million psychiatric hospital to replace the obsolete and unsafe Oregon State Hospital.

But mental health advocates warn that it won’t cure Oregon’s ailing mental health system.

As they tell it, the new hospital envisioned by state leaders as a “world class” psychiatric facility won’t succeed unless the state finds more money to bolster community-based mental health services.

“My fear is, we have a monument to futility right now in the state hospital and we’re just going to build a nicer monument to futility,” said Chris Bouneff, executive director of the Oregon chapter of the National Alliance on Mental Illness.

“If they don’t come to some terms soon, we’re going to be stuck with our same old problems that we’ve battled now for decades. The only thing that will change is that we’ll have a nicer building.”

Community-based mental health services include housing, medication, case management, counseling and assistance with employment. Such services are essential to help people with mental illness maintain stable, productive lives, advocates said.

In some cases, proper assistance can prevent people from requiring hospitalization. In others, it can help former hospital patients stay on the path of recovery.

All too often, though, the critical services are lacking in communities across the state.

That’s why Jason Renaud of the Mental Health Association of Portland objects to massive state spending on the new hospital in Salem.

“We believe the state’s attention and funds should be going towards the outpatient system, which is so crippled and porous that people end up in the hospital when earlier and less expensive intervention would have been more successful,” he said.

Like the antiquated state hospital, Oregon’s community-based mental health system has been “broken for generations,” Renaud said.

County jails and state prisons now harbor thousands of mentally ill Oregonians, partly owing to inadequate community-based programs and services, he said.

“The community system has been starved to the point where people migrate from their first episode into jails, into prisons, into parole and probation departments and into the state hospital,” he said.

Also troubling, he said, has been the evolution of the state hospital into a forensics facility, largely housing patients who were judged guilty of crimes except for insanity.

“Looking at the history of the hospital over time, it really has become an annex of the corrections system more than an annex of the mental health system,” Renaud said, “and it is the most feared place for people with a mental illness in the state. It should be the safest and most beneficial place but it hasn’t played that role for several decades. That’s entirely, I think, due to the neglect by the state legislature.”

Hospital projects on track

Gov. Ted Kulongoski, Senate President Peter Courtney and other legislative leaders have stated their intent to go forward with two new psychiatric hospitals to replace the 126-year-old state hospital.

The 620-bed Salem facility is scheduled to fully open by 2011. A 360-bed facility in Junction City is scheduled to open in 2013.

Legislators approved spending $458 million for building the two hospitals. The pivotal decisions came before the state was sent reeling by a deep economic recession and slumping tax revenue triggered by one of the nation’s highest unemployment rates.

Now, legislators face a $3.8 billion shortfall in the 2009-11 budget cycle. Legislative budget writers working to plug that hole recently unveiled a two-year budget that calls for an 11 percent cut for the state Department of Human Services, which oversees mental health programs.

Mental health advocates fear that the underfunded community-based mental health system will remain “broken.” They said that doesn’t bode well for mentally ill people struggling without adequate help in the community or patients deemed ready to leave the state hospital.

“One of the largest problems we face is the lack of step-down services,” Bouneff said. “We have a shortage of residential beds and community-based programs. There’s really nowhere for someone to go once they are well enough and it’s no longer clinically necessary for them to be in a hospital.”

The state has made concerted efforts in recent years to expand the supply of group homes and residential facilities for patients leaving the state hospital. But progress has been slow, partly because of community opposition to such facilities.

“And we’re certainly not making any big new investments in that in the current budget climate,” Bouneff said. “So that’s still a big problem.”

Meanwhile, the state hospital will continue to devour money, he said.

“We’re spending a significant amount of money to house people in the Oregon State Hospital,” Bouneff said. “In the most extreme cases, it costs upwards of $200,000 a year.”

First phase of new hospital

ABC, short for admissions, behavior and corrections, is the term state planners use for the first phase of the new hospital.

It will have 124 beds and house patients in three separate programs:

-Admissions will be the 44-bed entry point for new patients. They will undergo clinical evaluations and get stabilizing treatment, then move to other areas of the hospital for additional treatment.

-Behavior will have 60 beds for patients who violate hospital rules or instigate violence. Such patients now are housed on maximum-security wards in the J Building.

-Corrections will consist of a 20-bed unit reserved for mentally ill patients transferred to the hospital from the state prison system. After short-term care, these patients will go back to the prison system.

Construction of ABC will begin next month with site prep work, followed by laying of a concrete foundation.

Development of the first component of the new hospital marks the beginning of a multi-phased building program. The new hospital is being built south of Center Street NE, within the southern part of the existing hospital campus.

The sour economy could produce early cost savings on the project because firms are hungry to work and tamping down their bids for contract work, said Linda Hammond, hospital replacement administrator for the state Department of Human Services.

“We’re getting some good bids back,” Hammond said. “I’m optimistic about the savings we can make with the condition of the economy.”

The state recently accepted bids on $40 million worth of contractor work on the project, including setting the concrete foundation for the first section of the new hospital and reinforcing parts of the existing hospital’s creaking J Building.

The state plans to seek bids soon for $120 million worth of contract work on the project.

Hammond envisions a short-lived opportunity for cost savings.

“You’re going to lose that advantage pretty quickly when the stimulus projects start hitting the street,” she said. “Right now, companies are looking to keep their doors open until these other projects come along.”

OUR COMMENT – Oregonians have the opportunity to entirely repair our state’s public mental health system – both at the state hospitals and in the county-based outpatient mental health programs through their vote and through their advocacy with our state legislators. It is not a question of malfeasance, or stigma, or corruption, or old-fashioned ideas. It’s really only a question of money.