Salem Statesman Journal, March 18, 2012

For decades, the Oregon State Hospital was mired in misery.

Behind the Salem hospital’s crumbling facade, mentally ill Oregonians were packed into a bleak, antiquated and unsafe asylum.

New state-of-the-art facilities are now in place, but opinions are divided when it comes to a key question: Are patients receiving better treatment in the new hospital?

Doubts are expressed by some patients.

“I don’t know if the treatment we’re getting is that much better, but it is definitely a nicer place,” said patient Renee Putnam, 31.

Patient Stava Rikai said he is reserving judgment on the quality of care delivered in the new facility. But he said the push for improved treatment has gained momentum in recent years with the creation of treatment malls, where patients gather during the day for therapy.

Development of the treatment malls ended the outdated practice of keeping patients cooped up on crowded treatment wards for therapy.

Therapists and mental health activists describe the treatment malls as a significant reform.

Maggie Bennington-Davis, a psychiatrist who runs Cascadia Behavioral Healthcare, a non-profit agency that provides community-based services for people with mental illness, sees signs that patients coming out of the hospital after stints of treatment are better prepared to resume their lives.

“It seems like people are readier, further down the road, in terms of thinking about their own recovery and being engaged in treatment,” she said. “So I think the treatment within the walls is probably improving. Certainly a new facility helps along those lines, especially when you’re moving out of a pretty awful old facility.”

As many people tell it, Greg Roberts, superintendent of the hospital since September 2010, has played a key role in turning around the hospital.

“Greg Roberts is persistent,” said psychologist Daniel Smith, who has worked at the hospital for eight years. “He is working with both unions here at the hospital and with the management staff to bring about change. In 18 months, he has brought more change than occurred here for quite some time.”

During Roberts’ tenure, the hospital has slashed the number of internal committees, filled long-vacant administrative posts, streamlined how patient privileges are determined and given patients more say about their own treatment.

Roberts also has pledged to reduce and eventually eliminate mandatory overtime, a promise that appeals to staffers who long have complained about mandated double shifts.

The hospital chief also has won over mental health activists who describe him as a skilled catalyst for positive change.

“He doesn’t accept pat answers, and he’s got some real social skills in terms of leadership that I haven’t seen in a superintendent previously,” said Beckie Child, executive director at Mental Health America of Oregon.

Unlike past hospital leaders, Roberts is no stranger to patients and staffers on the front lines of care, Child said.

“Greg is out walking the wards,” she said. “He comes at odd hours to see what’s happening at the hospital. That thrills me.”

History of Neglect

State leaders long turned a blind eye to institutional decay. They also neglected the human anguish that piled up like dirty laundry at the same hospital where “One Flew Over the Cuckoo’s Nest” was filmed in the 1970s.

Now, though, many people say the 129-year-old psychiatric facility is on the upswing.

“I think the most outstanding thing is that we’ve done away with the old Cuckoo’s Nest and replaced it with something that is more beneficial and more humane,” Rikai said.

Rikai, 29, moved into the new hospital this week, along with about 180 fellow patients. They made up the last wave of patients to exit old hospital units and settle into the new 620-bed facility.

For Rikai, preparing for the switch revived memories of the former hospital’s prison-like look and feel.

“It was just very oppressive,” he said. “There is no way that razor wire can be humane.”

Living conditions in the new hospital provide patients with more privacy and dignity, Rikai said.

Staffers agree.

Joe Thurman, a nurse who has worked at the state hospital for 15 years, described the new facility as “a godsend.”

“I’m glad they have it done,” he said. “I think our patients deserved better than (conditions at) the prisons, and we do have some good programs.”

Smith, the psychologist who has worked at the hospital for eight years, said staff morale has rallied amid the shift to modern facilities and a push to provide each patient with individualized therapy.

“As would happen with any facility, there’s some growing pains as we find out that there are some flaws,” he said. “Overall, it’s a tremendous benefit. We are better able to provide services. The environment itself is physically safer.”

With full occupancy of the 870,000-square-foot complex, Smith envisions the psychiatric hospital entering a progressive new era.

“We have, in general, more resident freedom on the grounds than at any other time in the history of the hospital,” he said. “We have more opportunities for community integration. And we are moving more toward a recovery model. And staff are embracing that model as they see it be successful.”

Talk of a turnaround at OSH is noteworthy, in part, because of its long-troubled history. Until recent years, state leaders ignored a litany of hospital problems, including severe under-staffing, high rates of patient-caused violence, security breakdowns and dangerous conditions in run-down buildings.

A multitude of flaws and failings were spotlighted in January 2008, when the U.S. Department of Justice issued a blistering report that criticized nearly every facet of patient care and hospital conditions.

Federal investigators urged the state to make sweeping improvements or risk being hit with a civil rights lawsuit that could put the institution under federal court control.

The harsh federal critique prompted state officials and legislators to allocate extra money for additional staffing and speed up other improvements.

Construction of the new hospital was green-lighted by legislators before the damning federal report. The building came on line in phased fashion, culminating in this month’s last round of patient moves into the completed facility.

Chris Bouneff, executive director of NAMI Oregon, short for the National Alliance on Mental Illness, expressed mixed emotions about the new facility.

“The Salem campus is not ideal,” he wrote in an e-mail to the Statesman Journal. “Congregate care for 620 people is never ideal. But without the reconstruction of the state hospital, providing any care would have remained impossible. You cannot heal when the physical environment is in shambles, nor can you provide proper care if your physical workplace is in such disrepair that it works against you.”

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