It’s time to reform the Psychiatric Security Review Board

Guest column by Bob Joondeph, Executive Director, Disability Rights Oregon

The signers of a May 9 letter to the editor about the Psychiatric Security Review Board are a group of highly respected, accomplished and intelligent professionals (“Changes to Oregon State Hospital policies would threaten public safety,” They are rightfully proud of their roles in creating that board because it has been remarkably successful in achieving its stated purpose, to keep “the small portion of the mentally ill who commit significant crimes” in state custody for as long as possible.

The board was created to be insulated from the political, administrative and fiscal constraints that other state agencies must endure. The board has virtually unfettered discretion to keep patients in the state hospital for as long as it sees fit. It can do so regardless of whether the hospital’s doctors and treatment staff think a patient no longer needs hospital-level services. In effect, it can make Oregon pay for hospitalization of people who just need custody, not expensive hospital treatment. The head of the PSRB is appointed by the board, not the governor. The board contracts with a lawyer to represent patients and can choose another contractor if that representation becomes too bothersome.

Contrary to the impression left by both your May 2 editorial, “Swinging doors at the state hospital,” and the May 9 letter, pending legislation does not eliminate the PSRB, nor does it diminish the role of district attorneys, crime victims or law enforcement to participate in release decisions. It does try to inject some fiscal and treatment accountability to its activities; something that schools, human services, public safety and other public services are not allowed to avoid.

The letter says that “community mental health resources are tragically inadequate,” but accepts no responsibility for that harsh reality. The fact is that the PSRB has channeled a disproportionate share of mental health resources into keeping its patients warehoused in an expensive state hospital. Oregon is nationally unique in the high proportion of its mental health dollar that is spent on this population. This is why the vast majority of other states have not, in fact, adopted the PSRB model and why the National Alliance on Mental Illness of Oregon and Mental Health America of Oregon strongly support pending legislation to reform the board.

Disability Rights Oregon has worked to improve conditions in our state hospitals for 25 years. In that time we have seen chronic overcrowding, understaffing and decrepit physical conditions. Under the pressure of numerous lawsuits and demands from the U.S. Department of Justice, we are starting to see improvements. It is curious that the signers of the letter do not concern themselves with these conditions or the realities of the state budget. Times have changed since the 1970s when the board was created. With all due respect to the framers of the board, it should not be exempt from reform.