Opinion: More options, not more beds

The Register-Guard, April 21, 2016

When a state psychiatric hospital has empty beds, it’s a good sign for Oregon’s health system and for people who struggle with mental illness. While a March 22 Register-Guard story focused on unopened beds at the Oregon State Hospital facility in Junction City, Oregon’s state hospitals are grappling with a growing capacity challenge: a rising tide of people committed for long hospitalizations due to minor criminal offenses, not because a hospital stay is the best treatment option.

In Oregon, we want to provide a comprehensive range of mental health treatment options in the community and, only when necessary, at the state hospital. We know treatment is most effective when people receive the right services at the right time, in the least-restrictive setting and for the appropriate length of time. This approach is the best way to promote public safety, patient-centered recovery and the efficient use of state and county resources.

Before the Junction City campus opened, planners projected it would take several years before all beds would be used.

That’s good for patients, their loved ones and taxpayers. When more people receive treatment in less restrictive, community settings, it keeps them closer to their homes and out of the hospital — the most restrictive and most expensive element of the system. (It costs about $700 per patient, per day, to treat someone at one of the state hospital campuses.)

Until recently, Junction City had been on track to remain on a slow and steady growth path. That’s changing, due to an unforeseen source of commitments.

Increasingly, Oregon State Hospital beds are being filled by a growing number of commitments from the criminal justice system — people who receive a court order to undergo mental health treatment so that they are able to “aid and assist” in their own defense. Junction City is preparing to open a new 25-bed living unit to absorb civilly committed patients from the state hospital’s Salem facility who have been displaced by the influx of patients sent there by a criminal court order.

Many of these patients have been charged with low-level, nonviolent misdemeanor offenses, such as disturbing the peace or disorderly conduct. They are sent to the state hospital because they’re not mentally competent to assist in their own defense.

In these cases, the hospital’s job isn’t focused on promoting long-term recovery, as it is with people who are civilly committed. It is limited to stabilizing and returning that patient to jail so he or she can participate in the court process.

The state hospital can’t address this issue alone. We’re working with local partners — including county commissioners, judges, district attorneys, sheriffs and county mental health programs — to divert more misdemeanor defendants from the state hospital to more appropriate community treatment.

For example, Marion and Washington counties have mobile crisis units that team mental health professionals with law enforcement.

They work to avoid arresting and jailing people who are in mental health crises. With this approach, people get the mental health services they need without being arrested, resulting in fewer admissions to the Oregon State Hospital. It also means that mentally ill people are not taking up space in jail.

For counties, building resources does not happen overnight. Some of the success Marion County has seen is because it has been working on building support services over the past 20 years. Lane County is building its support services, and in addition to two mobile crisis units is working on developing a crisis assistance center.

For any county making steps toward supporting mentally ill people in their community, there has to be the commitment of long-term funding.

The Legislature is doing its part. In 2013 and 2015, lawmakers invested more than $86 million in the community mental health system so that other parts of the state could develop their own programs like those in Marion and Washington counties.

We need collaboration in every county to ensure that people with mental illness get the most effective treatment in the right setting. Today, too many mentally ill people wind up in the criminal justice system and, ultimately, in the state hospital.

The solution isn’t to add more beds. It is to give local public safety officials more options, so the people who are committed to the state hospital are only those who truly need and can benefit from hospitalization.

Greg Roberts is superintendent of the Oregon State Hospital.