From the Eugene Register Guard, June 25, 2011

A $5 million allocation from the Legislature is a fraction of the projected cost, but sources say the proposal is just delayed

Legislators are close to unveiling a proposal that would allocate $5 million for infrastructure costs over the next two years for the state psych­iatric hospital proposed for Junction City.

That’s down from the $83 million Gov. John Kitzhaber recommended for the project in his February budget — which would have funded full construction of the hospital — and down also from a later proposal of $33 million in the coming biennium for partial construction.

But the small allocation doesn’t necessarily mean the project is dead.

Multiple sources close to the situation say that the current intention is to carry on with the project, albeit in an altered form, and that the Legislature could come back with more construction funds as soon as the 2012 legislative session, which begins in February.

The $5 million allocation — which will primarily go to infrastructure and planning, not actual buildings — allows the Legislature to keep the project moving in a difficult budgetary time, proponents argue.

It also allows the state to defer the completion of a hospital that won’t be needed until early 2015, when two of Oregon’s smaller psychiatric hospitals, OSH Portland and Blue Mountain in Pendleton, are scheduled to close.

“We’re moving forward in a prudent way,” said Dr. Bruce Goldberg, the director of the Oregon Department of Human Services and who has been involved in the negotiations. “Why pay interest on construction bonds when we won’t need those hospital beds immediately?”

Now, legislative leaders envisage a facility in Junction City that would start out as a secure psychiatric hospital but would transition over time, as the need for secure hospital beds decreases, into a Department of Corrections facility, specializing in handling prisoners with mental health and addiction issues.

For Lane County’s economy, any new state facility at the Junction City site would be a boon, bringing hundreds of well-paying jobs. Local lawmakers are pushing for the project, but have met plenty of resistance, both on financial and mental health treatment grounds.

Hospital-based vs. community-based care

Part of the debate about the Junction City psychiatric facility has long centered on the question of the actual need in Oregon for hospital-setting secure psychiatric beds.

Those beds involve around-the-clock treatment and supervision, and they cost the state more than $200,000 a year per patient. By the end of 2011, the state’s largest psychiatric hospital, the new OSH Salem, is expected to have 620 operational beds, and the proposed Junction City facility is scheduled for 174 beds when completed.

Although the most recent forecast by the Department of Human Services concluded there was still a need for both facilities, mental health advocates argue that many individuals with mental illness would be better served and have a better quality of life in less restrictive community settings.

“That (DHS) forecast is based on our current patterns of locking down mentally ill people,” said Chris Bouneff, executive director of the National Alliance on Mental Illness (NAMI) Oregon.

“There is this supposition that there is a large group of people that can’t ever be let out, under any circumstances, and that’s not accurate. We need to develop a clear picture of who’s in (OSH Salem) and whether they could be better treated elsewhere.”

The move away from “big-box” psychiatric facilities to community-based mental health care is also one that the federal government is pushing for, particularly during the Obama administration.

The U.S. Department of Justice is investigating how Oregon treats individuals with mental illness. Records provided to The Register-Guard’s public records requests show that federal justice officials in April requested extensive state data relating to that type of treatment.

Federal Justice representatives met with Kitzhaber earlier this month, Christine Miles, a spokeswoman for the governor, confirmed Friday. The content of those discussions is a “private matter,” she said.

The federal Department of Justice does not comment on ongoing investigations.

The Legislature’s response

Two bills moving forward in the Legislature would attempt to tackle the problem of how to better utilize the beds in secure psychiatric facilities and potentially pave the way forward to smaller community-based facilities.

Both bills make changes to the authority of the Psychiatric Security Review Board, which has jurisdiction over individuals who plead “guilty except for insanity” to crimes and enter mental health treatment facilities.

House Bill 3100 would require a state-certified psychologist or psychiatrist to evaluate individuals before they can enter a guilty plea except for insanity.

Senate Bill 420 would place individuals in secure psychiatric hospitals under the jurisdiction of the Oregon Health Authority, which actually runs the state hospital.

Mental health advocates argue that that arrangement makes more sense and will allow people who have committed nonviolent crimes and who don’t need hospital-level care to move to community-based care more quickly. Critics worry that it could pose a public safety risk by letting unstable individuals back out into society.

Rep. Tina Kotek, a Portland Democrat who has worked on both bills, said she believes the proposals will allow psychiatric hospitals to be used more efficiently.

“It’s all about managing hospital populations better, and putting the right people in the right settings,” she said.

Though both bills — particularly SB 420 — are expected to be hotly debated once they hit the House and Senate floors, they passed out of the Legislature’s chief budget-crafting committee Friday, usually a sign that legislative leaders are supportive.

What effect the two bills could have on the need for the hospital beds at a possible Junction City facility remains to be seen.

While NAMI’s Bouneff and other advocacy groups say the bills could lead to a mental illness treatment system in Oregon that relies on only one secure hospital in OSH Salem, legislators are more cautious.

Rep. Val Hoyle, a Eugene Democrat, said that the state will still need a secure psychiatric facility in Junction City over the next few years as it starts to focus on expanding community-based care.

“If we do approve the two PSRB-related bills, it won’t be a case of us snapping our fingers and instantly changing the population with mental illness,” she said. “It will take time.”

Others agree.

“The effects (of the possible PSRB changes) are not going to be dramatic, but they will lower our bed need a bit,” Oregon DHS director Goldberg said. “It will take us a decade to significantly reduce our population to a point where we wouldn’t need a second hospital in Junction City.”

Lawmakers also will need to find money to build more community-based facilities, Goldberg said, as well find suitable sites for such facilities, often a challenge due to stigmas surrounding mental illness.

Both of those will take time, Goldberg said.

However, unlike earlier this session, proponents of the hospital now do see a point where a Junction City psychiatric hospital might not be needed in the long run.

When that occurs, legislators could transform the facility into a specialized prison that would handle criminals with mental illnesses but who haven’t pled guilty except for insanity, a growing population in the state’s prisons, experts say.

“It would be a correctional institution that could provide a higher level of care for individuals who don’t fit in with the general population,” Hoyle said.

“I think the (Junction City facility) will get built,” said Sen. Alan Bates, a Medford Democrat. “What it looks like in the future, however, is still up in the air.”

Bates said lawmakers don’t yet know if their plan for a slower transition to community-based mental health care, which involves moving forward with a Junction City facility, will be acceptable to federal Justice officials and prompt the federal government to end its investigation.

“It’s really a hard question to get at,” he said. “We don’t know. It’s all happening behind closed doors, and we’ve had no indication one way or another. We just know they want more community-based mental health care facilities.”