Psychiatric Security Review Board Faces Scrutiny From Budget Committee

From The Lund Report, May 26, 2011 – by Amanda Waldroupe

Rep. Mitch Greenlick sharply criticized the Board for not releasing patients to community settings

A discussion of the proposed budget for the Psychiatric Security Review Board (PSRB) turned heated in the Joint Ways and Means Subcommittee on Human Services on Wednesday as lawmakers’ demands and frustrations bubbled forth that the Board should be doing more to release patients into community settings.

Rep. Mitch Greenlick (D-Portland) raised the most criticism during discussion of its “budget note,” that includes basic expectations and directives on how state dollars should be spent.

The budget note says, “The Oregon Health Authority is directed to work with the Psychiatric Security Review Board to determine the need for community placements for PSRB patients at the Oregon State Hospital for whom a hospital level of care is not necessary on an on-going basis, and recommendations for meeting this need. The recommendations should address the potential need for additional 16-bed residential treatment facilities as well as other types of facilities. This report should be prepared for consideration in the February 2012 legislative session.”

“16-bed residential treatment facilities” refers to community-based residential treatment facilities providing mental healthcare and case management. These facilities must have 16 beds or less to receive federal matching Medicaid dollars.

Made up of five Governor-appointed members, the PSRB has jurisdiction over patients at the Oregon State Hospital who’ve been found “guilty except for insanity,” after committing a crime they would not have committed had they not been suffering from a severe mental illness.

The Board holds hearings to determine if a patient’s mental illness can live in a community setting, or live independently.

Recently, it’s come under sharp criticism from mental health advocates for not releasing more patients to the community (currently its recidivism rate of the people who reoffend once release from the Hospital is 2.3 percent, which is extremely low). Advocates are working, as The Lund Report has reported, to pass legislation to reform the Board.

Greenlick said that getting the report in February is “way, way too slow for what we need to be doing in this situation.”

He mentioned that around 50 people in the Oregon State Hospital have been granted conditional release by the Board — permission to move to a community treatment facility, with restrictions—but have been unable to leave because community treatment facilities are full.

“We need to get these facilities sited and get them out there,” Greenlick said.

Rep. Tina Kotek (D-Portland) disagreed with Greenlick’s call for urgency. “We don’t have the money, and I don’t think siting is going to happen simultaneously.”

Sen. Alan Bates (D-Ashland) agreed with Greenlick. “This has been a foot dragging situation for many years. We have too many people in the hospital, and we can’t continue to maintain people at the Oregon State Hospital at that cost.”

Bates was referring to the $200,000 annual cost of keeping one person in the state hospital.

“I think we all agree with that,” responded Sen. Jackie Winters (R-Salem).

Although the budget note was ultimately approved by the committee, Greenlick objected.

He again criticized the Board for its “key performance measures,” which set standards to make certain general fund dollars are used efficiently.

Every two years the Board must hold hearings to determine if a patient is ready for release. Bates questioned whether that timeline was sufficient.

[Mary Claire] Buckley [Executive Director of the PSRB] hesitated slightly in her response. “I think, ideally…it would be beneficial to have them more frequently. I think there’s merit in some of the concerns that members [of the committee] have about the stays at the hospital.”

Then, Greenlick asked about the Board’s key performance measures that deal with customer service and satisfaction.

“We consider that to be any of our stakeholders,” Buckley replied. That includes the public, victims, family members, providers and hospital patients.

Last year the survey was given out at a statewide conference and a variety of stakeholders participated, including “some patients,” Buckley added.

“That seems like a pretty sloppy way of getting to these measures,” Greenlick said. “You should do away with all of these measures if that’s the way you do it. That’s just window dressing. Your customers are the people you should hear from.”

“That’s not appropriate [measure],” Kotek said.

“That is an absolutely serious statement,” Greenlick said, with a stern expression on his face. “You don’t have to go to a conference. You should survey [the patients] once a year.”

“If they rejected ten applications for very valid public safety reasons, you’re going to have ten very unhappy people,” Kotek responded.

In the end, the committee approved the Board’s proposed $1.899 million budget, which still needs approval by the full Joint Ways and Means Committee.