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Erik Ayala’s case reflects the difficulty minorities have getting mental health treatment, advocates say

Shortly after Erik S. Ayala was diagnosed with schizophrenia in high school, the Salem-Keizer School District tried to help him get coverage under the Oregon Health Plan so his family could pay for his medication.

The state denied the request because his family was unable to provide proof of residency, according to a Keizer police report obtained through a public records request.

Nine years later, Ayala didn’t have a problem presenting an alien resident card and the required proof of residency, utility bills showing he had lived in Oregon 90 days, to buy a 9mm handgun. Ayala used the gun to take his own life after firing on a downtown Portland crowd Jan. 24, killing two teenage girls and wounding seven other people.

A multi-agency team of law enforcement, school counselors and psychologists met repeatedly to discuss Ayala’s mental stability during his high school years and cited concerns in 2000 about the ability of Ayala’s family to pay for the medication needed to help their son, the Keizer police report shows.

Portland police have said there was no evidence that Ayala received any consistent mental health treatment or medication as an adult.

Mental health advocates say Ayala’s case reflects the difficulty ethnic and minority populations face in obtaining treatment.

The Keizer report provides more details about Ayala’s troubles at McNary High School and the efforts taken by the Mid-Valley Student Threat Assessment Team to address them.

On Sept. 11, 2000, Keizer police Officer Dan Kelley was notified by a McNary High School assistant principal that Ayala had said something about bringing a gun to school because he was mad at some of the “preps.”

The officer spoke with Ayala that day. According to the officer’s report, Ayala seemed quiet and uninterested in talking about himself. He denied saying he’d bring a gun to school. Ayala told the officer he wouldn’t hurt anyone. He hesitated, adding that what he had actually told another student was that he wanted to put a gun to his head and end it all, the report says. Ayala told the officer he wasn’t happy with himself or school.

The Keizer officer spoke with the school’s counselor, who notified the school district to arrange for a “suicide assessment.”

On Dec. 1, 2000, the officer learned Ayala had overdosed on Aleve, an over-the-counter pain medicine. He was reported to have been in a coma for two weeks in a Salem hospital and then taken to a private mental health facility, Pacific Gateway in Portland, which no longer exists.

The Keizer officer and a high school counselor visited Ayala’s home Dec. 13, 2000. His mother told them she was not sure “why these things were happening to her son,” the police report says.

Ayala’s mom let the officer look in Ayala’s room. Kelley examined several of the youth’s CDs and looked for any of his writings.

The next day, members of the Student Threat Assessment Team met. Its agenda: steps needed to ensure the safety of students, staff and Ayala upon his return to school. They learned he would be released from the mental health facility after being placed on medication, having been diagnosed with “numerous mental disorders.”

The team discussed several options, such as a home tutor and further assessments to determine his mental stability.

“A second concern was if Mr. Ayala would be taking his medication and his parents’ ability to purchase the necessary medication to help Mr. Ayala,” the officer’s report says. “The school district attempted to have Mr. Ayala placed on the Oregon Health Plan, but as we have learned they have denied this request due to the family being unable to provide proof of residency.”

Ayala was not a U.S. citizen. Noncitizen applicants for Oregon Health Plan coverage must show proof of legal permanent residence and that they’ve lived in Oregon for five years. Federal guidelines require a noncitizen entry card, granted through the federal immigration service or homeland security, according to Karen House, of the state Department of Human Services.

In 2005, the requirements became stricter for U.S. citizens, who now must prove citizenship.

School records show that Ayala, a native of Mexico, had been enrolled in the Salem-Keizer School District continually since January 1995 and graduated from McNary in 2002. It is unclear why his family couldn’t prove residency in 2000, yet Ayala had an alien resident card by age 24.

Chris Bouneff, executive director of the National Alliance on Mental Illness-Oregon, said reforms to the health plan’s rules are needed.

“They put such stringent requirements on proving citizenship and residency that people who could be eligible were being turned away,” Bouneff said. “We’re talking about populations who had difficulty finding their birth certificates.”

A November 2008 state report says 15,521 adults in Oregon have a serious mental illness and are not covered by insurance or otherwise treated by state programs.

The report shows that ethnic and minority populations seek mental health services at a lesser rate than nonminorities. Latinos receive the lowest percentage of mental health care services, or 4.7 percent, despite making up the largest minority group in Oregon, at 10.2 percent.