State’s mental health services critiqued

From the Salem Statesman Journal, November 19, 2009

One report lauds reforms at state hospital; another decries failings of the system

Wide-ranging reforms are boosting patient care and safety at the Oregon State Hospital, the leader of the Salem psychiatric facility told a legislative committee Wednesday.

But on the heels of the upbeat assessment by Roy Orr, the same panel heard about troubling disparities in state funding for mental health services.

Oregon’s mental health system is “out of balance,” according to Richard Harris, Addictions and Mental Health Division director for the Oregon Department of Human Services.

Here’s the crux of the problem:

Nearly 60 percent of the state’s mental health budget goes to help 12 percent of the population: people who are receiving services in the most expensive settings. This population numbers 9,528 people residing at state mental hospitals and residential facilities.

In stark contrast, 42 percent of the mental health budget goes for community outpatient clinics and services. This population numbers more than 66,000 Oregonians, or 88 percent of the state’s mental health clients.

Harris cited several concerns about the mental health system in a report to the Senate Interim Committee on Health Care. Among them:

    -Mental health services are inconsistent throughout the state.

    -Length of stay in mental health residential settings often is too long, causing “backups” throughout the system.

    -Health disparities cause people with mental illness to die 25 years younger than the average age.

    -There is a lack of supported housing that encourages independence.

    -Teens and young adults served by the mental health system often have trouble transitioning from the youth system to the adult system.

Mental health advocates long have complained about a lack of state funding for community-based outpatient clinics and preventative-care services. They view such services as essential to help people with mental illness lead stable, productive lives.

Amid tough economic times and fierce competition for state resources, some advocates bitterly object to huge state funding, totaling $458 million, earmarked for construction of two new psychiatric hospitals designed to replace the existing 126-year-old facility in central Salem.

A 620-bed facility, now being built on the state hospital campus, is scheduled to partially open in late 2010 and become fully operational in 2011.

After that, a 360-bed psychiatric facility is slated for construction on state prison land in Junction City. The smaller hospital is scheduled to open in 2013.

Critics say money going to build and operate two new hospitals would be better spent on community mental health clinics and other services.

The Mental Health Association of Portland, in a commentary posted on its Web site, harshly criticized the state’s push to build new hospitals “when the preponderance of evidence shows the greatest need for funding is in the community.

“This misappropriation of funds toward hospitals, which are prisons, and away from community mental health clinics — and those who know better and are not speaking up — is a grave betrayal of persons with severe and persistent mental illness for future generations.”

Other mental health advocates say state hospital improvements are long overdue and they wouldn’t want community funding to come at the expense of efforts to provide better institutional care.

Hospital reforms are being spurred, in part, by an ongoing investigation by the U.S. Department of Justice.

Federal investigators issued a searing critique of patient care and hospital conditions in a January 2008 report. A federal team made up of mental health experts and lawyers returned to the hospital in late July and early August for a follow-up visit.

In his report to the legislative panel, Orr said the federal agency hasn’t given the hospital any indication when, or if, it will issue a written report of its latest findings.

Meanwhile, the hospital continues to make progress, Orr said. Among the advances he cited Wednesday: incidents of patient aggression have markedly decreased; patient escapes and unauthorized leaves from passes have declined; long vacant hospital leadership positions have been filled; and infusions of new employees have bolstered chronically low staffing levels.

Orr credited a streamlined hiring process for plugging a former 30 percent vacancy rate in the hospital’s ranks of registered nurses.

The hospital chief said patient treatment has expanded and improved with the opening of several centralized treatment malls.

When another treatment mall opens next month, the hospital will move closer to complying with U.S. DOJ standards that call for each patient to participate in 20 hours of active treatment per week, Orr said.

Eventually, the hospital expects to exceed the benchmark federal requirement, he said.