The trap we’re laying for the weakest among us

Editorial published in The Oregonian, by Michael M. Moore, a board member of Sisters of the Road, October 19, 2010

The Oregonian’s “Hard Choices” series frames the problem of dwindling state resources coupled with increasing demand for state services as a trap from which our state must free itself. But there’s another trap we’ve created for people with mental illnesses that only worsens our state’s budget problems. That trap is one that results in sending people who would benefit from treatment in our communities to large, less flexible and vastly more expensive institutions like prison or the Oregon State Hospital.

We lay that trap by defunding programs that offer early intervention and prevention, supported employment and education, safe and affordable housing, jail diversion, drug and mental health courts, case and medication management, and more. We tighten the trap with so-called “livability” laws that further stress already over-stressed populations of people battling mental illnesses and addictions.

The scenario is all-too-familiar to many who have experienced homelessness: a citation for sitting or sleeping somewhere that an ordinance has made impermissible; a missed court date or unpaid fine resulting from that citation that leads to a bench warrant; an arrest and a few days in jail; a return to the streets to repeat the cycle.

Even scenarios that don’t result in incarceration often involve exclusions or bans that separate vulnerable people from whatever support network they’ve assembled on their own. These scenarios have the effect of exacerbating their mental health difficulties and inhibiting their access to the services that do exist and that might be able to help.

Given the propensity of self-medicating with drugs or alcohol among people with mental illnesses, our current policies have the effect of virtually guaranteeing people caught in this trap will deteriorate, until such time as they seriously injure themselves or others and wind up in places that are least equipped to help them get better, like the state prison system, or that can do so only at great expense to taxpayers, like the state hospital system.

The bright spot in this situation is that doing the right thing would also be doing the more cost-effective thing. Unnecessary use of costly jail and prison resources can be reduced by establishing a range of effective options, including local diversion programs that help defuse crisis situations and ensure that people with mental illnesses will receive evaluation, treatment and referrals as needed. Valuable criminal justice resources can be re-tasked to tackle problems they are better suited to solving.

Currently, police officers are our front-line personnel for dealing with people who need treatment, a job they are not paid nor trained to provide. The Oregon Department of Corrections estimates that nearly half of the 14,000 inmates in state prisons have mental illnesses. Jail surveys show that at least 20 percent of the 540 defendants booked daily into Oregon county jails have a serious mental illness. None of these statistics are terribly surprising when you consider that we seriously underfund the very programs that would reduce our prison populations and recidivism rates.

As Jason Renaud of the Mental Health Association of Portland has observed, “The way to measure the success of a hospital is when patients get well, leave and don’t come back. But at the [Oregon State Hospital], too many patients never leave, and too often they leave for situations which are unsustainable. And then they come back ….”

We can free ourselves from this trap by funding more creative, effective and evidence-based community services that promote and sustain mental health recovery before mental illness threatens public safety and burdens our criminal justice system. Instead of attempting to criminalize homelessness, addiction and mental illness, we can provide solutions that resolve these problems rather than move them around from place to place.

The choices really aren’t as hard as they might seem if we demonstrate a willingness to stop thinking reflexively.