There’s a better alternative to a new psychiatric hospital

By Gary Crum, Guest Columnist, The Oregonian, October 18, 2011

Renovations continue at the Oregon State Hospital in Salem. (Photo: Hoffman Construction)

Renovations continue at the Oregon State Hospital in Salem. (Photo: Hoffman Construction)

The Oregon Legislature’s upcoming decision regarding funding for the construction of a new state mental hospital near Junction City must consider treatment philosophy, community support and, of considerable importance in today’s fiscal environment, funding difficulties. I am an outspoken opponent of the project and wish to offer an alternative idea.

First, as a staunch supporter of the concept of the least restrictive appropriate treatment placement for Oregonians needing treatment for mental illness, I support the availability of community-based treatment options. If there are institutional beds available, but no community-based placements available, the institutional placement becomes the “least restrictive treatment setting” available and the de facto choice for treatment placement. The maintenance of the current level of institutional beds or increasing that number promotes the placement of patients to fill those beds.

Moreover, I suggest that a significant percentage of the currently institutionalized population could be better served in community-based facilities. Specifically, I feel many patients adjudicated to hospital placement after committing non-Measure 11 offenses (40 percent of the forensic patients at the Salem facility on Aug. 1, 2011) could very possibly be served as well or better in community-based 16-bed facilities.

Additionally, we have an increasing population of geropsychiatric patients currently on locked wards in the state mental hospitals. It’s generally acknowledged that these patients, many very elderly and quite infirm, would pose no threat to public safety in community-based treatment placement. The placement of these two groups of patients in less restrictive community-based facilities would significantly decrease the need for institutional beds, and the proposed Junction City facility would not be necessary.

On the flip side, we recognize that it’s extremely difficult to site new community-based care facilities. We live in a NIMBY (not in my backyard) society. Most people are very supportive of community-based care, with the caveat that it be some other community or, at a minimum, some other neighborhood. Additional logistical issues involve the need to transport patients to needed ancillary/support providers.

May I offer a suggestion which addresses the issues regarding this policy decision; first, a description and then a rationale for the idea.

The state-owned 40-acre site between Eugene and Junction City is already approved for public facility use and has water and sewer infrastructure in place. I propose that this site be used, but not for a state mental hospital, as proposed. Instead, the property should be developed as a campus for the location of 10 or more 16-bed community-based treatment facilities. Each cottage would be an independent, community-based program with the community-involvement components in place, just as they would be if the cottage were located elsewhere in the community.

Photo: Images_of_Money

Additionally, the campus would include an on-site medical facility (including psychiatric support services) to provide needed assistance. The site would also provide an activities center that would, as I envision it, include a gym, fitness facilities, indoor pool, activity areas and classroom facilities. A set of small, independent facilities, combined with the provision of these support facilities, would create programs providing a level of care far surpassing institutional placement and, because of the ready availability of additional support services and facilities, surpassing the care available in existing community-based programs.

I consider “community-based” a treatment model, not a location. This is a matter of considerable importance, since community-based treatments in facilities housing 16 or fewer patients are eligible for matching federal funds. The cost of a community-based facility is approximately $80,000 per bed per year. DHS acknowledges that the cost per bed per year in the proposed Junction City facility will be $280,000. The campus-based community treatment, even without federal funds, would not only be superior in the treatment provided, it would also be significantly (make that very significantly) more cost-effective than the institutional hospital model.

At a recent town hall meeting in Junction City, Gov. John Kitzhaber acknowledged the tremendous problems associated with siting community-based mental health facilities. He suggested it might even be necessary for the Legislature to consider action to create “super-siting” authority to site community-based mental health facilities. I feel such action would be better avoided. The campus idea, providing small, independently functioning community-based treatment centers, but locating them in a less contentious fashion, would avoid these issues. I propose the idea as a compromise, creating community-based programs while avoiding the chief roadblock to developing such programs.

The tremendous cost savings in both construction and ongoing program costs would allow the development of support facilities and programs that would enrich the treatment atmosphere by providing additional positive components to treatment regime. The plan offers tremendous treatment, logistical and fiscal advantages that would benefit patients, staff and community. I offer the idea as basic concept in an effort to promote discussion of it and, possibly, other concepts that might better serve all of us.

I hope the governor and our legislators are willing to pause to consider such an idea before moving forward with construction of the hospital as planned. I suggest we can do better — much better.

Gary Crum lives in Junction City and is a retired teacher/counselor who spent 28 years working with dysfunctional adolescents.