Opinion by Daniel Smith, published in the Salem Statesman Journal April 18 2009

Dr. Daniel Smith has spent 25 years working in community mental health, the past six as a forensic psychologist at Oregon State Hospital in Salem.

The governor’s special master, Judge James Hargreaves, reported that poor planning and a lack of urgency are at the heart of problems that continue to plague the Oregon State Hospital in Salem.

Hospital Superintendent Roy Orr points to significant progress in reaching accepted standards of care of the mentally ill.

Who is right in this glass half-full/half-empty debate? As a psychologist who evaluates mental-health consumers at the hospital, I don’t think either view is wrong. Yet each falls short of assessing the status of efforts to turn our state hospital into a modern mental-health treatment facility.

Efforts to recruit qualified staff, increase morale and modernize treatment have achieved some results. Administrators, nurses and physicians have been hired and old buildings are being refurbished, moved and razed in anticipation of a new facility in the aftermath of a scathing federal condemnation of hospital conditions.

These early steps tell me that if we fund clinically appropriate levels of direct-care staffing and services, Oregon can improve treatment of serious mental illness and give renewed hope to patients and their families. But that’s a big “if.”

One recent advance, the opening of cottages for residents preparing to return to their families, points up the need for good planning and preparation. Protocols were not complete when residents moved in, leading to problems. Other promising new transition programs have been rolled out before they were ready.

And even before the new central facility is complete, there are some warning signals.

Envisioning the best of all possible futures, the Oregon Department of Human Services set about to create a facility too small to meet the anticipated need with an eye toward compelling the state to revitalize and reinvent community mental-health programs throughout Oregon.

Then the economic crisis arrived. I know all about the downturn’s potential impact on services. I’m on the team negotiating a new state contract on behalf of 18,500 state workers represented by Service Employees International Union Local 503.

But coupled with a lack of public appreciation of the severe shortage of community mental-health care options, the budget crunch poses special threats for our new hospital, which could be understaffed and overcrowded from the day it opens.

We do not have to look far to see where that leads. Lack of community-based treatment has criminalized mental illness in Oregon. With few alternatives, localities treat the mentally ill through the criminal-justice system.

We have made some progress in de-stigmatizing mental illness and overcoming resistance to community group homes, but a lack of transitional housing continues to clog jails and send more individuals to the state hospital than we can properly treat.

These conditions contribute to a sense of frustration and futility in many residents and some respond violently, endangering themselves, their peers and the staff. And while reduced use of restraint and seclusion are notable reforms, they increase exposure of direct-care staffers to serious injury, accelerating a destructive cycle. Workers on paid medical leave exacerbate the staffing shortage, mandating overtime that increases cost of care and staff burnout.

READ – James Hargreaves’ report on the Oregon State Hospital