Patients are being flown in and out of Oregon State Hospital faster than before to meet court-mandated mental health treatment deadlines so they can defend themselves against criminal charges.
But as they leave state-run inpatient psychiatric hospitals, the mental health system that cares for them is struggling to keep up with growing demand for services, from outpatient counseling to housing, to keep them from ending up on the streets.
Oregon State Hospital treats so-called aid and assist patients for three months to a year, depending on the severity of the charges, under a court order to ensure the suspects do not languish behind bars. After years of litigation and input from outside experts, state hospitals are now on track to discharge most patients.
But many of these patients still require treatment after discharge. As more patients leave state hospitals, the responsibility for caring for them shifts to community mental health systems run by counties or their contracted providers. Community mental health programs can include outpatient services such as counseling and therapy as well as residential care in facilities.
Healthcare providers say care at the community level is critical. When suspects don’t get the care they need, they may reoffend, end up homeless, or both. That’s why prosecutors, police and local officials are urging lawmakers to consider the needs of the entire system.
“I don’t want people to stay at Oregon State Hospital, just like you don’t want people to stay at Oregon State Hospital,” Marion County Commissioner Danielle Bethel told a legislative panel Wednesday. “But they also can’t just walk up and down my street, causing decompensation and creating more crime. It’s not good for them and it’s not good for our neighbors.”
Said that the number of people participating in community programs across the state has increased from 355 in July 2022 to 630 in September this year Cheryl Ramirez, Executive Director, Oregon Association of Community Mental Health Programs. These programs are funded by other sources, including state and federal grants.
As a result, the group is asking lawmakers for an additional $7.5 million per year so providers can hire more staff and pay for housing, Ramirez told the House Behavioral Health and Healthcare Committee.
Lawmakers won’t make decisions on the community mental health budget and other budgets until the 2024 session. Rep. Rob North, D-Portland and committee chairman, said it sounded like a reasonable request.
local pressure
Outside the state Capitol, the lawsuit is still pending.
In September, Marion County sued Oregon State Hospital and the Oregon Health Authority, which operates the facility, in Marion County Circuit Court. The lawsuit alleges the health authority failed to provide the personnel, resources and facilities needed to treat the defendants, as required by state law.
“No county commissioner in history has ever said that when they can’t work with their partners, the first thing they want to do is file a lawsuit, but our county is suffering serious losses,” Bethel said.
In 2002, disability rights advocates, including Disability Rights Oregon, filed a lawsuit in federal court, which ruled that patients needed to be hospitalized within seven days of a court order for treatment. Otherwise, they will go to jail. But the lawsuit continued after the hospital disobeyed.
In this case, advocates and the state hospital agreed to work with outside experts to promptly treat the suspect. A federal judge ruled that patients with misdemeanors should be treated and discharged within three months, patients with nonviolent felonies should be treated and discharged within nine months, and patients with violent felonies should be treated and discharged within 12 months.
In some cases, prosecutors can require a person to remain in the hospital beyond the deadline if the person is facing a violent felony charge and there are compelling public safety concerns or the need for hospitalization. Misdemeanor defendants may stay in a state hospital for up to an additional 30 days if they have placement with a community mental health provider.
Even so, people are still leaving hospitals and not getting the community care they need, said Marion County District Attorney Paige Clarkson. They also don’t go to court because they don’t have the capacity to stand trial.
“We do find ourselves in what I call an underserved black hole with some of these people,” Clarkson said.
Oregon State Hospital to shorten wait times
Wait times for patients to get into state hospitals have been shortened.
In September 2022, when the court-mandated treatment deadline was set, patients were waiting an average of 35 days to be admitted. Dolly Matteucci, president of Oregon State Hospital, told lawmakers the average wait time is now a little more than six days. That means these patients spend less time in county jails waiting for hospital treatment.
Matteucci said the hospital has maintained that level while seeing an increase in admissions – from an average of about 70 to 97 per month.
Most patients, nearly three-quarters, are discharged before reaching court-ordered restrictions and returning to the community, she said. About 27% of people were discharged because the time limit had expired and they could no longer be hospitalized.
Although staff turnover has slowed after a wave of retirements during the pandemic, patient demand is higher than before, Matage said.
“They’re doing their usual work and therapy, and they’re doing it at a faster pace,” she said.
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