KC Lewis
Lewis is the managing attorney for Disability Rights Oregon’s Mental Health Rights Project. He lives in Portland.
Stretched to capacity and struggling with a staff shortage, Oregon’s state psychiatric hospital sent out an SOS to members of the National Guard two weeks ago for help with caring for patients. For the sixth time in a year, Oregon State Hospital paused admissions, leaving mentally ill criminal defendants to wait in jail longer than seven days for treatment – a violation of their constitutional rights.
One of the forces fueling this crisis is Oregon’s decades-long disinvestment in community mental health services. Oregon State Hospital patients and people in need of mental health services are paying a steep price for that choice.
Oregon State Hospital is one part of our mental health system and provides institutional care, the highest level of care our state offers.
It serves those with the most acute, complex needs: individuals who have been civilly committed; those found guilty except for insanity by a judge; individuals with dementia and organic brain disease in need of hospital care; and a fourth group of “aid and assist” criminal defendants. This group includes pre-trial detainees who are unable to assist their attorney in their defense and need treatment before their trial can proceed.
For decades, Oregon has overinvested in institutional care at the state psychiatric hospital – at the expense of what should be the backbone of the entire system: community mental health services. These are the organizations and agencies that provide access and help with medication; connections to vital services such as housing, transportation, and training; or sometimes just a peer who can listen and help someone through a hard time. All of these services can help to stabilize people before a mental health issue becomes a crisis.
This underinvestment should not surprise anyone: A 2020 audit of the state’s mental health system by the Secretary of State’s office noted, “Reports dating back 19 years identify state agencies and systems as … not adequately serving the continuum of care.” Yet Oregon State Hospital’s huge share of the entire mental health budget has grown at a much faster rate than that of the community mental health services.
As a result, people struggle to access mental health services in their community. Without access to treatment services, individuals can end up in crisis or arrested for low-level offenses like trespassing and enter the criminal justice system. The numbers illustrate just how big a problem this has become. The aid and assist population has more than tripled in less than 10 years, based on data from the Oregon Health Authority. Previously, Oregon State Hospital served twice as many civilly committed patients as aid and assist patients; now, the hospital serves more than 10 times as many aid-and-assist patients as civilly committed patients.
The funding imbalance has created a self-fulfilling prophecy: greater demand for the state hospital, where people can actually get mental health services, which, in turn, prompts the hospital to ask for greater resources that go to more rooms and more institutionalized care.
Today, the Oregon State Hospital occupies a role within the system that it was never meant to play, serving individuals that it was never meant to serve in such vast numbers at tremendous cost to the state as a whole. When the only way to access treatment services is through institutionalization, we’re denying individuals—the consumers of these services—any true choice. This approach runs contrary to the core principles of the disability rights movement, which has been fighting institutionalization for generations.
Most tragically of all, by not providing mental health services in the community, we’re not only fueling the crisis unfolding at the state psychiatric hospital, we’re putting individuals in need of treatment vulnerable to far greater harm. The lack of community services has led to people in crisis on the street, leaving them at enormous risk of being shot and killed by law enforcement.
The solution is a steady influx of funds into community mental health services. People in need of treatment would do better if they had access to care in the community, our communities would do better, and our dollars would go farther. And we would honor the right of an individual with a disability to access services without being unnecessarily confined.
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