Coos and Lane Counties Now Lead State in People Sent to State Mental Hospital

People sent to the hospital to be treated after they are arrested for crimes has been a serious problem in Oregon for several years, but while Marion and Multnomah County have made progress, other counties, especially Coos, continue to send more than their share out of their community to the high-cost Oregon State Hospital.

The steady stream of people with mental illness into the Oregon State Hospital has subsided from Multnomah and Marion counties, but two new outliers have taken their place -- Lane County and Coos County.


For several years, the number of people sent to the state mental hospital to seek treatment while they await trial, the so-called “aid and assist population,” has been growing, although the patient census has been down in the past year compared to the winter of 2016-2017, according to data provided by the Oregon Health Authority.


After peaking at 240 patients near the end of 2016, the population dropped for much of 2017 before spiking up again in the past winter to about 225 patients -- the highest of any class of patient, including civil commitments and people guilty of crimes except for insanity.


The biggest outlier among Oregon’s 36 counties in overuse of the state hospital for people accused of crimes is now Coos County, which sends the most people per capita to the hospital.


Although only the 16th-largest county by population, Coos County now sends more people -- 18 are currently at the hospital -- than all but three other counties, Multnomah, Washington and Lane, all of which are at least six times as large as Coos.


Clackamas County has done the best job of keeping its residents out of the state hospital, with just 12 patients at the state hospital as of April, despite the state’s third-largest population. Washington, Jackson and Deschutes were also well below the state average per capita. Lane County is the second-worst per capita, after Coos.


Many of these people do not need the expensive, high level of care offered in the state hospital but are not treated adequately in their community. They come into contact with police and are arrested and sent to the Oregon State Hospital, often for petty crimes that prosecutors would not pursue if the person were not mentally ill.


These patients take up space in the state hospital that could otherwise be used to treat people who are in need of a civil commitment because they are a harm to themselves or others. The situation is forcing the state to make higher-acuity civil commitment patients wait. The Oregon Health Authority is also on the hook for higher-cost treatment for aid-and-assist patients that cannot be reimbursed by Medicaid. If they were treated in the community, their health needs would be covered by the Oregon Health Plan with federal help or by private insurance.


Marion County, which contains the central state hospital and has long had a higher number of people with serious mental illness than other counties, has also been a leader in a more proactive approach to diverting people in crisis away from jail and the state hospital. Both Salem Police and the Marion County Sheriff have crisis response teams that pair specially trained officers with behaviorists, a successful model which state policy leaders have tried to expand statewide, with limited funding.


In Multnomah County, Judge Edward Jones has worked to place all criminal cases involving a mental health crisis under his docket, which allows him to more rationally decide which individuals need referred to the state hospital. The crisis in overcapacity at the state hospital had been driven largely by Multnomah County in 2016, but more recent data show Jones’ approach appears to have had success, as Multnomah County’s numbers are more closely in line with its share of the state population.


Since October 2016, Multnomah has also reduced the portion of its patients sent to the hospital solely for misdemeanor charges from 42 percent to 31 percent. The rest are accused of felony crimes.


Solutions in Lane County


Officials at the Coos County Behavioral Health Department did not return calls for comment, but Karen Gaffney, the Lane County health and human services director, said reducing the number of people arrested and sent to the state hospital was a top priority for her county.


Gaffney said Lane County was learning from other counties’ approaches to the problem and taking many of the same steps to better assist people with serious mental illness who come into contact with police.


Lane County cut its patient count at the state hospital by about one-sixth between February and April 2018, from 37 people to 31, but that’s still significantly more per capita than any county except Coos, and short of only Multnomah County in raw numbers. Multnomah has 45 aid-and-assist patients at the state hospital.


“I think our numbers will continue to get better,” Gaffney said.


“We need to make sure we have local supports so they can be safely secured in the community,” said Gaffney, who blamed the housing crisis on her community’s large homeless population and the undesirable overuse of the state hospital. She said judges send individuals there because they believe there is no good alternative in the community.


While Lane County rental prices are only about half of those in Multnomah County, the Eugene area has a very low vacancy rate, especially for low-income housing. Lane County is making a significant investment in permanent supportive housing with a new 50-unit complex near its behavioral health department.

Gaffney said the county has also identified the 100 people who have the most frequent interactions with police or show up in the emergency-room for non-emergent situations, and directed services at them to help them into housing well as treatment so their lives can become more stable.

Additionally, the nonprofit White Bird Clinic and its mobile crisis response team, CAHOOTS, have long worked with public safety dispatch to assist in mental crisis situations on the streets of Eugene and Springfield and connect people with social services. Gaffney said Eugene Police and Lane County Sheriff officers receive crisis intervention training, which has been put to similar use by the Portland Police Bureau.

Reach Chris Gray at [email protected].


Lane and Coos have been leaders in using the State Hospital for years.  For Coos, Bay Area Hospital should be part of the solution.  For Lane, a willingless to part with Junction City Hospital in order to use the funds for community services.