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Officials Tie Psychiatric Hospital’s Needs To More Community Programs

Legislators grilled an outside expert and the Oregon Health Authority about a proposal to charge counties that don’t accept Oregon State Hospital patients.
Oregon State Hospital in Salem. | BEN BOTKIN/THE LUND REPORT
February 17, 2022

People working at the Oregon State Hospital often hear the alarm for help sounding off at the residential psychiatric facility. Due to understaffing, at times they can’t respond to assist their colleagues — and hope security officers can make it. 

Lawmakers on the House Behavioral Health Committee heard that perspective — among others — on Thursday. The testimony comes as they consider long-term solutions for Oregon’s behavioral health system and seek ways to boost community mental health programs that serve people outside the state hospital.

“You just hold your breath hoping security can get there in time,” Kimberly Thoma, an administrative specialist at the state hospital, told lawmakers. “It’s horrible, and this is where we’ve been.”

Untangling the hospital’s problems will be complex. One of the simpler approaches is more money to hire additional staff at the facility, which has a main campus in Salem and a smaller campus in Junction City with 706 beds. The Oregon Health Authority has requested $20.5 million for 359 full and part-time positions across a one-year period starting in May, which lawmakers are considering this session. Rep. Rob Nosse, D-Portland and the committee’s chair, said he expects lawmakers will help the beleaguered hospital.

“I feel like the way I’m reading the tea leaves, we’re going to come through with a lot of what you need,” Nosse said.

The state hospital’s challenges go beyond more employees, though. The hospital faces a logjam: More than 100 people sit in county jails waiting for transfer to the state hospital after a judge ordered treatment so they can aid in their defense of pending criminal charges. The lengthy waits sparked litigation in 2002 that led to a judge’s order that those people — so-called “aid and assist” cases — receive a transfer to the hospital within seven days of a judge’s order. An outside expert has started working with the Oregon Health Authority and Disability Rights Oregon, a watchdog advocacy group that sued the state as part of a pre-settlement agreement reached in December.

The first report and recommendations came out Jan. 30. Lawmakers heard from the expert, Dr. Debra A. Pinals, a clinical professor of psychiatry and director of the Law, Psychiatry and Ethics program at the University of Michigan.

Pinals’ recommendations — backed by the health authority — include legislation that would charge counties that don’t accept patients that are ready to exit Oregon State Hospital and go to a lower level of care, such as a residential facility or community mental health program. The recommendation comes because the hospital has about 100 patients who no longer need hospital level care but cannot return to their communities. That forces patients in jail to wait longer.

“If you cannot open your back door, you cannot open your front door,” Pinals said.

There’s no bill this session that would put that mechanism in place, called “county financial risk sharing.” But it drew deep scrutiny from counties  and lawmakers concerned that community mental health providers lack the resources they need to accept outgoing Oregon Hospital patients.

Under grilling from lawmakers, Pinals said she did not interview counties or community mental health providers in Oregon before drafting that recommendation. She noted she talked to state hospital patients about their community-level experiences, judges and Oregon Health Authority staff and relied on her expertise to reach that recommendation.

She said she plans to talk to community providers and has a scheduled meeting with one county that has raised concerns about liability. Her follow-up report and more recommendations is due in April, under the interim settlement agreement. 

She stressed the concept is not to penalize counties but rather encourage the parties to work together. Counties are responsible for community mental health programs and often do so through contracts with providers and technical support from the health authority. 

“The hospital and communities have to work together,” Pinals said. “You don’t want the community infrastructure to fall apart because of fines and fees.”

When the report came out, it drew criticism and concerns from county officials, including at Multnomah County, Oregon’s most populous. 

Lawmakers stressed the need for counties to have the resources they need — and frustration about a recommendation that implies they aren’t doing enough.

“It’s very frustrating to me to hear the attacks on counties saying they’re not doing enough,” said Rep. Lily Morgan, R-Grants Pass. “A report saying counties need to pay more when they weren’t even at the discussion table in the first place really is not an appropriate response.”

In response, Nosse noted the Legislature passed a slew of bills in the 2021 session with investments into behavioral health care. The total package is about $1 billion and includes $130 million to expand residential capacity in communities across Oregon.

“Some of that money is coming out, albeit maybe too slowly,” Nosse said.

Stressing there’s no bill yet, Nosse said the health authority has signaled to lawmakers the state can get more people back into communities with more resources and this idea is “a little bit of a stick along with a carrot to do that.”

Lawmakers heard from Oregon Behavioral Health Director Steve Allen, who also said counties need more resources.

Morgan asked Allen if there is anything counties and community mental health programs currently have the resources to do that they are not doing that would make a penalty necessary.

“It was never designed to be framed that way,” Allen said.

Allen said a request for proposals for shovel-ready residential projects attracted a dozen proposals from 11 entities that would open up 193 beds. Of those, 141 beds would serve children and 52 beds would serve adults.

He didn’t identify the applicants, but said they represented potential projects in Multnomah, Lane, Benton, Douglas, Jackson and Washington counties.

KC Lewis, an attorney for Disability Rights Oregon, told lawmakers that 112 people are waiting in jail for transfer to the state hospital and more than a dozen have been there longer than 40 days. In one instance, a 23-year-old man died of suicide in jail two days before a hearing, he said.

Lewis said Disability Rights Oregon wants to work with the state on solutions, but didn’t rule out other alternatives in court.

“If we are not able to get this wait list down... we’re going to exercise all of our options under the law to advocate for our clients,” Lewis said.

He noted a class-action lawsuit filed in Washington found that state in contempt. Washington state was levied about $83 million in fines in that case, filed in 2014.

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.