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State Hospital measures cause ripple effects, expert finds

Oregon’s psychiatric hospital is quickly admitting ‘aid and assist’ patients while the state works to ease ‘strain’ around patients’ transitions to community programs
Large red building, the Oregon State Hospital
Oregon State Hospital in Salem. | BEN BOTKIN/THE LUND REPORT
October 26, 2023

While Oregon State Hospital continues to comply with a federal civil rights order, it’s straining other parts of the behavioral health system, according to a court-appointed expert.

Dr. Debra Pinals made the observations in her seventh report as an independent expert tasked with helping state health officials meet a 2002 federal court order intended to expedite treatment for people unable to stand trial because of mental illness. She found that the Salem-based psychiatric facility is meeting the order’s seven-day limit to admit defendants deemed unable to “aid and assist” in their own defense.

Between July 20 and Oct. 15, the state hospital admitted 273 of these defendants within seven days, according to Pinals’ report. Another eight defendants weren’t admitted in the timeframe because of “late receipt of orders or delayed transportation decisions by the counties.”

It’s a marked improvement from the Spring of 2019, when the wait time averaged 26 days for aid and assist defendants, prompting Disability Rights Oregon to reopen litigation over state hospital admissions. That led to U.S. Judge Michael Mosman issuing a controversial and sweeping order in September 2022 that set timelines for how long aid and assist defendants could be housed at the state hospital. 

Pinals, a psychiatrist who teaches at the University of Michigan, called the state hospital’s recent compliance with the order a “remarkable achievement.” She praised the state hospital and the Oregon Health Authority for their efforts. However, her report also called out how the logjam at the state hospital is being pushed elsewhere. 

“Still, it remains clear from all these efforts that the Aid and Assist system is overwhelming to partners in the process, and this continues to lead to strain across systems,” she wrote. 

Pinals wrote that there is concern that some aid and assist defendants will be found “never able” to participate in their defense and will be placed indefinitely into community mental health programs. 

The report also describes multiple long-term programs being developed to ease patients’ transition from the state hospital to community settings. The health authority is slated to select pilot sites for “community navigators” who will help these patients with the transition. It’s also seeking to increase access to substance use disorder treatment in community programs that serve aid and assist patients. 

You can reach Jake Thomas at [email protected] or via X @jakethomas2009.