Unity Center for Behavioral Health was supposed to answer Portland’s mental health crisis when it opened in 2017, relieving emergency rooms of patients in crisis.
Instead, the center is grappling with what its medical director called a “real state of crisis.”
The situation is so bad that patients are forced to languish for days in recliners in an open room that was meant for quick treatment rather than a long-term stay. And as they sit there, arriving patients are turned away.
This treatment crisis, coming on the heels of a financial crisis, is described in just-released emails that were obtained by the Portland Tribune, which first reported on the situation.
The release follows a report earlier this month about Unity’s financial woes. The Northeast Portland mental health hospital racked up $35.3 million in losses through the fiscal year 2019 and expects to lose another $21.4 million this fiscal year, according to a financial statement Unity made to the Oregon Health Authority in December.
That document said the hospital was overloaded with patients awaiting a bed in the Oregon State Hospital. But it said the area designed for quick treatment was working well. That space, the PES or Psychiatric Emergency Service, holds dozens of recliners in an open room where patients are supposed to be quickly stabilized and discharged.
The document called the PES “a great success,” saying that up to 75 percent of patients are seen by a physician or psychiatric nurse practitioner, given a treatment plan and discharged within 18 hours.
But many other patients are not getting the help they need, according to these latest emails.
The situation is so dire that Dr. Gregory Miller, Unity’s medical director, cried out for help in an email last Thursday sent to officials at the Oregon Health Authority, Oregon Health & Science University and Multnomah County:
“I am writing about the serious conditions evolving at Unity,” Miller wrote. “As you know, we have the lion’s share of committed patients in the Multnomah county region. We currently have 25 patients awaiting transfer to (Oregon State Hospital), and we have had one transfer since the cessation of civilly committed patient transfers on December 27. We have 15 patients today waiting in PES to come to an inpatient unit, one of them who has been in a recliner chair for over six days.”
An update from Miller this past Monday said that 12 patients were waiting to be admitted to a room, including some that had waited close to five days. He said 30 percent of patients in the 107 beds at Unity needed to be transferred to the Oregon State Hospital.
“We have 29 committed and four guardian patients with 25 waiting for the state hospital,” Miller wrote. “There are 30 patients waiting in the community who cannot be transferred over.”
Miller said Unity has practically had to close its doors, sending patients arriving by ambulance elsewhere.
“We are on almost constant divert, causing patients to be mounting in area medical beds,” Miller wrote. “This situation is approaching a public health emergency. What can we do to address this issue as fast as possible. This is a real state of crisis for emergent psychiatric cases in Portland.”
Legacy Health, which runs Unity, did not respond to a request for comment. The hospital was created by OHSU, Legacy, Adventist Health and Kaiser Permanente to provide a place for Portland-area mental health patients to be treated instead of languishing in emergency rooms.
The newly appointed president of Unity, Melissa Eckstein, said she contacted other area behavioral health hospitals but was told they were full, according to another email last Thursday. The Oregon State Hospital is also crowded. The hospital's chief of psychiatry, Dr. Sara Walker, said they could take only one patient.
The state hospital has financial problems of its own. The Oregon Health Authority plans to ask the Legislature for nearly $82 million for the hospital. It’s been strapped with an overload of so-called aid-and-assist patients who are languishing in jails, awaiting treatment so they can be stabilized to stand trial for criminal charges.
In response to Unity’s call for help in December, the Oregon Health Authority convened a working group to discuss the facility’s financial problems. And in response to Miller's alert this month, the state's behavioral health director, Steve Allen, wrote, "This is very serious."
But the working group is not expected to meet until February.
You can reach Lynne Terry at [email protected].
When Unity was planned, they purposely decreased the number of acute inpatient psychiatric hospital beds available in the Portland metro area despite Oregon already being severely "underbedded" in both acute inpatient psychiatry beds as well as state hospital beds. So part of their crisis was created by the very health systems that planned and opened the unit. Many of us pointed this thinking error out at the time that Legacy, OHSU and Adventist were planning the Emergency Psychiatric Service that was to be the foundation of Unity. The plans also predicted a higher rate of discharge than they are currently seeing.
Most notably, Oregon continues to lose both state hospital beds and acute inpatient psychiatry beds. Oregon has not reformed its outpatient committment procedures in a way that will allow those with severe mental illness complicated by anosognosia (lack of insight and appreciation that they have an illness and need medications) to receive treatment.
Steve Allen is correct that Oregon needs an overall coordinated plan to meet the needs of citizens with mental illness. This would require many with diverse views to come together including members of the legislature who need to change the laws. The laws only allow for short term commitments for diseases that last decades, do not allow for a reasonable period of stabilization prior to hearing so that more people could be stabilized and discharged without needing a court commitment. Innovative ideas such as linking county of residence to bed days in the state hospital would help everyone to have both the same short term and long term goals-the money goes to the county when patients are out of the hospital receiving care at the community health centers, and the money goes to the state hospital when people are inpatient there. New Hampshire had such a system and it really worked.
Oregonians deserve a system that follows those with mental illness before, during and after crises. At least in the 15 years that I have been in Oregon, we have never had anything close to that.
As state hospital beds go down, suicide rates go up. It doesn't have to be this way.