As Oregon State Hospital comes under control over years of waiting lists, small treatment groups say they are struggling to keep up with the growing number of patients being discharged from the state psychiatric hospital.
Community mental health workers on Wednesday asked members of the Oregon House Behavioral Health Committee for financial assistance to help pay for treatment for patients being discharged from state hospitals.
The patients in question have been charged with a crime but have been deemed mentally unfit to proceed. They cannot stand trial until their mental capacity is restored.
Cherryl Ramirez, executive director of the Oregon Association of Community Mental Health Programs, urged lawmakers to consider increasing the state’s annual budget for aid and support programs, which is about $11 million.— A difference of $7.5 million.
She said the money, which OHA will allocate directly to community mental health programs, will immediately be used to hire staff to treat patients recently discharged from state hospitals. This includes everyone from social workers, case managers, and peer support specialists to psychologists and nurses.
The additional funds will also be used to secure housing for patients. Ramirez said many patients leaving state hospitals need emergency assistance to cover rent or need money to stay in a hotel room.
“If someone loses their home, that’s not a good environment for them to recover,” Ramirez said. “That’s almost impossible.”
The new funding will allow community mental health providers to provide medicines to patients and other basic needs, it said.
Most “auxiliary aid” patients (so called because they are unable to help defend themselves in court) are sent to state hospitals for treatment. A 2002 federal court order requires these patients to be hospitalized within seven days rather than languish in jail.
But after years of backlogs of hospitalizations made worse by the pandemic, a federal judge in 2022 announced strict deadlines for aid and assistance patients (90 days for patients charged with misdemeanors, 90 days for patients charged with felonies, and 90 days for patients charged with felonies). It was ordered that the patient must be discharged from the hospital within 6 months. — To make room for new patients.
As a result, dozens of patients are discharged each month before their treatment is complete. As a result, Ramirez said, the workload for local treatment agencies has increased.
Oregon State Hospital President Dolly Matteucci told lawmakers Wednesday that about 27% of patients discharged from state hospitals are released because they have reached a court-ordered time, not because their treatment is complete. Ta. There were 28 cases in October, according to the state’s dashboard.
In some cases, even after reaching the maximum length of stay in a state hospital, it is determined that the person cannot defend himself and the charges are dropped. Some people are ordered to have some kind of supervision, such as guardianship.
But across the state, more and more patients are being sent to their home counties to continue treatment. Under Oregon law, “community recovery” programs are supposed to help individuals regain their ability to protect themselves. The program includes legal skills training, meetings with courts and district attorneys, and more.
Ramirez said community recovery must also include treatment and human services, such as helping patients have food, clothing, and shelter.
“It doesn’t make sense for them to just focus on community recovery so they can build up their strength[to move forward with trials],” Ramirez said. “It makes much more sense to support them because they have underlying mental illness and substance use disorders so they can recover and get better and hopefully live in the community. Become.”
She pointed out that until a few years ago, behavioral health was chronically underfunded.
Ramirez added that most community restorative services are not considered a medical necessity and therefore are not reimbursed by Medicaid, leaving treatment organizations to pay for them.
Patients seeking community remediation often encounter long waiting lists, she said. Treatment facilities often refuse to accept patients whose needs are too high or who have other medical problems that the facility cannot address.
And Dr. Ramirez says some patients simply refuse to participate in treatment after being discharged from the hospital.
At a Congressional hearing, other mental health providers and elected officials spoke about the impact the surge in assisted living patients is having on their communities.
Three Marion County officials, District Attorney Paige Clarkson, Sheriff Nick Hunter and County Commissioner Daniel Bethel, told lawmakers the county is not keeping up with the influx of cases.
Clarkson, an early critic of the court order, said it created “legal ambiguity.”
“Those discharged early are not yet fit to proceed with criminal proceedings because they are discharged in poor health,” she said. “We cannot move the justice system forward with them and there is no justice for the victims.”
But while Clarkson opposed shortening patient release deadlines, she also expressed doubts about whether the community is an appropriate place for patients, especially those charged with violent crimes, to continue their treatment. She said community recovery programs are often ill-equipped to handle these patients, and many end up returning to prisons without treatment facilities.
A recent court-ordered update allows district attorneys to request extended stays for patients they believe pose a threat to public safety.
Several Oregon counties are pushing to end court-ordered releases, but officials in Marion County are taking a particularly aggressive stance.county sued state hospital and Oregon Health Authority About not providing enough beds for mental health treatment.
Marion County officials also tried to send recently released patients. Return to state hospital. In October, U.S. District Judge Michael Mossman ordered Marion County to end the practice.
—Jayati Ramakrishnan; [email protected]