As Oregon struggles with how best to treat patients with severe mental illness, a group of Portland-area mental health leaders say involuntary treatment is an important piece of the puzzle, but It’s unclear which location is best for patients.
In the wide-ranging panel discussion hosted by oregon health forum On Wednesday, five community leaders discussed the need for an increased supply of behavioral health housing and stabilization centers to provide social services to people with mental illness.
Speakers, including county commissioners, judges, and the interim director of Portland Mental Health Crisis Services, agreed that the current system of directing patients to the criminal justice system before they receive mental health treatment is unsustainable. did.
Panelists said Oregon lacks space for patients in crisis, especially those who are unable to advocate for themselves.
Doctors and county health officials can order people who pose a danger to themselves or others into involuntary restraint for up to 72 hours, which a judge must determine will last longer. However, in reality, there are very few facilities to house people detained for treatment.
Oregon State Hospital in Salem, the state’s largest psychiatric facility, currently admits few such patients. That’s because it is filled with patients who come through the criminal justice system, have been convicted of crimes other than insanity, or are unable to support their own trials.
Instead, patients in acute mental health crises often flock to medical hospitals that are ill-equipped to care for them.
“Oregon’s largest involuntary treatment system is its prisons and jails,” said Robin Henderson, chief behavioral health officer at Providence Oregon. “This is a traumatic place and it’s not a good situation.”
Dr Henderson said the increasing privatization of psychiatric services has made it difficult to find beds for patients.
“There are no concessions in the system,” Henderson said.
Multnomah County Circuit Court Judge Nan Waller presides over the county’s mental health court, which also oversees hearings for people charged with crimes but deemed mentally unfit to defend themselves in court. There is.
Waller said that during his years on the bench, he has seen patients in the throes of mental illness and addiction who struggle to stay in treatment. Some hope he goes to jail, others just languish on the streets.
“I work in a mandated system,” she said. “In some ways, people don’t really have that ability. It’s not humane in my opinion to leave people on the street and let them make decisions.”
She advocated for the creation of alternatives to prison, places where people could be dropped off in a crisis and then moved elsewhere, whether for substance abuse treatment or psychiatric treatment.
Waller and others at the Multnomah County organization spent four years planning the Portland Crisis and Sobriety Center, which focuses on drinkers with co-occurring mental health issues. Once they sober up, health care workers can assess them and connect them with treatment and services.
But that effort has been hampered by the board’s ability to distribute treatment funds under Drug Decriminalization Measure 110, conflicts of interest between city and county officials, lack of buy-in from the county, and lack of a strong advocate. Rejected and collapsed. The county government is currently considering building a limited number of customized sobriety centers, but funding for this has not yet been secured. He approved $7 million for the county to establish a separate 20-bed stabilization center.
Waller said people with mental illnesses should have access to treatment, regardless of whether they face criminal charges or the severity of their illness.
“People with behavioral health issues who are involved in the criminal justice system can be turned away and literally given the cold shoulder by housing and programs,” she says. “The stigma of criminal charges, in addition to the stigma of mental illness, places those involved in the criminal justice system at a significant disadvantage.”
Leela Layton, a licensed clinical social worker and interim director of Portland Street Response, believes there is a time and place for restrictive interventions, such as referring people who are unable to make decisions for themselves to psychiatric treatment. He said there is.
But many patients may be more likely to seek treatment if basic needs such as shelter and physical safety are met, she said.
“I think voluntarily choosing to receive care is a good start,” Leighton said. “But what’s more interesting to me is being realistic about what we’re asking people to consent to. Helping them get to the emergency room sounds like a great idea to us.” Maybe, but what does that mean for their belongings and safety? Will they have to return after dark? Can they be discharged within two hours? Many of their complaints are , driven by unmet basic needs.”
Jonathan Mroz, a communications specialist with Central City Concern, said his struggle to meet these basic needs is hampering his recovery.
Mroz said he started using drugs several years ago after a traumatic event in his personal life. He ended up living on the streets of Old Town in what he described as a “constantly hypervigilant state.”
“Even without drugs, homelessness can be deeply traumatic,” he says. “It’s created a never-ending cycle. You lose your backpack, you lose your phone, and it takes so long to get back all the things that make us human. It imposes the burden of remaining sane enough to obtain.”
He cited a critical shortage of psychiatric beds and subsequent housing for patients, as well as the need for a place for patients to simply get off the streets while their symptoms stabilize.
“At that point we create a never-ending cycle of abandonment,” he says.
While panelists considered immediate solutions, some emphasized the need for long-term planning.
“We don’t have a plan or a functioning system,” said Multnomah County Commissioner Sharon Mayeran, who also works as an emergency room physician. “Unless you do that, you’re just throwing good money at bad results.”
Maylan suggested someone who could coordinate mental health efforts between the state and county.
“We don’t need more studies, meetings, task forces, committees,” she said. “We need someone to bring it together and connect the dots and move us forward.”
—Jayati Ramakrishnan; [email protected]