Four of Oregon’s largest hospital systems are suing the state over a system that “neglects” people with serious mental illnesses who haven’t committed a crime.
PORTLAND, Ore. In Oregon, there are two ways a person with a serious mental illness can be forced to receive treatment and care.
The first path is through a process called “civil commitment” where doctors and a judge can order involuntary treatment if they find a person is a danger to themselves or others, at imminent risk.
The second way is through the criminal justice system. A person can commit a crime, be arrested and then evaluated and transferred from a prison to a facility like Oregon State Hospital for mandatory treatment and possible restoration if they are deemed unable to help and assist in their own defense
Over the past five years, the “civilian” route to preventive care has disappeared in Oregon.
Lisa Dailey, executive director of the nonprofit Treatment Advocacy Center, which studies commitment laws state by state, the system is not really treating people within the non-criminal part of the system, making them easily criminalized. (Oregon) is going in the wrong direction.
And with the treatment of acute mental illness left to local institutions, four of the state’s largest hospital systems are suing the Oregon Health Authority for “negligence” of civilly committed patients.
RELATED: Providence, Legacy, PeaceHealth sue Oregon over mental health treatment
Shrinking beds and court orders
Nationally, the number of state mental hospital beds has been declining for decades, and in the past 15 years, the share of beds occupied by criminal patients has exceeded the percentage of beds occupied by civilian patients, according to TAC.
The change reflects a system that expects people with serious mental illnesses to commit a crime before imposing treatment, and perhaps nowhere in the country is that change more evident than in Oregon.
As recently as 2018, Oregon State Hospital reported a fairly even split of care among its three main patient types, including civil commitment, aid and assistance, and the medical review board. psychiatric safety. The latter refers to people who have been found guilty of a crime “except by reason of insanity” and committed to state custody, rather than those awaiting trial.
However, people in prison with serious mental illness who were helping and assisting patients were waiting too long for care and transport, breaking national standards.
In 2019, a judge ordered the Oregon Health Authority to comply with a federal order and bring incarcerated patients with serious mental illnesses to the state hospital within seven days.
Compelled by this court order, OHA began prioritizing criminal justice cases, significantly decreasing the number of civilian patients it would admit in order to open up bed space.
RELATED: Court rulings require Oregon State Hospital to walk the line between patient rights and public safety
By 2021, civil engagement in Oregon was all but extinct. As a result, long-term mental health care is often only available to someone who has committed a serious crime.
“Just going deeper into a hole”
Beyond the confines of state custody, people with serious mental illness often move in and out of acute care hospitals and community options that are ill-equipped to provide long-term treatment leading to a dangerous game of ‘just wait.
They’ve been abandoned by the state and forgotten, said Melissa Eckstein, president of the Unity Center for Behavioral Health, a referral source for mental health treatment in Portland.
Eckstein told KGW that Unity used to send about 400 people a year to the state hospital for treatment. Now, with admissions priority to criminal patients, Unity sends “only a handful” each year.
“Our treatment team is really in a difficult situation because the things that they think are going to help this person have the most fulfilling life and be able to stay stable are not available to them,” Eckstein said.
Asked if there is an option other than Oregon State Hospital where Unity could transfer these types of civilian patients, Eckstein said: Right now, not really.
KGW has shared stories of individuals and families looking for answers within the system.
Eric Gardners family said Eric is now homeless after he could not be forced to care. Kenny Benton was unable to recognize his own illness, only receiving treatment after threatening his mother with a knife. And Brett Meister was civilly committed four times, but failed to get help after each pitch.
In 2023, Oregon State Hospital admitted 1,209 patients with treatment and restoration orders so they could help and assist with their own pending criminal case, according to OHA. The hospital admitted only 15 civil commitment patients that year.
It seems like with each passing month, he got deeper into a hole, Eckstein said.
Without a place to go, patients with serious mental illness are occupying critical and limited community hospital beds, according to Eckstein.
In response, four of Oregon’s largest hospital groups, Legacy (which includes Unity), Providence, PeaceHealth and St. Charles are suing the OHA, saying the state has failed to care for people with serious mental illnesses by neglecting civil commitments and instead “warehousing people” in acute hospitals.
A federal judge ruled against the hospital systems and will appeal that decision, with a hearing set for May 8.
Last in the nation
Compared to other states on civil commitment standards and admissions, Oregon is increasingly alone.
A study by the Treatment Advocacy Center found that Oregon uses 7 percent of the available mental health care space in the state on civil cases, instead of criminal ones. Which ranked last in the country among any state that allows civil engagement. The national average of civilian patient employment is 48%, according to the TAC.
“You’re basically creating a system where the only time people get care is in the most expensive, costly and least effective setting,” Dailey said.
Dailey told KGW that society would not tolerate this system of crime before care for any other type of health care, asking why should we have mental illness?
You’re creating a system where care is based on the idea that there has to be a victim, Dailey said. I don’t think it makes any sense and I don’t think most people would agree that they want that.
Washington County District Attorney Kevin Barton told KGW that Oregon’s civil commitment process is “broken,” saying the standards are so high that it forces the justice system to step in as a last resort
“It’s often the only path someone has to some level of mental health treatment, and this is a silly way to approach this problem,” Barton said.
Barton said all levels of government and health care believe there is a serious problem, but there has been little motivation to make sweeping changes.
“There is a lack of political will and leadership to really address the problem,” he said. “Instead, we have task force after task force … but nothing really happens to fix it, and I find it incredibly frustrating.”
This is part two of a three-part KGW “Uncommitted” series exploring how Oregon has effectively criminalized serious mental illness over the past five years, often waiting for people to commit a serious crime before seeking treatment. Reports will air at 6:30pm during KGW’s The Story broadcast this week.
FIRST PART: A Portland couple tried everything to get their son mental health treatment. Then, he killed his mother
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