A federal judge has ordered the release of more than 100 patients from the state’s closed psychiatric hospital. Nobody is sure what will happen next.

Oregon State Hospital, the state’s closed psychiatric hospital, suddenly announced three weeks ago that, in response to an order from a federal judge, it would send more than 100 patients to their counties early.

Many of the facility’s patients face criminal charges and are detained until they are stable enough for trial.

In interviews, sources familiar with Oregon’s struggling mental health system said the new policy won’t solve the system’s long-standing deficiencies: There simply aren’t enough treatment options for people with severe mental illness. The emergency release is the latest symptom of a system critics say is wholly unsuitable for Oregon’s mental health challenges.

The early release is a “total failure,” says Kevin Fitts, executive director of the Oregon Mental Health Consumers Association.

“Where do these people go? There is not enough capacity,” Fitts says. “I’m not talking about a simple lack of capacity. I’m talking 20 to 30 percent of what’s needed.”

The hospital did not say who would release him, which alarmed the prosecution.

“It’s the most ridiculous thing in the world we don’t know,” says Washington County District Attorney Kevin Barton. “And not only that, they won’t tell us.”

Oregon is near the bottom in the states’ mental health outcome rankings. Here, arrest is the only way to receive treatment. And when people are out of order, they are often caught again.

“It’s like squeezing a balloon,” Barton says. The hospital was pressed, and he showed up at our end. But there is no place to put these people.”

Jason Reno of the Portland Mental Health Association supports the new policy but says it won’t solve the underlying problems. “A proportion of those released will be back in prison in a few weeks,” Reno says.

When these patients fall through the cracks, they make alarming headlines.

Take Terri Lynn Zinser, for example, a 54-year-old woman who was discharged from an Oregon State hospital in April after a four-month stay. She was referred to her local treatment center, Al Wahda Center for Behavioral Health, but left shortly thereafter. Court documents show the county then lost track of it before she was found wrapped under a baby’s bed covers in a Northeast Portland home on Tuesday. Zinser was charged with burglary and harassment and released.

The pandemic has devastated the state’s mental health care system. In a presentation to lawmakers earlier this year by Steve Allen, the state’s director of behavioral health, the slide for community-residential bed losses was described as “amazing.” Only 16 beds are safe for Level 1 residential treatment, the highest level of care available to returning patients, still in Multnomah County.

In a taped call with county officials earlier this month, Allen struggled to answer questions about the public safety implications of the new policy. His agency released written answers to questions from county officials and WW earlier this week.

But many questions, including the long-term effects of the policy, remain unanswered. Here it is.

Why is Oregon State Hospital doing this?

Many people suffer from mental illness so severe that they need to be hospitalized, but there are not enough beds. (The hospital has a current capacity of 705 patients).

For people accused of crimes, it means imprisonment. Defendants can only appear in court if they are stable enough to “help and assist” in their own defense. Meanwhile, they are waiting in prison until a state hospital bed is opened so they can be treated.

This process can take months, and judges have found it unconstitutional. In 2002, Disability Rights Oregon won a court order requiring the hospital to accept people within seven days. For 15 years, the state fulfilled this mandate, until “significant cuts” in mental health services during the recession increased the waiting list, says Emily Cooper, legal director of the Office of Human Development.

By 2019, the average waiting time was 26 days.

“We continue to be terrified that there are people with mental illness waiting in prison for court-ordered mental health services and who – if not suffering – are dying,” Cooper says. She points to the death of 22-year-old Bryce Baby, who was waiting in the Washington County Jail for a bed at the state hospital.

On August 29, US District Judge Michael Mossman ordered state health officials to follow an outside counsel’s recommendation to fix the backlog: release pretrial patients early. While state law previously required the hospital to release defendants within three years, the new order reduces that to a maximum of 90 days for misdemeanors and a year for violent crimes.

Cooper says the timelines bring Oregon into line with other states. “You can’t just lock people away in a state hospital and throw the key away.”

How many patients does the hospital plan to be discharged from, and when?

According to the Oregon Health Authority, approximately 120 patients were newly eligible for discharge at the time of the order. Not all of them will be discharged at once, however, counties will be notified 30 days before they are discharged. The first batch of notifications was released last week.

Multnomah County ranked first on Friday, says Julie Dodge, the interim director of behavioral health for Multnomah County.

Dodge says she is not concerned about the county experiencing a “rapid influx” of new patients. However, it’s an unwelcome change to a system that struggles to house and care for the patients it already has, she adds. The county has only three beds available in its closed treatment centers.

“We’re in this perfect storm,” says Dodge. “It’s going to take time to process it – and we don’t have time.”

Where will the discharged patients go?

It depends, says Judge Nan Waller, who presides over the county’s specialized mental health court, which deals with such cases.

Depending on the circumstances, defendants could be handed over to “restore society” programs or simply left. In extreme circumstances, prosecutors can request that the defendant be declared “extremely dangerous,” and if the judge agrees, they will be sent back to the state hospital. But, Waller says, this is very rare.

The court is working with the county, nonprofit organizations, and insurance companies to try to find the best treatment option in the community for each defendant. But there is not enough family. There is no requirement that residential treatment centers receive a person. That can make finding places for people with a criminal history of some crimes, such as arson, difficult if not impossible, Waller says.

“People end up on the streets.”

Why isn’t Oregon just expanding the state hospital?

This requires the approval of the Oregon legislature. The state recently opened several smaller “huts” at the satellite site of the State Hospital in Junction. But, on top of that, “they have not expressed an interest in expanding the state hospital,” Behavioral Health Director Allen told county officials earlier this month.

Rep. Rob Nosey (D-Portland), who chairs the House Interim Committee on Behavioral Health, says hospital expansion is not a short-term solution.

Meanwhile, Nosse points to more than $1 billion in new funding for mental health care. But Noss says it will take at least two years for the Multnomah County mental health system to catch up with demand.

Although he wishes the county had more time to prepare, he understands the logic behind Judge Mosman’s order.

“This is a big problem,” he says. “These people deserve to bypass this system faster.”

Well, the state opens its checkbook. Where does all this money go?

Higher salaries for workers who take care of patients in a state hospital and other treatment facilities, for one reason.

During the pandemic, many employees refused to come to work at the state hospital, and officials had to call in the National Guard. During the summer, employees routinely worked overtime shifts, says David Lynch, a hospital nurse and union president.

When asked why it is difficult to hire workers for these jobs, Lynch had a simple answer: “violence.”

Earlier this month, Oregon Occupational Safety and Health announced that it would issue three hospital citations related to “workplace violence and injuries.”

Lynch says recent wage increases have helped, but the hospital’s new lay-off policy hasn’t.

“It will increase the severity of the risk,” he says, noting the amount of attention patients need to ensure their own safety and that of staff. “There will be less time to stabilize in them, and employee turnover will increase.”

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