Grading the States 2006: Oregon - Narrative
Oregon is one of those systems that may look better on paper than in actuality. There are major problems in its mental healthcare system that cannot be ignored. At the same time, the state is taking some positive steps to improve services for its residents with serious mental illnesses.
Problems at the 122-year-old Oregon State Hospital (OSH) in Salem are legion. The hospital houses 690 patients and long has struggled with inadequate staffing, poor physical conditions, overcrowding, and violence - let alone its therapeutic programs. Most residents at OSH are forensic patients, under the jurisdiction of the State's Psychiatric Security Review Board (PSRB). Empty beds for civil patients are virtually non-existent, which has a domino effect, leading to overcrowding in acute care hospitals and emergency rooms throughout the Williamette Valley.
In January 2006, after negotiations with state officials had proved fruitless, the Oregon Advocacy Center filed suit against the state, seeking a court order to increase staffing and improve safety and quality of care at the Hospital. To its credit, the state legislature acted swiftly. Meeting in emergency session, the legislature, through its Emergency Board, approved $9.2 million in new state funds to hire additional staff at the hospital, fund community placements for currently hospitalized individuals who are ready for community placements, and renovate a leased facility in Portland for individuals under civil commitment orders.
NAMI Oregon considers remediation of conditions at OSH one of its greatest priorities - along with design of a comprehensive community service system. Improving conditions at the current hospital is a step that will help for the immediate future, but the most effective long-term solution must include new inpatient and community-based alternatives both for current residents and to prevent unnecessary hospitalizations in the future. The state is expected to release a long-term master plan for the state hospital shortly, which is expected to include a recommendation for the construction of a new state hospital rather than renovating the existing antiquated and crumbling facility.
In 2004, a Governor's Mental Health Task Force issued a "Blueprint for Action" containing proposals for improvement of services for Oregonians of all ages with mental illnesses. Two of the recommendations have since been enacted: mental health insurance parity and suspension rather than termination of Medicaid benefits upon incarceration.
Oregon's mental health parity law was enacted in 2005 after many years of effort by advocates and will take effect in 2007. When it does, it is expected to alleviate some of the burden on the public mental health system that results when families who do not have access to treatment through private insurance are forced to turn to the public system. However, it should be noted that the law only covers those who have insurance through their employers and excludes those who self-insure.
Although the Governor's Task Force was required to keep funding constraints in mind while developing recommendations, the blueprint emphasized that the system is significantly under-funded and that continuing to "defer discussion of financing is to assure that the problems will grow and become more expensive in future years." The problem became acute in 2004 when the medically needy program of Oregon's Medicaidprogram (the Oregon Health Plan) was eliminated, which resulted in cuts in vital services for many people with serious mental illnesses. While some who were cut off from Medicaid have since been restored, the negative effects of the cuts are still very much evidenced through gaps in services for many people.
On a positive note, Oregon is working to improve services. Most noteworthy is the state's commitment to expand access to evidence-based practices (EBPs). Twelve Oregon counties, with more than 65 percent of the state's population of people with serious mental illnesses, today offer Assertive Community Treatment (ACT) services, which meet model standards.
In 1999, the state created a Community Mental Health Housing Fund with proceeds from the sale of its old Dammasch State Hospital property. A portion of the site was reserved for community housing for people with mental illnesses. Reinvesting property assets "in trust" for consumers is an emerging, creative innovation nationally, and Oregon has helped blaze the trail.
Lane County (a large county that includes the City of Eugene) has adopted a comprehensive initiative for jail diversion and re-entry services for individuals with mental illnesses who are released from jails and prisons. It is the only Oregon county to have done so to date; however, the legislature took a step forward in 2005, requiring that Medicaid benefits for jail and prison inmates with serious mental illnesses be suspended only rather than terminated upon incarceration.
Oregon, in keeping with its pioneer spirit, is taking some innovative steps forward to improve services for people with serious mental illnesses. However, services remain fragmented or non-existent for many in the state. Advocates, mindful that small advances may be threatened the next time a state fiscal crisis occurs, must remain ever vigilant.
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