Is this Oregon’s gift to mentally ill patients?

By Rep. Dennis Richardson
The holiday cheer, the lights, the gift giving, the carols, the shopping and delicious treats are all part of our holiday excitement.  Christmas and Hanukkah’s Festival of Lights are times of joy and celebration, but this season is also a time of introspection and humility. We who have sound minds and bodies have reason to be most grateful. Not everyone has been so blessed.

Those Oregonians who suffer from mental illness carry burdens others cannot fathom. Sometimes mentally ill patients are anti-social and need patience and understanding.  Sometimes they are dangerous and must be placed into secured facilities for the safety of themselves and those around them. Sometimes they are tortured with voices and visions we cannot comprehend.

How a society deals with its mentally ill members reveals a great deal about that society. Oregon has a dark history of dealing with mentally ill patients. During my first legislative term in 2003, I learned that many of the patients in the Oregon State Mental Hospital did not have treatment plans and were essentially being warehoused without a plan to return them to society—tragic cases of forgotten men and women.  Not long thereafter, Senator Peter Courtney and other Oregon legislators uncovered this disturbing fact: copper canisters containing cremated remains of 3500 souls sat on forgotten shelves of Building 60 at the antiquated State Hospital in Salem. And as you may recall, it was Oregon’s deteriorating, century-old State Hospital that was selected for filming the disturbing movie, “One Flew Over the Cuckoo’s Nest.” 

In recent years, the Oregon Legislature has worked to rectify decades of neglect by authorizing the construction of the new state mental hospital in Salem. This 620 bed, half-billion dollar mental facility is near completion. It will provide quality mental care that comes at a cost of more than $211,000 per patient, per year to operate.

More controversial is a proposed second mental hospital to be built in Junction City. This project was initially planned to provide an additional 360 mental patient beds and would be built next to a proposed new prison. Today the Junction City mental hospital project has been scaled back to 170 beds and carries a construction price tag of $88 million.

Although more than $24 million has already been spent on infrastructure and planning for the Junction City Hospital, this second mental institution project has been surrounded with controversy from its outset.

At the heart of the controversy is how to most effectively and economically deal with potentially dangerous mental patients. Should Oregon (1.) spend another $88 million constructing a second State mental hospital in a city that is distant from the families of those who will be placed there, or (2.) spend $35 million constructing multiple, community-based 16-bed secured facilities near the patients’ friends and families whenever possible?

Placing patients in huge mental hospitals continues a costly and antiquated treatment model and the operational costs are paid 100% by Oregon taxpayers ($580 per day per patient). The alternative is to construct 16-bed secured facilities in communities around the state and the operational costs are shared with only 40% paid by the State ($158 per day, per patient) and 60% paid with federal funds ($258).   For those mental patients who do not pose a danger to themselves and others, the savings to Oregon taxpayers is even greater.

Those who favor constructing the Junction City mental hospital say constructing sufficient secured 16-bed facilities is unrealistic since neighborhoods don’t want 16-bed facilities with dangerous mentally ill patients living in their residential neighborhoods.

Those opposed to constructing another large mental hospital point to more than a dozen community-based, 16-bed mental facilities already existing in Oregon, and the fact that other states safely provide 16-bed facilities.  Community-based facility advocates argue that safety is assured by appropriate design, not size-of-facility. Neighborhood placement concerns could be resolved with minor changes in Oregon’s state-wide zoning laws.  Specifically, community-based mental facilities could be sited in industrial areas, far from residential neighborhoods, yet close enough for families to visit and provide needed social support for mentally ill relatives and loved-ones.  From a budgetary position, both construction and net operational expenses to the state are substantially reduced with the 16-bed community-based, secured facilities model.

While the Governor and some Legislative leaders support the construction of the second mental hospital, the vast majority of knowledgeable individuals and credible organizations that advocate for mentally ill patients are decidedly against the Junction City project.
I
n a Register-Guard article St. Rep. Sara Gelser (D-Corvallis), stated: “If we build a second state hospital in Junction City, we will be indentured to the institutional style of care for mental illness in our state for as long as we can foresee.” She went on to say, “We will have taken a clear position. There will be no reverse course.”

The article continues…“The National Alliance on Mental Illness and Mental Health America are lobbying for a shift toward community-based care, where they say patients are treated more humanely in smaller facilities and given more independence.”

“It’s not good policy to build ‘big box’ hospitals,” said Chris Bonueff, executive director of NAMI Oregon. (Article.)

The Association of Oregon Community Mental Health Programs (AOCMHP) reminded the Legislature that the US Supreme Court in Olmstead v. L.C. set limitations on state use of mental institutions. The U.S. Supreme Court held that mental patients qualify under the Americans With Disabilities Act and, when feasible, should place mental patients in a community-based environment. Thus, Oregon may be in violation of Olmstead if it constructs a second state mental hospital instead of construction community-based facilities.

More recently, the eight member Mental Health Association Board of Portland unanimously opposed the Junction City project in their article entitled, “Junction City Hospital–the Worst Way to Treat Mentally Ill,.       

So, where can we turn for an unbiased and evidence-based opinion on whether or not to commit another $88 million to construct the Junction City mental hospital?

In 2009, the Oregon Legislature passed Senate Bill 25 to provide informed and unbiased policy recommendations on Oregon’s mental health issues. Senate Bill 25 was passed by a near-unanimous vote in both the House and the Senate.  S.B. 25 established in the Department of Human Services, the 16-member Oregon State Hospital Advisory Board is charged by law with the duty to conduct “comprehensive review of…rules, policies, procedures and protocols of the Oregon State Hospital related to the safety, security and care of patients.” For me, such an Advisory Board’s opinion carries substantial weight on whether or not to proceed with constructing a second large state mental hospital.

The Oregon State Hospital Advisory Board presented its opinion earlier this year to the Oregon Legislature. The Board began its report by saying “….the OSH Advisory Board unanimously voted to express our objection to the plan to place a State Hospital at the proposed Junction City site.”

The Advisory Board concluded its unanimous findings with the following:

“Oregon cannot afford – either fiscally or philosophically – to build another State Hospital in Junction City.”

The battle lines are drawn. The Governor and the Senate President want to invest another $88 million to build a second State mental hospital and operate it with 100% Oregon tax dollars. Oregon’s most credible mental health associations and the Oregon State Hospital Advisory Board disagree. They oppose construction of a second monolithic state mental hospital in favor of secured, community-based facilities where 60% of the operational expenses are covered by federal tax dollars.

As one of the Co-Chairs of Oregon’s budgeting committee, I would appreciate hearing your opinion on this issue. Please complete this brief survey and share your opinion on whether a second state mental institution should be located in Junction City.

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