As Oregon State Hospital discharges more patients, community mental health programs are asking for help to keep operating

As Oregon State Hospital brings its years-long backlog of admissions under control, smaller treatment groups say they are struggling to accommodate the growing number of patients discharged from the state’s mental institution.

Community mental health workers asked members of the Oregon House Behavioral Health and Health Care Committee on Wednesday to help fund treatment for patients being discharged from a state hospital.

The patients in question have been charged with crimes but have been declared mentally incompetent to continue with their legal proceedings. They cannot be tried until they regain their mental capacity.

Cheryl Ramirez, executive director of the Oregon Association of Community Mental Health Programs, asked lawmakers to consider increasing the state’s annual budget for outreach and assistance programs by about $11 million. for $7.5 million.

She said the funds, which OHA distributes directly to community mental health programs, will immediately go toward hiring more staff to work with patients recently discharged from the state hospital. This includes everything from social workers, case managers and peer support specialists to psychologists and nurses.

Additional funds would also go to the accommodation of patients. Ramirez said many patients who leave the state hospital need immediate help with rent or money to stay in a hotel room.

When someone is homeless, it’s not a good environment for them, Ramirez said. It’s almost impossible.

The new funding would also help community mental health providers afford patients’ medications and other basic needs, she said.

Most patients who are so-called because they are unable to help and assist in their own defense in court are sent for treatment to a government hospital. A 2002 federal court order mandates that those patients be admitted within seven days and not languish in jail.

But after years of backlogged admissions, exacerbated by the pandemic, a federal judge ordered in 2022 that assisted living patients must be released from the hospital within a strict timeline of 90 days for patients charged with misdemeanors and six months for those charged with felonies . make room for new patients.

As a result, dozens of patients are discharged from the hospital each month before their treatment is completed. In turn, Ramirez said, the workload on community-based treatment organizations has increased.

Oregon State Hospital Superintendent Dolly Mateucci told lawmakers Wednesday that about 27 percent of patients discharged from the state hospital were discharged because they arrived at a court-ordered time, not because their treatment was completed. In October, according to state data, there were 27 patients.

Charges are dismissed against those who reach the maximum time in a state hospital but are still found unable to assist in their own defense. Others are ordered to have some type of supervision, such as guardianship.

But a growing number of patients across the country are being sent to continue treatment in their home countries. Under Oregon law, community restoration programs are supposed to help restore individuals to competency so they can stand up for themselves. Programs may include legal skills training, meetings with the court and district attorneys.

Ramirez said rebuilding the community must also include treatment and human services, such as helping patients afford food, clothing and a place to stay.

It doesn’t make sense to focus only on rebuilding the community to get fit (to continue with the trial), Ramirez said. It makes a lot more sense to help them with their underlying mental illness or substance use disorder so they can recover, get better, and hopefully live in the community.

She noted that until a few years ago, behavioral health was chronically underfunded.

Ramirez added that Medicaid does not reimburse most community restoration services because they are not considered medically necessary, leaving treatment groups to foot the bill.

Patients trying to get into Community Rehab often face long waiting lists, she said. Treatment facilities often turn away patients whose needs are too high or who have other health problems that the facility cannot address.

And, Ramirez said, some patients simply refuse to engage in treatment once they’re released.

During the legislative hearing, other mental health providers and elected officials spoke about the impact of the surge in assisted living patients on their communities.

Three Marion County officials, County Attorney Paige Clarkson, Sheriff Nick Hunter and County Commissioner Daniel Bethel, told lawmakers their county is unable to keep up with the influx of patients.

Clarkson, an early critic of the court order, said it created a legal limbo.

“People who have been discharged early are being discharged without being healthy, so they are not yet fit to go forward in our criminal case,” she said. We cannot progress with them in the court system, and there is no justice for the victims.

But while Clarkson opposed the shortened time frame for releasing patients, she also expressed doubt that the community is the right place for patients, especially those charged with violent crimes, to continue treatment. She said community rehabilitation programs are often not equipped to deal with these patients and many end up returning to prisons that are not equipped to treat them.

According to a recent update to the court order, district attorneys can now apply to extend the stay of patients they believe pose a threat to public safety.

Several Oregon counties have pushed to end court-ordered releases, but Marion County officials have taken a particularly aggressive stance. The county sued the state hospital and the Oregon Health Authority for failing to provide enough mental health treatment beds.

Marion County officials also tried to send a recently released patient back to a state hospital. In October, U.S. District Judge Michael Mossman ordered Marion County to end the practice.

Jayati Ramakrishnan; jramakrishnan@oregonian.com

Note: The number of patients discharged from Oregon State Hospital in October has been updated from 28 to 27 based on new information from the Oregon Health Authority.

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