Oregon State Hospital in contempt of court for failing to admit patients

The Oregon State Hospital has been in contempt of a court order for more than a month as it has failed to admit people with significant mental illnesses who need long-term treatment.

Statewide, 18 people who have been found guilty except for insanity are awaiting admission into the state’s psychiatric hospital for treatment and to serve their sentences, court records show. At least some of those people have been waiting in local jails for months.

“Since the beginning of 2021, there have been no transports to (the Oregon State Hospital) from any jurisdiction in Oregon for defendants found (guilty except for insanity) and committed to the hospital,” Multnomah County Circuit Court Judge Nan Waller wrote in her contempt order signed Sept. 22.

The order came as pressure has built on the state hospital to increase capacity and admit people going through the criminal justice system while often experiencing a crisis. At the same time, the Oregon Health Authority, which runs the state hospital, has reported that increasing its health care staff is extremely challenging amid the pandemic due to staffing shortages and worker exhaustion. Twice during the pandemic, members of the Oregon National Guard have deployed to assist with staffing shortages at the hospital.

“The state hospital can’t maintain its current staffing, much less expand its capacity to admit the people that are languishing in jail for their services,” Disability Rights Oregon legal director Emily Cooper told OPB’s Think Out Loud on Tuesday. “We still do not have a clear answer of why the staffing crisis is as bad as it is and the state’s plan to fix it.”

Disability advocates such as Cooper note the problems at the state hospital have been building for years, and argue one of the reasons behind the admissions delays is there aren’t enough community-based treatment options to intervene before a would-be patient’s mental health spirals out of control.

“You cannot put the burden of an entire system of care onto one entity, one hospital,” Cooper said. “Unlike the medical system, the mental health system has not gotten out ahead of the curve.”

The state hospital cares for three types of populations, including long-term patients found guilty except for insanity and shorter stay patients, under a category known as aid and assist. Those are people deemed too mentally ill to continue with their criminal cases but can be released back into the justice system after receiving care.

Waller’s contempt ruling on the guilty except for insanity patients addresses people who effectively have been sentenced. In the ruling, she found the state hospital willfully decided to not admit two people in Multnomah County. One person had been waiting in jail since March and the other since May, court records show. Waller has sanctioned the state $100 per day, per person, as long as they wait for admission in jail.

Waller stated it was choices made by leaders at the state hospital and health authority that confined the two people “to jail for an indefinite period of time during which they are neither getting treatment” nor a hearing that would release them to a community-based treatment center. The effects of the “indefinite confinement,” Waller noted in her order, were clear when one of the men “appeared in court in a suicide smock.”

A spokeswoman for the Oregon State Hospital did not return the request for comment.

For nearly the last two decades, the aid and assist population at the hospital has been under a federal court order, which requires someone found unable to aid and assist to be admitted to the hospital from jail, within seven days. That ruling was temporarily relaxed during the pandemic under an order from U.S. District Court Judge Michael Mosman, but a subsequent appeals court ruling called for a permanent solution to ensure people are receiving care at the state hospital promptly.

Attorneys with the Oregon Department of Justice who represent the state hospital argued in court documents the state can’t comply with both Waller’s order to admit long-term patients while prioritizing those entering the hospital as short-term, aid and assist patients.

“Where federal law and state law requirements are competing for the same finite resources, (the state hospital) must resolve the conflict in favor of complying with federal law,” Assistant Attorney General Kate Beck wrote in court documents.

But Waller rejected those arguments, saying that while Mosman did make changes to a long-standing order on hospital admissions, his order did not direct the state hospital to stop admitting patients found guilty except for insanity.

Waller wrote that the Oregon Health Authority and the Oregon State Hospital “have made a choice [sic] to prioritize (aid and assist) transports over (guilty except for insanity) transports.”

During the last legislative session, state lawmakers invested heavily in mental and behavioral health services, agreeing to invest as much as $350 million in the state hospital as well as programs outside. Part of that funding included $31 million to open 48 beds at the state hospital’s Junction City campus.

Some of those beds were scheduled to open this month, but hiring has been slow.

The pandemic has shown weaknesses in the state’s mental health system, though the current situation is also a symptom of underinvestment, advocates argue.

State Sen. Kate Lieber, D-Beaverton, who was elected last year and helped craft the budget package, acknowledged that the state has not funded mental health at the level necessary.

“You have to open up the beds at the state hospital and you have to make huge investments in the community level in order for us to not have to open up more beds,” Lieber said.

Those community investments could provide more supportive housing to either prevent people from getting to the state hospital or support them as they transition out.

“We can spend $100,000 on someone in the state hospital and two months later they’re homeless,” said Lieber, a former Multnomah County prosecutor who also served on the state’s Psychiatric Security Review Board. “That’s not a good investment. And I don’t think anybody in the system would think that’s a good investment.”

Lieber acknowledged the situation is dire, one that will require federal funding.

“It’s too big of a problem for the state to solve on its own,” she said. “And it’s too big of a problem not to solve.”