Oregon State Hospital meets compliance with federal order

For the first time in four years, Oregon State Hospital, the state’s psychiatric hospital, is in compliance with a federal order requiring that certain patients be admitted to the hospital within seven days. Emily Cooper is the legal director of Disability Rights Oregon. She joins us to share more on what changed at the hospital and its future looking forward.

Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. For the first time in four years, the Oregon State Hospital is in compliance with a federal order requiring that certain patients be admitted to the hospital within seven days. These are known as aid and assist patients. They’re people who face criminal charges but have been deemed unable to aid in their own defense and first need psychiatric care. Emily Cooper is the legal director of Disability Rights Oregon. That’s an advocacy group that brought the suit more than 20 years ago that led to this seven-day requirement. She joins us once again to talk about this latest development. Welcome back to the show.

Emily Cooper: Thank you for having me.

Miller: We last spoke about two years ago. Can you just remind us what conditions at the state hospital were like back then?

Cooper: They were not good. The state was not only not in compliance with the order - so people were waiting weeks or even months for transport to the state Hospital. But as many folks might remember, the National Guard was sent in because the State Hospital didn’t have enough staff to treat the patients they had. So it was a really scary time for our clients two years ago.

Miller: And then fast forwarding a year from that, about a year ago. There was a kind of breaking point. A federal judge ordered some big changes that were pretty dramatic and made headlines. What did Judge Mosman say?

Cooper: Judge Mosman’s order from September of 2022 said two main things. First, he limited who came to the state hospital. So people charged with nonviolent, nonperson misdemeanor charges like vacancy or trespassing or charges pretty much related to houselessness, he ordered the state to stop admitting those patients for restoration and instead ordered the state to provide those services in the community.

Miller: Restoration to mental competency to understand, say, the charges against them?

Is that what restoration means?

Cooper: That’s exactly it. So restoration. So they regain the ability to aid and assist in their own defense.

Miller: What effect did his orders have?

Cooper: Well, the second piece that was really important is that he limited how long someone can be at the state hospital receiving restoration treatment. And the two things limiting who comes to the hospital and shortening how long they’re there, the waitlist of people waiting in jail for the admission to the state hospital precipitously dropped. It went from, again, weeks or months to today the average wait time is six days.

Miller: So the order worked.

Cooper: Yes.

Miller: But there were a lot of negotiations and a lot of consternation about it. What were some of the communitywide effects of that order?

Cooper: I think the first thing that was revealed to me is that the state hospital for years has been used as pretrial detention. It’s the sense that we’re going to charge these folks with sometimes behaviors related to their mental illness. We’re going to send them to the state hospital and we’re going to wait years before we even try them.

Miller: Was one example, stealing a ding dong at a convenience store?

Cooper: Yes, for over a year, that person was at the state hospital.

Miller: And obviously every case is individual. But what’s the likelihood that these people, who are in effective pretrial detention, [would get] care that could actually help them understand and aid and assist in their own defense?

Cooper: I think the first thing that’s really important for people to realize is people with mental illness, when we get the services we need, we recover. And a lot of times people get into this system because we haven’t gotten the services we need. And so that’s one thing that’s really important. But for the folks that fall through those cracks end up in the criminal justice system and go to the State Hospital, they get medication, they get group individual therapy. At the time, before the pandemic, there was a treatment mall where they could go and get better and recover. And once they were able to aid in the system offense, the trial picked back up and the court went on from there. What happened in the pandemic is the treatment mall shut down. People were locked on their units. And so we had really grave concerns about the level of restoration treatment available to patients two years ago at the State Hospital.

Miller: What about the treatment now? Separate from the numbers coming in, numbers going out who’s being referred there, what does treatment look like these days? And how effective is it?

Cooper: I think that’s the part that I get really excited about, is treatment has improved at the State hospital, the treatment malls are open again, visitors can come and what we’re looking at pushing the state to do next is expand programs like community navigators.

So once someone has restored a competency and they’re doing better, how do we keep them there so they never have to come back? And what we know from the data is a lot of people come back and we know that they come back because they don’t get the mental health services they need or the drug addiction services they need. So again, we know when people get services they need, they recover. And so that is our next big push in this case, is expanding home and community-based mental health services.

Miller: Well, I want to hear more about that but we sort of skipped ahead to the outflow of this system out of the state hospital, but what about the pipe leading in? What’s happening at the county level in terms of referrals to the hospital?

Cooper: Where Oregon was a leader in 2019 is that we passed something called community restoration. There was a recognition that there is a subset of folks who are not violent, just are really ill and they need those restoration services, but they can and should be served in their communities. That’s where they’re renting their hotel from or they’re getting services or that’s where their family is and so not taking them out of their homes actually works.

Miller: So the idea is that they would still be in a kind of pretrial detention/treatment, but not at the orient state hospital, instead at community based centers or homes where they could still ideally get treatment before awaiting trial?

Cooper: That’s exactly right. So you may get to stay in your apartment, you get to still see your therapist, see your family, see your dog.

Miller: You said that was the plan in 2019. Is that happening in 2023?

Cooper: No, I think that’s the problem is there are not enough community restoration services for people who need them.

Miller: OK. That’s before the hospital and ideally heading off at the pass, going to the hospital. But for people who are being admitted and now are being let out at some point, where are they going?

Cooper: That’s the role of community restoration, too. It could be a step down, and again…

Miller: It could be the same facilities that you say we don’t have enough of?

Cooper: It’s not necessarily facilities. Community restoration is really similar to in the hospital setting. It’s the provision of addiction services, medication, therapy, but it doesn’t need to be in a locked unit.

Miller: Do you see a connection between what you say Oregon needs more of and what Oregonians have been promised that we would get more of from Measure 110, or are these very different?

Cooper: It’s a great question and I actually think they’re related. How I think they’re related is that for over 50 years, we have not invested in community behavioral health. And so where we are now is we have a legislature dealing with a problem they didn’t create and wasn’t created in the past year. It has taken us decades to get here to not invest in the community the way we need to. And so I’ll give you an example. I talk about the Mosman Order as being one reason the waitlist came down. Another thing I think I would be remiss in not mentioning is two years ago, the legislature had unprecedented funding for community behavioral health. It set up more community restoration. It set up more of these home and community-based services. We’re looking at community navigators, we’re starting to see those investments bear fruit. And so my question is, if we fund it even more, will we get out of this problem forever?

Miller: Was that based on one-time federal funding?

Cooper: It was the legislature from Oregon, two years ago, that had unprecedented behavioral health funding. Millions of dollars went into the system.

Miller: One-time funding?

Cooper: That’s right. And so we need to see that funding continue and, if anything, expand.

Miller: And just briefly, what happens in December, like three months away, when the judge’s order for releasing patients on a particular timeline dissolves?

Cooper: I’m worried that when no longer held to the federal courts’ limitations on restoration, we’re going to go back to waitlists and back to people waiting in jail. And you’re not checking checkbox from a federal from. These are people are our brothers,                                                                 our sisters, our family members waiting in jail. And what we know is when people wait in jail without mental health services, they’re harmed and can even die.

Miller: Emily Cooper, thanks very much for coming in.

Cooper: Thank you.

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