Portland’s Mental Health Crisis: A Continuing Dilemma

You won’t want to miss this informative breakfast forum on May 25.


Portland’s overcrowded emergency rooms have become a place of last resort for psychiatric patients. Psychiatric boarding, defined as psychiatric patients’ waiting in hallways or other emergency room areas for inpatient beds, is a serious problem nationwide.

Boarding consumes precious emergency room resources and delays patients receiving treatment. It is often the result of an inability to gain timely access to community-based care – waiting lists for outpatient treatment is now up to eight weeks.

Oregon Health Forum is bringing together a panel of experts on Wednesday, May 25 who’ll look into proposed solutions by delving into this critical issue from the perspective of the institutions, the criminal courts and the hospitals.

Registration is now open for this breakfast forum which gets underway at 7 a.m. on Wednesday, May 25 at the Multnomah Athletic Club.

Our esteemed panel includes:

  • Christine Farentinos, MD, CADC III, Unity Center – Legacy Health. A long-time advocate of bringing a psychiatric emergency department to Portland.
  • Sharon Meieran, MD, emergency room physician. A member of the Community Oversight and Advisory Board, the City Council-appointed oversight for Portland’s settlement with the Department of Justice.
  • Edward Jones, Multnomah County Circuit Court Chief Criminal Judge.
  • Jason Renaud, Mental Health Association of Portland.

Learn more by registering today for this interactive forum and bring your questions for our panelists. If your organization is interested in supporting this breakfast forum or has ideas for future events, please contact Diane Lund-Muzikant, executive director.

Oregon Health Forum is the educational arm of The Lund Report and collaborates with other nonprofit organizations to sponsor monthly breakfast forums.

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Crisis training can change the way officers respond to persons with mental illness

The New York Times, April 25, 2016

Officers Michael Hastings and Brad Yakots on duty in downtown Portland

Officers Michael Hastings and Brad Yakots on duty in downtown Portland

The 911 caller had reported a man with a samurai sword, lunging at people on the waterfront.

It was evening, and when the police arrived, they saw the man pacing the beach and called to him. He responded by throwing a rock at the embankment where they stood.

They shouted to him from a sheriff’s boat; he threw another rock. They told him to drop the sword; he said he would kill them. He started to leave the beach, and after warning him, they shot him in the leg with a beanbag gun. He turned back, still carrying the four-foot blade.

In another city — or in Portland itself not that long ago — the next step would almost certainly have been a direct confrontation and, had the man not put down the weapon, the use of lethal force.

But the Portland Police Bureau, prodded in part by the 2012 findings of a Justice Department investigation, has spent years putting in place an intensive training program and protocols for how officers deal with people with mental illness.

At a time when police behavior is under intense scrutiny — a series of fatal shootings by police officers have focused national attention on issues of race and mental illness — Portland’s approach has served as a model for other law enforcement agencies around the country.

And on that Sunday last summer, the police here chose a different course.

At 2:30 a.m., after spending hours trying to engage the man, the officers decided to “disengage,” and they withdrew, leaving the man on the beach. A search at daylight found no signs of him.

People with mental illnesses are overrepresented among civilians involved in police shootings: Twenty-five percent or more of people fatally shot by the police have had a mental disorder, according to various analyses.

In Chicago, for example, police officers killed a 19-year-old mentally ill man, Quintonio LeGrier, in December after the police said he had come at them with a baseball bat. In Denver, Paul Castaway, 35, who had a history of mental illness, was fatally shot by the police last year after they said he moved “dangerously close” to them, holding a knife to his own throat. Similar encounters have occurred in Albuquerque, Dallas, Indianapolis and other cities.

In response to public outcry, many police departments have, like Portland, turned to more training for their officers, in many cases adopting some version of a model pioneered in Memphis almost three decades ago and known as crisis intervention team training, or C.I.T.

Studies have found that the training can alter the way officers view people with mental illness. And the approach, which teaches officers ways to defuse potentially violent encounters before force becomes necessary, is useful for officers facing any volatile situation, even if a mental health crisis is not involved, law enforcement experts say.

Whether the training leads to less use of force by officers, however, is still an open question: The findings of studies have been mixed, although one study to be published later this year suggests that Portland’s program, which is based on C.I.T., is having an effect. And training alone is not enough, experts say. For the approach to be effective, it needs the full backing of a police department’s leadership, continual checks on its effectiveness, and collaboration with the mental health community.

“The training is great, but it’s not magic,” said Laura Usher, coordinator of crisis intervention team training for the National Alliance on Mental Illness. “The thing that actually transforms the way the system works is when everyone gets together.”

Debate Signals a Culture Shift

The decision by the Portland police to leave the sword-wielding man on the beach was controversial within the department. Some officers argued that more should have been done: What if the man had injured or killed someone?

Others countered that it was late and that the secluded area was deserted. The man had committed no crime. And a confrontation could easily have ended with him or the officers being harmed.

But the discussion itself, some officers said, was a sign of change.

“Ten years ago, we would have been more proactive in dealing with him at the start,” said Officer Brad Yakots, a specialist in mental health issues who was called to the scene. “It’s a new way of looking at it.”

As in other cities, change in Portland began with a fatal encounter: On Sept. 17, 2006, James Chasse Jr., 42, a singer in a local band who had schizophrenia, died after a confrontation with police officers.

Mr. Chasse’s death outraged the public. The Police Bureau, in response, revised policies and required all its officers to complete 40 hours of crisis intervention training.

But after more troubling instances involving the mentally ill, a Justice Department investigation concluded in 2012 that the Police Bureau had shown “a pattern or practice of unnecessary or unreasonable force during interactions with people who have or are perceived to have mental illness.”

This time, the Police Bureau’s leadership responded far more aggressively. In addition to the mandatory training for the entire force, a group of about 100 patrol officers signed up for 40 extra hours of instruction to handle more complex calls involving mental illness or drug and alcohol addiction.

Teams of officers were paired with mental health clinicians to follow up on cases. New protocols were put in place. And the police connected with housing and mental health organizations to help further.

“It’s really about a culture shift,” said Lt. Tashia Hager, who heads the unit that coordinates the department’s mental health response.

She noted that in cases like that of the man with the sword, “there’s a potential negative outcome regardless of the decision we make.”

‘A Fractured Mental Health System’

Officers need to be educated about mental illness, many criminal justice experts say, because cutbacks in financing for mental health services have put them on the front lines of dealing with many people who have psychiatric disorders.

Jails around the country have filled with mentally ill inmates who, unable to obtain treatment in the community, are arrested time and again for minor offenses like disorderly conduct and petty theft. Police officers have been forced to play dual roles as law enforcers and psychiatric social workers.

“We are working in the backdrop of a fractured mental health system that has gotten worse and worse,” said Portland’s police chief, Lawrence O’Dea III.

Yet many police officers know little about mental disorders, and what they do know is often shaped by stigma. Bizarre behavior is often interpreted as a prelude to violence. And routine police actions aimed at control — placing a hand on a person’s shoulder, for example — can backfire with someone with a severe mental illness.

“Instead of being calming, it can trigger them to either pull away or resist,” said Matthew Epperson, an assistant professor of social work at the University of Chicago. The officers, in turn, can misinterpret such responses as resistance or an attempt to flee, he added.

In the crisis training, officers learn about psychiatric medications, role-play various scenarios, and have opportunities to interact with people who have a mental illness when they are not in crisis.

The officers are told, among other things, to use distance and time to try to defuse potentially violent encounters.

About 2,700 law enforcement agencies around the country use some form of the approach, said Ms. Usher, of the mental illness alliance, and that number is growing as more departments have come under pressure to change police behavior.

In January, responding to a series of high-profile shootings across the country, a group of law-enforcement leaders urged departments to adopt higher standards for the use of force than those set down by the Supreme Court, and to adopt methods to defuse volatile situations and avoid violence.

Some departments require crisis training for all their officers. But Maj. Sam Cochran, who coordinated the first crisis intervention program in Memphis and now consults with other departments, said he believed the training worked best when departments trained a smaller group of volunteers who then took the lead on police calls involving mental health issues.

“There’s all kinds of specialization in law enforcement,” Major Cochran said. “We’ve got bomb technicians, narcotics, robbery. I want all the officers present at a scene to understand that this C.I.T. officer is the leader. That represents clarity, and responsibility brings about a level of accountability.”

Officers Adapt to New Reality

In a draft report released this month, outside monitors concluded that the Police Bureau in Portland still had more to do, including keeping better track of how many police contacts involved mental health issues.

But the bureau, the monitors said, had made “substantial progress” in improving the way they dealt with the mentally ill.

And the study of the Portland police that is to be published later this year found that the use of force by officers had decreased by 65.4 percent from 2008 to 2014, as measured in quarterly reports. The researchers attributed the drop in large part to increased training and oversight in recent years, although the study did not specifically look at interactions with the mentally ill.

Police shootings, the researchers found, had also dropped, averaging three a year from 2007 to 2014, compared with eight a year from 2002 to 2005.

And allegations of excessive force by citizens declined by 74.2 percent from 2004 to 2014, a decrease that Tim Prenzler, an adjunct professor of criminology at Griffith University in Australia and the lead author of the study, called “a remarkable achievement.” The research will appear in Journal of Criminological Research, Policy and Practice.

Officer Yakots, who has been on the force for nine years, said he thought that the department’s efforts to shift course had been largely successful. But he added: “Do things fall through the cracks? Yeah, it’s not perfect. A lot of times we have limited resources.”

It was a Monday night in late February when he and his partner, Officer Michael Hastings, were making the rounds of makeshift homeless camps and downtown street corners, listening for radio calls that might require their presence.

An adolescent girl was on an overpass, threatening to jump. A college student had called his mother in another city and told her he was going to kill himself. A 38-year-old woman was standing outside a mental health treatment center demanding to be taken to the hospital because, she said, “I am suicidal and homicidal.”

Officer Hastings said that before the department changed its approach, the attitude was “enforce, enforce, enforce, arrest, arrest, arrest.”

But taking people to an emergency room or putting them in jail did nothing. “These people, they’re out within four hours most of the time,” he said.

At least in Portland, Officer Hastings said, most police officers had accepted that part of their job was now dealing with mental illness and helping to find longer-term solutions.

“We’ve realized that it is what it is,” he said, “and we’re the ones that are going to be responding to that.”

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Opinion: More options, not more beds

The Register-Guard, April 21, 2016

Oregon State Hospital, Junction City

Oregon State Hospital, Junction City

When a state psychiatric hospital has empty beds, it’s a good sign for Oregon’s health system and for people who struggle with mental illness. While a March 22 Register-Guard story focused on unopened beds at the Oregon State Hospital facility in Junction City, Oregon’s state hospitals are grappling with a growing capacity challenge: a rising tide of people committed for long hospitalizations due to minor criminal offenses, not because a hospital stay is the best treatment option.

In Oregon, we want to provide a comprehensive range of mental health treatment options in the community and, only when necessary, at the state hospital. We know treatment is most effective when people receive the right services at the right time, in the least-restrictive setting and for the appropriate length of time. This approach is the best way to promote public safety, patient-centered recovery and the efficient use of state and county resources.

Before the Junction City campus opened, planners projected it would take several years before all beds would be used.

That’s good for patients, their loved ones and taxpayers. When more people receive treatment in less restrictive, community settings, it keeps them closer to their homes and out of the hospital — the most restrictive and most expensive element of the system. (It costs about $700 per patient, per day, to treat someone at one of the state hospital campuses.)

Until recently, Junction City had been on track to remain on a slow and steady growth path. That’s changing, due to an unforeseen source of commitments.

Increasingly, Oregon State Hospital beds are being filled by a growing number of commitments from the criminal justice system — people who receive a court order to undergo mental health treatment so that they are able to “aid and assist” in their own defense. Junction City is preparing to open a new 25-bed living unit to absorb civilly committed patients from the state hospital’s Salem facility who have been displaced by the influx of patients sent there by a criminal court order.

Many of these patients have been charged with low-level, nonviolent misdemeanor offenses, such as disturbing the peace or disorderly conduct. They are sent to the state hospital because they’re not mentally competent to assist in their own defense.

In these cases, the hospital’s job isn’t focused on promoting long-term recovery, as it is with people who are civilly committed. It is limited to stabilizing and returning that patient to jail so he or she can participate in the court process.

The state hospital can’t address this issue alone. We’re working with local partners — including county commissioners, judges, district attorneys, sheriffs and county mental health programs — to divert more misdemeanor defendants from the state hospital to more appropriate community treatment.

For example, Marion and Washington counties have mobile crisis units that team mental health professionals with law enforcement.

They work to avoid arresting and jailing people who are in mental health crises. With this approach, people get the mental health services they need without being arrested, resulting in fewer admissions to the Oregon State Hospital. It also means that mentally ill people are not taking up space in jail.

For counties, building resources does not happen overnight. Some of the success Marion County has seen is because it has been working on building support services over the past 20 years. Lane County is building its support services, and in addition to two mobile crisis units is working on developing a crisis assistance center.

For any county making steps toward supporting mentally ill people in their community, there has to be the commitment of long-term funding.

The Legislature is doing its part. In 2013 and 2015, lawmakers invested more than $86 million in the community mental health system so that other parts of the state could develop their own programs like those in Marion and Washington counties.

We need collaboration in every county to ensure that people with mental illness get the most effective treatment in the right setting. Today, too many mentally ill people wind up in the criminal justice system and, ultimately, in the state hospital.

The solution isn’t to add more beds. It is to give local public safety officials more options, so the people who are committed to the state hospital are only those who truly need and can benefit from hospitalization.

Greg Roberts is superintendent of the Oregon State Hospital.

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Anna Putnam on road back from bipolar disorder

Portland Tribune, April 14, 2016

Anna Putnam

Anna Putnam

Anna Putnam will always remember the day her mind snapped.

“I remember exactly where I was and when,” Putnam says. “I was watching the Oregon vs. Oregon State Civil War football game on TV in December 2010. Some switch flipped in my brain, and I went into a deeper and deeper tailspin.”

It was the beginning of a long ordeal for Putnam, who was once considered a nanoscientist of immense potential. After she earned her bachelor’s in chemical engineering from Oregon State University, some of the finest graduate schools in the country came calling — including Stanford, where Putnam accepted a full-ride scholarship easily worth half a million dollars.

And then Putnam’s life came to a screeching halt. She was stricken with bipolar disorder, which scrambled her mind and took it to places she says most people cannot even imagine. Her moods swung way too high, then way too low.

The highs could be exhilarating, making her “insanely happy” and even lifting her to higher levels of creativity, but “the highs were the dangerous and main part of my illness,” Putnam says. Her depressions were soul-crushing, but her manias were addictive and even more threatening to her mental health.

Putnam was placed in mental hospitals, where she suffered physical abuse. She had run-ins with the law. She was even homeless for a summer. A life of great potential was on the verge of turning into a tragedy.

“I stood at the mouth of hell,” she says.

But today, the brave young woman is on the comeback trail. She has been able to stay out of hospitals for the past 18 months, and she is regaining her creativity. She is happy, she says, and she has achieved peace.

Part of her road to recovery has gone through Lake Oswego. Putnam now makes greeting cards for On A Whim Studios, where owners Deborah Ulrich and Suzanne Buxton gave her a chance to be an artist and businesswoman.

“Anna was our first artist,” Ulrich says. “I love the way she uses five layers of paper and images that create her own style. Her cards have a unique Oregon feel to them. Suzie and I have been so impressed with Anna’s spirit. She has worked so hard to make her product a success.”

“I like the layeredness of her cards,” says Buxton, herself an accomplished artist. “The images she picks convey what the cards mean. I’m a person who finds it hard to verbalize what I think on a card, but Anna’s cards do that for me.”

Putnam says she loves selling and creating cards and receiving high praise for her work, but she acknowledges that it took a long time to get to this point.

“I never had the stability to focus on making a business with cards until last year,” she says.

Her life’s journey has been full of great suffering, pain and loss, but now things are finally on an even keel.

“I have a deep sense of contentment and I’ve never had that before,” Putnam says. “I’m happier than I’ve ever been.”

Girl interrupted

While she was growing up in Happy Valley, the sky seemed to be the limit for Putnam. From the earliest age, she showed remarkable intelligence.

“Anna was unique to raise. She was brilliant,” says her mother, Lanie Putnam. “It was really exciting raising such a brilliant child. Anna’s teachers were always thanking us.”

However, a few trouble signs started showing up when Anna reached junior high.

“Her brain was going too fast,” Lanie Putnam says. “She would come home and be so anxious if she got a grade less than an A, and she would hide under the bed. My husband Todd and I would go to parent-teacher conferences and the teachers would say, ‘I just want to thank you for raising such an amazing child.’ But at home, she would show her angst to us.”

Still, at this point nothing was slowing Putnam’s rise in the academic world. She was valedictorian of Clackamas High School, where her picture is still on display in the school trophy case. Some of the nation’s best engineering schools, such as Harvey Mudd College in Southern California, offered her scholarships, but she chose to attend the honors college at Oregon State University.

Her future looked astonishing. OSU’s Terra Magazine took note with a profile on Putnam and her work in nanotechnology. Her work on a revolutionary battery — lighter, tougher and more durable, for use by the U.S. military — put her “at the front edge of innovation.” Other students worked under her supervision, and even her professors were amazed by her.

After graduating from OSU, she was once again pursued by the finest schools. She chose Stanford. And then her great mind revolted.

Putnam’s life was turned inside out by her bipolar disorder, and confusion reigned — especially since her disorder was not diagnosed. Eventually, she felt compelled to leave Stanford and return home.

In Oregon, Putnam continued to struggle with the loss of her mental health. She endured mistreatment in mental hospitals, she says, and medications that failed and only made her feel numb. During her manias, her brain would “fire 1,000 times faster” than normal. Her life of extremes was wearing out her brain, spirit and soul.

“I was up and down, up and down, up and down,” Putnam says. “At first you feel like a superhero. You feel a desire to save the world. But eventually you can’t sleep and your logic shuts off. Being able to think so quickly works against you.”

Putnam’s parents were deeply disappointed, stunned and confused.

“We loved her to death,” Lanie Putnam says. But they could not understand why she had given up her scholarship to Stanford or why her behavior had become so drastically different. The Putnams thought Anna was just making the wrong choices.

“She wasn’t sleeping, she would step in front of moving vehicles, she would talk nonstop in her room when there was nobody else there. She was doing things that were endangering her,” Lanie Putman says. “Her brain had gone from so brilliant to struggling. She didn’t mind her manias, because they were exhilarating to her. But they were playing havoc on us. In her right mind, she was a loving, caring, generous girl.”

Putnam was also a very stubborn girl, and in her manic frame of mind she refused to take the medication that had been prescribed for her. The repercussions of her manias got worse and worse, causing a crisis for the Putnam family in the summer of 2014. It was decided that Anna had to leave home, and she chose to live on the streets. In her state of mind, she was fine with the decision, but her parents were heartbroken.

“Your No. 1 goal is for your child to be safe,” Lanie Putnam says. “Allowing her to live on the streets was the hardest thing we’ve ever done. But you can’t lock Anna in a room.”

Lanie Putnam never broke contact with her child. She would bring her “care packages” with blankets, food, money and other supplies. But “in a few days,” she says, “Anna lost everything.”

The most dreadful thing for Todd and Lanie Putnam was the waiting. But they were also hanging onto hope.

“We’d be waiting at the phone for the next phone call,” Lanie Putnam says. “We knew that at some point, she would be in so much pain that she would have to take her medications. That was the most excruciating summer of our lives.”

The road back

Thankfully, that call finally came.

“My parents let me stay on the streets and deal with the pain of that until I decided for myself to get help,” Putnam says. “So after a summer of never sleeping in the same place twice, being constantly robbed and even sexually assaulted, I made the decision to get the help I needed.”

Putnam was accepted into a group home in Oregon City operated by Cascadia Behavioral Healthcare, where the staff worked with her to find the proper formula of medication that helped control her dopamine levels but still let her feel her emotions.

It was there, Putnam says, that she finally realized she was not going through a spiritual transformation and had actually been stricken by a serious mental disorder.

“It takes more than medication to find complete mental peace,” she says. “I spent years working on my inner thought life to obtain the quiet brain I have now. And I have to always work on it to maintain it.”

Mostly, Putnam says, she’s proud of herself for surviving.

“What is so valuable to me is that my suffering showed me how strong I am,” she says. “I now know how well I can handle intense hardship and pain.”

From so much pain has come understanding, she says.

“As soon as my parents heard I had a bipolar disorder, they forgave me everything,” Putnam says “They saw there was a reason for the choices I made, and they were fully there for me the entire struggle. They had to show some tough love to get me to choose to take the medication.”

Lanie Putnam says her daughter’s recovery is a miracle.

“She hasn’t been in a hospital for 18 months and we couldn’t be more thrilled,” she says. “We can tell the difference between true happiness and a mania. Anna hasn’t lost her great mind. The medications have not stifled her ability to think. I’m so encouraged, because this girl carries a lot of love inside her. She does so well at writing and public speaking. I think eventually she could be a mental health advocate.”

Putnam has come out of her ordeal a better, and certainly happier, person. Her perspective on life has undergone a dramatic change.

“I have no desire to make a lot of money like I used to,” Putnam says. “I’m productive now, and I’ve always liked being productive. I wouldn’t want to change a thing about my life. I wouldn’t want to go through it again, but I wouldn’t change it.

“As weird as it sounds, I honestly don’t think there are as many people as happy as I am.”

Putnam is now on the way to reclaiming the exciting promise her life once showed, and she has a great desire to tell people how she got out of such a deep, dark place. She wants to give them hope, and to change the way people think about mental illness.

“Society calls it ‘mental illness,’” Putnam says. “But I see it as an extraordinary challenge that carries with it extraordinary possibilities.”

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Appeal by Matthew Klug Delayed by Police No-Show

Press Release – immediate April 20, 2016
Mental Health Association of Portland

CRC Votes To Compel Testimony

Matthew Klug waited a year for justice – and will wait at least another month.

Both officers and commanders of the Portland Police Bureau – as directed by Commander Donna Henderson – failed to show up at the regularly scheduled meeting of the Citizen’s Review Committee, Portland’s appointed police oversight.

Matthew Klug was in attendance, as were a handful of peaceful neighbors and friends, and about twenty city employees. But no police.

You can learn about Matthew Klug’s case and read all associated documents, including witness video evidence of Klug being Tasered by Portland Police Bureau Members here – and here – Matthew Klug

UPDATED READ – After a No-Show, Police Watchdogs Are Forcing Cops to Appear – But That Doesn’t Mean They Have to Like It, The Portland Mercury, April 27, 2016

UPDATED READ – Police Don’t Show Up For Oversight Meeting; Frustrated Committee Votes To Legally Force Them To Show Up Next Time, The Portland Mercury, April 21, 2016

READ – Stunned: Matthew Klug and the ‘pattern and practice’ of police force – One man’s complaint against Portland police illustrates multiple system pitfalls, Street Roots, December 17, 2015

At the meeting March 30, 2016, a member of the committee was doused with water by a member of the public. In response, tonight’s meeting started with the reading of a set of new rules to enhance safety and mutual respect. City Auditor Mary Hull Caballero, the only elected official to attend, apologized to the Citizen’s Review Committee members for the stress and any perceived lack of security in the prior meeting.

Citizen’s Review Committee Chair Kristin Malone read a letter from Donna Henderson saying the Citizen’s Review Committee meetings were “corrosive and intimidating” and the Portland Police Bureau would no longer attend.

READ – Police chief, police union urge officers not to attend citizen review panel hearings, Oregonian April 2015

The Portland Police Bureau has a long history of refusing civilian oversight. Though the Bureau and politicians tout “community policing” and through the settlement of Department of Justice v. City of Portland exclaim better community relations, tonight’s failure-to-show undermined that effort. In their Findings Report on Portland’s police, the Department of Justice found our police have a pattern and practice of harming people with mental illness – including excessive use of Tasers.

Matthew Klug is a person in recovery from mental illness.

Audience members tonight were in agreement. The Portland Police Bureau was disrespectful of Matthew Klug and disrespectful of the members of the Citizen’s Review Committee.

Portland Police Bureau Chief Larry O’Dea and Police Commissioner Charlie Hales had a month to work out a plan with the members of the Citizen’s Review Committee so police officers, who typically attend meeting in uniform and armed, would feel safe. They failed to act.

Members of the Citizen’s Review Committee, advised on the law by a city attorney with the Independent Police Review, unanimously voted to compel the Portland Police Bureau to send officers and commanders to their next meeting, to be held May 4, to hear Matthew Klug’s case. This action is unprecedented in the history of the Citizen’s Review Committee.


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Portland Punk Posters circa 1978-1983

These posters accumulated in the Mental Health Association of Portland’s giant warehouse as we created the award-winning documentary, Alien Boy: The Life and Death of James Chasse.

Chasse, a fan and musician in Portland’s early punk scene was brutally killed by three law enforcement officers in 2006. The State, City and County failed to hold any of them accountable for criminal or administrative crimes.

You can download the posters below individually or get the entire set of 45 posters (about 280 MB) by clicking here.






















































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Medical leaders at Unity Center announced

Gregory A. Miller, M.D., MBA

Gregory A. Miller, M.D., MBA

The Department of Psychiatry at Oregon Health Sciences University is pleased to announce that Gregory A. Miller, MD, MBA has agreed to join our faculty and be the first Chief Medical Officer for the Unity Center for Behavioral Health.

Dr. Miller joins us from the State of New York, where he serves as Medical Director for Adult Services. Before that, he was the Chief Medical Officer for Providence Behavioral Health Hospital in Holyoke, Massachusetts. Dr. Miller has served at the North General Hospital in New York City, first, as the Residency Program Director, then as Chair of Psychiatry and finally as the Medical Director and Chief Medical Officer of that hospital.

Dr. Greg Miller has a nursing degree from the University of Tennessee, an MD from The George Washington University School of Medicine, and an MBA degree from Baruch College, Zicklin School of Business, CUNY. He did his residency training at Vanderbilt University Medical Center in Nashville, Tennessee.

Dr. Miller will be joining our faculty in June 2016 and will help plan for the opening of Unity Hospital, and will welcome new faculty as they arrive in Portland. Please join me in welcoming Dr. Miller to OHSU!

Kathryn Flegel, M.D.

Kathryn Flegel, M.D.

Kathryn Flegel, M.D. has accepted the position of Child and Adolescent Psychiatry Medical Director at Unity Center for Behavioral Health. Dr. Flegel will start in June 2016 at Randall Children’s Hospital preparing the Legacy pediatric psychiatry ward in its transition to Unity and report to Dr. Greg Miller, chief medical officer.

Dr. Flegel began her medical career at Good Samaritan Hospital in Internal Medicine. She practiced as an Internist for 13 years before deciding to enter residency training in Psychiatry at OHSU, finishing her Child Psychiatry Fellowship in 2002. She is a Diplomate of the American Board of Psychiatry and Neurology with a Child and Adolescent Psychiatry Subspecialty.

Dr. Flegel is a member of the Oregon Medical Association, the American Psychiatric Association, the Oregon Psychiatric Association and the Oregon Council of Child and Adolescent Psychiatry, where she was the CME Program Chair from 2011 through 2015 and President of that organization in 2015. She practices at OHSU and Providence Health Systems, and is pleased to be joining the team at Legacy Randall Children’s Hospital.

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Junction City institution remains costly and half occupied step backwards

The Lund Report, April 13, 2016

Oregon State Hospital, Junction City

Oregon State Hospital, Junction City

The view from behind the gray concrete walls of the Oregon State Hospital in Junction City looks out upon the yellow-green bucolic plain of the Willamette Valley to dark green foothills on both sides of Lane County.

The view inside the immaculate hospital is of a fresh, bunkered community college, still new-smelling from its opening a year ago. The warm, inviting library is filled with thousands of donated books; the fitness room has new equipment, and the recreation room has new air hockey, ping pong and foosball tables, no knob yet broken.

Patients line up single-file in the hospital corridors as staff leads them from lunch to the afternoon’s treatment mall activities, each designed to speed their progress toward the green plains and hills outside. “We believe that everyone is going to get to the point of recovery,” said Shaunia Scales of the Oregon Health Authority, a “lean leader” at the hospital.

That means coursework in anger management, substance abuse treatment or art therapy, as well as creating positive interactions with the other patients. It’s a far cry from the bad old days when patients might be routinely kept in restraints or isolated in padded rooms. Those options still exist but happen rarely, and only for those in the more intensive units at Junction City. “We consider any use of restraint or seclusion as a failure,” said Scales.

As they improve, patients get increased opportunities to visit the outside world, first to a nearby nature park, then into Junction City, as well as the Coast or Eugene before they are finally ready to leave.

The Junction City hospital sees two types of patients — people who are civilly committed because their mental state poses a threat to themselves or others, and criminal offenders who are guilty except for insanity. A third, steadily growing group of patients at the Oregon State Hospital — people who are charged with crimes but cannot stand trial because of mental instability — are only treated at the big hospital in Salem, which has about 600 beds to Junction City’s 150.

Junction City today is only half full, although an empty wing will open next month to treat an additional 25 civilly committed patients.

Hospital Was Controversial

The view of the hospital from policymakers and advocates is more mixed — almost every mental health advocate, as well as the legislators who most frequently hammer out mental health policy — opposed its construction.

“It goes back to a master plan that was designed to increase the capacity. I’ve been opposed to it,” said Sen. Alan Bates, D-Medford. “Other states are closing their institutions. We’re the only ones opening new ones.”

“This is a step backwards,” said former Rep. Carolyn Tomei, D-Milwaukie, who chaired the House Human Services Committee for almost a decade. “They’re investing in the old system. We need to deinstitutionalize people, not create another institution.”

The federal government through the U.S. Justice Department has investigated the state’s lackluster mental health system and forced it into a multi-year plan to clean up its act, with a focus on treating people in the least restrictive environment. Odds are the department will issue their final opinion before President Obama leaves office, and it’s unclear whether they’ll give Oregon an OK.

The Justice Department did not intervene in the construction of the new hospitals, but federal policy opposes big institutions as the delivery model for mental health services and Oregon cannot get any federal dollars to support the care of institutionalized patients, even as federal Medicaid dollars pick up the vast majority of healthcare costs they might receive in an outpatient or community hospital setting.

“The cost of running it will be huge,” said Bates, who oversees the budget for the state hospitals and put the price tag at $300,000 per patient, per year, all from state dollars. The hospital cost $80 million to build and costs $38 million a year to operate.

Bates instead wanted the state to build a bunch of 16-bed facilities around the state to cater to psychiatric patient’s needs in their communities. The state could have counted on federal Medicaid dollars to pay for most of that care. A pilot of that model is opening in Pendleton, site of the former Blue Mountain/Eastern Oregon State Hospital.

But Tomei said legislative leadership, including former House Majority Leader Val Hoyle, D-Eugene, whose district includes the hospital, and Senate President Peter Courtney, D-Salem (whose district includes the other state hospital) were determined to build the hospital:

“Once he [Courtney] makes up his mind, he’s adamant. He wanted a second hospital, and by damned, that’s what he got, even though there was nobody in the mental health profession who wanted it,” she said, including an advisory group specifically set up to address the costs and benefits of two new hospitals.

Advocates also objected to the downstate location of the hospital and the closure of the old state hospital in Portland. But 31 percent of the patients at the Junction City facility are from Lane County, and another 33 percent are from southern Oregon. Only 15 percent come from the Portland metro area.

Oregon State Hospital spokeswoman Susan Stigers said only 40 percent of the patients at the old Portland hospital were from the Portland metro area, and those patients were transferred primarily to the hospital in Salem. That’s outside the metro area by most definitions, but at 47 miles from downtown Portland, it’s about the same distance as the Western Washington State Hospital from Seattle.

Democratic Leaders Stood Firm

Courtney ignored requests from The Lund Report for comment through his spokesmen, Robin Maxey and Rick Osborn.

But in 2008, he told the Statesman-Journal: ‘‘We have set a course for how we are going to deal with the mental health crisis in this state, and we have set it in terms of two institutions.”

The master plan had initially come about because of a different set of lawsuits against the state, focused on the abysmal condition and substandard treatment methods at the old Oregon State Hospital in Salem.

To stick to his original plan, while pivoting toward the community mental health that the feds, advocates and legislators like Bates and Tomei demanded, Courtney, along with then-Gov. John Kitzhaber, invested many more millions in community mental health, using both a dedicated cigarette tax source that Courtney commandeered from Republicans, and a marked new investment from the general fund.

In a press release after the money for the hospital was approved by the 2013 Legislature, Hoyle seconded Courtney’s message for both the hospital and more community investments: “[I] helped secure the $80 million required to build the project. The Junction City Hospital is now under construction, bringing a huge influx of jobs to the area and paving the way for a high-quality acute care psychiatric facility.

“The Legislature also increased funding for community mental health care by 40 percent and is coordinating with local jurisdictions to deliver community-based care when and where people need it.”

Those investments have continued under Gov. Kate Brown, but given their reliance on funding from volatile individual income taxes, the community mental health system will be vulnerable in the inevitable next economic downturn, and much easier for future state budget writers to scale back than big hospital operations.

Change on the Ground

Bates said state community mental health services needs to be cut from the counties and handed to the coordinated care organizations, which already have the main stream of Medicaid dollars to fund the system thanks to the Affordable Care Act. State dollars could supplement that money, particularly for stable housing, which the feds are more reluctant to pay for.

As a physician, despite the talk of a sea change in community mental health, Bates isn’t seeing anything changing on the ground, at least for people at the outset of a psychotic break. He knew of a patient in need of psychiatric care at one of the Medford hospitals who’d been boarded in the emergency room for two months without treatment.

But, Chris Bouneff, the director of the National Alliance of Mental Illness — Oregon, though long a critic of the Junction City hospital, does think the community mental health investments will move the dial.

“You do have to credit someone like Peter Courtney. His commitment was to continue his investment in the community,” Bouneff said. “All signs point to continuing those investments in 2017. Those are the investments that are gonna make a difference. The improvement from those investments, you can’t have a ribbon-cutting for, you can’t run a one-year anniversary story.”

For the view back at the Junction City Hospital, interim administrator Kerry Kelly concedes that the state hospital system is not the ideal place to put individuals, but notes the backlog of people needing intense, acute care. When the new wing opens in May, it will relieve pressure on patients around the state who, like the patient Bates mentioned, are cooped up in local hospitals, often simply in emergency rooms, and need the extra care.

“An institution is an artificial place. People are not meant to live in institutions,” said Kelly. “In a perfect world, we wouldn’t exist.”

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