By Robert Landauer – editorial columnist for The Oregonian, April 21, 1996. Not available elsewhere online.

Imagine Oregon’s seriously mentally ill patients leaving psychiatric hospitals. Picture them skiing down the slope of that graph over there. See them gliding into community programs with supervised housing, calming drugs and counseling.

As background music, play “America the Beautiful”: Thine alabaster cities gleam, Undimmed by human tears! End of daydream.

That ski slope is a cliff. At its base is wreckage, not snow angels. Tears, not smiles.

Severely mentally ill Oregonians are crashing into a system of walls with few gates.

Oregon closed Dammasch State Hospital, the regional psychiatric center in Wilsonville, on July 26, 1994. Resources were supposed to follow patients to their communities. Witnesses describe effects of cutbacks and the closure:

Acute-care beds (about 190 in Multnomah County) and support services are too scarce.

Dr. J. David Kinzie, director of psychiatric clinical services at Oregon Health Sciences University, struggles with the problem daily: “We are discharging patients that most modern industrial countries would not discharge into the community. Then we support the patients less well than other countries do with housing, money to live on and medical help. It’s awful.”

As hospital beds disappear for the mentally ill, jail beds take their place.

“It is estimated that 7.6 percent of all persons in jail are mentally ill,” Richard Sherman reported in a 1994 survey of counties for the state’s mental -health division.

On an average day, 130 mentally ill persons are in Multnomah County Jail. That is about half the state total, says Jack Wolinski, director of the Alliance for the Mentally Ill of Multnomah County.

Jail beds substitute poorly for farsighted care of the mentally ill.

Mike McCracken bangs the point home with four hard jabs: “This population doesn’t do well in jail. They don’t normally follow the rules. They don’t understand or comply with incentive systems. As a result, they stay in jail much longer than healthy inmates.”

McCracken is executive director of the Association of Community Mental Health Programs — 32 county-based operations that run publicly funded comprehensive mental -health services for 50,000-plus Oregonians.

Police and sheriff’s deputies are diverted to tend the mentally ill.

Some deputy sheriffs are doing social work as opposed to penal work with the mentally ill, says Cmdr. Vera Pool, the sheriff’s Jail Support Division boss in Multnomah County. The goal is to find them housing, so they can be released. “These people should be treated, not jailed. We feel obligated to go beyond our job descriptions to give them the services they need.”

Lt. C.W. Jensen, the Portland Police Bureau’s spokesman, adds, “The last people who should be penalized for government’s decisions are the people in crisis.”

The bureau has created a Crisis Intervention Team — volunteer officers trained to keep those in mental flux from endangering themselves, the public or police. The officers often are pulled from other duties, routinely get “no-room-at-the-inn” rejections at hospital emergency rooms; and drive sick people around for hours in the hope that they can safely be put back on the street.

The system will get worse before it gets better.

Many day-treatment programs are closing or are reducing services, says Carol Laine, of Gresham, an eight-year, full-time-volunteer advocate for families of persons with serious mental illness. “So we are seeing people who are sicker, who have more needs, and simply not enough dollars to meet their requirements.”

Add this to the gloom: Starting next January, the state will send many hundreds of its criminal prisoners back to the counties. Local jails will get more mentally ill inmates — most of them untreated.

Lack of capacity will drive the relentless triage harder, pushing our mentally ill from hospitals to streets, from streets to jails and from jails to . . .

That’s not enlightened. It’s insane.

By Robert Landauer – editorial columnist for The Oregonian, April 18, 1996. Not available elsewhere online.

“Police shootings in August 1994 of two mentally disturbed women in less than a week shocked and appalled Portland and Gresham.”

“The cream of the crop.”

The phrase is common, but both the source and the subject are surprising.

The praise comes from Margaret Taylor. She is executive director of the Salem-based Oregon Alliance for the Mentally Ill. She is talking about Portland-area police, mostly in the Portland Police Bureau.

The change of perception is startling. Police shootings in August 1994 of two mentally disturbed women in less than a week shocked and appalled Portland and Gresham.

But the tragedies should not have surprised them.

Oregon has been downsizing its mental -health-care institutions and underfunding community-based alternatives for years. It had just closed its regional psychiatric hospital in Wilsonville, Dammasch State Hospital.

“The last resort” is what doctors, judges, police and advocates for the mentally ill called Dammasch. The pun was marginally cruel, bitterly ironic — and chillingly apt.

“We would see them in the sobering station, and they had just gotten off the bus with prescriptions from Dammasch,” recalled Ed Blackburn, director of Central City Concern’s Hooper Detoxification Center in Northeast Portland.

Calls for police intervention mounted as the population of the seriously mentally ill on the streets rose.

The killings of the two women were a peak, a summit. But not a triumph.

Gendarmes feared they were becoming forced draftees for police-assisted suicides. Most disliked being cast as head-thumping, guns-and-guts, “Robocop” stereotypes.

Portland police responded creatively. Sgt. Karl McDade and Carol Sweet of the bureau researched and helped develop a Crisis Intervention Team. It was operational and plugged into the 9-1-1 emergency system a year after the two deaths.

The idea is to get 90 to 100 officers — three to four every day on every shift in each precinct — who have been trained to identify the mentally disturbed and deal safely and sensitively with them.

The bureau is two-thirds of the way toward its goal, says Capt. David Butzer, who leads the Family Services Division. He makes another point worth appreciating:

“These are all volunteers, no extra pay, and we’ve asked far too few people (to handle) the needs, demands and great stresses.”

The effort is noticed:

Jack Wolinski, director of the Alliance for the Mentally Ill of Multnomah County: “During the training period, consumers talked to these police officers and were telling them what was going on in their minds during the psychotic episodes. The police discovered that the mentally ill person was very frightened and confused. Even if there was a weapon, it was for self-protection, not to inflict harm. . . . The dialogue taught them to be patient, and the crisis could be resolved in a peaceful manner.”

Howard Klink, deputy director of Multnomah County’s Department of Community and Family Services: “I would absolutely support the idea that there is a sea change in both law enforcement people’s understanding and their concern for mentally ill people on the street.”

Police understand “the inappropriateness and inhumaneness of putting these people in jails.”

Mike McCracken, executive director, Association of Community Mental Health Programs, also sees changes occurring: “Police are taking a leadership role in advocating for better services in jails, better diversion processes and community networks of services. Police and sheriffs are not Bubbas. They do not want the mentally ill to have to suffer in an inappropriate setting.”

Beyond our own shortcomings — but close to our vulnerabilities — is where compassion and pragmatism meet.