From the Medford Mail Tribune, January 30, 2011

John Thiry - December 11, 2011

As the Ashland homeless man acquitted in the Oak Knoll fire case was about to be released from jail Dec. 10, his defense attorney was asked: What do you think will happen to John Thiry?

“He’ll probably be back in jail within a week,” public defender Andy Vandergaw said.

READ – Everything about Oak Knolls fire, from the Ashland Tidings

It took a little longer than he predicted — about six weeks — but he was right. On Jan. 22, Ashland police arrested Thiry after witnesses said he threw a 3-foot orange traffic pin off the Ashland Street bridge and onto Interstate 5, then allegedly began screaming at people in the Rite Aid parking lot to give him money.

A grand jury on Tuesday indicted Thiry on a felony charge of throwing an object off an overpass and misdemeanor charges of disorderly conduct and recklessly endangering another person.

“He’s definitely one of the people who have fallen through the cracks in our system, and he’s going to keep falling unless he gets the help he needs,” said Vandergaw, who no longer represents Thiry. “There are gobs of people I represent — half a dozen right now — who have serious mental health problems that have never been addressed, so they’re in and out of prison and they’ll continue to be.”

Thiry, who turned 41 on Friday, is believed to be mentally ill, according to Vandergaw and community members who say they frequently witness him behaving erratically in south Ashland, not far from a field where investigators believe he started the city’s worst residential fire in at least a century on Aug. 24.

A Jackson County Circuit Court judge said Thiry likely did start the fire that burned 11 homes, but prosecutors didn’t prove he was aware of the dangers of his actions, a condition that needed to be met for a conviction of reckless endangerment. Immediately after the fire, as Thiry was being interviewed by police officers, he flicked a lit cigarette into dry grass, according to court testimony.

After being released from his 107-day incarceration, he took the $30 the court gave him and said he was going to buy himself a beer.

“He didn’t recognize how unsatisfactory it was for him to say that,” Vandergaw said. “He doesn’t recognize that getting beer puts him right back in the same position he was in when he was intoxicated before the fire.”

The rail-thin man appeared on Ashland’s streets later that day, walking along his old routes, listening to music on yellow headphones and acting strangely, witnesses said.
He began once again mumbling to himself, screaming at passersby and aggressively panhandling, said Kevin Willis, a cashier at the Arco station adjacent to where the fire started. Thiry also was seen frequently drinking out of large beer cans, which appeared to make his mental illness worse, Willis said.

“Mr. Thiry will tell you himself he drinks a minimum of four beers a day, and they’re the tall, big ones,” Vandergaw said.

So why was a man whom community members — police, fire victims, his defense attorney — believe has a significant mental illness and is prone to acting recklessly allowed to roam the streets of Ashland again?

What is to prevent him from flicking a cigarette in the same bone-dry field this summer? After Judge Lorenzo Mejia said Thiry didn’t know what he was doing was reckless, why wasn’t anyone trying to help him realize it was?

These are questions the Oak Knoll fire victims and many community members are asking, especially in light of last weekend’s incident, which didn’t cause a freeway crash but could have, police said.

“The case of John Thiry is actually kind of a sad commentary on the mental health system,” said Ashland Police Chief Terry Holderness. “Jail is not the best place for the mentally ill, but sometimes the only way to get them into a facility is through that process.”

THE MENTAL HEALTH SYSTEM

Ashland police officers frequently saw Thiry walking the streets and acting strangely, but department officials didn’t believe — and still don’t believe — he meets the state criteria for being placed in an involuntary mental health hold, Holderness said.

“I would expect if we took him to county mental health, he’d be released very shortly thereafter, in which case, that’d be kind of a waste of our time,” he said.
Police can take people they believe are mentally unstable into custody, but they must immediately be assessed by a doctor and psychiatric nurse to see whether they meet the state criteria for a hold.

People who are suicidal, homicidal or completely unaware of their actions while they are being assessed can be placed in a hold, said Martha Hutchison, program manager for access crisis services, the county’s mental health triage unit.

“It has to be an imminent risk issue, not like it could be a risk or it might be a risk a week from now or a month from now — it’s a risk in that moment,” she said.

“That can be hard for community members, because they’re seeing something starting to build or someone starting to decline, and they find it frustrating because, legally, we can’t do anything until it’s reached this critical point.”

On Halloween in 2008, Ashland police took a man who was slicing his face open with a razor blade in the Plaza to the county mental health ward, Holderness said. Hours later, the man was released, because he was no longer determined to be an imminent risk to himself, the police chief said.

“Basically, they said, ‘Well, he can’t kill himself by slicing his face with a razor blade,’ ” Holderness said. “The mental health system is majorly underfunded — there’s not enough beds, so they’re only going to keep the worst of the worst.”

David Eisenhaure, the lead pre-commitment investigator for Jackson County Mental Health, said he vaguely remembered the case Holderness mentioned but couldn’t comment on details. Hutchison said patients are sometimes released quickly, if the doctor has determined they are no longer a threat to themselves, perhaps because they have calmed down or are no longer intoxicated.

The county’s mental health ward at Rogue Valley Medical Center has 18 beds and is frequently full, meaning new arrivals have to be transferred to other hospitals in the state, often as far away as Eugene or Portland, Eisenhaure said.

“We’ve been at 95 percent or at 100 percent capacity about 80 percent of the time since at least the first of the year,” he said. “It seems like if we’re able to get some discharges, that night the beds fill back up again.”

If a doctor does sign off on a hold for an adult in the county, the case is evaluated within five judicial days by Eisenhaure or the other pre-commitment investigator for the county mental health department. The investigators are responsible for determining whether they should ask a judge to rule on an extended hold, for up to 180 days.
People on extended holds can be transferred to a state mental hospital or other specialized facilities, or can be released early if they agree to continue therapy, Eisenhaure said.

If people don’t meet the criteria for a hold and don’t have insurance, there are few mental health resources available to them, said Eisenhaure, who has held his position for the last 20 years.

“We try to do the best we can and serve the most people we can with the resources we have, but we have to kind of pick and choose, and look at the acuteness of the illness and the severity,” he said.

“We don’t have the funding, the indigent funding, to see a lot of people the community sees roaming the streets, panhandling or obviously not taking care of themselves, maybe mumbling to themselves — people seen in Ashland and Medford quite frequently. There isn’t the funding for them, and that’s unfortunate.”

THE CRIMINAL JUSTICE SYSTEM

Sometimes it seems the only avenue to mental health treatment for some people is to go to jail first, Holderness said.

“The best thing we can do sometimes is get them into the criminal justice system because the court has more leeway to order someone into receiving treatment,” he said.

“I certainly wouldn’t have a problem with the concept of a judge ordering Thiry to do time in a mental health facility, instead of in jail.”

But oftentimes, even in the criminal justice system, as in Thiry’s case, the mentally ill don’t receive treatment, Vandergaw said.

“The system is not designed to provide people help,” he said.

A social worker at the jail can refer inmates to Jackson County Mental Health workers, who will assess their cases to see whether they meet the qualifications for a hold. The social worker at the Jackson County Jail never referred Thiry’s case to mental health workers during his previous incarceration, likely because he didn’t believe Thiry was an imminent danger to himself or others, Eisenhaure said.

The District Attorney’s Office and defense attorneys can also decide to argue that defendants are unable to determine right from wrong or are unable to control their behavior. Lawyers essentially must prove the defendant is insane, Vandergaw said. Oregon, unlike many other states, has no diminished-capacity defense, he said.
Like many mentally ill people, Thiry appears to have good and bad days — and is not always “out of it,” Vandergaw said.

“Sure, he’s mentally ill, but the question is, at the time he’s before a judge will a psychiatrist testify that he’s a danger to himself or others?” he said. “He has days where he’s almost normal and days when he’s just not there at all.

“When I represented him, it was my opinion that he didn’t meet the criteria of insanity, but that doesn’t mean he wouldn’t now.”

Jackson County Mental Health workers and police declined to comment on whether Thiry has been diagnosed with a mental illness. Vandergaw said he doesn’t know whether Thiry has ever been diagnosed, but that he exhibits some behaviors Vandergaw has observed in those with schizophrenia and bipolar disorder.

“He does need help, but he’s not going to ask for it — that’s how mentally ill he is, he doesn’t realize and won’t accept the fact that he needs help,” Vandergaw said.

Vandergaw and other mental health advocates have been trying for several years to get Jackson County Circuit Court to establish a Mental Health Court, similar to the existing Drug Court. Mentally ill defendants could be given an option to pursue therapy and treatment in return for a lesser jail sentence, said Patricia Garoutte, who helped establish Josephine County’s Mental Health Court.

“When somebody is picked up with mental health issues, they’re put in jail, which is the worst place for someone with mental illness to go,” said Garoutte, president of the Southern Oregon chapter of the National Alliance on Mental Illness. “Working with a mental health court, they can get help, they can get diagnosed, they can get medication.”

In December, the alliance met with the county district attorney, supervisors and judges to ask again for a Mental Health Court, she said.

“We got snubbed, again,” Garoutte said. “Again the thing that came up was a lack of funds. But we started this in Josephine County with very, very limited funds and we will keep fighting for it here.”

County officials believe there is simply not enough money for a Mental Health Court and related counseling services, said Jackson County Circuit Court Judge Patricia Crain, who thinks the county should use its limited resources to address the most common crimes, such as drunken driving and domestic violence.

“We have limited resources and this is a time of cutbacks, and we want to make sure we keep going with what we have at this point,” she said.

THIRY’S CASE

Meanwhile, John Thiry sits in Jackson County Jail, where his bail is set at $10,000. He faces one count each of first-degree throwing an object off an overpass, a Class C felony; second-degree disorderly conduct, a Class B misdemeanor; and recklessly endangering another person, a Class A misdemeanor, said Jackson County Deputy District Attorney Laura Abraham.

He is scheduled to appear in court again Wednesday and is waiting to be appointed an attorney, she said.

Abraham said Thiry may be mentally ill, but she believes he was aware of his actions during the bridge incident.

“I wouldn’t have charged him if I didn’t believe he knew what he was doing,” she said.

Thiry has a right to a trial within 60 days of his arrest and it’s unlikely he will be released from jail before then, because he lacks a permanent address and has a criminal record, Abraham said. Court records indicate Thiry has a history of felony burglary, menacing and trespassing convictions.

“I wouldn’t anticipate that he’ll be let out, but you never know, depending on crowding,” she said.

The maximum sentence Thiry could receive if convicted for the felony count of throwing an object off an overpass is 10 days in jail, because it falls in the lowest felony category, Abraham said. It’s possible he could receive more jail time if convicted of the misdemeanor charges, but Abraham has not determined whether she will pursue that, she said.

“I really couldn’t say at this time,” she said. “A lot depends on talking with the victims and what they say.”

While in jail, Thiry has access to medical treatment. But mental health and substance abuse therapy aren’t available to inmates awaiting trial, Vandergaw said.
Thiry came to Ashland about 13 years ago, after a divorce in Northern California, Vandergaw said.

He has lived on the streets for many years and Ashland residents say they’ve watched his behavior slowly become more bizarre. Vandergaw said he doesn’t know whether Thiry has family in Southern Oregon or Northern California, but he has spent most of his life in those regions.

In south Ashland, many residents said they’re relieved to know Thiry is back in jail.

“I know a lot of people feel at lot safer, knowing he’s in jail,” said longtime Ashland resident Erica Martin. “He’s been doing strange things ever since he got back from jail the first time. He needs help. He needs to go to a mental place.”

Eventually, Thiry is likely to be released from jail. As Oak Knoll residents rebuild their homes, they remain concerned there could be a repeat of last summer’s fire, said Dan Thomas, one of the victims.’

“Don’t let him out because he’s gonna hurt somebody someday,” Thomas said. “He’s getting a little more out of control.”

No one knows what will happen to John Thiry. But one thing is clear: What happens to Thiry could affect what happens to the community at large.

“I’m not a mental health specialist,” Thomas said, “but it doesn’t take a rocket scientist to figure out that the guy needs some help. There’s some crazy, haywire thing going on in his brain and you don’t know what he’s going to do.”

This view of 897-805 Oak Knoll Drive (from left) was assembled from photos shot the morning of Aug. 25, 2010.

All stories from the Medford Mail Tribune
Homeless man faces charges for starting fire, August 26, 2010 (PDF)
Questions remain about how Oak Knoll fire spread, August 26, 2010 (PDF)
Music of the Heart, August 28, 2010 (PDF)
A field of junk after the fire, August 31, 2010 (PDF)
Point of origin hard to trace – Investigators attempt to pin down exact spot and cause of Oak Knoll fire, September 1, 2010 (PDF version)
Costs of fighting Ashland blaze continue to mount, September 1, 2010 (PDF)
Oak Knoll fire suspect’s trial suspended, October 14, 2010 (PDF)
Thiry trial set to begin Thursday, October 13, 2010 (PDF)
Oak Knoll testimony recounts fire, December 8, 2010 (PDF)
Oak Knoll defendant offered hazy account of fire, December 10, 2010 (PDF)
Oak Knoll fire defendant found not guilty, December 11, 2010 (PDF)
Through the cracks, February 2, 2011 (PDF)
Man pleads not guilty to tossing object off an I-5 overpass, February 3, 2011 (PDF)
Thiry back in jail, March 17, 2011 (PDF)

Since September of 2006 the Mental Health Association of Portland has brought the community’s attention to the death and life of James Chasse.

This long effort is culminating in the production of a much-anticipated documentary film, Alien Boy: the Death and Life of James Chasse.

The film is beginning post-production NOW and is expected to be ready for festival release in the late Spring.

You can show your support and help get this film made by making a contribution through Kickstarter. Click through to see the film’s teaser – and a short interview with the film’s director Brian Lindstrom.

Over 40 people have made pledges in just the past 2 days – getting us over 20% of the way to our goal.

Many thanks to Eve Celsi, Steve Hohenboken, Morgan Miller, Amy K Schoppert, MK Bretsch, Katie Burnett, Harold Metzger, Cherie Blackfeather, Carrie Padian, Marie Lee, Terry Perrel, Anya Lewin, Julie Greicius, Sari Botton, Moss Drake, Elissa Wald, Lawrence Johnson, Andy Brown, George Johnson, Enie Vaisburd, Rosalee Rester, Ellen Vincent, Greg Netzer, Jane O’Keeffe, Crystal Shade, Greg Spies, Morgan Grether, Linda Austin, Chris O’Connor, Gena Hayes O’Flaherty, Nora McNamara, Karen Uhlmann, Lidia Yuknavitch, Nick Bruno, Richard Blakeslee, Anne Stark, Randall Payton, Amanda, Keri Miller, mmmwww, Wanda Boe, Frayn Masters, Kris Swanson, Laura Moulton, Misti Clinton Boone, and Kristine Laguzza.

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Elizabeth Lynn Dunham, May 12, 1961 ~ January 16, 2011

Known for her quick wit and fierce intelligence, she was a generous friend who loved her family, horses and dogs, cooking, and garage sales. In recent years, she was a volunteer with OPB and Forward Stride.

She is survived by her parents, Arlyss and Pamela Dunham; her brother, Mark Dunham of Lake Oswego, her beloved nieces and nephew, Emily, Katherine and Christian Dunham, as well as dear aunties and uncles and more than two dozen wonderful cousins.

A Mass of Christian Burial will be celebrated January 29th at a gathering for family and friends.

Charitable donations in Elizabeth’s memory may be made to National Alliance on Mental Illness, 524 NE 52nd Avenue, Portland OR 97213 or Legacy Hopewell House, 6171 SW Capitol Highway, Portland OR 97239.

Leave a message of condolence for Elizabeth’s friends and family.

From the Salem Statesman Journal, January 22, 2011

Kaufman Global is not a household name in Oregon.

But the Indiana-based consulting firm is well known to leaders of the state Department of Human Services.

Since 2007, DHS has awarded Kaufman Global three contracts for consulting services, and the firm has played an influential role in reshaping the state’s biggest agency, which has a $13 billion two-year budget and employs more than 10,000 workers.

The contracts:

-In 2007, the firm was paid $688,000 to assess the agency’s beleaguered financial department and identify cost-cutting efficiencies.

-Last April, Kaufman Global was hired at a cost of $742,000 to provide “hands on coaching” for DHS managers.

-Late last year, the firm landed a $2 million contract to craft a strategy for culture change at the Oregon State Hospital.

Taxpayers are leery about consulting contracts, especially now because of the state’s ailing economy and a projected $3.5 billion shortfall in the state’s 2011-13 budget period, which starts July 1.

However, DHS officials tout Kaufman Global as a consulting success story. They say the firm’s 2007 work for the agency paved the way for cost-saving initiatives that have reaped $100 million in savings.

Now, the state is banking on Kaufman Global to deliver results on a tough task — turning around the troubled state hospital.

READ – Kaufman Global’s contract with Oregon State Hospital to instruct their “Lean Daily Management System”

The firm has started working with hospital leaders and front-line employees to change the workplace culture at the 127-year-old mental institution.

Kaufman Global’s initial “cultural assessment” report, made public on Tuesday, concluded that OSH suffers from deeply entrenched problems, including poor communication, distrust and a lack of accountability.

The consultants pledged to help OSH become a first-class psychiatric facility by fixing the flaws.

“It’s now incumbent upon OSH leadership and stakeholders to help ensure these steps are taken to become the first class organization that it can be,” stated the report. “To that end, Kaufman Global pledges its intent not only to reveal those cultural issues that must be changed … but to roll up our sleeves and help implement those changes.”

Magnet for consultants

The Indiana firm is the latest in a succession of outside experts and consultants enlisted by the state to dissect the state hospital’s woes.

The Statesman Journal previously reported that former Lane County Circuit Judge James Hargreaves received $252,465 in state pay for the year he served as governor-appointed “special master” of the hospital.

His 14-page report, issued in early 2009, rapped hospital management for poor planning, undefined goals and a lack of urgency.

Another hard-hitting assessment of the hospital was issued last year by Liberty Healthcare, a Pennsylvania-based consulting firm that was paid $175,000 to study OSH. In that report, dated Sept. 30, consultants said the hospital has “invested great energy and vigor in striving to improve, but the results to date have been disappointing.

“It is paradoxical that the very efforts to improve the hospital have contributed to the current confusion because changes have been implemented on so many fronts and with such rapidity. The sheer volume of change at OSH would overwhelm any organization, but we believe that the essential problem has been the lack of adequate planning and coordination of these improvement efforts.”

Hospital Superintendent Greg Roberts said in a Friday interview that Kaufman Global’s ongoing work is designed to produce change, not just describe what’s wrong.

“We don’t need more and more assessments of the hospital,” he said. “We need to be focused on fixing the problem, and that is where Kaufman Global is coming from. What we need to do now is move on to take action steps to resolve the issues.”

Under its contract with the state, Kaufman Global’s work at the hospital will continue through June 30. Roberts emphasized that “their work is to help us find processes that will last beyond their contract.”
“Eager for change”

As spelled out in their initial report, the consultants plan to play an active role in prompting hospital change. Targeted areas for improvement include:

-Strengthening accountability throughout OSH and ensuring that projects stay on schedule and on budget.

-Providing coaching and mentoring to counter a lack of a shared organizational vision and strategy.

-Revitalizing and realigning senior leadership.

-Rebuilding trust and eliminating acts of retribution, real or perceived, through education, coaching and mentoring.

-Eliminating separate agendas and creating “a blameless environment designed to foster continuous improvement.”

“The report doesn’t just tell us what is wrong; it tells us why and provides some valuable insight on how we can fix it,” Roberts said in a message to members of the hospital advisory board. “The good news coming out of this report is that we as a hospital are eager for change and dedicated to improving patient care.”

Roberts said hospital employees demonstrated their desire to embrace change through a “sometimes overwhelming response” to Kaufman Global’s requests for input. More than 1,500 staff and patients participated in the firm’s cultural assessment, filling out surveys and participating in interviews and other exercises.

“For the next step, we will use the tools we learn from Kaufman Global to develop and implement strategies for bringing about the changes we need to instill positive cultural norms at the hospital,” Roberts said in his message to the advisory board.

Previous work praised

Kaufman Global has a proven track record in Oregon, DHS officials said.

In 2007, the department hired the firm, to scrutinize the agency’s embattled financial department.

Jim Scherzinger, deputy director for finance in DHS, said the state turned to Kaufman Global in the wake of a financial debacle that occurred prior to his arrival at the agency.

“When I came in, DHS was taking a lot of criticism because of its finance system,” he said. “Probably the worst thing was that they told the Legislature that their budget was balanced.”

In reality, the agency had a budget shortfall of more than $170 million. Legislators were stunned to hear about the hole, and they had to hold a special session to plug it. Lawmakers told DHS leaders not to let it happen again.

Kaufman Global, hired through a competitive bidding process, came on the scene in 2007. The consultants introduced “lean tools” to DHS.

Initially devised by Toyota, lean tools and techniques are widely used in the private sector to streamline processes and cut waste.

“Ultimately, what they’re designed to do is not to make people work faster or harder but to eliminate waste in the process,” Scherzinger said.

A state Web site entirely devoted to the Transformation Initiative describes “lean” as the primary tool DHS uses to “do the right work, the right way.”

Agency director Bruce Goldberg, in a message posted on the Web site, says: “Today’s economic climate means more families, seniors and people with disabilities are turning to us than ever before. The Transformation Initiative gives us the tools we need to stretch the public dollar in order to deliver critical services that help people through tough times.”

DHS first applied lean tools and training taught by Kaufman Global to the DHS finance department. By December 2008, officials said, the new efficiencies had generated more than $8 million in savings for the agency, far surpassing the $688,000 cost of the first consulting contract.

Kaufman Global was hired again early last year to provide more coaching for DHS managers at a cost of $742,000.

“What they’re really good at is (providing) training on the lean tools and helping you develop ways of engaging your workers in improving processes,” Scherzinger said.

The 2007 consulting work done by Kaufman Global paved the way for a broader DHS “Transformation Initiative.”

Lean tools and techniques have been applied to dozens of projects — from an accelerated hiring program for nurses at the state hospital to a streamlined intake process for applicants seeking food stamps, medical and day care benefits.

As of Jan. 14, 35 lean process improvement projects had been completed, resulting in savings valued at $99.6 million, according to DHS calculations.

About 100 more projects, all based on the lean process, are in varying stages of completion, officials said.

From the Salem Statesman Journal, January 21, 2011

A New Jersey physician has been hired to become the first chief of medicine at the Oregon State Hospital in Salem.

Dr. Brian Little comes to OSH from Ancora Psychiatric Hospital in New Jersey.

READ – DOJ CRIPA investigation of Ancora Psychiatric Hospital, August 2009
READ – N.J.’s Ancora Psychiatric Hospital patients remain ‘at risk of harm,’ feds say, New Jersey Star, August 24, 2009
READ – Ancora Psychiatric Hospital faces federal investigation, September 2008

Superintendent Greg Roberts, who came to OSH from New Jersey in September, said the chief of medicine position was created to better address patients’ physical health, as well as their mental health.

“Introducing a Chief of Medicine to the hospital is the next step in our path towards the integration of mental health and primary care,” Roberts said in a message to members of the hospital advisory board. “Physical well-being goes hand-in-hand with recovery, and we need to make sure we are effectively treating the whole person.”

Oregon’s main mental hospital has been criticized by mental-health advocates and federal investigators for lapses in patient care.

Roberts assumed the mantle of leadership at OSH after a long career as a psychiatric hospital administrator in New Jersey.

“There are a number of important similarities between OSH and Ancora,” Roberts said. “Both hospitals have come under USDOJ scrutiny in the last five years after experiencing significant overcrowding, as well as several negative incidents, including patient deaths. OSH and Ancora also both have large forensic and geriatric populations.”

Little served as chief of medicine at Ancora.

“Under Dr. Little’s leadership, Ancora developed and implemented a number of successful initiatives aimed specifically at providing appropriate medical treatment of all patients,” Roberts said. “We are fully confident he will do so here as well.”

Roberts said Little will report directly to him until a new chief medical officer is hired. A nationwide search is being conducted to fill that vacant position.

Dr. Mark Diamond recently stepped down as chief medical officer to assume new duties as a part-time staff psychiatrist.

From the Eugene Register Guard, January 19, 2011

Planners say a smaller psychiatric facility in Junction City is needed

A new forecast Tuesday said a psychiatric hospital is still needed in Junction City, but it should serve fewer than half the number of patients called for in the original plan.

The report, issued by the state Department of Human Services, comes as critics of institutionalized care are trying to persuade the Legislature to kill plans for the hospital in favor of more residential treatment facilities dispersed throughout the state.

The report said the hospital should be built to accommodate 174 patients, down from the original recommendation of 360 beds.

The state recently opened a 620-bed replacement for the Oregon State Hospital in Salem. It is preparing the Junction City site for construction next year and completion in 2013. State hospital administrators last year estimated the Junction City hospital would create about 1,200 jobs, including about 705 nursing positions. The new forecast calls for 522 full-time-equivalent employees to serve a smaller patient population.

Last year, state hospital planners said they would reduce the Junction City facility’s capacity to 270 beds. But then, as now, they said it wasn’t feasible to scratch it altogether because of the continued need for a secure, institutional setting for some patients, as well as the need to replace facilities going off line in the near future in Portland and Pendleton.

“It’s a smaller hospital than was originally anticipated. It has some case load growth built into it, but it’s mainly replacing existing facilities,” said Richard Harris, administrator for the state’s Addictions and Mental Health Division.

Critics of the hospital have said the state won’t be able to afford to operate it. Oregon’s general fund revenue is in free-fall and projected to be 20 percent, or $3.5 billion, short of meeting 2009 service levels in 2011-13.

Harris said the Junction City facility wouldn’t operate until the next biennial spending cycle and noted that its operating costs don’t drastically exceed what the state already spends for a smaller number of patients. The state’s lease of hospital space in Portland for 92 patients expires in 2015 and it is planning to stop using the Blue Mountain Recovery Center in Pendleton for 60 beds because that facility requires extensive rehabilitation to continue operating.

According to Tuesday’s report, the $101 million biennial cost of operating a scaled-back hospital in Junction City is $11 million beyond the cost of continuing with those two facilities after increasing staffing levels to meet U.S. Justice Department standards.

The Junction City facility’s patient numbers would fall for three reasons:

The overall number of beds forecast to serve people with mental illnesses through 2030 is down by 52, from the 1,012 forecast using an older methodology in 2005 to 960 using what officials consider a more accurate approach of projecting the number of patients requiring residential treatment.

The state thinks it could serve 70 older patients in community-based facilities, rather than at the Junction City hospital.

Officials expect to have bed space in secure treatment facilities for 64 patients who committed crimes but were either found “guilty but for insanity” by the courts or did not stand trial because they were unable to assist in their defense.

The new study examined alternatives to a scaled-down Junction City facility, but said they were not feasible. One alternative included building multiple 16-bed hospital and secure residential facilities — the 16 beds would allow each facility to qualify for federal Medicare and Medicaid dollars — but the added expense of separate administration would fail to provide cost-effective services, the report said.

Chris Bouneff, Oregon director of the National Alliance on Mental Illness, said Oregon should not be planning a second hospital in the southern Willamette Valley, in part because the larger Salem hospital it supported already is too far from the state’s population center in and around Portland.

“It seems like this is driven by politics rather than clinical care and clinical outcomes,” said Bouneff, noting that originally officials did not describe the Junction City facility as a replacement hospital as they are now in pressing their case.

Rep. Sara Gelser, a Corvallis Democrat and one of the Legislature’s leading skeptics of a Junction City psychiatric hospital, said she is “still not on the Junction City bandwagon, but this demonstrates a real thoughtfulness and a move in the right direction.”

Rep. Val Hoyle, a Eugene Democrat with Junction City in her district, said the report won’t end the debate about the planned hospital, but does underscore her point of view.

“This makes it clear that this facility is badly needed,” Hoyle said. “And since we do need it and it’s going to be built, I want it built in Junction City where these much-needed jobs will help my communities.”

Surprise! As the Oregon State Legislature begins to engage with a $3.5 billion shortfall in the 2011-13 biennium the Oregon State Hospital project at Junction City appears to be dissolving…

That’s okay because since it’s inception as an employment program by State Senator Peter Courtney independent advocates for mental health services have been skeptical of the $300 million project. Those dollars spent on treating people in community settings could PREVENT hundreds of hospitalizations each year and untold suffering.

It’s fine to retreat and re-evaluate a bad idea. The issue is that last session the state legislature, thanks to Peter Courtney pledged to DO SOMETHING about Oregon’s mental health crisis. If that $300 million dissolves away from Junction City and away from mental health services entirely, that pledge will be worthless and not one but TWO session of the state legislature will have been wasted.

Below is a document distributed by the Oregon State Addictions and Mental Health Division, January 18, 2011. To see in original format, Revised Forecast of Need for State Hospital Beds – 2010.

READ – New report: Controversial Oregon mental hospital in Junction City should be half as big as planned, Oregonian, January 18, 2011
READ – State recommends smaller mental hospital at Junction City, Salem Statesman Journal, January 18, 2011

Addictions and Mental Health Division – 2010 Revised Forecast of Need For State Hospital Beds – January 18, 2011

This is an updated forecast of the needed hospital and community-based treatment beds for people living with mental illness in Oregon through 2030.

This forecast updates the 2005 Framework Master Plan Phase II report. That forecast called for approximately 1012 total beds within and without community settings. Similarly, this forecast calls for 960 total beds.

Staff looked at the forecasting methodology and the assumptions used in the master plan and found that there is a need to change two significant factors to more accurately project the bed need.

1. The forecast used in this paper is history based. This is a change from the “population” based forecast used in the 2005 forecast. The “History Based Forecast” uses real hospital utilization data to forecast the number and types of individuals projected to need hospital level of care by 2030. Population based projection has proved to be less reliable when comparing projections to actual use.

2. The forecast used in this paper also moved from using average length of stay in a state hospital facility to using average daily population (ADP), based on average hospital daily utilization over a year. ADP can be better used to trend and forecast capacity needs in the future. ADP is linked to flow into and out of the hospital.

Additionally, under this forecast, a team of experts from AMH, OSH and the DHS/OHA Forecasting Unit revised the forecast of the need for hospital beds through 2030. Hospital level of care is defined as requiring 24-hour nursing and psychiatric care, on-site credentialed professional staff, organized medical staff, treatment planning, pharmacy, laboratory, on-site food and nutritional services, as well as vocational and educational services. Given the assumed closures of the OSH Portland campus and the Blue Mountain Recovery Center, there will be a continued need for hospital level of care in order to meet the intensive needs of a relatively small subset of individuals with mental health disorders.

The 2005 Framework Master Plan Phase II Report was prepared by the Reach New Heights consulting group. They have provided feedback on this updated forecast and their concerns were reviewed by the group. The consensus from AMH and the Forecasting Unit is that the proposed forecasting method is a more accurate tool.

Addictions and Mental Health Division (AMH) 2010 Revised Forecast of Need For State Hospital Beds

Forecasted Bed Need by 2030
2005 Forecast shows a need for 620 Beds – OSH Salem
2010 Forecast shows a need for 620 Beds – OSH Salem
2005 Forecast shows a need for 360 Beds – OSH Junction City
2010 Forecast shows a need for 174Beds – OSH Junction City

There continues to be a need for hospital-level care and transitional care at the proposed Junction City campus.

Of the forecasted 794 beds, the Salem campus will have 620 beds which we are targeting for completion at the end of 2011. The Junction City site should have 174 beds. That is a total reduction of 186 beds in Junction City.

Cost considerations relating to Junction City

In December 2010, Greg Roberts, OSH Superintendent, and Lee Hullinger, OSH Chief Financial Officer, jointly developed a staffing model for a proposed 174-bed facility in Junction City. Roberts based clinical staffing on US Department of Justice recommended classifications and ratios and Hullinger modeled non-clinical staffing to maximize efficiencies for Junction City to operate as a satellite campus with ongoing resources and senior management provided from the OSH Salem campus. Projected staffing totals for Junction City amount to 522 full-time equivalent employees equating to a staff to patient ratio of 3.00-to-1.

This recommendation assumes that the operating costs for OSH Portland and Blue Mountain would offset the operating costs for Junction City. If Junction City were not built, it would be necessary to increase staffing and operating costs for OSH Portland by $11.0 million and for Blue Mountain by $17.0 million. If this is considered in the overall cost to operate Junction City, the increase is $11.0 million.

OSH Portland has 92 beds in leased space, and the lease expires in March 2015. The current space is old and unsuited to the needs of a modern psychiatric hospital. It does not support 20 hours of active psychiatric treatment as required by US Department of Justice, and it is not possible to operate essential vocational services in the space available. The continued use of this space requires an agreement with the landlord to a long term lease and to provide additional space to support active treatment and vocational services. It also requires extensive remodeling, estimated at $13.0 million at the state’s expense, invested in property not owned by the state.

The continued use of the Portland facility beyond 2015 is not recommended.

The 60 beds at the Blue Mountain Recovery Center in Pendleton are in a building that is more than 60 years old and has exceeded its physical life cycle. The rough order of magnitude for remodeling Blue Mountain is $11.0 million. This assumes remodeling patient space and the kitchen. Given that the building is over 60 years old there are many factors that require engineering studies prior to creating an estimate that can be used for budget purposes. These include poor condition of plumbing, potential for lead water pipes, lead-based paint, asbestos, quality of electrical system and potential for seismic upgrades. There is also the factor of added costs if the facility is in use while the work is being done.

The attached graphic makes it clear that the hospital at Junction City must be built with at least 152 beds to replace the 152 beds lost as both OSH Portland and Blue Mountain are closed. Once those units are closed, there would be insufficient capacity to serve adults who are civilly committed, found guilty except for insanity or otherwise so ill that they require treatment provided by psychiatrist-led treatment teams with 24-hour nursing in a state hospital to stabilize their symptoms and prepare them to live safely and successfully in the community.

Projected operating costs for a 174-bed Junction City facility total $101.0 million and may be off-set by projected savings of $35.0 million for OSH Portland and $27.0 million for Blue Mountain, assuming both campuses were closed. All cost estimates are based on 24-months. The estimated biennial operating cost for a 174- bed Junction City facility is $11.0 million more than the costs for the closed facilities after staffing is increased to meet US Department of Justice standards.

The following table summarizes this information:

Addictions and Mental Health Division (AMH)
2010 Revised Forecast of Need For State Hospital Beds

Projected staffing & operation costs: $101.0 million
– less projected savings of closing OSH Portland ($35.0 million)
– less projected savings of closing Blue Mountain ($27.0 million)
– less projected cost to increase staffing for OSH Portland to meet US Department of Justice standards ($11.0 million)
– less projected cost to increase staffing for Blue Mountain to meet US Department of Justice standards ($17.0 million)
Biennial operating cost in addition to the savings from the closure of Portland and Blue Mountain – $11.0 million
Taken collectively over the next five years, these recommendations will allow Oregon to meet the forecasted need for hospital level of care, replace the Portland Campus of OSH and Blue Mountain and utilize community resources to meet the newly forecasted need.

Selecting the Junction City Site

Following the release of the Phase II Master Plan, the Governor and legislative leadership created a joint siting workgroup. The workgroup selected criteria to be used in evaluating possible sites for two state hospitals. The criteria included the cost of the site, the location of the site in terms of the ability to recruit and retain staff, the nearness to the families of persons served in the state hospital and the availability of transportation. The Legislature selected the existing OSH Salem campus on the south side of Center Street and the Junction City site on land owned by the Department of Corrections. These two sites met most of the criteria and were the most cost effective.

Notes to the Financing Plan

Note 1: If the state elected not to build Junction City, it would be necessary to keep both OSH Portland and BMRC open. In order to do that it would be necessary to increase the staffing levels to those acceptable to the US Department of Justice. This would cost $11.0 million for Portland and $17.0 million for BMRC, a total of $28.0 million.

Note 2: Beginning in April 2011 the monthly lease payment for Portland OSH increases from $113,000 per month to $128,000. The biennial lease amount will be $3,072,000 for most of 2011-13.

Note 3: The anticipated full biennial debt service for a smaller Junction City facility is estimated to be $19.7 million when all construction is completed.

Community-based care

The updated forecast identifies the need for additional beds in the community that will make it possible to move people out of the hospital. Thirty-two Secure Residential Treatment beds were identified in the Master Plan but not funded through the Replacement Project. Addictions and Mental Health has opened one
16-bed facility and is in the process of developing 16 additional beds in the community by July 1, 2011.

The Oregon State Hospital and Addictions and Mental Health, in partnership with Seniors and People with Disabilities, are developing a plan to move neuro-geriatric patients out of the hospital and into community long-term care placements. The plan calls for reducing hospital level of care beds by 70 and utilizing community long-term care facilities and programs to serve these individuals in a less restrictive community setting. There will be new costs to the system to develop and implement a new model for serving individuals disabled by age-related disorders or by brain injuries who are not successfully served in current community-based programs.

In addition, Addictions and Mental Health is responsible for developing or reprogramming capacity to serve the continued growth in the forensic population. This need is forecast to grow an additional 64 forensic beds by 2030. The estimated cost for the 10 community forensic beds needed in 2011-13 is $ .7 million for start up and $1.6 for operating costs. The remaining 51 beds will either be built in future years, or the capacity will result from reprogramming or using existing capacity more efficiently.

Addictions and Mental Health started a new program, known as the Adult Mental Health Initiative (AMHI), to manage utilization of residential facilities at the local level. The goals are to reduce length of stay in community-based mental health facilities, to increase the rate of discharge of patients from the state hospital system into the community, and to organize services that support individuals living in the most integrated and independent environment. The effective management of the current residential capacity will result in shorter lengths of stay. This results in more people being served at this level of care within the existing bed capacity. For these efforts to be effective, there must be a continued investment in mental health services through the Oregon Health Plan and the Community Mental Health Programs.

Alternate options

The first option considered was to proceed as recommended by the Phase II Master Plan. Further analysis made it clear that there is no longer a need for 980 hospital beds.

The second option considered was to build multiple 16-bed hospital facilities and 100 secure residential treatment beds in 16-bed facilities spread throughout the state. It is not cost effective to attempt to staff and provide hospital level of care in stand alone 16-bed facilities. It is necessary for the facilities to be stand alone administratively and operationally in order to obtain Medicaid financing. The cost for five of these facilities (needed for 75 hospital level beds) and regional medical supports is estimated to be more than $92.5 million. The cost for seven 16-bed Secure Residential Treatment Facilities needed for 100 transition beds is $2.5million for start up and $45.3 million per biennium for operations. The total cost of this option is $140.3 million. These scenarios assume entities other than the state will build the facilities with minimal state-paid start up. To do otherwise would require bond financing to construct these facilities. Neither of these scenarios provide cost-effective services.

Advocates for community-based services have been vocal in their support of 16-bed facilities in the community as a better alternative in terms of Medicaid financing and smaller size. This alternative is not workable for individuals who require hospital level of care. While 16-bed Secure Residential Treatment Facilities may be preferable to larger institutions, stand alone facilities cannot easily provide the robust level of treatment and rehabilitative services that prepare people to live in less structured, more independent environments. Addictions and Mental Health is committed to community-based services that are more integrated and support individuals in their own homes.

The third option considered was to build a 242-bed facility in Junction City. The refined analysis suggests that this is still more beds than Oregon needs. The costs for 242 beds are estimated to be $123.5 million without owners’ project management, staffing and Behavioral Health Integration Project costs.

These three options are not recommended.

Conclusion

The 2010 updated forecast shows that the need for treatment facilities for people living with mental illness is close to what was predicted in 2005. Additionally, a certain percentage of that population will continue to need hospital-level care that it is not feasible to provide in community settings.

At the same time, the Addictions and Mental Health Division remains committed to ensuring that people who do not need hospital level care can receive treatment in the least restrictive environment possible. Therefore, while the overall forecast for mental health treatment beds remains stable, where those beds are allocated has been changed.

There is a need to build capacity for 794 beds in the state hospital system. That is a reduction of 186 hospital-level beds from the 2005 forecast. The 620 beds in Salem are targeted for completion at the end of 2011. The remainder will be in a 174-bed facility in Junction City.