Oregon’s Mental Health History
Updated September 2013
Persons with active mental illness are the most discriminated against persons anywhere in the world, now and at any time in history. Public services for these individuals in our city, county, state, nation and world, are terrible – when they’re available at all.
People with mental illness are the most routinely harmed by public institutions and those employed by them. They die decades earlier than average. They are overrepresented in prisons, jails, emergency rooms, poverty rolls, unemployment lines and homeless shelters. They are underrepresented in job opportunity, public discourse, self-sufficiency and polite society. And almost exclusively, they are the ones killed by cops.
2013: THE NUMBERS
In any given year, 1 in 5 Americans have a diagnosable mental disorder – over 760,000 in Oregon.
Over 10 million, each year, have a mental illness that’s serious enough to interfere with life activities.
Of those, 8.5 million do not receive minimally adequate treatment.
More than 107,000 Oregonians live with severe and persistent mental illness, such as schizophrenia, severe depression, or bipolar disorder.
28-30% of the population have a mental disorder, an addictive illness, or both.
Nationally, the total economic cost of mental illness is more than $150 billion per year.
In 2010, 685 persons in Oregon died by suicide.
2012: ADDRESSING THE NEED
There are no cures for mental illness or addiction, and none in the foreseeable future. Symptom reduction, remission and recovery can and do happen, but it takes a sustained effort by treating professionals and their clients. Such efforts have never been fully funded.
The state of Oregon spent $377.4 million on mental health services (not including addiction treatment) in 2011, up 23% from the prior year’s budget – one of the largest increases in the nation.
In 2007, the number of persons served by the state mental health system was 109,758; in 2010, 105,820. This number does not include an estimated 60,000+ persons in addiction services or private pay mental health treatment, veterans, jail or prison inmates, or people receiving certain parole services.
The total number of patients in the Oregon State Hospital (Portland and Salem) in 2007 was 1,601; in 2010, it was 1,465, in 2013 it’s under 700.
Still, services and spending fall far short of the need. Richard Harris, until recently the director of the Oregon Health Authority’s Addictions and Mental Health Division, wrote in 2012 public funds provide than less than half the services needed by persons with severe emotional and mental disorders, and only 20% of what’s needed for addiction. Figures, see www.oregon.gov/oha/budget/2011-2013/wm/amh.pdf
The cost of untreated addiction (health care, lost earnings, criminal justice and other expenses) totals $5.93 billion per year in Oregon, according to Harris. Recent analyses from the American Journal of Psychiatry and elsewhere place the total economic burden of serious mental illness in the U.S., conservatively, at $193.2 billion per year. These are potential savings, which can only happen by fully funding mental health care. Figures, http://www.nimh.nih.gov/about/director/2011/the-global-cost-of-mental-illness.shtml)
Reductions in addiction and mental health public treatment directly increase costs for emergency room care, police, jails, courts, prisons, and parole.
Unavailability of treatment increases domestic violence, child abuse, person-to-person and property crimes, unemployment, bankruptcy, school drop-outs, homelessness, hunger, auto crashes and gun accidents.
Thousands of Oregon veterans developed PTSD during their service in Afghanistan and Iraq. Their primary medical provider, the VA, has failed to provide sufficient treatments.
The projected loss in Medicaid match funding for Oregon in 2012 is $156 million. Supposedly, the new Coordinated Care Organizations (CCOs) will effectively manage less money for more people. This remains to be seen.
Local control of community-based treatment services is now in the hands of CCOs and outside the oversight of public officials.
Mental health policy and reform have historically been dominated by professionals and government-funded agencies, not patients in recovery, friends and family members, who are arguably the real experts; until the last five years, they have been systematically shut out from administrative, political, provider and advisory roles.
The most expensive and least effective way to mitigate mental and addiction health issues is the one we use most, the law. The least expensive and most effective way is the one we starve and ignore: fully-funded, effective and worthwhile treatment on demand.
1813+ John Day, a member of John Jacob Astor’s overland party becomes “demented” and dies on the return journey.
1843 – James Hawthorne opens the Oregon Hospital for the Insane in Portland. It is the first ‘hospital’ in the Oregon Territory. Closes in 1883.
1846 – First mass grave burials for inmates of the Oregon Hospital for the Insane at Lone Fir Cemetery in SE Portland. Over 130 bodies are estimated to have been buried there over many years by Dr. James Hawthorne; no remains have been found. In the 1940s Multnomah County built an office building over the graves; this was torn down in about 2005. Plans were made but never completed to create a memorial for Asylum inmates but never completed; as of 2013 it remains an unused gravel lot.
1868 – Hillside Farm for the poor opened on Canyon Road at the location of the Portland Zoo. It closed in 1910 after members of local charities dubbed the crumbling building and its deplorable conditions disgraceful. Their report spurred county commissioners to speed work on the Multnomah County Poor Farm at Edgefield, which opened in 1911. Human remains were discovered during exhibit construction at the zoo in 2008, and again in 2013. Those remains were reburied near the spot they were found. No memorial marks the spot.
1913 Oregon State Insane Asylum opens in Salem with Hawthorne as it’s first superintendent.
1904 Morningside Hospital open by City father Henry Waldo Coe where Mall 205 is now. Holds large federal contracts for native Alaskans, private-pay mental and addiction health patients. Closes in 1968.
1907 Oregon State Institution for the Feeble-Minded opens. Closes as the Fairview Training Center in 2000. In 2006 Governor John Kitzhaber apologies for the forced sterilization of thousands of Oregonians at Fairview and in other facilities.
1910 – 1930 A variety of mental health clinics open, including Crystal Springs Sanatorium, Lee Miller Sanatorium, Klock Sanatorium, Weir Mitchell Sanatorium, Fir Grove Sanatorium, and others. Mountain View Sanatorium for Alcohol, Drug, Mild Mental Cases opens in 1908 and closes in 1920.
1910+ State asylum cemetery sold. Over 4000 bodies exhumed and cremated by inmates; most are still kept in the Oregon State Hospital basement.
1913 Eastern Oregon State Asylum opens in Pendleton to ease overcrowding in Salem. It now operates as the Blue Mountain Recovery Center with about 90 beds.
1913 Oregon Board of Control created. Governor Tom McCall, Secretary of State Mark Hatfield and Bob Straub are key members in the mid-1960s. The routinely visit the state hospital and other large institutions, talk with inmates, care staff, families and administrators. Lasts until 1977.
1915+ Waverleigh Crest Sanatorium for Nervous Diseases opens. Closes 1939.
1939 The “Big Book” of Alcoholics Anonymous is published.
1942 Close to 500 patients and staff members at the Oregon State Hospital accidentally poisoned by a patient helping in the kitchen; 46 die.
1944 20+ deaths at jail drunk tank launch blue ribbon committee. No changes occur.
1958 Blanchet House opened in NW Portland.
1959 Columbia Park Hospital in The Dalles opens for geriatric and chronically ill persons (including persons with mental illness and addiction). Closes in 1977.
1960 Camp White becomes the Veteran’s Administration Domiciliary at White City, near Medford. Now called Southern Oregon Rehabilitation Center & Clinic it is a residential hospital for military invalids, including veterans with mental illness and addiction.
1961 Dammasch State Hospital for general psychiatric conditions opens. Population peaks in about 1990 with 600+ people with mental illness and addiction. Closes in 1995. By the time Dammasch closes, the Portland, Pendleton and Salem branches of the Oregon State Hospital rarely accepted persons who were not civilly committed. and 70% of inmates were “forensic patients,” meaning the had been found Guilty Except for Insanity.
1962 Ken Kesey’s critique of behaviourism, ‘One Flew Over the Cuckoo’s Next,’ is a bestseller, and set in the Oregon State Hospital.
1963 Kennedy signs the Mental Retardation Facilities and Community Mental Health Construction Act launching a national effort to move psychiatric patients from hospitals to community-based clinics, which substantially fails: state hospitals are closed but cities and counties do not provide sufficient services.
1963 Portland Metropolitan Steering Committee launches with a Federal grant intending to coordinate anti-poverty programs. It closes in 1977 after blowout of Executive Cleveland Gilcrease and accusations of loose financial control. It is succeeded by the Community Action Agency of Portland in 1983.
1965 Medicaid becomes available as Title XIX of the Social Security Act.
1967 Tri-County Community Council formed as merger of three county “Community Councils”. Investigates drug abuse, foster homes, etc. Merges with The United Way in 1983.
1968 Outside In opened by Dr. Charles Spray to help hippies who were having “a bad trip”.
1969 Dean Brooks, MD, superintendent of OSH gives his ‘Bushel of Shoes’ speech; “Dehumanization can be defined as the divestment of human capacities and functions and the process of becoming or the state of being less than a man.”
1971 Oregon Legislature recognizes alcoholism as an illness.
1972 City drunk tank closed. Medical detox clinic opened by Golden Nissen across the street (over current Bijou Cafe) from Central Precinct. Moved to 20 NE Union Avenue in 1983 and renamed David Hooper Detoxification Center for the last person to die in the drunk tank.
1973 Oregon Community Mental Health Programs Act established the State Mental Health Division with three program categories – Alcohol and Drug (A&D), Mental and Emotional Disturbances (MED), and Mental Retardation and Developmental Disabilities (MR/DD). A&D and MED are merged to be Addictions and Mental Health Services in 2000+.
1975-2000 Burnside Community Council begins and its shelter, Baloney Joe’s is operated by Michael Stoops, a Quaker and an advocate. Stoops is chased out of town with unfounded accusations published in Willamette Week of sex with a teenager.
1975 Film of ‘One Flew Over the Cuckoo’s Next’ by Milos Forman, shot at Oregon State Hospital, wins Academy Award. Administrators fail to understand Kesey’s thesis.
1977 Burnside Consortium starts to gather forces of dozens of agencies and individuals and buildings. Under former sheriff & county commissioner Don Clark becomes Central City Concern in 1984.
1979 Sisters of the Road Cafe launched by Sandy Gooch and Gennie Nelson.
1981 Mental Health Services West launched by June Dunn.
1983 Pacific Gateway Hospital & Counseling Centers opens as Oregon’s only private psychiatric hospital with 66 beds. Closes in 2001 after accusations of poor security and patient Jose Mejia Poot murdered by three police officers; bulldozed in 2002.
1988 Governor’s Task Force on Inpatient Psychiatric Services finds serious deficiencies in the state’s three major psychiatric hospitals. The Task Force recommends the renovation or closure of Dammasch State Hospital and several long-term structural changes to the Oregon State Hospital.
1992 Ballot Measure 5 limits property tax ties to government operations. This is felt by the closure of Dammasch State Hospital and the inability to follow through on many of the recommendations from the 1988 Governor’s Task Force on Inpatient Psychiatric Services Report. (source: http://www.oregon.gov/OHA/amh/publications/mhawg_report2001.pdf)
1993 Oregon Health Plan launched to manage Medicaid and indigent patients. Hospital losses drop 16% in year one.
1995 Holladay Park Medical Center begins to lease ward space to the state. It currently has 60+ beds for court-committed persons with mental illness and now functions as the Oregon State Hospital – Portland, or POSH.
1997 New Avenues for Youth opened.
1969 Burnside Projects started by Reverand Luray of the Downtown Chapel. Becomes Transition Projects in about 1991.
DATE NEEDED State blue ribbon committee proposes involuntary commitment for alcoholics.
DATE NEEDED Various county and private crisis hotlines consolidated to Metro Crisis Hotline. Calls were answered by trained volunteers. It closed 2006 as cost-cutting measure.
Multnomah County provided limited mental health services integrated with primary care from the early 1970s until contracting with five Medicaid-funded nonprofits:
North/Northeast Community Mental Health (opened 1980) and Garlington Center (opened 1989) – in NE Portland. Reverend John Garlington was the first president of the Albina Ministerial Alliance.
Delaunay Center – in N Portland. Started in 1967 as Delauney Institute for Mental Health as an outgrowth of University of Portland as a Catholic charity and named for John B. Delaunay, Dean at UP and former jail chaplain.
Southeast Mental Health Network – in opens in SE Portland in 1983.
Mt Hood Community Mental Health Center – in opens in Gresham in 1982.
Mental Health Services West – serving the westside, opens 1981
Treatment provided included medications, individual and group psychotherapy, housing, family counseling, case management and money management. Most clients were defined as “chronic” and dependent on services. High mortality rates were guarded from circulation. Little oversight, no outside advocacy.
Alcohol & drug treatment was not provided by mental health agencies. Funding was separated at the state level; most professionals believed the issues were not related. The county contracted with many secular and faith-based agencies, including:
ASAP – DUI services) – now defunct
Central City Concern, including Hooper Detox and alcohol-free housing
Chicano Concilio (focus on Spanish-speaking people) – now defunct
Delta Clinic and several others (methadone)
DePaul Treatment (inpatient & outpatient treatment)
Native American Rehabilitation Association (state and federal contracts)
Project for Community Recovery (focus on African American people) – now defunct
Salvation Army (work and prayer as therapy)
Transition Projects – no longer providing treatment services
Addiction treatment was largely non-professional, long-term and abstinence-based.
Hospital-based psychiatric wards included OHSU (two wards), Portland Adventist (first to develop a dual-diagnosis unit), Emanuel, Woodlawn Park, Providence, St. Vincent’s (including inpatient treatment for eating disorders), Good Samaritan, Mt. Hood, and Meridian Park.
1990s A series of escapes at Oregon State Hospital forces a leadership transition and increased security.
1997 Crisis Triage Center opens, primarily for police custody admissions. It closes in 2001 amidst widespread criticism for high-cost treatment with limited effect. Closure was accelerated by the death of patient Jose Mejia Poot.
Mental Health Redesign, 1998 / 2003
1998 Oregon MED releases a highly critical ‘performance audit’ Multnomah County’s mental health services. The county could not produce satisfactory accounts for how many persons were served, what sort of services were being provided, the cost of those services, or their effectiveness. In their defense county officials pointed to a jumble of responsibilities, crossed lines of authority, various streams of funding, poor information sharing and keeping, poorly managed contractors, and finally racial persecution.
Bev Stein called for a blue ribbon panel to map the system and found it unmappable. There was no obvious entrance to the mental health system and there was no exit. People weren’t getting well. Family and friends were routinely ignored or even denounced by clinical professionals. Agencies had long burning turf wars. Limited funding was always an excuse.
A further Design Team chaired by Ed Blackburn created a dozen committees to redesign the mental health system for Multnomah County. Each committee met five to twenty times with between 10 and fifty members of these committees. Committees included housing, police engagement, outpatient care, residential care, integration with public health and addiction health, information technology, crisis outreach, and others.
The Design Team’s review brought new leadership to the County’s mental health department, consolidated five CMHCs to one – Cascadia, closed the Providence CTC, Cascadia financially accountable for hospitalization of it’s clients, and caused Cascadia to open five psychiatric urgent care clinics and five coordinated psychiatric outreach teams (think of Project Respond on steroids).
The new clinics and outreach teams were immediately successful and reduced jailings and hospitalizations. Police and agencies used the system. Clients – especially people who were not yet engaged in treatment – used it.
2001 Gov. John Kitzhaber’s Mental Health Alignment Workgroup.
2001 Pacific Gateway Hospital closes after three Portland police officers kill misdiagnosed involuntary patient Jose Mejia Poot, transferred on involuntary hold by Providence Crisis Triage.
2003 Kendra James is killed during traffic stop by PPB officer. James begins a series of high profile police-involved deaths of persons impaired by mental illness, including James Jahar Perez, Raymond Gwerder, James Chasse, Keaton Otis, Jack Collins, Aaron Campbell, Brad Morgan and Billy Simms.
2005 Children’s wards at the Oregon State Hospital closed amidst charges a dozen young patients were sexually abused by psychiatric aides from 1989 to 1994.
2006 Patient advocates bring journalists, artists, legislators, academics and former patients to the derelict Oregon State Hospital to see the cremated patient remains. The MHAP stewards 500 news stories over the next three years resulting in the demolition and rebuilding of the hospital.
2007 Mayor Tom Potter convenes a Mental Health Task Force in response to criticism about the police-involved death of James Chasse. Conclusions include support for training all police officers, opening an inpatient crisis center, more dialogue within the community.
2008 All Portland police officers finish crisis intervention classes with civilian trainers. CIT advocates say training is not CIT; officers see training as punishment.
2008 Cascadia has financial troubles and top staffers leave. Multnomah County attempts to shut down the nonprofit, awarding its profitable contracts to competitors Lifeworks NW and Central City Concern.
2010 Telecare opens the Crisis Assessment and Treatment Center (CATC, pronounced “Cat-See”). It has limited availability and does not take police custody admissions.
2010 Portland leaders, unable to mitigate legal and political damage by police-involved deaths of impaired persons invite lawsuit by Department of Justice and settles in 2012 for dozens of repairs to police training, procedure, public oversight and urgent care for persons with mental illness. No police officers are held accountable for killing the subjects of the suit.
2012 Portland State University professor Jan Haaken makes the documentary “Guilty Except for Insanity,” a rare inside look at the the Oregon State Hospital.
2012 Coordinated Care Organizations assume responsibility from the state, counties and cities, for public mental health services throughout the state.
2013 Brian Lindstrom and Jason Renaud release the documentary “Alien Boy: The Life and Death of James Chasse,” detailing the police-caused death of a man with schizophrenia.
MHAP Policy Recommendations for CITY OF PORTLAND
The City should not provide services for persons with mental illness. Instead city leaders must hold Multnomah County accountable for services.
All police officers should be equally able to engage and help persons who are impaired by mental illness or addiction – and held equally accountable.
The City should expand it’s police crisis training to all interested public service workers, including bus drivers, postal workers, librarians, fire workers, sheriff’s deputies, parole officers, home health care workers, utility workers.
MHAP Policy Recommendations for STATE LEGISLATORS
The state should provide effective treatment, seen as worthwhile by patients, on demand.
Protect state mental health Medicaid-match funding, but tie funding to performance.
Maintain adequate numbers of inpatient beds for psychiatric treatment, hold providers accountable for unnecessary hospitalization costs.
Implement mental health screening and assessment programs which are welcoming and culturally competent.
Support programs designed to educate families, peers and the public about serious mental illness and how to respond to people living with these illnesses.
- The state should open local psychiatric wards as needed to serve non-committed Medicaid or indigent persons.
Olaf Larsell, ‘The Doctor in Oregon: A Medical History,’ sections about mental health summarized in the Dec. 1945 OHS Quarterly. About 20 pages.
Bob Nikkel, ‘A Short History of the Public Mental Health System in Oregon,’ unpublished but online, 2000. Seven pages.
NAMI, ‘State Mental Health Cuts: a National Crisis,’ 2011 – available online
Mental Health Association of Portland, web site – compendium of articles and photographs.
Oregon State Hospital Museum, web site – compendium of articles and photographs.
Living self-taught historians, David Cutler, MD, Bob Nikkel, MSW, Barry Kast, MSW.
AA, ASAM (American Society of Addiction Medicine) and FSPHP (Federation of State Physician Health Programs), by Oregon Physician Advocacy Group