Mental Health Association of Portland

Gov. John Kitzhaber

In 2011, Oregon Gov. John Kitzhaber faced a vexing problem: The state had a $2 billion hole in its Medicaid budget and no good way to fill it.

He could cut doctors’ pay by 40 percent, but that might lead to them quitting Medicaid altogether. He could drop patients or benefits, but that would only compound costs in the long run. A former emergency room doctor, Kitzhaber remembers culling the Medicaid rolls in the 1980s, when he served as a state senator.

“When I went back home, and went back to the emergency department, I saw a couple of people who came in who lost coverage under that decision,” he said. “One of them was a guy who had had a massive stroke. These people don’t disappear.”

So Kitzhaber did something that many before him have done in desperate times. The governor who favors cowboy boots over dress shoes made a bet that Oregon could not afford to lose.

The deal Kitzhaber struck was this: The Obama administration would give the state $1.9 billion over five years, enough to patch the budget hole. The catch: To secure that, Oregon’s Medicaid program must grow at a rate that is 2 percent slower than the rest of the country, ultimately generating $11 billion savings over the next decade. If it fails, those federal dollars disappear.

Oregon is pursuing the Holy Grail in health-care policy: slower cost growth. If it succeeds, it could set a course for the rest of the country at a pivotal moment for the Affordable Care Act. Under the law, many states will expand Medicaid programs to cover everyone below 133 percent of the federal poverty line, adding 7 million Americans to the program in 2014 and leaving states looking for the most cost-effective way to cover that influx of patients.

In Oregon alone, Medicaid is expected to enroll 400,000 new patients by 2022, nearly doubling its current numbers, according to an Urban Institute analysis.

As Oregon’s population grows, the state has come to realize that Medicaid is not a bottomless bucket of money. The state’s budget cannot sustain that. Instead, it strives to deliver what health policy experts call “the triple aim”: higher-quality care that leads to better outcomes, all delivered at a lower cost.

“Oregon is trying to change the way that health care is delivered with incentives to deliver smarter, better care, instead of just imposing budget changes that cut back on health care,” said Cindy Mann, director of the Center for Medicaid and State Operations. “They’re doing this statewide and it’s very exciting for us.”

Under the new deal, Oregon does not get a lump-sum payment. Instead, the federal government doles out the $1.9 billion over five years. If the state cannot deliver cost savings up front, while hitting certain quality metrics, it’s cut off. The money it needs to keep doctor salaries stable and patients’ benefits covered dries up.

“In terms of cost-control experiments, the likes of this are something we have never seen in health care,” said John McConnell, a health policy researcher at Oregon Health & Science University who is studying the Oregon Medicaid waiver. “The natural questions are: Is it going to work? Is the state going to fix the budget? And if they do fix the budget, how are those savings accomplished?”

As Kitzhaber sees it, failure isn’t an option. The state’s Medicaid program needs that $1.9 billion to make ends meet now, even if it means paying big dividends back to the federal government later. It’s not unlike a payday loan, with a quick influx of cash and a large obligation to follow.

“There’s no more money,” Kitzhaber said. “This is one where you really have to change how you do business in order to survive.”

The phone started ringing, Kitzhaber said, when he landed that $1.9 billion. Other states wanted to know the trick. Then he explained what he committed to.

“We got a lot of calls, things like ‘How did you get all that cash and how can we get some?’” he said. “They never called back.”

30 years and no solution

Oregon has a long history of leadership when it comes to the Medicaid program, which covers nearly 62 million low-income and disabled Americans nationwide. In the early 1990s, it was among the first to use a federal waiver to expand limited coverage to all Oregonians living below the poverty line. Oregon’s uninsured rate quickly dropped, from 18 percent in 1994 to 10 percent in 1998.

Maintaining a robust health plan, however, hasn’t been easy. The state’s tax revenue dropped during the economic downturn of the early 2000s. To keep the Medicaid program afloat, the state charged significantly higher co-pays for some: $50 for an emergency room visit and $250 for a trip to the hospital.

Medicaid enrollment shrank by 46 percent as patients affected by the changes left the program — likely relegated to the ranks of the uninsured — between February and December 2003, according to research published in the journal Health Affairs.

Separate research has found that when Medicaid premiums rise by 1 to 5 percent of an uninsured family’s income, their odds of participating drop from 57 to 18 percent.

“For the last 30 years, both the private and public sector have done the same things to manage health-care costs,” said Bruce Goldberg, the Oregon Health Authority director who oversees the Medicaid program. “They’ve cut people from coverage, cut payment rates or cut benefits

“It’s been 30 years of doing that, and we haven’t solved the problem.”

This time around, Oregon wanted to try something different. Instead of dropping patients, the goal is to make high-quality health care less expensive.

Goldberg says that a small experiment in Oregon last year gave the state clues about a better way to reduce health spending. It took place at St. Charles Hospital in Bend, a mountain town known for its snowboarding, white-water rafting and microbreweries.

St. Charles noted that 144 patients tended to use the emergency room the most. Taken together, they averaged 14.25 trips each over 12 months. These patients drove much of the area’s Medicaid spending.

Researchers focused on them. Despite the frequent visits to the ER, these patients tended to be disconnected from the system.

More than half did not list a primary-care doctor. Some didn’t even have a preferred hospital: 27 percent had visited multiple ERs. The majority had unmet mental health needs, even though most had Medicaid, which provides mental health coverage.

Much of that seemed to have to do with the fragmented nature of Oregon’s Medicaid program.

“In our old system, we had people who had a physical health plan, a mental health plan and a dental plan,” Goldberg said. Patients would have three insurance cards, one for each type of service.

Where health-care services tended to be siloed, providers in Bend decided to integrate. It stationed community health workers in emergency rooms, who could help assess why patients had turned up.

Behavioral health specialists were embedded in clinics that traditionally dealt only with physical issues, in order to give patients a point of contact when they walked in the door.

The program was not a complete success. Of the 144 patients in the study, only 62 percent agreed to work with a community worker on a plan for their care. The others proved difficult to track down or did not want to participate.

Still, it did significantly change how the most-expensive patients used the health-care system. Emergency department visits fell by 49 percent. On average, the program generated about $3,000 in savings per patient.

Now, the Oregon aims to bring an approach that worked with 144 patients in Bend to Medicaid’s 564,470 patients across the state.

Oregon divided the state into 15 region and gave each one a set amount to care for each patient. These regions can divvy their dollars however they please, so long as patients hit certain quality metrics, like ensuring that adolescents get well-care visits and that steps are taken to control high blood pressure.

The hope is that each of the 15 regions, known as coordinated care organizations, will invest only in the most cost-effective health care. A behavioral health worker who can prevent emergency admissions becomes a lot more valuable, the thinking goes, when Medicaid funding is limited.

In this way, the Oregon plan has some parallels to Republican ideas to “block grant” the Medicaid program, and give states a set amount to run their programs. Both rely, in part, on a fixed budget to put downward pressure on health spending.

“You can call it what Oregon calls it, a global budget, or you can call it a block grant,” said Tevi Troy, assistant Health and Human Services secretary under George W. Bush. “There’s a semantic aspect to it. At the end of the day, we’re talking about putting limits on what we’ll spend on Medicaid.”

Democrats have typically opposed block grant proposals out of fear that they could lead states to skimp on care to meet spending targets. Safeguards in the Oregon plan, like the quality metrics, however, have made the approach more palatable to liberals.

“The idea of a global budget is to try to wring those costs without actually making consumers or seniors bear the heaviest burden,” said Neera Tanden, the Center for American Progress president who has advised President Obama on health policy.

Hope in Prineville

At the Mosaic Medical clinic in Prine­ville, a tiny Central Oregon logging town of 9,192, Juana Martinez and Michelle Ortiz are practicing the type of medicine that Kitzhaber thinks could fix the system. They are community health workers, the ones who make sure that patients do not slip through the cracks.

“Back there, you just get patients’ vitals,” said Martinez, motioning toward the exam rooms. “Here, it’s more knowing about them and making sure you can help them.”

That’s what she and Ortiz have done with Rebecca Whitaker. The 53-year-old Medicaid patient moved to Prineville last year, after shuffling through three Arizona nursing homes in six years, while recovering from a stroke.

Doctors had prescribed her 28 medications. Her social anxiety would get so bad that, sometimes, she rubbed her hands raw. By the time Whitaker got to Prineville to live with her cousin, she had given up on the health-care system.

“I tried to make it on my own for three months,” she said. “I was a diabetic without insulin. I wore a size zero pants. I tried suicide twice. I swore I’d never see another doctor.”

At Mosaic Medical, Whitaker received care for her diabetes and blood pressure. She also began seeing the clinic’s behavioral health specialist every week, who helped tend to her anxiety and depression.

Community health workers aided in other ways. They helped to ease her social anxiety by attending bingo night together. When Whitaker expressed an interest in moving out of her cousin’s house, Martinez helped her find an apartment.

“They have been the most moral support I’ve ever had in my life,” Whitaker said. “They cared, and that made me want to care. Little by little, when things got too frustrating in life, I’d see one of them. They changed my whole life.”

Worry in Portland

The governor’s gamble looms large for those who have to execute his plan: When you have a fixed number of health-care dollars, who gets the biggest slice of the spending?

The question weighs heavily on the doctors at Richmond Clinic in Portland, a federally qualified health center that is run by Oregon Health & Science University and sees a large load of Medicaid patients. Doctors there are pleased about the opportunity to be paid for some of the services they wouldn’t now, like having a long talk with a patient about diabetes management.

“What we’re excited about, with this whole transformation process, is having the mental space and time to address our patients’ needs,” said Nick Gideonse, the clinic’s medical director. “If we can get off the reimbursement system that is totally dependent on face-to-face visits, we might have more space to anticipate our patients need, rather than respond to them as they happen.”

The Richmond clinic recently added a behavioral health specialist to its staff. Rather than have the patient schedule a separate appointment at a different location, the specialist can pop in for a visit where a doctor notices unmet mental health needs.

“Almost every day, whoever is on for mental health will come down to the doctor’s pod and say, ‘Hey, does anyone have someone on their schedule we should talk about?’ ” Gideonse said. “They’ll literally go through every provider’s schedule and see who will benefit from a mental health touch.”

At the same time, others at the Richmond Clinic worry about how big their share of the lump-sum payment will be.

“I’m reassured by people talking about the role primary care providers need to play,” said Ern Teuber, the clinic’s executive director. “Still, when we start talking specific dollars, the perception is there isn’t enough money to go around and that somebody has to lose.”

The worry is especially acute for the hospitals that tend to deliver more expensive types of medicine. Their business model has traditionally relied on keeping beds full, as each patient brought in new payments.

“If we can’t reduce the cost of hospital care, we become a cost center rather than revenue generator,” said Greg Van Pelt, chief executive of Providence Health. “If Medicaid is going to grow slower, you have to figure out a way to get it to cost less.”

That process isn’t always easy: Van Pelt notes that he has had to oversee workforce reductions, as the hospital has become more efficient. His providers, for example, started a program to reduce elective Caesarean-section births before 39 weeks, which can lead to costly medical complications. Fewer babies ended up in neonatal care and, suddenly, a smaller neonatal staff was needed.

“There’s some tension since we haven’t figured out how the funding breaks down yet,” Van Pelt said. “Everyone is a little anxious.”

To alleviate some of that worry, Kitz­haber is looking at creating an innovation fund for the state’s hospital, one that rewards steps taken to reduce the care it provides.

“It’s a huge issue, and there’s no doubt that hospital business models are going to have to change,” Goldberg said. “We’ve started an open, frank conversation about that fact.”

Van Pelt thinks the potential rewards make the risks worthwhile.

“The first few years are going to be very difficult financially, politically and culturally,” he said. “It’ll be about hanging in there. We know this is the right thing for us to do. We all complain about health-care spending, but nobody does anything about it. Now, that’s changing.”

For Kitzhaber, the Medicaid experiment is just a beginning. If the state can achieve savings with this population, he could see using global budgets in the health plans that cover state workers and teachers. The private sector might get on board, too, if it sees proof that quality health care does not have to bankrupt employers.

Kitzhaber estimates that, if every state cut its Medicaid costs as Oregon plans to, the federal government would save $1.5 trillion.

“Medicaid by itself isn’t enough to change things,” he said. “For a lot of hospitals, it’s maybe 7 percent of their business. We have another 600,000 people the state covers. If their health-care costs grow slower, it’s just a game changer for state budgets.”

It’s too early in the game to know whether this bet will pay off.

By Andrea Damewood, Willamette Week, Dec. 3, 2012

Portland Police Chief Mike Reese, standing off to the side at the news conference.

READ – Statement of Findings of the DOJ investigation of the Portland Police Bureau, September 2012
READ – Statement of Intent between Portland Police Bureau and Department of Justice, September 2012

WATCH – Department of Justice Use of Force News Conference, September 13, 2012

Assistant Attorney General for the Civil Rights Division Thomas E. Perez Speaks at the City of Portland, Ore., Press Conference

September 13, 2012

READ – this speech on the DOJ web site.

Good morning. It is wonderful to be back here in Portland. I am honored to join Mayor Adams, Chief Reese, and my colleague U.S. Attorney Amanda Marshall to report on the results of our investigation of the Portland Police Bureau, and to discuss the road ahead. Today is an important and exciting day for the people of Portland, and for the dedicated men and women of the Portland Police Bureau.

I would like to thank Mayor Adams and Chief Reese for their cooperation throughout this investigation. When we announced our investigation, Chief Reese observed that this is a “unique opportunity to be at the forefront of best practices.” You correctly noted that Portland is not the only city that is addressing the difficult issue of providing police services to people with mental illness. Mayor, you noted at our announcement that you were “humbled in the knowledge that we don’t have it all figured out.” Both the Mayor and the Chief expressed an understandable and well-founded pride in your police department, and pledged their complete cooperation. They delivered on that pledge, were consistently responsive to our document requests, maintained an open door and open file policy throughout our site visits, and have been very receptive to our feedback. I would also like to thank the officers of the Portland Police Bureau for their cooperation and feedback. Our job is to make your job safer and more rewarding. Finally, we are very grateful to the community. We held a town hall meeting, conducted scores of interviews, and listened and learned from so many community members. Your perspective was and continues to be critical, and we will continue to seek out your views.

As a result of the cooperation we received throughout the investigation, we made remarkable progress in record time. As U.S. Attorney Marshall pointed out, we have completed our review; we have diagnosed the problem; identified its root causes; and have reached a preliminary agreement with the city of Portland and PPB, which will remedy the problems and enhance both officer and public safety, while allowing PPB to be at the forefront of best practices.

As U.S. Attorney Marshall outlined, for more than a year, the Justice Department has been conducting an in-depth investigation of PPB’s use of force, with a particular focus on its interactions with people with mental illness or in mental health crisis. Our review was prompted in large part by the high number of officer involved shootings of people with mental illness. The investigation was driven by a single goal: to ensure that Portland is served by an effective, accountable police bureau that controls crime, respects the Constitution, and earns the trust of the public it protects.

Our investigation was exhaustive and was conducted by department attorneys, investigators and subject matter experts, including police practices experts and a psychiatrist who specializes in working with law enforcement to develop models for effective interaction with people with mental illness. We conducted a thorough review of use of force by PPB officers, which included reviewing thousands of pages of documents, and conducting extensive outreach to the community, through hundreds of interviews with community members, mental health service providers, city officials, PPB officers, supervisors and command staff. We looked at a range of police interactions, including encounters with people who have mental illness or were perceived to have mental illness. Let me focus on the problem we identified. Based on our review, we have concluded that, while most uses of force were lawful, there is reasonable cause to believe that PPB is engaged in a pattern or practice of using excessive force against people with mental illness, or those perceived to have mental illness. We found that encounters between PPB officers and persons living with mental illness too frequently result in a use of force, or in a higher level of force than necessary. We further found that, when dealing with people with mental illness, PPB officers use electronic control weapons, or tasers, in circumstances where the use of tasers was not justified, or deploy them more times than necessary. Finally, in situations where PPB officers arrest people with mental illness for low level offenses, we found that there is a pattern or practice of using more force than necessary in these circumstances.

It is important to reiterate that the challenges we identified here are not unique to Portland. Police work has transformed dramatically in recent years. One Portland officer described how years ago, encounters with people who have mental illness were few and far between. Today, it is a daily occurrence for most officers, and often occurs more than once per day. Communities across the United States are wrestling with how to deliver police services to people with mental illness. We have seen and are working on these issues in other communities and believe that the work we do here in Portland will serve as an important guidepost for communities facing similar challenges.

Let me next turn to root causes. We conclude that deficiencies in policy, training and supervision contribute to the problems we identified. These underlying deficiencies have existed for many years, and precede the tenure of Mayor Adams and Chief Reese. While they did not create the problems, they own the problems, and they have accepted ownership of both the problems and the solutions. They wasted no time in beginning the reform process. A number of critical reforms are already in place. When we presented our findings to them, we immediately pivoted to brainstorming and problem solving, even though they did not agree with everything we found.

As a result, we have reached a preliminary agreement with the city and PPB about the path forward. We have developed a blueprint for sustainable change that will enhance public safety and officer safety, ensure constitutional policing, and enhance public confidence in PPB. The blueprint, which we are in the process of memorializing into a binding, court enforceable agreement, will require PPB to do the following:

• Develop state of the art policies and protocols for interacting with people who have mental illness or are perceived to have mental illness;
• Dramatically expand its capacity to provide services to people with mental illness by expanding its mobile crisis unit, establish a mental health desk at the Bureau of Emergency Services so that 911 calls are properly funneled to the appropriate response team, and assist in leading efforts to increase community mental health treatment options, such as 24 hour walk-in centers and other facilities that expand options for police officers seeking to assist a person who is experiencing a mental health crisis;
• Revamp and expand training related to crisis intervention and use of force;
• Enhance usage of its early warning system to better identify officers whose actions may require review;
• Ensure that effective supervisory and accountability systems are in place to review use of force; and
• Create a mechanism for ensuring that community stakeholders and front-line officers have a meaningful opportunity to weigh in on critical reforms.

Before we finalize any agreement, we want to go back to the community and hear from them again, and hear from other key stakeholders, including police officers. To all who have weighed in during this process, I recognize that this is your agreement; this is your department; this is your community, and we want to ensure that your voice is heard.

I am very excited about our blueprint, and look forward to hearing feedback from key stakeholders in the days ahead. Our goal is to complete our work in the next month.

I am acutely mindful of the fact that this agreement alone will not solve the problem in its entirety. Our findings take place against the backdrop of a statewide mental health infrastructure that has a number of key deficiencies. The absence of a comprehensive, community-based mental health infrastructure means that front line officers confronting a person experiencing a mental health crisis frequently have only two options: take the person to jail or the emergency room. In communities across the country, the largest mental health facility is the jail. That isn’t right. People in mental health crisis are sick, and generally don’t belong in jail. The largest mental health facility in a state or county shouldn’t be the jail. Officers must have additional options, and people in crisis must have additional options. We have worked successfully with other states, such as Delaware, to build a comprehensive community based mental health infrastructure. As the United States Attorney mentioned, we are working here in Oregon with state officials in a constructive, collaborative fashion on the development and implementation of a holistic, community based mental health infrastructure that, when implemented, will enhance both officer and public safety.

Our formal findings in this case are focused on PPB’s interactions with people who have mental illness. While the bulk of our investigation focused on this area, it was not limited to this area. A number of additional concerns were brought to our attention. While we did not make any formal findings regarding these additional concerns, it is impossible to ignore the tensions that exist between PPB and certain communities of color in Portland. Last year, Mayor Adams noted that one reason he welcomed our presence was his hope that this would lead to improved relations between PPB and Portland’s communities of color. We heard consistent and serious concerns from across the city that members this community, particularly the African American community, believe that they are subjected to bias stops and force based on their race. Although these tensions predate Chief Reese’s tenure, they persist to this day.

Our agreement with the city will begin to address these important issues in two ways. First, the new policies, procedures, training and accountability surrounding force will help ensure that unnecessary and unreasonable force is eliminated. Second, a community body will be created to monitor the agreement, collect feedback from the community and provide recommendations to PPB and the department. The mechanism for community engagement and input that we are creating as part of this resolution will not be limited to mental health issues. Rather, it is deliberately designed to create an opportunity for dialogue and action between PPB and communities of color.

Considerable work lies ahead. Change is not easy. Change requires time, persistence, partnership, a sound plan, resources, effective leadership and sustained community engagement. All the ingredients are here in Portland. We have made great progress. I am very confident that we will achieve Chief Reese’s goal of placing PPB at the forefront of best practices. Portland is a great community, and when these improvements are fully in place, it will be an even greater community.

The Department of Justice Reviews The Portland Police Bureau

September 13, 2012

When the Department of Justice announced a federal investigation into our officers’ use of force last year, I said that I welcomed the inquiry and noted that we had even asked for a best practices evaluation. What I said then holds true today: “We are humble in the knowledge that we don’t have it all figured out.”

In its year-long investigation, the Department of Justice has committed to rooting out the issues this City and its Police Bureau face, especially in dealing with a growing population facing mental health crises. I am grateful for the expertise brought to bear in its evaluation.

Sam Adams,
Portland Mayor

The Oregonian, September 14, 2012

Mayor Sam Adams’ Statement 9/13/12

Dear Portlander,

Two years ago, community leaders, Portland City Commissioner Dan Saltzman and I asked the U.S. Department of Justice’s Civil Rights Division to review the Portland Police Bureau for bias, regardless of whether or not it is intentional, unconscious or institutional. Anything.

During this federal investigation, we opened our books, our doors and our minds.

Yesterday, I received a 42-page letter detailing the findings of their 14-month investigation.

It includes a critique of our financially-starved community-based mental health system. It states, “Our findings take place against a backdrop of a mental health infrastructure that has a number of key deficiencies…” with, “…insufficient options for adequate community based mental health services.”

Given our anemic community-based mental health system, I appreciate that the findings note that the already tough job of our police officers has gotten even tougher, with situations that “…often shifts to law enforcement agencies the burden of being first responders to individuals in mental health crisis.”

In my last budget, this local mental health system crisis was a key reason I did not cut sworn police or firefighter positions. My thanks to the hardworking officers of the Portland Police Bureau for working in a tough situation.

I am pleased that the findings state that, “…most uses of force we reviewed were constitutional…” that “…many of the systemic deficiencies discussed in this letter originated prior to the current PPB administration, which has been aggressive in pursuing reform.” I agree, we have a great improvement-minded Chief of Police in Mike Reese.

But the findings are blunt in its assessment that we get a failing grade dealing with the growing number of Portlanders who face serious mental illness and addiction. We occasionally use, “…unnecessary or unreasonable force during interactions with people who have or are perceived to have mental illness.”

Without defensiveness or finger pointing, we all need to absorb the seriousness of this critique and the urgent need for change. We all need to take our portion of the responsibility to improve the situation.

We will improve and we will begin to do it quickly.

Some needed changes are already underway. Like our new Police Training Center and Citizen Advisory Council. Like the diverse classes of new police recruits, drug testing and officer evaluations. I have agreed in concept to others changes in the letter of agreement:

1 Use of Force: The City is committed to revise its use of force policies to ensure that officers have necessary guidance when encountering someone with mental illness or perceived to have mental illness. In particular, the City will enhance its policy guidance on the use of Electronic Control Weapons (ECW) and techniques to de-escalate encounters arising from non-criminally related well-being checks and arrests for low level offenses.

The Chief’s initiative to ensure that supervisors respond to the scene of uses of force will be continued and there will be meaningful use of force reviews through the chain of command. Training curricula will be reviewed and adjusted where appropriate to reflect the requirements of the agreement.

2 Crisis Intervention: PPB will continue to provide crisis intervention training to all officers. In addition, it will expand its Mobile Crisis Unit to ensure availability at all times and enhance non-law enforcement capacity to respond to persons in crisis that do not pose a public safety threat. Each Mobile Crisis Unit team will consist of one specially trained officer and one specially trained mental health worker from a local social services agency.

The City agrees to establish a mental health desk at Bureau of Emergency Communications (911) staffed by trained dispatchers to ensure that calls are properly dispatched. BOEC will also direct suicide prevention/mental health calls to the County Crisis Call Center or Lines for Life when on-site PPB response is not appropriate.

The City also agrees to lead efforts to increase community mental health treatment options, such as through the establishment of a 24 hour secure drop-off and walk-in center that will provide police officers more options when assisting persons experiencing a mental health crisis.

3 Early Intervention System: The City has a robust Early Intervention System (EIS) that can track officer specific information as well as unit level and trend data. The City will utilize the system to identify individual officers, supervisors, and units for non-punitive corrective action, and to assess gaps in policy, training, supervision and accountability.

4 Misconduct Investigation: Investigations of allegations of officer misconduct are effective and fair to the officer, complainant and community only if they can be completed in a timely manner. The City agrees to take necessary steps to expedite the investigations of those complaints while preserving the thoroughness and quality of investigations and community participation.

5 Community Engagement and Outreach: Community participation in the oversight of this agreement will be important to its success. A community body will be adopted to assess on an ongoing basis the implementation of this agreement, make recommendations to the parties on additional actions, and advise the Chief and Mayor on strategies to improve community relations. The body will also provide the community with information on the agreement, its implementation and receive comments and concerns. Membership will be representative of the many and diverse communities in Portland, including persons with mental illness, mental health providers, faith communities, minority, ethnic, and other community organizations, and student or youth organizations.

These reforms and new resources will propel the Portland Police Bureau further down the path as it becomes the best local peacekeeping agency in the nation.

I welcome your thoughts and ideas.

Thank you,

Sam Adams – Portland Mayor

Feds: Portland Police Bureau has pattern of excessive force

From KGW.com, September 13, 2012

A U.S. Department of Justice investigation concluded that the Portland Police Bureau engages in “a pattern and practice of excessive use of force,” specifically when dealing with the mentally ill, U.S. Attorney Amanda Marshall announced Thursday.

The investigation found such use of force violates the U.S. Constitution. Still, she said, the problems revealed in the probe are not unique to Portland and the vast majority of PPB’s use of force falls within constitutional limits.

The investigation was launched in June, 2011 to examine the use of deadly force against all citizens, with a specific look at the mentally ill.

The PPB had a “high number of officer-involved shootings, especially those involving people with mental illness,” Assistant Attorney General for the Civil Rights Division Thomas E. Perez explained at a press conference Thursday.

The findings revealed that too often Tasers and other uses of force were used when they were not necessary, Perez said.

He said training deficiencies within the department helped lead to the civil rights issues, and department has wasted no time in beginning the process of improving.

The investigation followed several controversial police shootings, including the death of Aaron Campbell. The January 2010 incident sparked protests and one officer was fired for his use of deadly force.

Another high-profile case was the death of James Chasse, who died in PPB custody after an encounter with police in Old Town in September 2006. Officers said Chasse appeared to be urinating outdoors and when he tried to get away they tackled him. His autopsy revealed that Chasse suffered 26 rib fractures and a punctured lung.

Investigators said they would look for systemic problems within the PPB and would also meet with community leaders outside of the bureau.

A press conference was scheduled for 10:30 a.m.

Mental health expert: PPB report good 1st step

From KGW.com, September 13, 2012

A federal investigation has concluded the Portland Police Bureau has a pattern of excessive use of force, and a mental health advocate told KGW the findings should be seen as a positive step.

But he said the agreement between the Dept. of Justice and the bureau lacks the teeth to effect significant change.

Chris O’Connor is a local attorney and board member of the Mental Health Association of Portland.

He agrees with the conclusion that there is a lack of infrastructure to deal with people suffering from mental issues. But he does not agree that the suggested policy changes laid out Thursday–like expanding the city’s mobile crisis team–will reduce excessive use of force cases involving the mentally ill.

“At the end of the day, there’s still no power in the hands of civilians,” O’Connor said, “to remove dangerous officers or discipline in a meaningful way, those who are violating their own policies,”

O’Conner believes local governments need to redirect resources to provide mental health services up front, instead of arresting and incarcerating people suffering from them.

Report: Portland police using excessive force against mentally ill

From KOIN Local 6, September 13, 2012

Portland police officers use excessive force against people with mental illnesses, a U.S. Department of Justice report has found.

The Justice Department presented its findings in a press conference Thursday in downtown Portland. The investigation, which began in June of 2011, determined that the “Portland Police Bureau (PPB) has engaged in an unconstitutional pattern or practice of excessive force against people with mental illness,” according to a press release.

The joint investigation by the Civil Rights Division Special Litigation Section and the U.S. Attorney’s Office for the District of Oregon focused heavily on the police response to mental health situations. There was “reasonable cause to believe that PPB engages in a pattern or practice of excessive force, in violation of the Fourth Amendment of the U.S. Constitution and the Violent Crime Control and Law Enforcement Act of 1994, in certain contexts,” the department said.

Specifically, the report found that officers are often utilizing Tasers for situations that do not justify their use, and furthermore, that they frequently Taser someone more times than necessary. It also found that officers will often use excessive force for what it termed “low level offenses.”

At Thursday’s press conference, Assistant Attorney General for the Civil Rights Division Thomas Perez said that over the last three years, Portland police have used deadly force 12 times, 10 of which involved people with mental health issues. Perez cited longstanding training practices as the root cause of the problem.

“These underlying deficiencies have existed for many years, and precede the tenure of Mayor Adams and Chief Reese,” Perez said. “While they have not created the problem, they own the problem, and they have indeed accepted ownership of both the problems and the solutions that lie ahead.”

The Justice Department stated that the 42-page report was presented to Portland Mayor Sam Adams and Portland Police Chief Mike Reese, who were in attendance at Thursday’s press conference. A preliminary agreement has since been reached to make changes to PPB officer training, practices and supervision, the Justice Department said.

Perez disclosed that Portland police cooperated fully with the over one-year long investigation, maintaining what he called an “open door policy.”

In response to the report, Adams issued a statement that read, in part:

“The findings are blunt in its assessment that we get a failing grade dealing with the growing number of Portlanders who face serious mental illness and addiction… Without defensiveness or finger pointing, we all need to absorb the seriousness of this critique and the urgent need for change.”

The mayor laid out a series of changes that will be implemented, including setting up a mental health desk at the Bureau of Emergency Communications (BOEC) and expanding its Mobile Crisis Unit, which handles mental health calls.

Q&A: DOJ Critical Of Portland Police Over Use Of Force

From OPB News, September 13, 2012

LISTEN – OPB News Q&A on police and civil rights, September 13, 2012

The U.S. Justice Department announced Thursday that the Portland Police Bureau has “engaged in a pattern and practice of excessive force against people with mental illness.”

OPB’s Kristian Foden-Vencil has been covering this issue and joins us in the studio now. Hello.

Kristian: Hi, Beth

Beth: This sounds pretty serious. Can you give us a little background?

Kristian: Absolutely. Last year, Mayor Sam Adams, Commissioner Dan Saltzman and many others called for a civil rights investigation into the police.

It came after a series high profile cases, like the shooting of Aaron Campbell, who was distraught over the death of his brother; and the death of James Chasse, who was mentally ill and died after being forcibly arrested.

So, the Department of Justice has now finished that investigation and delivered this report.

Beth: Apart from the finding that police use unreasonable force against people with mental illness, what else was in the report?

Kristian: Well it’s extensive and it found officers used stun guns when they weren’t justified – or stunned suspects repeatedly without reasonable cause.

One example in the report, involved a man who was screaming in his apartment. Police got a key and found him naked on the floor shouting for help. When he saw them, he leapt-up and ran towards them. But an officer immediately fired his stun gun. The man fell to the ground and when he attempted to get up, he was stunned three more times. Anyway, it turned out he was diabetic and experiencing a medical emergency.

So the report has several of those kinds of examples and it concludes that the police bureau acted unconstitutionally.

But I want to make it clear that the Justice Department did not to point to problems with individual officers. Instead, the Department found that there are key deficiencies in the mental health infrastructure which leave police as the line of last resort when dealing with the mentally ill. Here’s Assistant U.S. Attorney General Thomas Perez.

Thomas Perez: “The challenges we identified in Portland, are not unique to Portland. Police work has transformed dramatically in recent years. I remember vividly a Portland police officers who described how, years ago, encounters with people who have mental illness were few and far between. Today that person pointed out, it is a daily occurrence.”

Beth: How have the police bureau and Mayor Sam Adams reacted?

Kristian: Well, the mayor said there’s a need for change and that the police bureau has already begun that change. He was also pleased the report highlighted the problems in Oregon’s mental health system.

Sam Adams: “Without defensiveness or finger pointing, we all need to absorb the seriousness of this critic and urgent need for change. We all need to take our portion of the responsibility to change the situation.”

Kristian: The chief of police, Mike Reese, took the report hard. He was sombre, but stressed that his agency has already entered into a preliminary agreement with the Department of Justice to rectify the situation.

He told me afterwards that his officers will be trained to look for the difference between a suspicious criminal and someone who is mentally ill or in crisis.

He said officers will be trained to de-escalate situations and check to see if someone is not taking commands because they’re being belligerent or because they’re having mental health problems.

Finally, he said he’s hoping for new tools, that will provide officers the information they need when they’re in a tricky situation.

Mike Reese: “There’s a lot of information that health care providers have, that we don’t have access too and in a moment of crisis I think we should access to that information if we’re going to provide a better service to that person. Conversely we have a lot of information we would be happy to share with mental health providers so that they know this person is interacting with police frequently. There are things we can do in terms of dispatch protocols. So when dispatchers take that 911 call from a citizen, and they ask, police, fire or medical, we want them to ask mental health.”

Beth: Finally, how are people in the mental health community reacting to this report.

Kristian: Good question. In a nutshell, they’re pleased. Derald Walker of Cascadia Behavioral Health says he hopes this will wind up helping the mentally ill.

Derald Walker:“I think sometimes unfortunately what has to happen in these situations is that the Department of Justice has to step in, render an opinion and almost force our system to provide the funding necessary to really get us up to where we should be.”

Beth: So, what’s next?

Kristian: Well, a series of public meetings will be organized for the next month. That’ll give Portland residents a chance to look at the preliminary agreement — and perhaps add their own recommendations.

Beth: Thank you Kristian.

Kristian: My pleasure.

Justice Dept.: Portland police use excessive force, particularly against mentally ill

From the Oregonian, September 13, 2012

The Portland Police Bureau has engaged in a “pattern and practice” of excessive use of force, particularly against mentally ill suspects, the U.S. Justice Department has concluded after a 14-month investigation.

U.S. Attorney for Oregon Amanda Marshall announced the findings at a news conference Thursday.

Marshall said the findings of the report were “grave and serious.”

The report found problems with Portland Police Bureau’s policies, training and supervision.

Assistant U.S. Attorney General Thomas E. Perez pointed to deficiencies in Oregon’s statewide infrastructure for mental health. He added that it was impossible to ignore the “the tensions that exist” between police and communities of color in Portland.

The federal inquiry also found that Portland police have too frequently used Taser stun guns on suspects.

Officials at the news conference said that the Justice Department and the police bureau had reached a preliminary agreement to implement changes that address the problems highlighted in the report.

The agreement calls for community feedback and input on Portland police practices.

Mayor Sam Adams, who also attended the news conference along with Police Chief Mike Reese, said, “Without defensiveness or finger-pointing, we all need to absorb the seriousness of this critique.”

He said the police bureau already has begun making changes, citing the creation of a new training center and police training advisory council.

“There is an urgent need for change,” Adams said.

Reese reacted to the report by saying, “It’s disappointing to learn the Department of Justice believes you haven’t got it right.”

But he also said he sees room for bettering the way the bureau works.

“We need to react to people in mental health crisis with empathy and compassion,” Reese said. “We can’t treat them the same way we treat a bank robber.”

He said the bureau needs to forge better relationships with social services partners.

“We all agree this bureau and this community can improve the way we serve Portland’s vulnerable population,” Reese said.

Feds find cause to believe Portland police use excessive force on mentally ill

From CNN.com, September 13, 2012

Federal civil rights investigators have found “reasonable cause” to believe that police in Portland, Oregon, use “unnecessary or unreasonable force” with persons who have mental illness, the U.S. Justice Department said.

The department’s civil rights division and U.S. Attorney’s Office in Oregon issued a letter to Portland Mayor Sam Adams stating that local and federal authorities will “continue our collaborative relationship to craft sustainable remedies.”

In the 42-page letter, federal officials outline remedies that include training and new policies to investigate alleged police misconduct.

Investigators found cause to believe that the Portland Police Bureau engages in “a pattern or practice of using excessive force in encounters involving people with actual or perceived mental illness.”

“We found instances that support a pattern of dangerous uses of force against persons who posed little or no threat and who could not, as a result of their mental illness, comply with officers’ commands,” said the letter, which was signed by Assistant Attorney General Thomas E. Perez and U.S. Attorney Amanda Marshall.

“We also found that PPB employs practices that escalate the use of force where there were clear earlier junctures when the force could have been avoided or minimized.”

One incident in December 2010 involved several officers who used “repeated closed-fist punches and repeated shocking of a subject who was to be placed on a mental health hold,” the letter said.

Adams, in a posting on his web page, vowed that the city and its Police Bureau would improve quickly, and listed a series of changes:

– The city will revise its use-of-force policies — particularly those regarding the use of stun guns — “to ensure that officers have necessary guidance when encountering someone with mental illness or perceived to have mental illness.”

– The police will expand their Mobile Crisis Unit — composed of an officer and a mental health worker — “to ensure availability at all times and enhance non-law enforcement capacity to respond to persons in crisis that do not pose a public safety threat.”

– The city will establish a mental health desk at its 911 calling center to ensure calls are properly dispatched.

– The city will lead efforts to boost community mental health treatment options, such as establishing a 24-hour secure drop-off and walk-in center, “that will provide police officers more options when assisting persons experiencing a mental health crisis.”

– The city will use an early intervention system to identify officers, supervisors and units “for non-punitive corrective action, and to assess gaps in policy, training, supervision and accountability.”

– The city will move to speed investigations of complaints about possible officer misconduct.

– A community body composed of representatives of a variety of groups will assess how well the agreement is being implemented, offer recommendations on additional steps, and advise the police chief and Adams on how to improve community relations.

Justice Department cites five instances to show Portland Police’s pattern of excessive force

By Helen Jung, The Oregonian, September 13, 2012

The U.S. Department of Justice pointed to five instances from 2010 and 2011, taken from a “larger group of problematic cases” to show the Portland Police Bureau’s pattern of excessive force. These are summarized from Justice Department findings and police reports of the incidents:

May 14, 2010: Police were called to Old Town to investigate reports of a man wandering in the street, spitting on cars and talking to himself. They found Aaron Emanuel Ferguson who “raised his fists to the officer’s face in an effort to show the officer his hospital identification bracelet,” the Justice Department report states. Assistant Sgt. M. Delenikos shoved his fist away and saw Ferguson take “a fighting stance.” He ordered him to back up and then pepper-sprayed Ferguson, who walked backward toward the street. Delenikos warned him to sit or he would use a stun gun on him, but Ferguson didn’t sit down. Delenikos fired his Taser at him four times, claiming that Ferguson “turtled up” and wouldn’t extend his arms to be handcuffed.

Among several issues, the Justice Department report notes that “spitting on passing cars is a low-level offense, if an offense at all and does not warrant this degree of force.” The federal investigators wrote that the supervisor found the use of force to be permissible “and no attempt to even counsel the officer on better tactics was even offered.”

Aug. 15, 2010: Police entered a downtown apartment where they heard the occupant yelling for help and believed him to be suffering a medical emergency. Inside, they saw Anthony Charles Caviness lying naked on the floor. He was unarmed. Police say he leapt up and ran toward them. Officer Joshua Sparks fired his Taser without warning at Caviness’ chest and repeated the cycle three more times. After police handcuffed him, officers learned he was diabetic and suffering a medical emergency.

Federal investigators noted, among other things, that “though the officers may have felt threatened when the individual ran towards them, this threat is mitigated, at least in part, by the presence of three PPB officers facing a naked, unarmed individual.”

Dec. 26, 2010: Two officers were called to help mental health workers who wanted to evaluate Samuel Michael Serrill at an Old Town apartment building. Serrill followed officers’ orders to come out of his room, put his hands on his head and take a seat. Officers verified he had no weapons. After Serrill made incoherent statements, the mental health workers asked police to detain him. Officers grabbed for his arms, but Serrill rolled onto his stomach, hiding his arms under his body, according to the Justice Department report. Officer Chad Phifer warned him to show his arms and then applied his Taser to Serrill’s back. Phifer continued firing it several more times as the man tried to pull away. Phifer then punched Serrill in the ribs as many as six times while Officer Kevin Allen hit the man with a closed first to the back of his neck and shoulders. The officers fired the Taser at him another six times before handcuffing him and taking him to a mental health hospital.

Among other issues, the Justice Department investigators noted “the officers were there to perform a welfare check, not to arrest someone for committing a crime.”

May 15, 2011: Officer Richard Storm went to check on an unarmed man who was standing in the rain in Southeast Portland for more than an hour. They couldn’t communicate because of a language barrier and Storm went to call for help from a Spanish-speaking officer. When Storm stepped out of his car, Fausto Brambila-Naranjo “kicked at” the officer but did not make contact, the Justice Department report states. Storm grabbed his leg and threw him on the ground. As Brambila-Naranjo rolled onto his back, Storm punched him seven to 10 times in the face while the man tried to grab the officer’s hands to stop the blows. After learning Brambila-Naranjo’s name, Storm recalled he had been reported missing by a group home that was concerned about his diabetes, according to his police report. The Justice Department investigators noted that Brambila-Naranjo was acting in self-defense from being hit in the face: “The officer made no attempt to explain in his (report on use of force) why so many punches to the head were necessary to control the subject.”

May 17, 2011: Officers were called to a home where 42-year-old Joseph James Dowless allegedly threatened his mother and hit her in the head. Dowless had a history of mental illness. Officers were told that he had a sword in his room. Police went up to the son’s room after he ignored their orders to come downstairs. They opened his door and ordered him to stand and put his hands on his head. Although Dowless stood up, he wouldn’t put his hands on his head and moved toward the door, the Justice Departmentreport states. Officer Gedemynas Jakubauskas shot him with a beanbag round. Officer Kevin Wolf wrote in his police report that Dowless then refused to interlace his fingers, prompting Wolf to fire his Taser at Dowless’ back. This occurred, the Justice Department report noted, even though Dowless’ hands were clearly visible and officers didn’t see a sword or any other weapon in his possession. “There were less intrusive alternatives available than shooting the suspect with a bean bag gun” and Tasing him, the federal report said.

Portland police promise improved approach to mental illness after scathing Justice Department report

By Maxine Bernstein, The Oregonian, September 13, 2012

Facing an ultimatum from the U.S. Department of Justice, the Portland Police Bureau Thursday pledged to pair more officers with mental health experts, bring back a specialized team of experienced officers to respond to mental health calls and help reroute certain 911 calls to mental health providers.

These are some of the reforms that the bureau has agreed to make after federal justice officials announced they’ve found Portland police have engaged in a pattern and practice of using excessive force against people who suffer from or are perceived to suffer from mental illness.

Many of the Justice Department’s recommendations aren’t new. Community activists, mental health advocates, lawyers who have sued the police bureau, and even some Portland officers have urged the bureau to take similar actions for years, without much success.

“On paper all of the recommendations seem to make sense, and actually parrot lots of complaints that the community and people like me have been making for a long time,” said Tom Steenson, the attorney who represented the families of James P. Chasse Jr. and Aaron Campbell, two men who died in police custody.

Assistant U.S. Attorney General Thomas E. Perez released the highly critical report of Portland police use of force after a 14-month-long federal investigation. Perez stood with U.S. Attorney Amanda Marshall, Portland Mayor Sam Adams and Police Chief Mike Reese in a police bureau conference room at the downtown Justice Center.

Marshall called the findings “grave and serious.” Yet Marshall and Perez said they’re confident the city of Portland would embrace the necessary reforms to ensure people from Portland’s most vulnerable population and their families aren’t afraid to turn to police for help.

The bureau and the Justice Department aim to finalize a more-detailed agreement by Oct. 12, after seeking further community input. The agreement will be signed by a federal judge and could be enforced by the court. Federal justice investigators would provide continued oversight.

“While we have indeed identified serious deficiencies” Perez said, “we have reached a preliminary agreement to improve public safety and to ensure the Constitution is respected.”

Perez highlighted the considerable gaps in mental health care in the state and the high number of homeless people in Portland as conditions that have forced police to serve as first-responders to people suffering mental health crises.

Adams acknowledged the city and police “get a failing grade” in dealing with the mentally ill. He estimated the changes may cost “millions of dollars,” and suggested the city will be working with the county, mental health providers and also pursuing federal grant money to help pay for them.

“Without defensiveness or fingerpointing, we all need to absorb the seriousness of this critique and urgent need for change,” Adams said.

The police chief described his initial reaction as one of disappointment.

“It’s disappointing to learn the Department of Justice believes you haven’t got it right.” Reese said. But while defending his officers, he pledged to move ahead with the reforms.

“We all agree this bureau and this community can improve the way we serve Portland’s vulnerable population,” Reese said. He added, “What we’re talking about today is about process and systems, not about police officers…They’re not the ones to blame. I support them.”

The Justice Department found that Portland police:

• too frequently use a higher level of force than necessary against people suffering from mental illness;

• use Taser stun guns when their use is unnecessary or fire repeated Taser shocks against individuals that are unwarranted; and

• use a higher level of force than justified for low-level offenses.

In a 42-page letter to the mayor, the federal officials found officers frequently escalate conflict, rush in to an encounter when they can hold back, and continue to use force even when the need for it has waned.

Portland police have used Taser stun guns without warning, fired multiple Taser stun gun cycles on a single person and failed to re-evaluate the stun gun’s use between cycles. Even when officers’ Taser use clearly violated existing bureau policy, the Taser deployments later “were approved by the chain of command,” the letter said.

“We found that PPB officers often do not adequately consider a person’s mental state before using force and that there is instead a pattern of responding inappropriately to persons in mental health crisis,” Perez’s letter said. “These practices engender fear and distrust in the Portland community, which ultimately impacts PPB’s ability to police effectively.”

The DOJ said that its expert found Portland officers seem to harbor greater fear of people with mental illness than do officers in other cities.

The federal agency found that the excessive force used by officers results from bureau “deficiencies in policy, training and supervision” that have existed for a long time. Supervisors have failed to hold officers accountable for excessive force, and the city’s process for reviewing police use of force complaints takes too long, is “byzantine” and “self-defeating,” the review found.

The city of Portland has paid out about $6 million in the last 20 years to settle lawsuits related to alleged police misconduct.

“While they have not created the problem” Perez said of the current police administration, “they own the problem.”

Justice officials recommended that Portland police immediately stop using the term “mentals,” which the investigators heard used in a police roll call presentation.

In a footnote, the Justice Department cited as callous the Portland police training division’s use of former Officer Chris Humphreys‘ controversial use of a beanbag shotgun against an unarmed 12-year-old girl as an “exemplary” model of how a less-lethal weapon is used. The federal justice officials informed bureau managers, and Reese then forbade the incident from being used in training.

The proposed settlement between the police and federal justice department calls for an array of changes in bureau policies and practices.

The bureau would revise its use of force policies so officers have “necessary guidance” when encountering someone with mental illness. Taser use would be restricted and officers would be directed to focus on de-escalating encounters. The bureau would expand its single Mobile Crisis Unit team, which pairs an officer with a Project Respond mental health expert, to provide 24-hour, 7-day-a-week coverage. A Mental Health Triage Desk would be created at the dispatch center so that mental health-related calls are properly routed to the appropriate agency.

Under the agreement, the city would also work with community mental health providers to try to open a 24-hour secure center where police could drop off people suffering with mental illness, which would give officers more options. Clients could also walk into the center.

Justice officials also urged the bureau to bring back scenario-based role-playing in its crisis intervention training. The report advocates training officers to go “hands on” to make an arrest after an initial use of less-lethal force, and called for the bureau to find a way to interview officers involved in shootings immediately afterward.

Derald Walker, Cascadia Behavioral Healthcare’s chief executive officer, said many of the recommendations will take added resources. “Like so many thing, it’s all about the money,” Walker said. “It’s going to require a huge amount of political and public will to see that happen.”

Officer Daryl Turner, Portland Police Association president, said he disagreed with the federal agency’s conclusions. He called on the city to hire more officers to meet the requested reforms.

“As Chief Reese has said, the officers ‘are not to blame,’ ” Turner said, in a statement.  “Nevertheless, we all can take comfort in at least two things – the USDOJ did not find a pattern and practice of unreasonable force against any particular race, nor did the USDOJ find a pattern and practice of unreasonable deadly force.”

Perez, at Thursday’s news conference, said there were obvious “tensions that exist between the Portland Police Bureau and communities of color.” Perez said he hoped a new community group set up to monitor the proposed bureau reforms will also work to address this problem, as well.

He urged the bureau to conduct a bureau-wide “intensive cultural sensitivity and competency training.”

“All citizens – especially our most vulnerable – must be able to trust the police,” Perez said.

Mental health in Oregon: State has more work to do

By Michelle Cole, The Oregonian, September 13, 2012

At the podium, Amanda Marshall, U.S. attorney for Oregon. Behind her (L to R): Assistant U.S. Attorney General Thomas E. Perez; Portland Police Chief Mike Reese; Portland Mayor Sam Adams.

Six years ago, the U.S. Department of Justice launched an investigation into Oregon’s mental health system. A lot has happened since then but advocates say a person in the throes of a mental health crisis may actually be worse off today.

That was crystal clear Thursday when the federal Justice Department released an investigation into the Portland Police Bureau that concluded the “absence of a comprehensive community mental health infrastructure” means police are shouldering the burden of being the first to respond to people in crisis. That, despite the fact that Oregon has a new, state-of-the-art mental hospital.

The Justice report, released Thursday, quotes one “high level” Portland Police officer who said he used to encounter people suffering mental health issues “a couple of times a month.” Now it’s “a couple of times a day.”

Everyone seems to agree that the Portland Police report focuses on fixing a short-term crisis but the state needs to continue to work toward long-term solutions.

There are a lot of people working to improve mental health care in Oregon, says Bob Joondeph, executive director for Disability Rights Oregon.

“But I would not say that we have a significant change in conditions on the ground,” he adds. “That may be even worse because there are fewer resources available now than there were a few years ago.”

Still, Joondeph and other advocates say they’re hopeful about national health care reforms, which broaden insurance coverage for more people, and about Oregon’s new coordinated care organizations, intended to focus on prevention and integrate physical and mental health care.

U.S. Justice Department officials are also waiting to see whether the health reforms will take care of their concerns.

In 2006, federal officials warned Oregon that conditions at the state mental hospital violated patients’ civil rights. The state built a $458.1 million hospital in Salem.

Then, in 2010, the Justice Department widened its inquiry, looking at whether Oregonians with mental illness were able to receive care in their communities rather than in a large hospital far from home.

Just as it appeared that federal officials were running out of patience with Oregon’s progress, Gov. John Kitzhaber persuaded them to give the state more time.

The Justice Department agreed.

“We want to be sure we get it right,” Thomas Perez, the department’s top civil rights lawyer said Thursday.

Dr. Bruce Goldberg, head of the Oregon Health Authority, said Oregon has added about 100 beds — community residential treatment or supported housing — in the past two years, Goldberg said.

“It’s good, but it’s not enough,” he acknowledged. “I think we need to do more … Part of the issue is we’ve been challenged as a state by our economic issues.”

Beckie Child, an advocate who has dealt personally with mental health issues, says she wants to see the state invest in housing and peer support for people in treatment.

“They’ve been talking at the 90,000-foot-level and not what it is like for folks on the ground,” she said.

The state is planning to build a new 174-bed hospital in Junction City, though patient advocates argue that it would be better to spend the money helping people get care in their communities.

“The Health Authority needs to talk about how it’s going to make an investment to keep people out of crisis,” said Chris Bouneff, executive director for the National Alliance on Mental Illness in Oregon.

Instead, Bouneff says, state officials are “fixated on a giant institution in Junction City.”

Senate President Peter Courtney, D-Salem, says the simple fact that Oregonians are talking more openly about mental health care is a sign of progress.

Several years ago, Courtney was taken into what he calls the “room of lost souls,” where thousands of corroding cans containing the ashes of former hospital patients had been stored and forgotten.

For him, that became a symbol of the state’s long-neglected mental health system.

“We’re moving in the right direction because the only direction we could move was up,” he said. “Are we going fast enough? No. Are we anywhere near where we should be? No.”

Portland officer apologizes for ‘knee-jerk’ message criticizing federal inquiry

By Maxine Bernstein, The Oregonian, September 14, 2012

Portland Police Officer John Hurlman was seated in his patrol car Thursday morning, listening to a local radio station’s coverage of a news conference at police headquarters. Federal justice department officials were about to unveil their findings after more than a yearlong review of Portland police use of force.

Hurlman sent a text message out to all officers on the patrol car’s mobile computer, alerting them to tune in.

Shortly after the U.S. Attorney Amanda Marshall started to speak, another officer texted the news back to all: the U.S. Department of Justice had found that Portland police engage in a pattern and practice of excessive force against people suffering from mental illness.

Annoyed by the outcome, Hurlman said he typed back something like, “This is the same DOJ or people who created Waco and Ruby Ridge.”

The North Precinct officer was referring to two of the biggest federal law enforcement fiascoes in recent memory: the disastrous 1993 federal raid on the Branch Davidian compound at Waco, Texas. The other, the tragic 1992 encounter between the FBI and a band of white separatists at Ruby Ridge, Idaho.

Hurlman said he thought he had just responded to one officer but soon learned his message had popped up on all patrol officers’ mobile computers.

“It was kind of a knee-jerk reaction,” said the 21-year Portland police veteran. “In the current political climate, it wasn’t appropriate. On second-thought, I probably shouldn’t have done it.”

Yet Hurlman doesn’t hide his anger with the Justice Department’s ruling regarding Portland police.

“I was really annoyed at that moment, and, in fact, I think it’s nonsense,” he said Friday of the federal review. “Quite frankly, we’re being judged by people who don’t have much law enforcement experience.”

Hurlman said he was one of the original Portland officers to volunteer for crisis intervention training, before it became mandatory for all officers.

“We all know the lengths we go to to try to defuse these situations peacefully,” he said. “Nobody wants to go out and harm someone who is mentally ill.”

North Precinct Cmdr. Mike Leloff soon learned of the patrolwide message and called Hurlman into his office for a stern talk. Hurlman said Leloff appropriately, “chewed him out.”

As a result, Hurlman later Thursday texted an apology to all on his patrol car’s mobile computer.

He said it read something like this: “To those who received my earlier message, my remarks were unprofessional and insensitive. I apologize to anyone who received it.”

Portland Lt. Robert King said Friday, “The issue was addressed immediately by the Command Staff and the matter has been dealt with appropriately.”

Hurlman was back on patrol Friday, responding to emergency calls at North Precinct. He said he was advised to be careful about what he says and remain respectful.

A day after the federal report was made public, Hurlman added Friday, “People here are frustrated, to put it mildly.”

Portland Police Chief Responds To Federal Investigation

OPB News, Sept. 17, 2012

Portland Police Chief Mike Reese

Last week, the federal Department of Justice released the results of a long-running investigation into how Portland Police officers use force. It that found a pattern of excessive force, especially with people with mental illness.

Monday, on OPB’s Think Out Loud, Police Chief Mike Reese discussed the findings and the future of his bureau.

Host Dave Miller asked Reese what the ideal role would be for police to play with someone with mental illness.

LISTEN -

OTHER NEWS:

Feds: Portland police use excessive force, The Seattle Times, September 13, 2012

Portland police to reform dealings with mentally ill suspects, Los Angeles Times, September 13, 2012

Portland Police used deadly force, often against mentally ill, in 13 cases since 2008, The Oregonian, September 13, 2012

Portland police used excessive force on mentally ill – report, Chicago Tribune, September 13, 2012

Feds: Portland, Ore., police use excessive force against mentally ill, U.S. News & NBC News, September 13, 2012

Department of Justice: Portland Police Used Excessive Force Against People with Mental Illness, The Skanner, September 13, 2012

Feds: Portland, Ore., police use excessive force, San Francisco Chronicle, September 13, 2012

Federal justice agency reaches ‘preliminary agreement’ with Portland police on needed reforms, The Oregonian, September 13, 2012

Feds: Portland Police Bureau uses ‘excessive force’ with mentally ill, KVAL, September 13, 2012

Q&A: DOJ Critical Of Portland Police Over Use Of Force, OPB, September 13, 2012

Portland Reaches Agreement About Police Bureau’s Use of Force Against Mentally Ill, Opposing Views, September 14, 2012

U.S. inquiry finds Portland police use excessive force, The Bend Bulletin, September 14, 2012

Portland police use excessive force on mentally ill, Feds say, q13Fox (Seattle), September 14, 2012

Portland police efforts to fix crisis response are a failure, feds say, The Oregonian, September 15, 2012

Federal justice report on Portland police use of force to be released today

From the Oregonian, September 13, 2012

Officials from the U.S. Department of Justice Thursday morning are expected to announce the federal agency’s findings from a more than 14-month-long investigation into Portland police use of force.

Thomas Perez, Assistant Attorney General for the Civil Rights Division

The federal agency opened a civil rights investigation June 28, 2011, to determine whether the Portland Police Bureau engages in a “pattern or practice’’ of excessive force, particularly against people with mental illness.

Assistant U.S. Attorney General Thomas E. Perez came to Portland last June to announce the federal inquiry. He said then that the review was prompted by a significant increase in police shootings during the prior 18 months, the majority involving people with mental illness.

Perez is back in town Thursday, set to announce the findings with U.S. Attorney Amanda Marshall, Mayor Sam Adams and Mike Reese, chief of police, at 10:30 a.m. at the Justice Center, located at 1111 Southwest 2nd Avenue, in Room 14B.

Lt. Robert King, a police spokesman, declined to comment on the nature of the morning’s announcement.

The police investigation was to overlap with an ongoing federal investigation into Oregon’s mental health care system, federal officials said.

Special litigation attorneys in the Justice Department’s Civil Rights Division, along with the U.S. Attorney’s Office, have been evaluating bureau policies, procedures and practices, as well as specific officer-involved fatal shootings or deaths in custody.

In February, federal authorities held their first public forum in Portland’s St. Johns neighborhood to hear citizens’ accounts of their interactions with Portland police officers. And in August 2011, Justice Department officials held individual interviews with community groups.

If violations are identified, the federal agency will recommend remedies and may monitor the Police Bureau until it’s satisfied the bureau has addressed the problems.

Since the inquiry began, Chief Mike Reese has made some changes in response to federal recommendations. He began to require sergeants immediately initiate investigations into officers’ use of force and assigned a new inspector to analyze data on such incidents, a gap identified by the Justice Department during the course of the inquiry. Just last week, the Portland police released its own 4-page statistical report on police use of force, showing a 35 percent decline between 2008 and 2011.

Earlier this year, Reese defended his officers’ use of force. He cited increasing calls involving suicidal people and decried the faltering safety net for those with mental illness.

Portland joined a growing number of police agencies, including Seattle, Newark, N.J. and New Orleans, that have been targeted for federal review in the last few years, under a 1994 law passed by Congress after the brutal beating of Rodney King by Los Angeles police officers.

In Seattle, the federal agency announced this summer that a court-appointed monitor was to ensure that Seattle Police revise its use of force policies, and enhance its training, reporting, investigations and supervision of police use of force. The Justice Department found that Seattle police engaged in a “pattern or practice of excessive force,’’ but did not find a practice of discriminatory policing.

The federal inquiry in Portland – the first comprehensive federal investigation into the city’s police bureau- followed a string of controversial Portland officer-involved fatal shootings or deaths in police custody of people suffering from mental illness.

In February 2010, city officials, including former police Commissioner Dan Saltzman and Mayor Sam Adams, had asked the U.S. Justice Department to conduct a full review of the Police Bureau after the Jan. 29, 2010 police fatal shooting of Campbell, an unarmed black man who was distraught following the death of his brother earlier that day.

Community leaders disturbed by the high-profile police shootings and deaths in custody also pressed for such an inquiry.

Among their concerns: the high profile September 2006 death in police custody of James P. Chasse Jr., a 42-year-old man who suffered from paranoid schizophrenia; the fatal shooting of a 58-year-old homeless man Jack Dale Collins who emerged from a restroom at Hoyt Arboretum with an X-Acto knife; and the shooting of homeless veteran Thomas Higginbotham, who was shot 10 times after he emerged from a Southeast Portland car wash with a knife.

From the East Oregonian, June 15, 2012

The fuzzy outlines of an operation to save the Blue Mountain Recovery Center are coming into focus.

The Pendleton psychiatric facility dodged extinction numerous times in the past 20 years, but is scheduled for closure again in 2015. A group of about 25 individuals, including Oregon Health Authority Director Bruce Goldberg, gathered Friday to devise another 11th hour save or a way to repurpose the center.

State Sen. David Nelson, R-Pendleton, guided the free-flowing discussion between an eclectic group of health care, business, government and law enforcement professionals in the St. Anthony Hospital Blues Room. About half-way through the 1 1/2-hour-long meeting, Kevin Campbell, CEO of the non-profit Greater Oregon Behavioral Health Inc. — known as GOBHI — turned some heads by suggesting that the center could go private. Campbell said letting the facility fade away can’t be an option.

The two-story hospital at 2600 Westgate, formerly the Eastern Oregon Psychiatric Center, sits on 7.43 acres next to the Eastern Oregon Correctional Institution and treats up to 60 patients at a time. It employs 143.

“The footprint of the Blue Mountain Recovery Center is bigger than just Pendleton,” he said.

Relying on the center are 10 smaller private mental health facilities in other Eastern Oregon communities, such as McNary Place in Umatilla, a Lifeways operation, and Columbia Care in Boardman. He said all of the smaller mental health facilities depend on Blue Mountain and could dry on the vine for lack of referrals. Together, they provide more than 100 beds.

“So are you saying you want to run Blue Mountain?” Goldberg asked Campbell. “The state could sell the hospital to you and you’d operate and run it?”

“Talk to us,” said Campbell.

Pendleton Mayor Phillip Houk seemed to like the idea. He had prodded Goldberg earlier in the meeting, calling BMRC a “blue ribbon facility” that has helped a lot of people. He asked Goldberg if the community was spinning its wheels trying to keep the center open.

“It is likely to close,” Goldberg said. “Having said that, there have been times in the past when it was likely to close and it did not.”

Goldberg confirmed that construction has begun on a new 174-bed state psychiatric hospital in Junction City that would replace the 60 beds at the Pendleton hospital and 90 beds rented from Portland hospitals.

The Pendleton hospital, built in the early 1940s, needs an overhaul. Aging plumbing and electrical systems, lead pipes, lead-based paint, asbestos and remodeling would cost $11 million to mitigate. Recruiting psychiatrists to rural Eastern Oregon is difficult.

The discussion ranged from telemedical technology that could abate the need for psychiatrists moving to Pendleton to the burden mental illness puts on law enforcement. But, Campbell’s idea sparked the most hope.

“I believe we need to take proactive steps rather than keep trying to stop the clock,” he said.

“We are ready to sharpen our pencils,” Goldberg promised.

The two and their organizations will talk over the summer, they said. The group planned to reconvene in the fall.

Campbell also serves as CEO of the Eastern Oregon Coordinated Care Organization, a player in the state’s effort to revamp its system of delivering health care to Oregon Health Plan enrollees.

by Alan Gustafson, Statesman Journal, Mar. 26, 2012

The U.S. Department of Justice says it has reached agreement with Oregon officials on a yearslong strategy for reforming the state’s community mental-health system, correspondence obtained by the Statesman Journal shows.

Federal officials said in a recent letter to the state Department of Justice that the agreement paves the way for changes that will “improve the lives of thousands of Oregonians living with mental illness.”

S. Amanda Marshall

If envisioned reforms materialize, that will resolve an ongoing federal investigation of Oregon’s mental-health system, without legal action against the state, wrote Jonathan Smith, chief of the Special Litigation Section of the federal Justice Department, and S. Amanda Marshall, the U.S. Attorney for Oregon.

The newspaper obtained the March 13 federal letter, and a March 23 state response letter, through Oregon’s public records law. The documents were released by the state Department of Justice.

As outlined in the federal letter, the Civil Rights Division of the U.S. Department of Justice, along with mental-health experts hired by the agency, will work cooperatively with the state to identify and plug gaps in the community-based system. Federal involvement in Oregon mental-health reforms could last for several years, the letter says.

“We are hopeful that our work together will address the gaps in, and improve the quality of, the community system for persons with mental illness during the coming years,” it says. “It is contemplated that this process will successfully resolve our investigation once an array of essential community services are in place and positive outcomes are being achieved on agreed-upon metrics.”

The community mental-health system provides services and support for tens of thousands of Oregonians, including housing, case management, crisis services, drop-in centers, job training, living skills training, peer support and more.

Mental-health advocates long have complained about inadequate state funding for community-based services. They have argued that the state spends too much money on mental hospitals, at the expense of the community system. Such concerns have fueled intense opposition to a state plan to build a new psychiatric hospital in Junction City.

The state spends more money in total on community mental-health programs than at the state hospital. The current two-year budget for community care is $434 million; for the state hospital it’s $339 million, although the hospital cares for about 600 patients compared to the thousands of patients in community programs.

Federal officials mentioned the funding controversy in their recent letter to the state.

“Throughout our investigation, we have met with a range of stakeholders, including consumers, advocates, providers and elected and public safety officials,” it says. “We have heard a consistent message that the state must invest more in critical community based services and that investments in institutions – including the proposed hospital at Junction City – are draining resources that should be used to keep people in their homes and in the communities.”

The feds vowed to “continue to meet with these stakeholders as the state implements its reform process to ensure that this agreed-upon process translates to real improvements in the lives of people with mental illness.”

The behind-the-scenes agreement between the federal Justice Department and the state comes nearly six years after federal investigators, in June 2006, launched an investigation into patient care and conditions at the Oregon State Hospital in Salem.

A scathing report issued by the federal agency in January 2008 detailed a multitude of flaws at Oregon’s main mental hospital. The report came as the state was gearing up to replace the outdated and unsafe institution with a new $280 million hospital. The new state hospital complex became fully operational this month.

Amid reform-minded changes at the Salem psychiatric hospital, the federal Justice Department notified Oregon officials in 2010 that it was widening the civil rights investigation to examine state-funded community mental-health programs and services.

Key to the expanded federal inquiry is whether the state is violating provisions of the Americans with Disabilities Act by failing to provide mentally ill Oregonians with adequate community-based services.

Oregon’s push to overhaul health care, led by Gov. John Kitzhaber and Oregon Health Authority Director Bruce Goldberg, “provides a unique opportunity for the state and the Civil Rights Division to work together to address our concerns by embedding reform in the design of the health care system,” the federal letter says.

Under the agreement, specific reforms in the community mental health system will occur in stages during coming years, with desired outcomes spelled out in provider contracts, regulations and other documents, the letter says.

“Initially, the state has agreed to collect statewide system data on the services currently being provided and the people being served,” it says. “Working with the United States and our experts, this data will be transformed into outcome measures that will be included in plan documents, contracts and regulatory materials. We contemplate working cooperatively with the state for the next several years. In this unique context, we are optimistic that the iterative process to which we have agreed will improve the lives of thousands of Oregonians living with mental illness.”

In a March 23 response to the federal officials, Oregon lawyer John Dunbar, head of the Special Litigation Unit of the state Justice Department, expressed optimism about moving forward, along with some concerns.

“We agree that we have made tremendous progress,” he wrote. “We are appreciative of USDOJ’s outcome-driven approach, and we are glad to see you share our desire to avoid costly, wasteful litigation if possible.”

However, the state attorney also noted that he had “some substantive concerns” about the federal letter. For example, he said the document “appears to overstate the state’s commitments,” and he took issue with some of the reform metrics, or measurements, outlined by the feds.

“We should be able to straighten these issues out, but I wanted to make sure we were all on the same page so that misunderstandings don’t develop,” Dunbar wrote.

On Monday, two leaders of Oregon mental-health advocacy groups said they were encouraged by the accord on mental-health reforms.

“I think the overall message is that this is very encouraging and the timing is very good,” said Bob Joondeph, executive director of Disability Rights Oregon. “As in the spirit of health care reform, we’re hoping as advocates to have some input into this before it’s memorialized.

“It’s very much a breakthrough,” he added. “Interestingly enough, it’s a breakthrough that is very consistent with what Oregon is doing to reform its health care delivery system in the Medicaid world. So it may just be that the timing was right.”

Chris Bouneff, executive director of NAMI Oregon, a chapter of the National Alliance on Mental Illness, said: “It will take some time to digest the spreadsheets of measurements to draw a conclusion. At a rough first glance, the progress seems positive.”

Bouneff said he was put off, though, by Oregon’s objections to some of the reform measurements sought by the feds.

“One glaring omission on Oregon’s side is the state’s unwillingness to accept certain process measures that are widely credited with improving outcomes,” he said.

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From the Salem Statesman Journal, November 28, 2011

The administrator of the $458 million Oregon State Hospital replacement project will shift to a new job early next year, becoming interim director of the state office of addictions and mental health treatment programs.

Linda Hammond, who steered construction of the Oregon State Hospital replacement project, will become interim director of the state office of addictions and mental health treatment programs.

Linda Hammond, who has steered construction of a soon-to-be-completed state hospital complex in Salem, will succeed Richard Harris as head of the Addictions and Mental Health Division, or AMH.

Harris is retiring in January.

Bruce Goldberg, director of the Oregon Health Authority, announced the looming leadership change in an email circulated Wednesday.

Goldberg credited Harris for providing “innovative, thoughtful and inspirational” leadership “during a time of great change and challenge for our agency.”

Harris’ accomplishments included hiring Greg Roberts, the current superintendent of the state hospital, and overseeing transformation of the 128-year-old psychiatric facility “into a place of hope, healing and safety,” Goldberg said.

He said Hammond is the right person to step in as interim AMH director, citing her “strong administrative experience and a proven ability to lead people through change.”

Goldberg said a national search for a permanent director will be conducted in the summer.

Hammond has received kudos from state leaders for keeping the hospital replacement project on schedule and within its budget.

Completion of a state-of-the-art 620-bed hospital in Salem is scheduled for early next year. After that, construction will start on a smaller mental hospital on state prison land in Junction City.

In 2007, legislators approved construction of two hospitals to replace the crumbling, long-neglected psychiatric hospital in Salem, which opened in 1883 and was deemed obsolete and unsafe by state-hired consultants in 2005.

For the past several months, Hammond has held a dual role — as administrator of the hospital replacement project and interim chief financial officer for the Oregon Health Authority.

In an email to co-workers Wednesday, Hammond said Jodie Jones, deputy administrator of the hospital replacement project, will take the reins as its administrator.

“What I realized while I was in my dual-roles of interim chief financial officer and project administrator is that the project is too important — this team is too important — not to have a full-time, designated leader,” Hammond wrote.

“During my absence, Jodie has done an outstanding job, with support from all of you, as this project’s on-site administrator. I have asked and she has accepted this as her permanent role. She will continue to report to me but in my position as interim AMH administrator.”

To: Addictions and Mental Health Services Interested Parties
From: Bruce Goldberg, M.D., OHA Director

Richard Harris

Today I share news of the January retirement of Richard Harris, director of the Addictions and Mental Health Division.

Richard has been a truly outstanding leader at AMH and OHA during more than three years of service.

As many of you know, he left retirement from Central City Concern in Portland to guide AMH during a time of great change and challenge for our agency. His leadership has been innovative, thoughtful and inspirational. Among his many accomplishments are hiring the superintendent at the Oregon State Hospital, Greg Roberts, and overseeing
the rebuilding of the hospital into a place of hope, healing and safety. Richard has also been strongly committed to the work of better integrating addictions and mental health services into Oregon’s health care system. I for one am most appreciative of his contributions, and know everyone joins me in thanking him for his service to our clients, our agency and our state. He is leaving us better than he found us.

I have asked Linda Hammond to serve as interim director of AMH after Richard’s retirement.

As we work to transform the health care delivery system with our partners, over the next several months we will also need to transform ourselves and the way we work. Linda is the right person to lead us through that period of change. We will conduct a national search for a permanent director next summer, when we have a better idea of the needs of our agency, our health care system and our state.

I know many of you are familiar with Linda. She has served in key leadership roles in AMH and in community services in Oregonand elsewhere. She brings strong administrative experience and a proven ability to lead people through change.

Before her current role as administrator of the Oregon State Hospital Replacement Project, Linda was the budget administrator for AMH. Prior to that, she held key leadership positions at Oregon Housing and Community Services and other nonprofit organizations. She also worked in a community facility in England for children living with mental and physical disabilities. Linda holds degrees in psychology, specializing in child development, and business management.

Over the next few months Richard and Linda will work together closely to ensure a smooth transition. Please join me in expressing appreciation to Richard for his service and in welcoming Linda to her new role.

From the Eugene Register Guard, June 25, 2011

A $5 million allocation from the Legislature is a fraction of the projected cost, but sources say the proposal is just delayed

Legislators are close to unveiling a proposal that would allocate $5 million for infrastructure costs over the next two years for the state psych­iatric hospital proposed for Junction City.

That’s down from the $83 million Gov. John Kitzhaber recommended for the project in his February budget — which would have funded full construction of the hospital — and down also from a later proposal of $33 million in the coming biennium for partial construction.

But the small allocation doesn’t necessarily mean the project is dead.

Multiple sources close to the situation say that the current intention is to carry on with the project, albeit in an altered form, and that the Legislature could come back with more construction funds as soon as the 2012 legislative session, which begins in February.

The $5 million allocation — which will primarily go to infrastructure and planning, not actual buildings — allows the Legislature to keep the project moving in a difficult budgetary time, proponents argue.

It also allows the state to defer the completion of a hospital that won’t be needed until early 2015, when two of Oregon’s smaller psychiatric hospitals, OSH Portland and Blue Mountain in Pendleton, are scheduled to close.

“We’re moving forward in a prudent way,” said Dr. Bruce Goldberg, the director of the Oregon Department of Human Services and who has been involved in the negotiations. “Why pay interest on construction bonds when we won’t need those hospital beds immediately?”

Now, legislative leaders envisage a facility in Junction City that would start out as a secure psychiatric hospital but would transition over time, as the need for secure hospital beds decreases, into a Department of Corrections facility, specializing in handling prisoners with mental health and addiction issues.

For Lane County’s economy, any new state facility at the Junction City site would be a boon, bringing hundreds of well-paying jobs. Local lawmakers are pushing for the project, but have met plenty of resistance, both on financial and mental health treatment grounds.

Hospital-based vs. community-based care

Part of the debate about the Junction City psychiatric facility has long centered on the question of the actual need in Oregon for hospital-setting secure psychiatric beds.

Those beds involve around-the-clock treatment and supervision, and they cost the state more than $200,000 a year per patient. By the end of 2011, the state’s largest psychiatric hospital, the new OSH Salem, is expected to have 620 operational beds, and the proposed Junction City facility is scheduled for 174 beds when completed.

Although the most recent forecast by the Department of Human Services concluded there was still a need for both facilities, mental health advocates argue that many individuals with mental illness would be better served and have a better quality of life in less restrictive community settings.

“That (DHS) forecast is based on our current patterns of locking down mentally ill people,” said Chris Bouneff, executive director of the National Alliance on Mental Illness (NAMI) Oregon.

“There is this supposition that there is a large group of people that can’t ever be let out, under any circumstances, and that’s not accurate. We need to develop a clear picture of who’s in (OSH Salem) and whether they could be better treated elsewhere.”

The move away from “big-box” psychiatric facilities to community-based mental health care is also one that the federal government is pushing for, particularly during the Obama administration.

The U.S. Department of Justice is investigating how Oregon treats individuals with mental illness. Records provided to The Register-Guard’s public records requests show that federal justice officials in April requested extensive state data relating to that type of treatment.

Federal Justice representatives met with Kitzhaber earlier this month, Christine Miles, a spokeswoman for the governor, confirmed Friday. The content of those discussions is a “private matter,” she said.

The federal Department of Justice does not comment on ongoing investigations.

The Legislature’s response

Two bills moving forward in the Legislature would attempt to tackle the problem of how to better utilize the beds in secure psychiatric facilities and potentially pave the way forward to smaller community-based facilities.

Both bills make changes to the authority of the Psychiatric Security Review Board, which has jurisdiction over individuals who plead “guilty except for insanity” to crimes and enter mental health treatment facilities.

House Bill 3100 would require a state-certified psychologist or psychiatrist to evaluate individuals before they can enter a guilty plea except for insanity.

Senate Bill 420 would place individuals in secure psychiatric hospitals under the jurisdiction of the Oregon Health Authority, which actually runs the state hospital.

Mental health advocates argue that that arrangement makes more sense and will allow people who have committed nonviolent crimes and who don’t need hospital-level care to move to community-based care more quickly. Critics worry that it could pose a public safety risk by letting unstable individuals back out into society.

Rep. Tina Kotek, a Portland Democrat who has worked on both bills, said she believes the proposals will allow psychiatric hospitals to be used more efficiently.

“It’s all about managing hospital populations better, and putting the right people in the right settings,” she said.

Though both bills — particularly SB 420 — are expected to be hotly debated once they hit the House and Senate floors, they passed out of the Legislature’s chief budget-crafting committee Friday, usually a sign that legislative leaders are supportive.

What effect the two bills could have on the need for the hospital beds at a possible Junction City facility remains to be seen.

While NAMI’s Bouneff and other advocacy groups say the bills could lead to a mental illness treatment system in Oregon that relies on only one secure hospital in OSH Salem, legislators are more cautious.

Rep. Val Hoyle, a Eugene Democrat, said that the state will still need a secure psychiatric facility in Junction City over the next few years as it starts to focus on expanding community-based care.

“If we do approve the two PSRB-related bills, it won’t be a case of us snapping our fingers and instantly changing the population with mental illness,” she said. “It will take time.”

Others agree.

“The effects (of the possible PSRB changes) are not going to be dramatic, but they will lower our bed need a bit,” Oregon DHS director Goldberg said. “It will take us a decade to significantly reduce our population to a point where we wouldn’t need a second hospital in Junction City.”

Lawmakers also will need to find money to build more community-based facilities, Goldberg said, as well find suitable sites for such facilities, often a challenge due to stigmas surrounding mental illness.

Both of those will take time, Goldberg said.

However, unlike earlier this session, proponents of the hospital now do see a point where a Junction City psychiatric hospital might not be needed in the long run.

When that occurs, legislators could transform the facility into a specialized prison that would handle criminals with mental illnesses but who haven’t pled guilty except for insanity, a growing population in the state’s prisons, experts say.

“It would be a correctional institution that could provide a higher level of care for individuals who don’t fit in with the general population,” Hoyle said.

“I think the (Junction City facility) will get built,” said Sen. Alan Bates, a Medford Democrat. “What it looks like in the future, however, is still up in the air.”

Bates said lawmakers don’t yet know if their plan for a slower transition to community-based mental health care, which involves moving forward with a Junction City facility, will be acceptable to federal Justice officials and prompt the federal government to end its investigation.

“It’s really a hard question to get at,” he said. “We don’t know. It’s all happening behind closed doors, and we’ve had no indication one way or another. We just know they want more community-based mental health care facilities.”