Mind Games: Oregon’s Mental Health System
Fourth of a five part series on the Oregon State Hospital
From The Oregonian, October 26, 1987 – not available online elsewhere
When Lois Gleason closed the door for the last time on her West Hills apartment this month, she headed downstairs to another crisis in her 11-year history of mental illness.
“My friends all tell me I finally made it,” Gleason said, smiling weakly. “I finally made it to the street.”
Months earlier, Gleason spoke glowingly of a new beginning in her West Hills studio apartment, after years of being cooped up in unattractive apartments and overly strict group homes. But a tiff with her latest landlord had turned yet another new start into just one more dead end — her third move in a year.
A slender 27-year-old, with a taste for bright, sporty clothing, Gleason once aspired to be a model and still has the rail-thin physique of the runner she once was at Jefferson High School.
While in the West Hills, she hoped to enroll in an aerobics class, to get back her old job as a nursing assistant and to be middle class.
Now her world, the confused and confusing universe of paranoid schizophrenia , was falling apart. She told friends she might be going off the deep end. She was going out into “the street.”
The state Mental Health Division estimates 34,400 chronically and severely mentally ill people live in Oregon. About 55 percent of them receive treatment in state-financed mental institutions or community programs.
The rest, some 15,000 Oregonians, occupy an uncharted territory outside Oregon’s public mental health system. Many literally wander the streets.
A 1986 League of Women Voters report chronicled gaping holes in Oregon’s mental health care system — once reputed to be among the best in the nation.
“Many populations of mentally ill are unserved or underserved,” it concluded. “Community programs currently are serving twice as many persons as funded for, and yet they serve less than 60 percent of the chronically (or severely) mentally ill.”
These “outsiders” contribute to a glut in the state’s jail and prison system. Newspaper headlines proclaim their occasional acts of self-destruction and homicide. Last May 19, for example, two FBI agents fatally shot Stanley William Peregoy, a Tillamook man with what his family described as a history of mental illness, after he stormed into the agency’s Portland office and took five other agents hostage at gunpoint. The county medical examiner found Peregoy was intent on self-destruction and deemed his death a suicide.
Others are homeless. A Multnomah County survey of about 320 homeless people in 1984 and 1985 found that about a fifth of the men and nearly half of the women had been in psychiatric hospitals.
Social service providers such as Jean DeMaster, executive director of Burnside Projects Inc., estimate that as many as 40 percent to 60 percent of the state’s estimated 6,000 homeless suffer from mental illness.
Thousands of other outsiders, such as Lois Gleason, may be found in hotels, apartments and boarding houses across Oregon.
Bill Kruger, a social worker who runs the highly regarded 65-bed psychiatric day treatment program at the Providence Medical Center in Portland, calls them “the new lepers.”
“As lepers were in biblical times, they are shunned, scorned and misunderstood,” Kruger said. “Nobody is counting them. No one cares. They are a group our society would just as soon not exist.”
Medical researchers say mental illness may be hereditary. But unlike other genetic diseases, schizophrenia appears long after birth. It strikes when people are young, typically in their teens and early 20s.
While Lois Gleason was a student at Wilson and Jefferson high schools in the mid-1970s, she dabbled in hard drugs like LSD and methedrine and wondered whether she would survive to be 30.
Only much later would she recognize these years as precursors of madness.
Mental illness also afflicts her twin sister, Leah, now a patient at Dammasch State Hospital. It would devastate their lives, and their family.
Family relations would deteriorate. Lois would lose a baby to a medically recommended abortion. A roller-coaster lifestyle would take her in and out of hospitals for most of a decade.
Asked to describe the onset of his daughters’ illnesses, Bill Gleason, 61, a retired Portland schoolteacher who is now an elected Tualatin City Council member, paused, trying to recall a precise event or some telltale quirk.
Delinquent behavior and truancy first prompted Gleason and his wife, Doris, 55, to seek help. School officials called it a family problem, as did the police, even after Lois began running away from home.
The Gleasons tried to discipline her, without success. Private medical diagnoses concluded she suffered from early signs of mental illness.
When she was 13, the Gleasons reluctantly made Lois a ward of the court. A succession of foster homes would follow. “It was the only way we could afford care for her,” Gleason recalled.
By high school, Lois had gravitated to the “hoods” — a loose subculture of drug users and occasional criminals. Bill Gleason, a mild man who now serves as the chapel sexton at the Oregon Episcopal School, once brandished a baseball bat to scare off one of the “hoods,” a suspected drug dealer.
As the illness deepened, the Gleasons found themselves increasingly isolated.
“One of the big feelings I have is of being alone, of people wanting to stay away from that part of your life, as though it was contagious,” Doris Gleason, 55, recalled. “There was no help. There’s still a stigma. It was very painful.”
At 16, Lois smashed a foster home window with her left hand and was committed for the first time to Dammasch State Hospital. She had begun hearing imaginary voices — they said she was evil and urged evil acts. Lois was receding into what she called her “cartoon world.”
Her 10-month stay at Dammasch would be the “first relief” in years for Bill and Doris Gleason. For Lois, it would be the first of nine visits over the next eight years.
Tom Jacobsen, a private psychologist at the Goose Hollow Mental Health Clinic, counsels about 100 “chronics,” most of whom reside in West Portland apartments and hotels.
One is Lois Gleason.
A former Southern Baptist minister, Jacobsen, 42, considers himself a kind of last resort for patients who have nowhere else to turn. His flat rate for counseling is $65 an hour, but Jacobsen offers his low-income clients a discount, which he declines to specify.
He says most of his clients do not qualify for traditional community care programs because of a history of “obnoxious or bizarre behavior.”
Some are combative and assaultive. They threaten suicide. They badger, sometimes blaming Jacobsen for their troubles. But most of the time, their illness is hidden from public view.
Jacobsen takes it all in stride. He sees his clients once or twice a month, and sometimes counsels them by telephone, for free.
Not all therapists are as patient, or charitable.
“A lot of us don’t really want to deal with crazy people,” confided Dr. Ed Colbach, a Portland psychiatrist who admits he avoids deranged patients.
“They create havoc in our lives. And you get sued if you screw up,” he said. “I get stuck sometimes with a person who’s in my office, who’s threatening. I don’t want to be a part of that anymore. I’m too old.”
Other professionals privately agree with him. They say they will not work in public institutions or programs because the wages are too low, and caseloads too heavy.
“The most talented people,” said Colbach, “shy away from the sickest population.”
That kind of concern heightened after two psychiatrists were killed two years ago. Dr. Brian J. Buss, 37, was bludgeoned to death by a deranged patient at Salem Hospital in February 1985, and four months later a shotgun blast allegedly fired by a client killed Dr. Michael J. McCulloch in his downtown Portland office. (Buss’ assailant was found guilty except for insanity, while McCulloch’s client has been deemed unable to assist in his own defense and is at Oregon State Hospital until he is capable of being tried.)
Even if they could find willing private therapists, outsiders often can not afford them.
Public assistance provides barely enough to subsist on. Many, like Lois, receive about $340 per month in Social Security income. Others get only $230 a month in welfare from the state Adult and Family Services Division. The checks must cover rent, food and any private therapy. A welfare medical card issued to each mentally ill person covers only the cost of medications.
Some shun care, even if they can afford it.
Unlike their predecessors, the younger generations of mentally ill often eschew traditional structured forms of treatment as unwanted interference, and may reject medication.
Some make it alone. Others end up on Skid Road, a last refuge for clouded minds. Mental illness for the most seriously ill makes even such elementary tasks as managing money, keeping track of possessions and remembering appointments difficult.
Social service groups on Skid Road form the last line of defense for Oregon’s outsiders. Counselors of the mentally ill, who try to help them survive here, say many are victimized. They may be robbed, injured, even killed.
Not all the stories end so dramatically.
In early October, after being displaced from her $285-a-month Southwest Portland apartment, Lois returned to Oregon City, where she said she had spent some of the best and worst years in her life. It would be the first stop on what she called her journey into “the street.” She stayed with a friend there for a week, then moved in with a friend in downtown Portland.
“I know I’m getting worse. I’m going to end up in Burnside Projects,” she said of the Skid Road social service agency.
In 1984, after her last release from Dammasch, Lois had lived in Oregon City and had met a young man who was also mentally ill. She got pregnant, just as the relationship was disintegrating.
Her mental health counselors in Clackamas County advised an abortion, warning of potential birth defects caused by one of her medications, lithium, an anti-depressant. Lois said one counselor escorted her to the clinic for the operation on Sept. 9, 1985.
When she moved to Portland a year ago, Lois hoped to sever her ties with Oregon City and to make a new start. She moved in and out of a series of apartments and residential care programs. Some she found unacceptable and abandoned. At others, operators objected when they found out she is chronically mentally ill.
Her past record of drug and alcohol abuse, and a history of occasional run-ins and arguments with caseworkers, neighbors and therapists had made her unwanted in some established treatment programs. Mental Health Service West Inc., a non-profit group that is the main contract provider of care to the chronically mentally ill in Southwest Portland, had no room for her on its crowded caseload.
Finally, last year, she turned to Jacobsen, whose clinic agreed to supervise medications necessary to stabilize her erratic behavior.
Shots of Haldol, a powerful anti-psychotic, every three weeks controlled her auditory hallucinations, the voices in her head. Other pills controlled the drug’s side effects — wavering hands and a slackened jaw. Liquid doses of orange-flavored Antabuse deterred her liquor abuse.
But when her moods darkened, Lois sometimes fell back on illicit drugs and alcohol. Her spirits plummeted last summer, when she visited her twin sister, Leah, at Dammasch.
In July, Leah approached a Portland policeman in Hillsdale. “She asked (the officer) to contact Ronald Reagan. She said he would get her a place to stay,” recalled Doris Gleason, the women’s mother. Leah Gleason was found to be delusional and committed to Dammasch.
In the days leading up to her move out of the West Hills, Lois worried that she, too, might have to be hospitalized. She made and then canceled an appointment to be evaluated at the psychiatric crisis unit at Oregon Health Sciences University.
On the night she moved out of the West Hills, Gleason called Jacobsen to say she had reached her limit of coping.
Several days later, her outlook had brightened.
“I’m going to be all right,” she said. “I’m OK.”