Guest opinion by By Gary Crum, published in the Eugene Register-Guard, October 2, 2011.
Gary Crum of Junction City is a retired teacher and counselor.
In my opinion, the governor was the only speaker who focused on the real issues involving treatment for the mentally ill and the development of appropriate programs and placement for Oregonians in need of treatment. While he supported the construction of the hospital, his support was tempered by his acknowledged concern with the issue of the “least restrictive appropriate treatment setting.” I share that concern and wish to address several of the issues germane to the discussion.
First, it’s important to recognize that institutional placement of mentally ill patients is the most extreme treatment placement we have available. Incarceration in a locked ward of a mental hospital is the most restrictive treatment placement on the cascade of services for mentally ill individuals. It is, therefore, crucial that this placement be selected only if there is no other less restrictive appropriate placement available for the individual.
Many of the patients currently in locked state hospital wards could be served as well or better in community-based settings. For example, 40 percent of the court-adjudicated placements (called forensic placements) are patients who were found guilty (but determined to be criminally “non-responsible” because of mental illness) of offenses that were not Measure 11 felonies. Almost without exception, individuals committed to the state hospital after committing crimes such as burglary, identity theft and disorderly conduct serve more time at the hospital than “non-mentally ill” individuals who are convicted and sentenced for such offenses. These hospital inmates (excuse me, patients) would receive more appropriate treatment — including re-entry programs, family support counseling and development of community resource involvement — in community-based programs. As many as 40 percent of the individuals now in locked state hospital wards would be better served in community-based settings. This preference for expanded community-based treatment is shared by virtually all patient advocacy groups and mental health provider professional groups.
Certainly there are individuals for whom institutional placement is appropriate. However, I suggest we now incarcerate a state hospital population far beyond that population. I am not suggesting that public safety be compromised by placing dangerous individuals in less secure settings. I am suggesting that we need fewer, not more state mental hospital beds and that instead we need more community-based facilities and programs if we are to meet the mandated standard of “least restrictive appropriate treatment setting” for serving our mentally ill population.
We must also recognize that placement in the proposed state mental hospital in Junction City will cost $280,000 per bed per year. This is after, of course, spending at least $100 million to build the facility. And, with apologies to “Field of Dreams,” the reality is that “if we build it, they will come.” If such a facility is, indeed, built, there will be tremendous pressure on the state’s mental health system to justify the cost by filling the hospital. Moreover, the exorbitant cost of institutional care means there will be fewer resources available to develop and staff community-based programs — which, by the way, cost less than a third of the per-patient cost of the proposed hospital. The increase, rather than reduction, of hospital beds is a long time commitment to institutional care rather than the transition to expanded community-based programs. Given the realities of fiscal constraints, combined with the huge cost of state hospital placement, we simply can’t have both.
Patient advocacy groups, professional organizations and the governor-appointed State Hospital Advisory Board have all expressed their opposition to the Junction City hospital’s construction. And, may I repeat, hospital placement is, by a factor of three or more, the most expensive treatment choice. Put another way, we can serve three individuals in community-based facilities for the cost of one hospital placement.
Speakers at Wednesday’s town hall meeting celebrated the hospital as a “done deal.” May I suggest that, in every way possible, it’s actually a bad deal. I hope the Legislature and the governor study the issue very, very carefully before building the hospital and committing the state to that bad deal.