Health Care Reform Bills Omit Sociological, Psychological Services

By Amanda Waldroupe, for Street Roots, March 6, 2012

A patient’s housing and sociological condition can have a direct affect on his or her health care, but a bill in Salem to incorporate those providers into the new health care reform failed to make the books.

As a result, the legislature has left unanswered a critical question in the state’s new health care structure: Will health providers serving Oregon Health Plan patients work with social-service providers to address a patient’s sociological and psychological barriers to health care.

Senate Bill 1522 would have required Coordinated Care Organizations, which are currently developing to provide care to Oregon Health Plan patients by July, to incorporate and pay for addressing a patient’s sociological and psychological barriers to getting quality health care and becoming healthy.

Coordinated Care Organizations (CCOs) are the backbone of the reforms the Legislature has made to the Oregon Health Plan’s delivery system (see, “Just What the Legislature Ordered,” Street Roots, Oct. 14). CCOs are foreseen as locally driven organizations made up of patient teams — including doctors, nurses, behavioral health providers, community health workers, etc.

Those providers will coordinate and integrate the physical, mental and dental health care of Oregon Health Plan patients, who receive health care through Medicaid. The hope is that better coordinated care will keep people out of the emergency room, lower costs, and provide better healthcare.

Jennifer Pratt

Jennifer Pratt

But the Oregon Primary Care Association (OPCA), which represents the state’s safety net clinics, sponsored Senate Bill 1522 out of the concern that addressing those barriers would get lost in the shuffle of making sure that CCOs are able to adequately provide care by July.

“A great majority of patients that our clinics serve have behavioral and socio-economic barriers to health,” says Jennifer Pratt, the OPCA’s deputy director of policy. “It’s a critical issue.”

Behavioral, socio-economic and sociological barriers to health include homelessness, issues related to substance abuse, access to transportation, socio-economic status, rural isolation, race, ethnicity, and other factors that are often called the “social determinants” of health.

“They are part of a person’s health situation,” Pratt says. “They are intrinsic, not an add on.”

“This is where the rubber meets the road,” Doug Riggs, the OPCA’s lobbyist told the committee. “These are the most vulnerable patients.”

Pratt uses the example of people who are homeless and diabetic. People with diabetes have to manage their weight, diet, and also take daily medications that have to be refrigerated. All of those things become extremely difficult, if not impossible, if someone does not have a home.

In general, caring for those patients is more time intensive and costly because of the variety and complexity of the issues they face. They also tend to be unhealthier, Pratt and others say, which leads to a disparity in health among populations simply because they have more barriers to accessing healthcare than other populations.

The OPCA was joined by almost 30 organizations calling for Senate Bill 1522’s passage. But it died in the Senate’s Healthcare, Human Services and Rural Policy committee after two hearings. Legislators worried that the bill was unnecessary.

Alan Bates

Alan Bates

“The goal of CCOs is to take care of these people,” said Sen. Alan Bates (D-Medford). “I don’t think we need to call it out any more than we are.”

Without the bill, some worry that a segment of Oregon Health Plan patients will continue to be unhealthier than other populations. And without a legislative mandate, it will be up to each individual CCO whether it chooses to address barriers to health, or works with social service providers to better address those concerns.

The OPCA is planning to convene a workgroup to talk about the organization’s next steps and influence the development of CCOs when the Oregon Health Authority begins drafting and writing the administrative rules and regulations for CCOs this summer.

Bob Joondeph

Bob Joondeph

Bob Joondeph, the executive director of Disability Rights Oregon, says it’s going to be absolutely necessary to address a patient’s social and psychological needs, in addition to their medical ones.

“It’s going to be a really primary piece of what these CCOs are going to do,” he says. “Frankly, that’s where the state sees the opportunity to improve health and save money.”

Although Senate Bill 1522 did not pass, he thinks there is ample opportunity for people to influence the development of CCOs. Each CCO will have a “community advisory committee” made up of stakeholders from the community who are not involved in a CCO as providers. That, he says, provides an opportunity to pressure CCOs to take a certain course of action when it comes to determinants of health.

“Many, many more details are going to be worked out at the local level,” Joondeph says. “There’s a lot of opportunity for people to be engaged and to steer the course of how any particular CCO goes.”

He thinks it is highly likely that CCOs will begin forming strong partnerships with social service agencies to the effect of “social service-izing the medical world.”

“It goes beyond patching a person up,” he says.

Ed Blackburn

Ed Blackburn

Ed Blackburn, the executive director of Central City Concern, agrees. “The social interventions are going to be critical,” he says.

Central City Concern’s programs are built on the assumption that providing all the social services one might need — whether it’s housing, medical care, substance abuse treatment, detox services, drug free housing, etc. — can make providing health care to those people more effective.

“We know we can reduce incidents of hospitalization … and reduce conditions that are exacerbated by those (psychological and social) conditions,” Blackburn says. “Someday, we’ll not see (health care and social services) as separate.”

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New Peer Support Group for Women Survivors of Sexual Trauma Starts March 7

By: Women Survivors of Sexual Trauma, for The Lund Report, February 14, 2012

A new, weekly peer-facilitated support group, Women Survivors of Sexual Trauma, will hold its first meeting Wednesday, March 7, and thereafter it will meet every Wednesday from 7-8:30 p.m. at Empowerment Initiatives, 3941 SE Hawthorne Blvd. in Portland.

The group will be open to all women, including transgender persons who identify as women, who have undergone traumatic sexual experiences.

“We refer to ‘sexual trauma’ rather than saying the group is for survivors of rape, or abuse, or words like that, because often we have such shame that we tell ourselves it wasn’t really rape, it wasn’t really incest, and so on,” said co-facilitator Jenny Westberg.

“We don’t want women excluding themselves. If you’ve had sexual experiences that were traumatic, you’re welcome in this group.”

Approximately 1 in 4 Oregon women (1 in 5 nationally) have been victims of rape and/or other forms of sexual violence, according to a recent survey by the Centers for Disease Control and Prevention, but locally there are few resources. The groups available through the Portland Women’s Crisis Line, for instance, rarely have immediate openings. The new group will be one more resource for Portland-area survivors.

Organizers want the group to be a safe place to share, listen, and discover common areas of experience.

“In sharing our stories, we reclaim the parts of ourselves we lost in the trauma. This has an empowering effect and it connects us to others. When we release the secretiveness and shame, we reclaim our voices.” said co-facilitator Chaya Grossberg.

The group will be free of charge, with donations appreciated.

Co-facilitators Jenny Westberg and Chaya Grossberg are survivors and mental health activists who both work with the Mental Health Association of Portland.

The group is sponsored by Portland Hearing Voices, which has been running a successful Extreme States and Voices support group for the past three years. Portland Hearing Voices director Will Hall also provided facilitation training.


413.210.2803 —

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Shot on the Street
What the Shooting of Two Homeless Men Ought to Mean for Portland’s Camping Ban

By Denis C. Theriault, Portland Mercury, March 01, 2012

It was about 9pm on a blustery, rain-soaked Tuesday night — and, yet, thanks to a horde of Mardi Gras revelers, Old Town was unusually festive.

Precisely what happened next isn’t exactly clear, but the basic inflections of the story, told by a handful of different people, all agree on one point: A group of homeless men had been turned away from their usual overnight spot at Right 2 Dream Too (R2D2) — the camp-like refuge on NW 4th and Burnside — because the small lot, dotted by a few dozen tents, had already been filled by others with nowhere to go.

Shelter space, like it is every winter night, was also tight, and so the men had to make do. They could have crashed on the sidewalk across from R2D2, waiting amid drunken noise and dampness, until a tent maybe opened up in the wee hours. Instead, they split up. One man went in one direction, and the other two went another: east, across the Willamette River and down into the grim-but-dry industrial underbelly of the Morrison Bridge.

Sometime before 5am on Wednesday, February 22, they were sleeping, covered, when a dark-colored station wagon pulled down SE Belmont. Someone inside leaned out with a gun and opened fire, and then the car vanished as quickly as it arrived. Carter Hickman, 57, took a bullet to the chest, while Albert Dean, 43, was merely grazed — and soon both men were on the way to OHSU.

As crimes go, this was particularly horrifying. And the questions, and the fears, remain fresh: Did the men do something to bring this upon themselves? Or was this one of those rare, random, senseless incidents?

But none of that really matters. Because this was something else: a wakeup call. On the streets, violence and vulnerability are inextricably linked — it’s just that we never really hear much about it. According to Multnomah County’s 2011 one-day homeless street count, nearly half of unsheltered people reported enduring some kind of violence that might otherwise have been avoided behind walls or if they were just somewhere safe.

And that wakeup call comes at a portentous time for Portland. Twin protests over the city’s ban on tent camping — one of them around the clock — remain outside city hall, confronting staffers and politicians with the issue daily. On February 29, after at least one false start, the city is scheduled to present a tepid plan to settle a years-long federal lawsuit over that same camping ban. And March 1 will mark the second month of steep fines for R2D2’s landlord — continuing a code enforcement crackdown on the well-managed safe haven for the homeless that, its backers say, the city really ought to be embracing instead.

Like Chasing Ghosts

Until the night they were shot, Hickman and Dean — better known by some as “Joe” and “Allen,” respectively — had been staying off and on at R2D2 for about five weeks. They had a regular tent near the rest area’s entrance, specially chosen because of their work schedule.

“We’d always put them in the same spot” in C7, said Joe Green, R2D2’s top security man, a couple of days after the shooting. “They always had to get up early to go to work.”

That’s the point of Right 2 Dream Too. It’s built so people who need a night’s sleep, or several, or a place to dry out, can sack out in peace and store their belongings — and then maybe get their bearings enough to find and keep a job and begin the slog back up to self-sufficiency.

Most nights, if its residents can’t make it back early enough, there’s a long line of people hoping to check in by 7 pm. The site holds up to 80 people, and on any given day, two or three dozen of them are new faces.

Joe and Allen and their friend became quiet fixtures at the site, Green and others say. When they weren’t working, they would help keep things tidy and even helped reengineer some tents. They would take meals at Sisters of the Road or at nearby churches.

“There were always the three of them,” Green says. “We would call them our workers.”

Later, an Occupy Portland member wrote that he remembered seeing the men in camp last fall.

But learning more about Joe and Allen was, in some ways, like chasing ghosts. On Friday, February 24, police said, both were still in OHSU, with Hickman expected to live. But an OHSU switchboard operator said there was no record Hickman had ever been at the hospital and said Dean, despite what police said, had been released from the emergency room after the shooting.

Neither man has a serious criminal record in Multnomah County. Court records, in fact, show just a single TriMet exclusion for each, issued on separate days in August 2011. The files list the same cell phone number (it’s not working) and a common address, the Portland Rescue Mission, at 111 W Burnside.

It was only after I made my way to the end of the dozens-strong line of Rescue Mission visitors that someone’s ears perked up. “I know them,” said a stricken-looking younger man, who gave his name as John. “They came from Seattle.”

On his way inside the mission, John offered a heartbreaking detail: He said the men weren’t just friends, but partners who were living “as husband and husband.”

“They’re my best friends,” he finished, before disappearing inside.

“Am I Scared? I Don’t Know”

It’s still unclear, publicly at least, why Joe and Allen were shot. Police, despite offering a $1,000 reward for tips (503-823-4357), are sharing precious little about what detectives have uncovered, including during their interviews with the two men.

Rhetoric at city hall and among social services providers immediately homed in on the possibility that the attack was random — a sociopathic strike against two people who did nothing more than bunk up on a sidewalk under a bridge. That fear was felt on the streets.

Less than 24 hours later, a block east of the shooting, a man named Tim was propped up in a lawn chair keeping watch on three blanket-swaddled companions, one of them a pregnant woman. It was a gritty vigil, with trains lurching past a few blocks away, cars rumbling overhead, and rats skittering for food scraps.

“Am I scared?” he said. “I don’t know. I don’t know if I can get any sleep. Being out here like this, I don’t want someone to roll up and go pow-pow-pow-pow.”

Since then, reactions have grown more measured. But the emphasis on vulnerability remains.

“In terms of this specific incident, we don’t have a good idea yet of what was happening there. But we do know that people sleeping on the streets take a variety of different risks,” says Marc Jolin of JOIN, an agency that works to link homeless Portlanders with services and housing. “Violence, theft, assault. That is not uncommon. We get reports from folks of the violence they experience at the hands of partners on the street, and verbal and physical assaults… from strangers.”

The 2011 street count found more than 1,700 people sleeping outside, and a few thousand more in emergency shelters. The Portland Police Bureau does not directly track how many reports each year involve someone who’s considered homeless. Nor does the bureau track cases in which violence seems to be motivated solely because a victim is homeless. Multnomah County, alongside Street Roots, is currently trying to put a number on how many homeless Portlanders die on the streets — of natural causes and otherwise.

The National Coalition for the Homeless, however, has tracked a modest increase in hate-crime-like attacks against Oregon’s homeless in recent years. Overall, from 1999 to 2009, it counted 37 attacks, 10 of them fatal.

But some attacks never lead to a report. Not that they don’t hurt. The same night Joe and Allen were turned away from R2D2 — Fat Tuesday — drunks walking by couldn’t resist pounding on the site’s walls or shouting insults, says one of the men keeping watch that night, Dale Ardway.

Inside the Machine

The plight of Right 2 Dream Too — founded in October 2011 by the same organizers behind Dignity Village out by the airport — has added new electricity to the fight against Portland’s camping ban.

And because it sits on private land, hosted by a landlord who’s partially trying to jab a finger in the city’s eye, R2D2 has had time to show off its success. Cops in the area appreciate the eyes on the street. Neighbors, looking past the fact that the site sits under the Chinatown Gate, appreciate the quiet respect R2D2’s residents have for the area.

The place runs like a machine, with security patrols around downtown, governing meetings, ample storehouses of tools, blankets, and food, and strict rules against intoxication and violence. It’s given hope and offered a model for how to cheaply, if still imperfectly, help people in need at a time when government coffers are starving just as much. R2D2 takes couples and pets and undocumented immigrants, and asks few questions — something the shelters in town don’t always do.

And yet the city has declared the place an unpermitted recreational campground — and is bombarding its landlord with massive fines that could drive it out of existence. Getting a permit, and adding facilities like a sewer line to get legal, are too expensive for volunteers who rely on donations to pay for steady bills like laundry, electricity, and porta-potty service.

“We provide walls. We provide security, and they want to charge us money for something they should be doing,” says Ibrahim Mubarak, an R2D2 spokesman and founder.

Mubarak says close to 600 people passed through the site from February 1-15, and that security has to kindly refuse, on some nights, up to 20 people. Nearly a dozen inhabitants have found more permanent housing, he says, and dozens more have used the respite to find work.

They’re raising money, dreaming of a bigger lot downtown, close to social services—and pleading with city hall.

“If they close us down, where are these people going to go?” asks Mubarak. “What sidewalk can they sleep on?”

A Chill From City Hall

Reaction from Portland City Hall has so far been frigid. Commissioner Dan Saltzman, who runs the city bureau in charge of code enforcement, has steadfastly refused to waive any fines. In fact, his office says, they’re considering whether to ask a city hearings officer for permission to dramatically increase the $641 monthly fine in coming months.

At one point there was hope among organizers that Commissioner Amanda Fritz might broker a compromise — she showed up at a march in support of the site — but that talk has since fizzled.

Portland’s housing commissioner, Nick Fish, also has been quiet about the site. In the aftermath of the shooting, he issued a statement lashing out at the attack, but it was criticized by some advocates for not being more vocally supportive of R2D2.

“The city is making progress in its effort to end homelessness,” he wrote. “The opening of Bud Clark Commons is but one notable example. This shameful criminal act reminds us that everyone in our community deserves a safe and decent place to call home.”

The Commons, which wouldn’t be here without Fish, has been a godsend — for some. It has a day center that’s helped thousands since June 2011, but its shelter has room for only 90 men at a time, and its 130 apartments for the chronically homeless are already full (and they also allow substance abuse). Then there’s the cost: $47 million, making it hardly replicable.

If Fish is sympathetic to R2D2’s model, he’s keeping his cards very close. After protesters filled his office earlier this month, he agreed to sit down with Saltzman and talk about R2D2 — nothing more.

In his favor, last December Fish did push the council (over the clamor of the Portland Business Alliance) into backing a car-camping pilot program that could, one day, be stretched to include a site like R2D2. Under his plan, churches and nonprofits would be able to host as many as four cars, with a written agreement from Saltzman’s office directing code enforcers to turn a blind eye.

A dozen or so churches have expressed interest, and the Portland Housing Bureau is expected to release specific guidelines as soon as this week.

But when asked about R2D2 the day after Joe and Allen’s shooting — after the Mercury first reported the men had stayed there — Fish walked very carefully.

Instead, he said the shooting of Joe and Allen was a chance to rally against looming city budget cuts that might threaten millions in cash for things like short-term rent assistance, more social services, and more brick-and-mortar housing.

“I want to know what the options are at this site first,” he says. “You know there’s not support on this council for the wholesale relaxation of the camping ordinance, even though as practical matter we don’t always enforce it.”

The fluid nature of the city’s camping ban — a term of art some of its lawyers disagree with — is glaringly obvious down under the Morrison and Hawthorne Bridges, where some people prop up tarps and other structures that offer more cover than mere bedrolls.

It’s up to officers, right now, to decide when to enforce city rules against tents and sidewalk sleeping. One officer’s wishes on one night may not be the same as another cop’s on another night. Just like violence, that murkiness is another fact of life for Portlanders on the streets.

And whatever settlement emerges from court may not make that any clearer.

A previous attempt at an agreement would have allowed small tent clusters. The latest version, last time the city discussed it on the record, was expected to include only changes in training and enforcement, but not any exemptions.

“There’s no ban in town. It’s happening. It’s tolerated,” says David Woboril, a deputy city attorney who handles police issues and isn’t working on the settlement. “But the city has to manage it.”

Woboril and Fish both said the city worries that large camps won’t always be as well run as R2D2 — and will cost the city resources to keep the peace.

“Large camps have a victim problem,” Woboril says. “That’s always the question: Can you do it on a large scale?”

The folks at R2D2 say they, at least, have earned the right to keep trying. Mubarak says activists from California and cities across Oregon have come around to take notes. Cities don’t have to spend big, he says, or surrender the rule of law to let homeless residents help themselves.

Joe Green, R2D2’s main security volunteer, was thinking about all the other homeless Portlanders who could’ve wound up like Joe and Allen.

“Without us,” he said, “there’d be a whole lot more lives at stake.”

The Mercury’s Sarah Mirk contributed to this report.
Photos by Daniel Cronin

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Portland sues former insurance carrier to recover nearly $1.5 million in legal costs, in part for the James Chasse Jr. case

From The Oregonian, March 5, 2012

The city of Portland is suing its former insurance carrier to recover nearly $1.5 million in legal defense costs for the James P. Chasse Jr. case and eight other city employment-related claims.

The city spent a total of $1.97 million to defend the Chasse federal wrongful death lawsuit. Chasse, 42, who suffered from paranoid schizophrenia, died in Portland police custody in September 2006.

The city argues that the insurer’s share kicks in once the city’s “retained limit” of $1 million has been exhausted in defense costs.

But the insurer has refused to pay the excess amount of $970,749, arguing that the use of deputy city attorneys to defend the Chasse federal lawsuit isn’t considered “retained” but part of city overhead costs. Therefore, the insurer argues, the city attorneys’ costs don’t eat into that $1 million reserve and are not reimbursable.

The city counters that the policy language is ambiguous, because “defense costs” are not defined in the policy, and is suing the company for “breach of contract.”

“ICSP refused to assume the defense of the Chasse claim and has refused to pay for defense costs incurred by the City of Portland in excess of the retained limit,” says the city’s lawsuit, filed Friday in Multnomah County Circuit Court against the Insurance Company of the State of Pennsylvania (ICSP).

Chartis Insurance, which administered the Chasse claim and eight others named in the suit, is a sister company to ICSP. Marie Ali, Chartis’ vice president of media relations, declined comment Monday. The city has not contracted with Chartis Insurance since November 2010.

In the lawsuit, outside attorneys James McDermott and Kevin Mapes argue on behalf of the city that Portland saved its insurer money by keeping its legal defense in-house, and not retaining outside firms in the Chasse case, which would have cost significantly more. For example, they say city attorneys charge about $100 per hour, while outside counsel would have charged hourly rates of $200 to $295.

“ICSP thus received a multi-million dollar financial benefit stemming from the City of Portland’s decision to retain the Office of the City Attorney to defense the Chasse Claim,” the suit says.

In May 2010, the city settled the Chasse case for $1.6 million, the largest settlement in the city’s history. The insurer covered $833,333 of the settlement; the city paid the rest, $766,667, the suit says.

During roughly the same time frame, between 2003 and 2010, the city argues that it incurred “reasonable defense costs” in eight employment-related claims totaling $514,179, using “experienced employment attorneys” within the city attorney’s office.

For the defense of such Employment Practice Liability claims, the city contends the insurer was obligated to reimburse the city 50 percent of defense costs, up to a maximum of $250,000 per claim.

“ICSP has failed and refused to reimburse the city of Portland for any portion of the defense costs incurred in any of the Employment Practice Liability Claims,” the suit says.

Among the employment claims in dispute are: the city’s $122,054 defense costs to fight a lawsuit by Portland Officer Bert Nederhiser, who was demoted after shooting at a suspect and nearly striking officers; $94,731 to fight a wrongful termination case by former parks employee Mary Ann Huff; $76,848 to challenge a wrongful discharge claim by former fire deputy chief Scott G. Edwards; $63,457 to challenge a discrimination case filed by a Pakistan native who repeatedly applied for city engineering jobs and alleged he was passed over in favor of white applicants; and $22,341 to challenge an arbitrator’s award to firefighter Tom Hurley, who recently returned to work after collecting disability payments while working as a chef.

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Update: Man Safely Backs Down After Threatening To Jump Off Downtown Portland Building

By Dominique Fong, The Oregonian, Saturday, March 03, 2012

Police successfully negotiated with a man to safely back down after he threatened to jump off a building in downtown Portland near a food cart pod.

The man was on the fire escape of the ninth floor just before noon at 511 S.W. 10th Ave., facing the 11th Avenue side of the building, emergency dispatchers said. Police cordoned off 11th Avenue next to the food carts.

Police said the man reportedly had a handgun with him but they didn’t see it.

Police officers on scene said the man would be taken to a hospital, not a jail.

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Oregon State Hospital Prepares To Open Final Wing

by Chris Lehman, from National Public Radio, March 1, 2012

The tree in this courtyard was preserved when the previous State Hospital building was torn down to make way for the new one in the background. (Photo by Chris Lehman)

The tree in this courtyard was preserved when the previous State Hospital building was torn down to make way for the new one in the background. (Photo by Chris Lehman)

The Oregon State Hospital is just weeks away from opening the final wing on its newly updated Salem facility. But many of the beds will remain empty because of budget cuts pending in the Oregon legislature.

The new State Hospital includes common areas designed to maximize natural light. (Photo courtesy of the Oregon State Hospital)

The new State Hospital includes common areas designed to maximize natural light. (Photo courtesy of the Oregon State Hospital)

About 180 patients are scheduled to move into the new wing later this month. The building largely replaces a crumbling brick behemoth that dated back to 1883. It became famous as the filming location for the movie “One Flew Over the Cuckoo’s Nest.”

State Hospital spokeswoman Rebeka Gipson-King gave me a tour of the new building. She says it’s designed to look less like a prison and more like a place where people get better.

“I think that really helps, for the recovery oriented environment, to not see that cyclone fencing and razor wire,” Gipson-King says. “Instead you have these very nicely landscaped outdoor areas where patients can go to have fun and relax.”

The new hospital is designed to house as many as 620 patients. But about seven dozen beds would remain vacant for the next year under a budget-cutting proposal in the Oregon legislature.

Hospital officials say the cut would reduce their ability to place new patients in the unit most suited to their needs.

The new wing of the Oregon State Hospital will be open for public tours Friday March 2nd from 1 until 6:30 pm.

See also:

Statesman Journal: State Hospital Nears Finish of New Facility

Oregon State Hospital Replacement Project: Oregon State Hospital – The Story of Baby Hercules

Mental Health Association of Portland: Oregon State Hospital Opens New Wing, Offers Public Tours, and More

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Oregon State Hospital – The Story of Baby Hercules

From Oregon State Hospital Replacement Project

Baby Hercules

Baby Hercules

Fondly known as Baby Hercules, the recently restored cherubic statue was again placed prominently in front of the historic Kirkbride Building on the grounds of the Oregon State Hospital – more than 110 years following its initial installment.

Very little is known about Baby Hercules. The earliest photos featuring him were taken in 1905. He was a mainstay on the campus for 50 years but when the turnaround entry path where he was located became part of a parking lot plan, he was placed in storage.

Some time later the Superintendent’s Council, comprised of patients representing each of the hospital wards, wanted to do something nice for the community. After seeing photos of the statue, they decided this would be their gift to the community. They brought it out of storage, restored it and placed it on the corner of Center and 23rd streets. Within the first 24 hours it was vandalized. Patients repaired it and returned it to the corner, only to be vandalized again. At the suggestion of the superintendent’s wife, the statue was moved to the backyard of the superintendent’s home located on the state hospital grounds for safekeeping. And there he stayed until the superintendent and other staff moved on and the hospital began repurposing the cottages. Dismantled into three pieces so that he could fit into the small room where other artifacts were stored, Baby Hercules would remain in storage for decades. In 2011, he surfaced again when he became part of the OSH Replacement Project’s landscape restoration plan.

See also:

Statesman Journal: State Hospital Nears Finish of New Facility

National Public Radio: Oregon State Hospital Prepares To Open Final Wing

Mental Health Association of Portland: Oregon State Hospital Opens New Wing, Offers Public Tours, and More

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Gary Crum: We Must Stop Construction of Junction City Hospital

By Gary Crum, guest columnist

The Junction City library.

The Junction City library.

The Oregon state legislature has determined not to provide additional funding for the construction of a state mental hospital near Junction City.  However, the state hospital administration has decided to use $20 million, which was left over from construction of the Salem campus of Oregon State Hospital, to further develop the project.  The proposed construction will involve site construction and it will begin the construction of the building’s foundation.

I have been assured by State Senator Chris Edwards that, during the next legislative session, there will be a “clean” discussion of the relative merits of locked-ward hospital treatment vs. community-based programs, and this discussion will determine the future of the hospital project.

However, it’s very clear to me that the hospital administration is working to avoid that conversation and dialogue.

As Edwards knows, all stakeholders — patient advocates, professional organizations, the Oregon State Hospital Advisory Board and the federal government — strongly support community-based services.

At this juncture, the Junction City-area state-owned property could be used for a multitude of governmental functions.  It could be developed as a campus for community-based residential programs for the mentally ill; it could be the site for the Veteran’s Administration clinic slated to be built in the greater Eugene area; it could be a service park for future state and federal government offices and service centers; it could be many different things.  It has the proper zoning (public facilities); it has infrastructure in place to serve it; it’s in an excellent location, near major highways and the Eugene airport.  In sum, it offers tremendous potential for South Valley governmental services siting.

However, once foundation work for the new state hospital building is begun, I predict hospital administration will simply say, “Look, we’ve gone too far to change course now.  We can’t waste taxpayer dollars by deciding to change our minds.  We must go forward with the hospital as planned.”

What we must do is simple: We must stop construction on the actual buildings.  This may prevent the legislature from a final, absolute commitment to locked-ward hospital treatment as the direction the state wants to take for the future of treatment of the mentally ill.

I offer the following comments, hoping that our legislators will listen, and begin an open and inclusive dialogue to determine a better future.

And, I suggest that, when that dialogue occurs, those legislators will be convinced that state resources are best directed toward a cascade of community-based services, rather than focused on an extremely expensive commitment to hospital-based placement.

The decision to build or not to build a new $100 million mental hospital near Junction City will determine the focus of treatment for Oregon’s mentally ill population for years to come.

If the state decides to fund hospital construction, it will be committed to over $100 million in construction costs, and additional annual operating expenses of over $48 million (174 beds at $280,000 per bed per year).

This huge expenditure will drastically curtail funding for the development and operation of community-based services — community-based residential facilities, community mental health clinics, outpatient treatment and community-based crisis care.  Funding the hospital’s construction and then its operation will put all our mental health care dollars in one basket — and in my opinion, it’s the wrong basket.

Every stakeholder group engaged in this debate has publicly and vehemently opposed the hospital’s construction: every patients’ advocacy group has opposed it; every mental health professional organization has opposed it;  the governor-appointed Oregon State Hospital Advisory Board has opposed it and written a very strong letter of opposition to legislators.  The U.S. Department of Health and Human Services spoke with its wallet in opposition to large, locked-ward facilities.  Community-based treatment and services receive a 50 to 60 percent federal subsidy; locked-ward facilities such as the proposed Junction City hospital receive none. The Junction City proposal is both wrong-headed and hugely expensive.

The guiding principle of mental health care and treatment is “the least restrictive appropriate setting possible.”  Locked-ward placement is the most restrictive placement on the continuum of services for the mentally ill.  Funding the Junction City hospital will represent a commitment to continue that funding and that extreme level of treatment, at a direct “opportunity loss” cost to all other placement and treatment options.  Oregon, especially in these difficult economic times, simply cannot fund this facility and develop and support other, less restrictive, treatment options.

Even the proponents of building the hospital acknowledge that we do, indeed, need to move toward community-based treatment programs and services, but they claim another locked-ward facility is a necessary step toward those programs.  This argument is akin to suggesting the best way to drive from Eugene to Portland is to first travel to Medford.  Rather than taking us closer to that goal of community-based mental health treatment, the hospital’s construction takes us much farther away from that goal.

Most of the debate centers on forensic patients, individuals who have committed crimes, but are adjudicated “not guilty” due to mental illness, and sent to the hospital rather than being processed further into the criminal justice/penal system.

Based on August 2011 data, 40 percent of Oregon’s forensic patients were committed for crimes which were not Measure 11 felonies.  Had these individuals not been judged mentally ill and  instead were convicted of such crimes, they would have been sentenced to either very short periods of incarceration or placed on probation.

Most of these patients could be treated in the community at a much lower cost (about 14 percent of the cost of hospital placement), receive more appropriate treatment, and more readily transition back into the community. Importantly, they would present no risk to other patients, staff or the community.

In addition to forensic patients, locked-ward mental hospitals across the country, including Oregon, have an increasing population of geropsychiatric (older) patients, many quite elderly and infirm, who could be placed in community-based facilities with absolutely no risk to anyone.

We’re both violating the mandate for “least restrictive setting” and wasting tens of millions of tax dollars with these locked-ward placements — or, if you will, “misplacements.”

The simplest and most economical approach to forensic patient care is to provide proactive support; care, treatment and supervision before they commit crimes leading to their hospital placement; i.e., help them avoid becoming forensic patients.

Most (virtually all) forensic patients have long histories of mental illness.  They are individuals who when living in our communities received maintenance levels of psychotropic medications to treat, primarily, schizophrenia and bipolar disorder.  They function quite well in the community so long as they maintain that therapeutic level of medication.  However, nearly all psychotropic drugs have rather unpleasant side-effects: nausea, headaches, muscle and joint pain, stomach and digestive problems and, often, impotence and loss of libido.  Problems arise when individuals taking these medications decide to “self-UNmedicate” — to, on their own, reduce or terminate their medications.  Most of the incidents leading to forensic placement occur when such patients are “off their meds” and in the throes of a psychotic episode.

We need community resources to help these individuals continue their medication at an appropriate level.  We need outpatient support groups and individual therapy and counseling support. We need outpatient clinics with physicians and psychiatrists to help adjust medications and doses to minimize side effects. We need, when appropriate, nurse practitioners to supervise court-ordered medication dosing. We need community-based residential facilities with a continuum of security levels to house patients. We need community crisis centers for temporary secure placement to provide short-term detention, observation and evaluation and, when needed, to facilitate the re-establishment of therapeutic levels of medication.

We need the legislature to address this important topic with open minds, and to listen to the strong arguments for these community-based services which patient advocates, professionals in the field, and the Oregon State Hospital Advisory Board have put forward, to terminate the Junction City hospital project, and redirect funding toward proactive community-based programs and facilities.

The state hospital administration is working very hard to avoid the discussion we need, by forging on with construction of the hospital without the genuine, informed support and approval of the legislature.

Gary Crum is a resident of Junction City, Oregon.  He has been active in opposing the construction of a new psychiatric institution there.

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