From The Lund Report, November 30, 2011
The critical factor is increasing the availability of different types of residential facilities, according to Mary Claire Buckley
When legislators approved the Psychiatric Security Review Board’s (PSRB) budget earlier this year, they attached a string — the board needed to start thinking about ways to move patients out of the Oregon State Hospital into community treatment facilities. That string took the form of a “budget note.”
Budget notes can be written by members of the legislative budget-writing Joint Ways and Means Committee and included in budgets in an effort to direct state agencies to take specific actions, reforms or generate reports that might inform future legislation.
The PSRB’s budget note, which was also included in the Oregon Health Authority’s budget, reads: “The Oregon Health Authority (OHA) is directed to work with the Psychiatric Security Review Board (PSRB) to determine the need for community placements for PSRB patients at the Oregon State Hospital for whom a hospital level of care is not necessary on an on-going basis, and recommendations for meeting this need. The recommendations should address the potential need for additional 16-bed residential treatment facilities as well as other types of facilities. This report should be prepared for consideration in the February 2012 legislative session.”
Next February, when the legislature reconvenes, the board, together with the Oregon Health Authority, is expected to provide more details on the need for more treatment programs so patients can safely move into community settings.
“You could move people more quickly through these higher levels of care if the appropriate step downs were there,” Mary Claire Buckley, the PSRB’s executive director, told legislators recently, referring to care facilities where less intensive care is provided.
There’s an immediate need to increase the number of medical facilities that offer treatment for people with severe mental illness, such as treatment homes where people can live on a permanent basis while receiving mental healthcare and respite care to help people avoid mental health crises and hospitalization. Such facilities are not only less intensive, but also less costly than care at the Oregon State Hospital.
Some counties have secure residential treatment facilities—16-bed group homes that offer mental healthcare where patients are either guarded or not allowed to leave – but those counties lack treatment homes that are less restrictive which means patients must either stay at the facility or move to a different part of the state.
“Anything that we look to develop should first look to the counties where secure facilities are located, and where there are not residential treatment homes,” Buckley said. Some of those counties include Umatilla, Marion, Clackamas, Deschutes, Lane and Jackson counties.
A 16-member work group convened by the PSRB and the Addictions and Mental Health Division has been focused on this issue and will make a report to the legislature next February.
That work group, which has met twice, has been given data about 47 people under the PSRB’s jurisdiction — patients at the Oregon State Hospital. “We believe that this [patient group]…was a basic representative of the needs overall, on any given day” at the hospital, Buckley said.
On May 1, there were 736 individuals under the PSRB’s jurisdiction. Of those, 324 resided in the hospital, and the rest were “conditionally released” into community treatment settings.
The workgroup is looking into what patients may need in a community setting, such as personal care, medication, substance abuse treatment, legal issues and their housing preference.
“We didn’t want the hospital to tell us where someone needed to live, but their specific needs…and what supports would be necessary to have them in the community safely,” said Len Ray, the Oregon Health Authority’s adult mental health services administrator. “It allowed the conversation [of the workgroup] to be very specific.”
The workgroup is not recommending additional secure treatment facilities, Buckley said. Currently, the PSRB has access to 73 such beds outside the Oregon State Hospital, which is sufficient.
The workgroup is composed of 16 people, including mental health advocates, three representatives of community-based providers, two people representing Oregon counties, two people living with mental illness (one of whom has been under the PSRB’s jurisdiction), Buckley, two representatives of the Oregon State Hospital, and two from the Addictions and Mental Health Division of the Oregon Health Authority.
The PSRB, a five-member board, appointed by the governor, has jurisdiction over Oregon State Hospital patients. Essentially a parole board, it holds the power to decide whether patients remain in the state hospital, are released to community-level treatment facilities, or released to live independently. The board, which is charged with protecting public safety, is often criticized by consumers and advocates for being too conservative in releasing patients.
The PSRB is undergoing a substantive amount of reform on top of identifying individuals that could be released out of the state hospital and to less intensive treatment settings. Last session the legislature enacted two laws dealing with that board.
House Bill 3100 requires court-certified psychologists or psychiatrists to evaluate someone before they make a “guilty except for insanity” plea, and that people committing misdemeanor-level crimes and Class C felonies be sent to the hospital only if they need intensive services.