-By Jenny Westberg, Portland Mental Health Examiner
A striking transformation could be in store at the Oregon State Hospital, according to the facility’s new leadership team, Supervisor Greg Roberts, MSW, and Chief Medical Officer Mark Diamond, DO, who spoke about the future Thursday evening at Oregon Health & Science University.
Roberts and Diamond weren’t talking about cosmetic fixes, although those are badly needed as well. They spoke of a rethinking of institutional culture that would change OSH from the inside out.
“Construction of a new building certainly helps, but it will not, by itself, get us where we need to go,” said Roberts.
Diamond led off the presentations with facts, figures and PowerPoint slides. But it was Roberts who blew the doors off the auditorium with talk of a patient-based, recovery-oriented institution.
“Research clearly shows that recovery is not only possible, but more than likely for most individuals,” said Roberts.
“OSH needs recovery-oriented systems of care,” he said, announcing his intention to take it “from research to routine practice, from rhetoric to reality.”
Roberts said he is planning a culture change, and it will start with staff training.
“Employees,” he said, “often receive no training after their new employee orientation. Without this training, they will continue with custodial, control-oriented methods.” And that’s not all: They must demonstrate real-world competency.
Roberts said that staff must:
- Be confident in their ability to help people recover, and in each person’s own ability to recover.
- Treat each other and patients with dignity and respect.
- Inspire hope.
- Become non-reliant on threats, force and coercion.
- Listen to patients, instead of directing them. Let patients take the lead.
Will Hall: “Restraints have nothing to do with recovery”
Roberts went even further, calling for the elimination of seclusion and the “near-elimination” of restraints. To many observers, that would be a significant step toward improvement.
But some, like Will Hall, say “near-elimination” of restraints is not sufficient.
“Greg Robert’s remarks on restraints aren’t enough,” said Hall, a Portland therapist known internationally for mental health advocacy, who himself recovered from a diagnosis of schizoaffective disorder and experienced firsthand the terror of being restrained.
“The federal agency SAMHSA set the goal back in 2003 of eliminating all restraints,” Hall said. “I still suffer the traumatic scars of restraints from my hospitalization. Restraints have nothing to do with recovery.””
During Diamond’s presentation, the Chief Medical Officer explained that patient populations used to be primarily composed of civil commitments. Now, forensic patients are the largest group by far.
There are 432 forensic patients at OSH, and 63 geriatric/neurological patients. The Portland campus (“POSH”), meanwhile, houses 85 people with extended civil commitments. OSH also provides forensic evaluation services, such as “aid and assist” evaluations to see if an individual is competent to stand trial. For patients found incompetent to proceed in court, OSH attempts to restore competence.
Diamond mentioned the importance of making sure people are in the right place. There are hospital patients, he said, who should be in corrections, and vice versa.
More than “Cuckoo’s Nest”
Another vital element, said Diamond, is making sure that people who recover make it out of the hospital and into the community – and that they stay there. Factors affecting successful community placement include staying off drugs and tobacco (OSH is smoke-free); maintaining good nutrition, especially since many psychiatric drugs contribute to weight gain; continuing to take prescribed medications; acquiring occupational skills; and the use of Wellness Recovery Action Plans, or “WRAP plans.”
Diamond would like to see OSH become a community resource, “working with community providers to extend outreach to the homeless population in order to prevent admission or readmission to the hospital.” He would also like to establish an inter-agency formulary, to minimize medication changes as an individual moves from one service to another. Also, he wants to see the development of a master’s-level forensic mental health curriculum.
Diamond and Roberts have set a high bar.
But Roberts promised targets and accountability. He is confident that “OSH will become the recovery-based organization we want and need it to be.”
“We’d like to be famous for more than ‘Cuckoo’s Nest.”