Bill might prompt earlier releases at Oregon State Hospital

From the Salem Statesman Journal, April 24, 2011

Discharges of patients could be swifter if determined by hospital instead of board

A bill that could speed up sluggish release practices at the Oregon State Hospital is moving forward in the Legislature, boosting the hopes of patients at the Salem psychiatric facility.

Senate Bill 420 proposes to give the hospital rather than the state Psychiatric Security Review Board authority to say when a patient is ready for release from the hospital’s forensic program.

READ – Oregon Senate Bill 420, Calculates maximum period of jurisdiction of Psychiatric Security Review Board over person found guilty except for insanity of offense based on sentence person would have received had person been convicted of crime.

Patients and mental-health advocates say the legislation is needed because the PSRB takes a strict approach to releasing patients, resulting in excessively long and costly stints of hospital care.

Faced with an ongoing federal investigation of the state hospital and a $3.5 billion budget shortfall in 2011-13, Oregon can’t afford to continue warehousing patients, mental-health advocates say.

“In this fiscal environment, we can’t continue to shovel money into things that really don’t make sense,” said Robert Joondeph, executive director of Disability Rights Oregon.

The forensic program houses more than 400 patients, and it costs taxpayers about $200,000 a year for each. Community-based housing and mental health supports are much less expensive.

All too often, though, patients are kept inside the hospital after therapists have deemed them ready to leave, according to patient activists and mental health advocates.

The PSRB has become a frequent target of criticism and complaints.

“There are a lot of people locked up in the hospital that do not need to be here, and the reason they are here is due to the board and its stringent and overly cautious and conservative practices,” patient Matthew Kirby said last week. “Right now, the hospital feels like a prison. It feels like we are being warehoused.”

Kirby, who testified in favor of SB 420 at a legislative hearing on Monday, described the legislation as a much-needed reform.

“420 addresses the hospital’s back-door issues, so that people do not languish in an institution far longer than they need to,” he told the Statesman Journal. “In short, it places the determination of treatment needs in the hands of the doctors that work with us on a daily basis, as opposed to some alien body that listens to us for 20 minutes and doesn’t have to take our treatment needs into consideration.”

Senate Bill 420 was negotiated by a team that included the Chief Justice of the Oregon Supreme Court, representatives of the district attorneys association, the governor’s office and legislators.

The bill now awaits action by the Legislature’s budget-writing committee after clearing the Senate Judiciary Committee last week.

“What this bill is supposed to do is give us more efficiency in our mental health facilities,” said Sen. Floyd Prozanski, D-Eugene, chairman of the Senate Judiciary Committee. “This is also ensuring that the limited bed space we have is being used most appropriately for those in need of those services.”

Currently, the state hospital houses more than 400 forensic patients who were committed to OSH because they were judged guilty of crimes but insane at the time. Instead of doing time in state prisons or county jails, they were sent to the hospital for mental health treatment.

Under the current system, the PSRB controls patients’ discharge dates. The governor-appointed panel also monitors more than 300 former patients living in Oregon communities after being conditionally released from the state hospital.

Senate Bill 420 proposes to give the hospital the final say on when a patient is fit for release. The PSRB would continue to monitor the person after release.

The board also would retain its authority to order a person back to the state hospital for violations of release conditions, such as failing to take medication, drinking or drug use and skipping mental-health appointments. A person also can be returned to the hospital for stabilizing treatment if his or her mental-health condition deteriorates.

Since the PSRB was created in 1978 to provide added safeguards to the release process, fewer than two percent of conditionally released patients have committed new crimes.

Defenders of the board say that it has performed its primary mission, as set forth by state law, which is to protect public safety.

But mental health advocacy groups have persistently criticized the board’s strict stance on releasing patients.

“The feeling is that the PSRB has been very, very tight in terms of those decisions,” Joondeph said. “More to the point, the PSRB has not had any incentive to get people out of the hospital that don’t need to be there. It’s not their job to do that, so we spend a lot of money to keep certain people in there, even though the doctors, nurses and psychologists who evaluate them have decided they don’t need to be at that level of service. We essentially ask the state hospital to be a jail or a warehouse or a holding place for certain people, and we’re paying top dollar to keep them there.”

Shifting release authority to the hospital makes sense for economic, therapeutic and management reasons, Joondeph said.

“It’s one of a number of ideas kicked around about how to give the hospital more control over its beds,” he said. “We have been supportive of the idea as a way to do that, in order to make sure the right people are in the right place at the right time.”

The proposed legislation comes as federal investigators are scrutinizing length of patient stays as part of an ongoing civil rights investigation of the psychiatric facility.

The U.S. Department of Justice Civil Rights Division began investigating patient care and hospital conditions in June 2006. The investigation later expanded to include length of patient stays and community-based services and supports for people coming out of the hospital, as well as those at risk of being institutionalized.

Federal lawyers recently spent three days in Salem, April 6-8, conducting a series of interviews with state mental health administrators.

The federal Justice Department has not made any public statement about when the investigation might end or whether a lawsuit will be filed against the state for alleged violations of patients rights.