On the desk in Juliet Follansbee’s downtown Portland office is a thick book of Oregon laws. It contains only a few sentences that grant the state agency she operates tremendous power over the lives of hundreds of Oregonians.
In May, Follansbee was made interim executive director of the Psychiatric Security Review Board, a position she was permanently appointed to in November. Created by Oregon lawmakers in 1977, the 10-member interdisciplinary board has authority over individuals who have successfully asserted the “guilty except for insanity” defense, meaning they’ve committed a crime, but because of a mental illness or developmental disability did not fully understand what they were doing at the time.
Follansbee takes the reins of the PSRB at a time when the state has aspired to shift its mental health system to more community-based rather than institutional settings. Follansbee says that the PSRB has more resources to place people in community settings than ever before. Mental health advocates are also hoping that Follansbee will set a new tone for the PSRB, which some say was marked by a climate of fear and intimidation fostered by her predecessor.
Follansbee says she’s open to changing the PSRB’s processes and operations. She also wants to help standardize training and foster a collaborative approach with community health care providers. She says she wants the PSRB to accommodate change, the biggest of which is the increase in resources to treat clients in community settings.
“We (serve) just a small portion of the people who receive community mental health services,” says Follansbee.
Being placed under the PSRB, says Follansbee, who previously ran a program that restored the gun rights of Oregonians whose mental health had prevented them from owning firearms, is different from a civil commitment, where someone is involuntarily placed in a mental health setting. “This is something that our clients have chosen to do because they thought that they would do better in a mental health setting,” she says.
However, those who successfully assert the insanity defense grant the PSRB sweeping control over their lives. Depending on the severity of the crime committed, the PSRB (in consultation with community-based mental health providers) determines the settings clients are released into along with what sort of treatment and supervision they receive. Some clients living in more independent settings may have to check in twice a day with mental health workers. If someone is placed under the purview of the PSRB, odds are it will have authority over them longer than if they had gone to prison. Sometimes they will remain under the board’s authority for life. For most PSRB clients, the first stop after successfully pleading insanity is the Oregon State Hospital.
“We have the least amount of people in the hospital than we ever have, and the most amount of people in the community than we ever have,” says Follansbee. “And the reality is that whenever the hospital says someone is ready to be placed on conditional release, the board almost always approves it.”
Of the 559 people under the PSRB’s jurisdiction, 385 are on conditional release.
In 2011, lawmakers passed legislation that reformed the PSRB system and created a separate board run by the Oregon State Hospital to determine when patients, who haven’t committed violent crimes, can be released. Follansbee, who says there are about 90 people under the separate board, describes this reform as positive, saying that it offers patients one more avenue to obtain conditional release.
At the State Hospital, patients are subject to widely varying degrees of supervision, ranging from closely monitored settings to living semi-independently in group homes on the facility’s grounds. In late March, a patient at the State Hospital who had pleaded guilty except for insanity to an attempted murder charge walked away.
Rebeka Gipson-King, spokesperson for the Oregon Health Authority, says that people are often surprised that some patients live semi-independently at the State Hospital.
“The State Hospital is not a punishment,” she says. “They are sent there to get better.”
However, some mental health advocates have seen things differently.
“You have the use of the State Hospital as a punishment, a very expensive punishment,” says Chris Bouneff, the executive director of the National Alliance on Mental Illness Oregon. Bouneff says that under the PSRB’s previous executive director, Mary Claire Buckley, clients would be sent back to the State Hospital for relatively minor infractions, such as failing a drug test, which could be addressed in a less costly way. “It certainly wasn’t helping with the smooth operating of our mental health operation,” he says.
Patrick, who doesn’t want his real name used in this article because he’s still under the jurisdiction of the PSRB, says that his defense lawyer talked him into pleading guilty except for insanity to what he says was a bogus burglary charge. His lawyer told him he would spend a few months in the State Hospital. Instead he got 10 years of being under the PSRB’s jurisdiction.
After spending three years in the State Hospital, he was released to a group home in Portland, where he says the threat of being sent back was used as a threat to keep residents in line.
“The overall structure is, if you bring an issue to your case monitor that could result in very negative things happening to you,” he says.
An investigation into allegations that Buckley was verbally abusive was dropped following her resignation this past summer. She was hired by the Portland Police Bureau as a policy analyst in November.
Follansbee wouldn’t speak to criticisms leveled against her predecessor, but she did say that she wants clients, victims and mental health advocacy organizations, which she refers to as “partners,” to be heard throughout the process.
“They often have competing interests and views,” she says, noting that stakeholders’ interests won’t always align. “That’s challenging, and one of the ways we want to work collaboratively is to build relationships where all of our stakeholders feel like they’re getting a fair shake.”
Although Follansbee says she doesn’t want to keep someone in the hospital unnecessarily, she says a cautious approach is still needed.
Oregon law directs the board to have “as its primary concern the protection of society” when making decisions regarding the conditional release or discharge of patients. And to get out of the hospital, patients still have to go through four separate layers of approval, all of which Follansbee says are needed.
“The data suggests that slow incremental moves will give our clients the tools, so when they are no longer under our board, they can continue their stability,” says Follansbee. “It’s clear by our recidivism rate that when you’re under our board you’re going to remain stable.”
One thing that everyone agrees on is that the PSRB has been effective in carrying out its public safety mandate. The recidivism rate for the PSRB for the last 15 years is 2.66 percent. Of the 1,655 people who’ve obtained conditional release over the last 15 years, only 17 have committed new felonies.
“When you look at Mary Clare Buckley’s record and lack of recidivism, it’s clear that she didn’t take a lot of chances on people,” says Jason Renaud, spokesperson for the Mental Health Association of Portland.
“It seems like what happens when you have a strong personality in charge of an organization, the process just sort of fades,” says Bob Joondeph, the executive director of Disability Rights Oregon. Although the PSRB is designed to move carefully, he says, Follansbee has so far “brought a less hierarchical and more collaborative approach to making the process work the way it’s supposed to.”
Joondeph says that movies and TV have long fueled the notion that mentally ill people are dangerous and need to be locked up. He says that the PSRB should focus more on recovery and individuals under it should receive treatment in the least segregated settings possible, which he says the board doesn’t have the best track record on.
“It’s a difficult position to be in because public safety is our mandate,” says Follansbee. “It’s difficult to have everyone in our system happy with the results.”