The view from behind the gray concrete walls of the Oregon State Hospital in Junction City looks out upon the yellow-green bucolic plain of the Willamette Valley to dark green foothills on both sides of Lane County.
The view inside the immaculate hospital is of a fresh, bunkered community college, still new-smelling from its opening a year ago. The warm, inviting library is filled with thousands of donated books; the fitness room has new equipment, and the recreation room has new air hockey, ping pong and foosball tables, no knob yet broken.
Patients line up single-file in the hospital corridors as staff leads them from lunch to the afternoon’s treatment mall activities, each designed to speed their progress toward the green plains and hills outside. “We believe that everyone is going to get to the point of recovery,” said Shaunia Scales of the Oregon Health Authority, a “lean leader” at the hospital.
That means coursework in anger management, substance abuse treatment or art therapy, as well as creating positive interactions with the other patients. It’s a far cry from the bad old days when patients might be routinely kept in restraints or isolated in padded rooms. Those options still exist but happen rarely, and only for those in the more intensive units at Junction City. “We consider any use of restraint or seclusion as a failure,” said Scales.
As they improve, patients get increased opportunities to visit the outside world, first to a nearby nature park, then into Junction City, as well as the Coast or Eugene before they are finally ready to leave.
The Junction City hospital sees two types of patients — people who are civilly committed because their mental state poses a threat to themselves or others, and criminal offenders who are guilty except for insanity. A third, steadily growing group of patients at the Oregon State Hospital — people who are charged with crimes but cannot stand trial because of mental instability — are only treated at the big hospital in Salem, which has about 600 beds to Junction City’s 150.
Junction City today is only half full, although an empty wing will open next month to treat an additional 25 civilly committed patients.
Hospital Was Controversial
The view of the hospital from policymakers and advocates is more mixed — almost every mental health advocate, as well as the legislators who most frequently hammer out mental health policy — opposed its construction.
“It goes back to a master plan that was designed to increase the capacity. I’ve been opposed to it,” said Sen. Alan Bates, D-Medford. “Other states are closing their institutions. We’re the only ones opening new ones.”
“This is a step backwards,” said former Rep. Carolyn Tomei, D-Milwaukie, who chaired the House Human Services Committee for almost a decade. “They’re investing in the old system. We need to deinstitutionalize people, not create another institution.”
The federal government through the U.S. Justice Department has investigated the state’s lackluster mental health system and forced it into a multi-year plan to clean up its act, with a focus on treating people in the least restrictive environment. Odds are the department will issue their final opinion before President Obama leaves office, and it’s unclear whether they’ll give Oregon an OK.
The Justice Department did not intervene in the construction of the new hospitals, but federal policy opposes big institutions as the delivery model for mental health services and Oregon cannot get any federal dollars to support the care of institutionalized patients, even as federal Medicaid dollars pick up the vast majority of healthcare costs they might receive in an outpatient or community hospital setting.
“The cost of running it will be huge,” said Bates, who oversees the budget for the state hospitals and put the price tag at $300,000 per patient, per year, all from state dollars. The hospital cost $80 million to build and costs $38 million a year to operate.
Bates instead wanted the state to build a bunch of 16-bed facilities around the state to cater to psychiatric patient’s needs in their communities. The state could have counted on federal Medicaid dollars to pay for most of that care. A pilot of that model is opening in Pendleton, site of the former Blue Mountain/Eastern Oregon State Hospital.
But Tomei said legislative leadership, including former House Majority Leader Val Hoyle, D-Eugene, whose district includes the hospital, and Senate President Peter Courtney, D-Salem (whose district includes the other state hospital) were determined to build the hospital:
“Once he [Courtney] makes up his mind, he’s adamant. He wanted a second hospital, and by damned, that’s what he got, even though there was nobody in the mental health profession who wanted it,” she said, including an advisory group specifically set up to address the costs and benefits of two new hospitals.
Advocates also objected to the downstate location of the hospital and the closure of the old state hospital in Portland. But 31 percent of the patients at the Junction City facility are from Lane County, and another 33 percent are from southern Oregon. Only 15 percent come from the Portland metro area.
Oregon State Hospital spokeswoman Susan Stigers said only 40 percent of the patients at the old Portland hospital were from the Portland metro area, and those patients were transferred primarily to the hospital in Salem. That’s outside the metro area by most definitions, but at 47 miles from downtown Portland, it’s about the same distance as the Western Washington State Hospital from Seattle.
Democratic Leaders Stood Firm
Courtney ignored requests from The Lund Report for comment through his spokesmen, Robin Maxey and Rick Osborn.
But in 2008, he told the Statesman-Journal: ‘‘We have set a course for how we are going to deal with the mental health crisis in this state, and we have set it in terms of two institutions.”
The master plan had initially come about because of a different set of lawsuits against the state, focused on the abysmal condition and substandard treatment methods at the old Oregon State Hospital in Salem.
To stick to his original plan, while pivoting toward the community mental health that the feds, advocates and legislators like Bates and Tomei demanded, Courtney, along with then-Gov. John Kitzhaber, invested many more millions in community mental health, using both a dedicated cigarette tax source that Courtney commandeered from Republicans, and a marked new investment from the general fund.
In a press release after the money for the hospital was approved by the 2013 Legislature, Hoyle seconded Courtney’s message for both the hospital and more community investments: “[I] helped secure the $80 million required to build the project. The Junction City Hospital is now under construction, bringing a huge influx of jobs to the area and paving the way for a high-quality acute care psychiatric facility.
“The Legislature also increased funding for community mental health care by 40 percent and is coordinating with local jurisdictions to deliver community-based care when and where people need it.”
Those investments have continued under Gov. Kate Brown, but given their reliance on funding from volatile individual income taxes, the community mental health system will be vulnerable in the inevitable next economic downturn, and much easier for future state budget writers to scale back than big hospital operations.
Change on the Ground
Bates said state community mental health services needs to be cut from the counties and handed to the coordinated care organizations, which already have the main stream of Medicaid dollars to fund the system thanks to the Affordable Care Act. State dollars could supplement that money, particularly for stable housing, which the feds are more reluctant to pay for.
As a physician, despite the talk of a sea change in community mental health, Bates isn’t seeing anything changing on the ground, at least for people at the outset of a psychotic break. He knew of a patient in need of psychiatric care at one of the Medford hospitals who’d been boarded in the emergency room for two months without treatment.
But, Chris Bouneff, the director of the National Alliance of Mental Illness — Oregon, though long a critic of the Junction City hospital, does think the community mental health investments will move the dial.
“You do have to credit someone like Peter Courtney. His commitment was to continue his investment in the community,” Bouneff said. “All signs point to continuing those investments in 2017. Those are the investments that are gonna make a difference. The improvement from those investments, you can’t have a ribbon-cutting for, you can’t run a one-year anniversary story.”
For the view back at the Junction City Hospital, interim administrator Kerry Kelly concedes that the state hospital system is not the ideal place to put individuals, but notes the backlog of people needing intense, acute care. When the new wing opens in May, it will relieve pressure on patients around the state who, like the patient Bates mentioned, are cooped up in local hospitals, often simply in emergency rooms, and need the extra care.
“An institution is an artificial place. People are not meant to live in institutions,” said Kelly. “In a perfect world, we wouldn’t exist.”