Oregon State Hospital on Road to Recovery

Oregon State Hospital, ice bath therapy; taken sometime in the 1940s or 1950s

Oregon State Hospital, ice bath therapy; taken sometime in the 1940s or 1950s

From The Lund Report, November 4, 2010

Its new superintendent intends to take the hospital to a more person-centered, recovery-based approach

It’s time for Oregon to be known for something other than being the setting of One Flew Over the Cuckoo’s Nest, says the new superintendent of the Oregon State Hospital.

Greg Roberts, MSW, a New Jersey transplant who’s been in the job of turning the beleaguered hospital around for six weeks, talked about the future of the 127-year-old hospital last Thursday night. The Salem campus houses 432 forensic patients and 63 geriatric patients, while the Portland campus has 85 people with extended civil commitments.

He’s determined to take the hospital in a more person-centered, recovery-based approach – one that gets patients out of the hospital, into the community, and keeps them there. “Person-centered treatment planning is the name of the game for mental health care in the 21st century,” said Roberts who believes recovery is not only possible, but likely, for most patients – as long as they receive the right care.

In addition, Roberts – who noted that 50 percent of emergencies in psychiatric hospitals that require a doctor’s assistance are medical, not psychiatric in nature – said on-call primary care providers will be added to the evening shifts at the Salem facility.

“Not to be crass, but no one can recover if they’re ill, or especially if they’re dead,” Roberts said.

His vision includes vocational training for patients, involvement from family, friends and community members, and partnerships with local universities and community groups to help patients stay connected to their communities and fully re-integrate upon their release.

“I’m fully optimistic that the transformation of the Oregon State Hospital from what it’s been to what it needs to be will happen,” Roberts said. “But we all need to do it together.”

Dr. Mark Diamond, the hospital’s new chief medical officer, emphasized the need for community collaboration somewhat more concretely, saying that as budgets tighten, the only way the hospital will succeed is if officials work closely with other state departments, community organizations and businesses. “As budgets get tight, I think the key is, we can do it if we work together.”

“Do patients who need to be in the hospital end up in the right place?” asked Diamond, adding a second question that was underscored during Roberts’ presentation: “How do we get them out of the hospital?”

Cosmetic changes are already under way: old buildings at the Salem campus are being demolished and the campus is being expanded, with the intention of creating a less crowded, more livable place for patients.

Diamond, who has had a long career in mental health and forensic pathology – which began with a pathology residency at Oregon Health & Science University – emphasized the shifting role of state mental hospitals.

Currently there are 200 state mental hospitals in the U.S. — 5 percent of the number that were open in 1950, during the peak of their popularity. While Oregon State Hospital primarily houses forensic patients, the question of whether patients are in the right place – that is, whether they can be housed in a correctional institution, or shouldn’t be in a hospital at all, and whether some incarcerated individuals should actually be in hospitals – need to be asked in the wake of a Department of Justice investigation in 2008 that chronicled hundreds of incidents of violence, including self-injury by patients as well as mistreatment of patients, Diamond said.

This fall the hospital came into the spotlight again after a forensic investigation revealed that a patient who died in custody had passed away hours before nurses discovered his body. Five staff members were reprimanded in connection with the incident, but the hospital’s bad rap remains.

Roberts and Diamond definitely have their work cut out for them.

Our two cents – The headline is optimistic. Fixers for the Oregon State Hospital have come and gone over the decades and none have made measurable impact in the compassion or care at the hospital. All were good people, had the best of intentions, including the docs who, as seen in the photo above, used to torture patients in ice baths thinking it relieved psychiatric symptoms. But there’s no good reason to believe these new guys can do any better – other than we need them to be successful. New buildings mean nothing. We’d like to share their confidence, but today there’s no good reason to believe they will be successful.

Here are three tools Roberts and Diamond aren’t given, which would make a big difference.

1. The ability to hire and fire outside of the civil service system.

2. Reform of the Psychiatric Security Review Board so outpatient care is managed by the hospital.

3. Redirecting the capital and operating funds allotted to the Junction City hospital to be used on community-based care, which is effective, culturally-competent, outcome-based, peer-driven, & delivered on demand.