By Robert Landauer – editorial columnist for The Oregonian, April 21, 1996. Not available elsewhere online.
Imagine Oregon’s seriously mentally ill patients leaving psychiatric hospitals. Picture them skiing down the slope of that graph over there. See them gliding into community programs with supervised housing, calming drugs and counseling.
As background music, play “America the Beautiful”: Thine alabaster cities gleam, Undimmed by human tears! End of daydream.
That ski slope is a cliff. At its base is wreckage, not snow angels. Tears, not smiles.
Severely mentally ill Oregonians are crashing into a system of walls with few gates.
Oregon closed Dammasch State Hospital, the regional psychiatric center in Wilsonville, on July 26, 1994. Resources were supposed to follow patients to their communities. Witnesses describe effects of cutbacks and the closure:
Acute-care beds (about 190 in Multnomah County) and support services are too scarce.
Dr. J. David Kinzie, director of psychiatric clinical services at Oregon Health Sciences University, struggles with the problem daily: “We are discharging patients that most modern industrial countries would not discharge into the community. Then we support the patients less well than other countries do with housing, money to live on and medical help. It’s awful.”
As hospital beds disappear for the mentally ill, jail beds take their place.
“It is estimated that 7.6 percent of all persons in jail are mentally ill,” Richard Sherman reported in a 1994 survey of counties for the state’s mental -health division.
On an average day, 130 mentally ill persons are in Multnomah County Jail. That is about half the state total, says Jack Wolinski, director of the Alliance for the Mentally Ill of Multnomah County.
Jail beds substitute poorly for farsighted care of the mentally ill.
Mike McCracken bangs the point home with four hard jabs: “This population doesn’t do well in jail. They don’t normally follow the rules. They don’t understand or comply with incentive systems. As a result, they stay in jail much longer than healthy inmates.”
McCracken is executive director of the Association of Community Mental Health Programs — 32 county-based operations that run publicly funded comprehensive mental -health services for 50,000-plus Oregonians.
Police and sheriff’s deputies are diverted to tend the mentally ill.
Some deputy sheriffs are doing social work as opposed to penal work with the mentally ill, says Cmdr. Vera Pool, the sheriff’s Jail Support Division boss in Multnomah County. The goal is to find them housing, so they can be released. “These people should be treated, not jailed. We feel obligated to go beyond our job descriptions to give them the services they need.”
Lt. C.W. Jensen, the Portland Police Bureau’s spokesman, adds, “The last people who should be penalized for government’s decisions are the people in crisis.”
The bureau has created a Crisis Intervention Team — volunteer officers trained to keep those in mental flux from endangering themselves, the public or police. The officers often are pulled from other duties, routinely get “no-room-at-the-inn” rejections at hospital emergency rooms; and drive sick people around for hours in the hope that they can safely be put back on the street.
The system will get worse before it gets better.
Many day-treatment programs are closing or are reducing services, says Carol Laine, of Gresham, an eight-year, full-time-volunteer advocate for families of persons with serious mental illness. “So we are seeing people who are sicker, who have more needs, and simply not enough dollars to meet their requirements.”
Add this to the gloom: Starting next January, the state will send many hundreds of its criminal prisoners back to the counties. Local jails will get more mentally ill inmates — most of them untreated.
Lack of capacity will drive the relentless triage harder, pushing our mentally ill from hospitals to streets, from streets to jails and from jails to . . .
That’s not enlightened. It’s insane.