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The first patients to stay at the Oregon State Hospital in Salem came 127 years ago. In more recent years, the quality of patient care has repeatedly come under fire and the federal government has investigated the facility. Few if anyone disagrees with the idea that the Salem hospital needs replacing. However, the additional hospital in Junction City is another matter.
Advocates say the nearly three million dollars already spent on siting and other preliminaries for the new hospital is nothing compared to the hundreds of millions of dollars it will take to build — and the estimated $120 million a year to run it. They say the money is better spent on much needed community-based programs that would help many more people grappling with mental illness. Though the Governor and the OSH say the hospital must be completed in order to care appropriately for patients, other lawmakers say in these times, when budget shortfalls seem intractable, everything must be on the table.
Do you have a friend or relative in the Oregon State Hospital in Salem? Do you know someone in need of community mental health care? What should the state be weighing as it decides whether to continue to build a new mental hospital in Junction City? Where should the money come from? Where should mental health money be focused?
GUESTS:
- Richard Harris: Assistant director of the Addictions and Mental Health division of the Oregon Department of Human Services
- Dave Hunt: Speaker of the Oregon House
- Beckie Child: Board President of Mental Health America of Oregon
- David Clyne: City Administrator for Junction City
Tagged as: economy · mental health · politics · state hospital
Photo credit: Julie Manzerova / Creative Commons
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I am very lucky that I didn't end up under the PSRB when I commited my crime. Now most of the mentally ill end up in prison if they offend. Is it better in prison for these people? Our prisons are getting over crowded and they need to be reformed. Reagan had a bad idea back then when he empited the State Hospitals. Now we dump the mentally ill off on the streets of Portland.. Do we need a new State Hospital? The answer is yes, but we also need more help in the local communities where the mentally ill can be found.
I am also fortunate that I do fairly well on medication. I am also lucky that I am a veteran. I know several people who need more help from the community than we can help at this time. NAMI needs more funds to help the people who are on the street right now. But you cannot help people who do not want to be helped.
Where should the money come from? From the prison budget. There are way to many people in our prisons. Many of the lowest risk people should be put on Post Prison Supervision. That would allow some prisons to be closed.
Mental health money is hard to come by. But you are right that more community based solutions should be made available. At this point I am supported by a three legged stool: Therapy; Medication, and Community Support through NAMI. And NAMI only has so many resourses that they can depend on.
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A state hospital???
is that really the answer to persons being tomented by a mystery illness that physicans are unprepared to treat!
a hospital setting in the community where the mentally ill can be treated longer than 2 weeks would be much better answer.
physicans who are familiar with the illness and have the compassion and experience to treat the ill would be such a great solution.
a community center where everyone is admitted. not just those
who have a certain insurance and then throw them to the steets at exactly 2 weeks of care because that is all the ins co covers
i have been in the system for 8 years as a caregiver of someone
who would be classified as severely mentally ill. someone who can not care for themselves and who may very well be a danger to me at times.
i still believe the physicans in the local hospital should have the authority to keep them until the truely believe they are on the proper dose of medications and stable, or better yet....safely taper them off the meds and find out what the real issues are causing the illness.
i know for a fact that the antipsycotics meds such as ZYPREXA can make a normal human psychotic after years of use.
if you do not believe me ....try the meds daily for years....maybe you will belong in the state hospital too.
free housing and insurance for those released from prison but no care for the mentally ill until they commit a crime.
hello all physicans who have studied psychiatry....DO YOUR PART. DO SOME PRO-BONO.
TOO MANY QUACKS IN THE MENTAL HEALTH SYSTEM TO OPEN ANOTHER STATE HOSPITAL.
HOW MANY UNCLAIMED URNS AT THE OREGON STATE HOSPITAL IN SALEM.......5000 OR SOMETHING?????
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During a recent special legislative session in 2008, then Senator Margaret Carter proposed a bill to quantify where the money spent on Mental Health in Oregon was being spent. The results of that study were that nearly 40% of all mental health care tax dollars in Oregon were spent on the State Hospital system. Given that the number of persons treated by the State Hospital in any given year numbers approximately 1000 and serious mental illness strikes many more thousands than that, the need to carefully look at how money is spent is a very relevant topic. The Department of Justice CRIPA report also suggests that multiple persons who are well enough to be placed in community treatment facilities languish for months in the State Hospital system suggests that the real problem area right now is the lack of structured community treatment.
When I attended the Phase One hearings on the new State Hospital plan, the reporters suggested that a major problem in Oregon was the lack of an intake and reintegration system for citizens with mental health issues. To date that system has not been addressed. Until it is, any new facility will continue to house people in the most expensive and potentially unproductive manner. The money can be spent on better facilities to assist citizens in dealing with their issues of care and still protect public safety.
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From a practical standpoint, the Junction City site for this propsed Mental Health Hospital, is not a choice location.
First and foremost, there are numerous wetlands issues with the property, which would need to be mitigated at taxpayer expense. Then from a transportation perspective, the proposed site has numerous strikes against it. These issues weren't discovered until after the property had been purchased by the State of Oregon.
The property is bordered on the east and west by two major railroads. If access were to be obtained to the west, the State would have to obtain at least one permit to cross the Portland & Western Railroad, which is no mean feat.
Beyond the rail issues; to connect to a major high-speed highway (OR 99) is fraught with potential problems. The access they would seek would most likely need to be signalized, at least, and placing a traffic signal on a 55 mph highway has been shown to be hazerdous, resulting in an increase in high-speed crashes.
In short, the Junction City location for a proposed mental health hospital should have been given a lot more scrutiny before the State commited to buy the property. The State agencies in charge of this project, should just swollow their pride, learn from this experience, and admit they made a mistake.
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Oregon needs a safe and humane placement for individuals with severe mental illness who cannot be treated successfully in an outpatient facility. The Juncion City hospital site will provide secure 24-hour care for those unable to care for themselves in a less restrictive environment. Our local community health organizations are already overwhelmed and overburdened and suffer from quick turnover of staffing and inadequate programming for everyone. The idea that group meetings and weekly or monthly appointments for someone with severe mental illness is adequate is clearly mistaken; those with severe mental illness need constant, not occasional treatment, or will wind up in the prison system which will clearly cost more.
A generation ago when hospitals for the mentallly ill, such as Damasch, were closed, it was for good reason: they were inhumane and not providing treatment as much as warehousing individuals. With modern approaches that include medication management and individual supports, there is a need for adults with mental illness to be cared for in a humane fashion. When Damasch was closed, the emphasis was on improved outpatient services, which never fully materialized. If you walk into some outpatient treatment centers, as I have with a mentally ill relative, you will see how poorly they function for many people, especially those who sit there dazed and confused, not sure what they'll do next.
How can we expect the state to find alternatives to the Junction City Hospital when state funds are as low as they are and will be reduced even more? Our state already makes ridiculous decisions with our money, such as the news this morning that DHS will pay $193,000 for emotional intelligence testing and executive coaching of the 26 top managers at DHS, which incidentally is being paid to an Illinois firm?
For those with mental illness, better built and managed facilities are better than empty promises. We need to create a safe and well-run hospital for our most disabled adults with mental illness.
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corinnebsp,
Your comment assumes that treatment is better in a state hospital environment. That certainly doesn't appear to be the case at OSH. Decades ago deinstitutionalization started recognizing the limitations of isolated institutional environments. The ultimate goal is functioning in the community, and it is neither humane nor legal to institutionalize individuals permanently. Anything that might be learned in an institutional environment transfers poorly to the community. Many states have had successful programs for diverting persons from state hospitals. Instead of another hospital, it would be a better solution to create such programs, with adequate staffing, funding, expertise, and leadership. More hospital beds simply delays development of such programs.
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The mentally ill in Oregon are suffering because of the poor management by the OSH and bad decisions by the leadership in Salem, particularly Peter Courtney. Instead of rebuilding another institution in Salem, the State of Oregon should have sold all 148 acres and constructed community facilities around the state with a facility for forensics patients built near the cadet training facility in Salem.
The community model is used by every other state because it has a better record of success. The federal government also provides more matching funds for the community based approach which would help provide more care for those who need it.
Many of the employees at the State Hospital were against the Community Based approach because it meant moving or losing your job. The concern though should first be for the patients who need the care.
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Investment in "bricks and mortar" is a fairly inflexible fiscal commitment. Investment in community programs can be changed as needs change.
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There are patients in the state hospital who simply would not survive outside the facilities, most of them! Consider the man with schizophrenia who hears incessant voices telling him he's no good and to redeem himself he must do all manner of harm to others. He cries, shrieks and bangs his head against the wall in his attempts to make the voices go away. Consider the many who, as a result of this terrible disease, simply cannot take care of themselves. Are we going to send them away and presume others will care for them, or, more cruelly presume they can care for themselves when extremis becomes their reality? Community health centers are a great idea until the need for budget cuts obscures their services to humanity. Community health centers are a cop-out! We should not now unfund the Junction City Hospital. Let's accept the fact that there are unfortunate persons who need the in-patient services. It will always be so and the numbers are growing proportionately with the population. To believe that mentall illness can be cured with drugs is folly. Drugs most often just dull the symptoms and in the process of doing so they undermine a person's health. Many antipsychotics alter the body's cellular efficiency and usher-in diabetes and other maladies. Therefore, drugs do not obviate the need for inpatient care.
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I just saw this article about a new housing facility being built in Springfield:
http://www.kmtr.com/news/local/story/New-apartment-complex-will-house-and-help/V0fri7DMKkOzII5WFm1YCg.cspx?rss=191
Timely, I must say.
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Because of the size of the institutions people who go to the state hospital are no longer covered by federal Medicaid (OHP). That means even if it's for a heart condition 100 percent of the cost comes from the state. Also people get pushed into programs located hours from their community. We need to help people connect to their communities and families.
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"If we build it, they will come." I have seen patients get pushed from the county level to the state hospital because the county "can't overspend its budget." If people have to be hospitalized--and some do--the closer to home the better. Good Sam in Corvallis has an excellent facility. Part of that is, it's not too big. My relative has said, "If there has to be this kind of place, this is probably as good as it gets." And it's way cheaper than the state hospital. Once you get in that place, you don't get out for a long time.
It's needed for forensics patients, but not even all of them need to go to the state hospital. It's used for geriatric patients, I don't know if that's necessary.
If you can't even staff it--why build it?
DF Corvallis
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The decision by Speaker Hunt to cut the Junction City Mental Health Hospital is political, not practical. Hunt is punishing people in House District 14 because the Democratic Party appointee is being seriously challenged by Junction City Mayor Dwight Coon, a popular Republican. This has nothing to do with the merits of a mental health hospital and everything to do with election year politics.
It's politics in the worst sense!
House District 14 is a district that has been hit hard by the Great Recession. It is bad enough that the only other state project, the West Eugene Parkway was killed by the Eugene City Council because Democratic supporters rejected the people's vote for it. Now they are using the flimsy excuse of needing community-based care as an excuse to kill a vital economic development project that really is a community-based mental health project.
We in West Eugene deserve better from leadership in Salem.
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As a school nurse practicing in Oregon's largest and busiest urban/suburban area, I can verify the need for early identification and intervention. Each year I see more and more children (I serve K-12) needing some level of social-emotional-mental health support. This is the continuum we school nurses use; often problems first manifest as social/behavioral challenges and, if unaddressed, move along the continuum in severity. Early identification and appropriate interventions do work; often such measures make all the difference between success in school (and beyond) and/or repeated problems of escalating seriousness. Though I believe we do need facilities such as the one proposed in Junction City, we certainly would save so much in human capital, social capital, and financial capital if we invested more "up front" toward prevention. Prevention has in any area always proven more effective, efficient, wise, and humane than the other strategies our society is so enamored of.
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Junction city does not nees a mental hospital. It's soooo far off the beaten path it makes no sense. Plus, A lot of those who are released after long stays are going to be infused in the city cause they don't really have any where to go.. Not healty to the area if you ask me. This is actually a very unique and diverse community that I kinda think is being speculated by a bureaucracy. Possibly connected (or not) developers also tried building a bunch of new homes and have open lots in prearranged nieghborhoods.. It looks quite out of place actually. So now add a hospital with very well paid doctors and whatnot to buy up these homes and spend thier money in the local businesses. These are the same people who look at diversity as a mental illness. Again, not good for this town. So now you've outcasted the community.. Just take a fraction of the money and invest it in the community.. the people.. The KIDS.. The SCHOOLS and infrastucure..
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In support of the previous comment submitted by the school nurse:
Throughout today's discussion about the best use of "mental health dollars" I have heard guests and callers advocate for more money spent in the community for early intervention and prevention. I am a middle school teacher in a rural district who started teaching when there was at least a part time counselor for students with emotional and mental difficulties at all grade levels. I have watched as budget woes have resulted in a continual cut of mental health services until we have nothing. Many mental health difficulties manifest in the teen years. Teachers generally have enough training to recognize the possibility of the need for mental health intervention, but if there is no budget for a professional on staff or on contract with the school district, it is very difficult to suggest that parents or guardians seek help for their child on their own; especially if that means seeking assistance from a county health department 30 miles from their rural home. Where is the will to walk the talk of early intervention if the educational community is not able to support a counselor?
Please check with your school district. Are there professionals available to help children with emerging mental health issues? If not, why not? Have the teachers had training to help them recognise and refer students for help? Is this a budget issue that your school board should hear about?
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Focusing only on solution is not going to help anyone including the general public. Since the money is coming out of tax payers’ pockets, we should look into what is a productive and appropriate way to resolve the issue. Creating another big State hospital will not solve any problem, ESPECIALLY when the current system is not working for anyone.
Proposal: 1. Change the current State hospital’s function. In order to truly help the patients, we have to really respect and give them dignity. Current practice is not working..For example, placing someone who is going psychotic in a white, empty room will worsen the symptoms. What we have to do is the change the whole practice of therapy. 2. Higher pay for State hospital employees, 4 day work schedule, and more aggressive conflict solution (humane) training. Just focusing on “Fixing their problem” is not the proper way. Practitioners need to understand HOW to deal with mentally ill. Only way is to WORK TOGETHER..This is tough, therefore, higher pay, more education…eventually will cost MUCH LESS for the entire State. 3. Change the law. Waiting until the mentally ill causes harm to oneself or to other is a nonsense. What we need is a more aggressive training for mental health practitioners and social workers (and more pay) so that it would eventually cost us LESS (solution always costs us MORE, look at our prison system) and will benefit mentally ill AND everyone else. 4. Change our prison system and Veteran’s healthcare. Basically, we need a solid rehabilitation program inside the prison and job programs for prisoners so that they do not go back to the prison (save us $$$$$). Veterans (active or retired) need to get a mental healthcare (counseling, etc) BEFORE, DURING, and AFTER any draft..this will drastically decrease the homeless and mental health change (also save us $$$$$).
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Comments are now closed.
Until 50 years ago we dealt with the Mentally Ill by institutionalizing them for life in white prison-like Mental Hospitals.
In the Past 50 years, we have had a revolution in AntiPsychotic Drugs begining with Thorazine and Haldol. When patients stay on the medication, they are calmer, more sedate and less confrontational. In short they can be managed at home and in the local community. But paranoid ideas cause patients to fall off the regime, and then they relapse into acute psychotic ephisodes. Successes in psychiatric medication and backlash from media portrayals by movies like "One Flew Over the Cuckoo's Nest" lead the Reagan Administration to liberate the Mental Hospitals and reinstate the Freedom of the Mentally Ill.
And yet some were unable to care for themselves in society and end up on the street: soiled in their excrement, arguing with invisible enemies, pushing a shopping cart with hundreds of pounds of rags, and sleeping in doorways. Yes you saw historical change: Since the 80's our neighborhoods were invaded with an EPIDEMIC of HOMELESS--many mentally ill, drug addicted and alcoholic .
Now the Pendulum Swings Back. We realize that a small minority do worse off with their freedom since they are unable to care for themselves ie. bowel and bladder continence, refractory medical response to medication, frequent dose undermedication.
We still need mental hospitals, but populations will be smaller especially for the chronically ill population. You can learn a lot about mental illness just witnessing the homeless in a big city neighborhood. But most persons do not care personally nor allow their young daughters to be exposed to this interesting branch of humanity.
Yes, SOME NEED TO BE INSTITUITIONALIZED FOR LIFE. Junction City is needed if only to improve the Homeless situation in Downtown Portland. There will be a well worn path between these cities in the future---kind of like Moscow and Siberia.