This week, Attorney General Hardy Myers is considering
whether to ask the Legislature to overhaul the way Oregonians
with severe mental illnesses are treated.
There is no doubt that the current system--with its
paltry funding and routine tragedies--is in desperate
need of change. And the proposal Myers is considering
has an impressive pedigree. It was hammered out over
an 18-month period by the best thinkers and strongest
advocates in the field, people Myers himself appointed
as part of a blue-ribbon task force.
Yet the proposal is doomed to failure. Most task-force
members don't even support it.
The episode may offer proof that even the best intentions
go awry under the tutelage of a broad-based task force.
But it is also testament to the sheer magnitude
of the problem of treating people with serious mental
illnesses.
On one side stand family members of mentally ill
people whose main priority is to get their loved ones
help--even if they don't want it. On the other are
"consumer groups," often made up of people who themselves
suffer from mental illnesses, who believe they should
have the right to control their own destiny.
"I don't think I've ever worked on an issue that's
more difficult than this," says Myers' special counsel,
Mark Gardner, a former legislator and judge who chaired
the task force. "It was pretty apparent right off
the bat that there was not going to be consensus over
this issue. I don't think it's possible."
In order to grasp the conundrum facing Myers, you
first have to understand the workings of the mental-health
system, whose twisted logic and dead-end streets are
reminiscent of Joseph Heller's Catch-22.
For the most part, people with serious mental illnesses
must seek out treatment themselves if they're interested.
Many of them qualify for the Oregon Health Plan, yet
because of severe funding shortages, they're sometimes
met with disappointment. "If a person is mentally
ill and says, 'I want some help,' the system will
give some help, [but] maybe not enough or exactly
what they want," says Multnomah County Judge Lewis
Lawrence, who works with this population in court
proceedings.
But unlike someone with, say, a broken arm, people
with brain diseases like schizophrenia don't always
seek treatment, either because their thinking is distorted
or because they don't like the side effects of the
medication. When they deteriorate to a point at which
they might be dangerous, they're hauled into a hospital
and treated for a few days. Ninety percent of people
brought in for a hospital hold either cool off enough
to be released or consent to prolonged treatment.
The rest are brought before a judge for what's called
a civil-commitment hearing.
This is where the legal system and the public health
system collide, where the failure to help mentally
ill people is most tragically clear--and where some
task-force members think changes should be focused.
"I've been advocating for a few years that we make
changes to the civil-commitment process," says task-force
member Bill Toomey, the Multnomah County administrator
in charge of the civil-commitment process. "Pretty
much everybody complains about it."
Almost by definition, the daily fare in this courtroom
is a parade of tragedies. Judges must wade through
delusions, hallucinations and psychoses to decide
if the people are a danger to themselves or others.
If so, they can be committed to a hospital. If they
don't fit the criteria, they must be released. Often,
the process is quite unceremonious: They're simply
escorted to the courthouse door.
In 1997, psychiatrist Gene Minard and another doctor
approached Myers with a list of concerns, including
complaints that the criteria for civil commitment
had gotten dangerously narrow because of appeals-court
decisions. This narrowing, Minard believes, shut out
Mary Boos.
According to her mother, Carol, Mary was a lively
and popular University of Oregon student before paranoid
schizophrenia set in. When she agreed to treatment,
her symptoms became less severe, but her medication
caused dramatic side effects, including ballooning
weight.
Still, Mary, living in a studio apartment with a
landlady who looked out for her, fought her illness.
At some point, she lost the battle. "She kind of left
this world for a spiritual world," her mother says.
"There were 100 days when she didn't come out of her
room." Mary's parents made sure her rent was paid
and she was fed, leaving grocery bags at her front
door. Yet Mary refused to acknowledge her family's
existence, insisting they were dead.
Carol Boos and her husband decided to seek civil
commitment in 1996, arguing that their daughter could
no longer take care of herself. The judge, constrained
by the law that makes it almost impossible to commit
people unless they're dangerous, did not agree. Mary
left the courthouse in a hospital nightgown, in paper
slippers, without a penny in her pocket.
"We never really had any time with Mary again," her
mother says. Mary died in her apartment in October
1997, her illness untreated. The medical examiner
said she died of natural causes, but her body was
too decomposed to tell what happened for sure. "She
lived--well, she existed--and died...behind closed
doors," says Carol Boos.
Mary Boos' death, which came just one month before
the task force began work, hung heavy in the members'
minds and was a frequent topic of discussion. Their
proposal, in theory at least, will address people
like Mary. Called "intervention," it would allow judges
to order certain people to accept treatment in the
community. It would apply to people who don't meet
the commitment criteria but are so ill that they will
probably soon deteriorate to dangerous or unsafe conditions.
"The intervention process came up as a way to get
the system involved earlier," explains Toomey.
If people don't follow the judge's orders, they can
be hauled back into court by police and held in a
locked facility for a number of days. The catch is
that if people continue to refuse treatment, the judge
has no real legal power to force them to accept it.
Unless they deteriorate further, commitment is still
not an option. The idea is that the judge's order,
followed up with aggressive outreach from treatment
workers, will scare, threaten or cajole people into
doing what they're told.
Although the task-force members worked collaboratively
on the proposal, it has turned out to have little
support. "A lot of what happened with this is reality
setting in: the legal parameters, the financial limitations,
the differing interests," says Bob Joondeph, executive
director of the Oregon Advocacy Center, a clients'
rights organization. In fact, Joondeph likens discussions
of treatment for people with mental illnesses to the
debate over abortion, a case where opposing viewpoints
will never come together.
He has a hard time believing that the proposal will
do the trick for people who insist that they don't
want treatment. Moreover, Joondeph says, "I don't
think scaring people into treatment is the best way
to go about it."
Family members of people with mental illnesses have
mixed feelings about the proposal. Dr. Minard calls
it "convoluted, confusing and unworkable.... It appears
to me the original purposes of the task force have
been defeated." But Phillip Chadsey, a task-force
member who is president of the local chapter of the
National Alliance for the Mentally Ill, the country's
leading family organization, supports the proposal.
"It gives a right to treatment, which means the state
has to pay for it," he says.
Gardner says he's not sure what Myers will do about
the proposal, but he says that the process had made
one thing abundantly clear to him: A key ailment of
the public mental-health system is poor funding. "If
I was back in the Legislature, I would do everything
in my power to get more money into this system," Gardner
says. "It is tremendously underfunded."
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Willamette Week | originally
published March 24,
1999
