A Novel Court Case Reveals Yet Another Crisis in Oregon’s Mental Health System

PeaceHealth went to court to force the Oregon Health Authority to take responsibility for a patient.

A man referred to in court records as “R.T.” was well known to prosecutors in Lane County when they charged him with threatening two people with a knife on a Eugene street last November.

Since 1986, R.T., 58, has been charged with crimes at least 34 times. Records show he suffers from serious, persistent mental illness.

R.T. was charged three times in 2021 alone. All three cases were dismissed for the same reason: “The defendant is unable to aid and assist in his own defense,” wrote Lane County Circuit Judge Charles M. Zennache on Nov. 24, 2021.

Defendants judged unable to aid and assist in their own defense are typically sent to the Oregon State Hospital. The state hospital’s 705 beds, however, are always full.

With the charges against R.T. dismissed and no beds at the state hospital, officials tried a different tactic to get him help: A Lane County circuit judge civilly committed him for 180 days.

But officials could not find a placement in the community, so they sent him to the psychiatric unit at Eugene’s PeaceHealth hospital. Records show he remained there for more than 100 days.

The shortage of beds at the state hospital and community mental health facilities is a long-standing problem in Oregon—one that explains why at any one time dozens of Oregonians who may pose a danger to themselves and others are warehoused in hospitals ill-equipped to serve them.

But in R.T.’s case, PeaceHealth decided to fight. In a highly unusual move, the hospital petitioned to force the state to take responsibility for him.

On Feb. 12, a Lane County judge found for PeaceHealth, citing the Oregon Health Authority’s “deliberate failure to make any placement decision.”

PeaceHealth’s intervention and the judge’s ruling appear to be unprecedented in Oregon.

“To my knowledge that has never happened before,” says Allison Knight, a Lane County public defender who represented R.T. in criminal cases.

The decision could offer resolution for dozens of Oregonians each year who have been civilly committed then abandoned by authorities.

“The failure to move people through and out of the state hospital is a big part of why the state is out of compliance” with court orders, says KC Lewis, managing attorney of the Mental Health Rights Project for the watchdog group Disability Rights Oregon. “What we’re seeing is the result of a lot of parts of the system not working properly.”

In 2002, Disability Rights Oregon’s predecessor organization (then know as the Oregon Advocacy Center) sued the state hospital for failing to accept people such as R.T. in a timely manner. Since then, those unable to assist in their own criminal defense cannot be held in jail for more than seven days while awaiting a hospital bed or other placement.

For many people experiencing mental illness, the result is a revolving door: arrest, followed by a short stretch in jail and release to the streets.

After R.T.’s third dismissal, officials pursued civil commitment. That’s a legal process in which a judge can make a person the responsibility of the Oregon Health Authority, which operates the Oregon State Hospital and oversees Oregon’s mental health system. But with no beds free at the state hospital or in community settings, civilly committed patients often end up at hospitals.

That’s why R.T. landed at PeaceHealth.

His experience is relatively common: Administrators at both Providence Medical Group and the Unity Center for Behavioral Health in Portland recently told lawmakers their organizations have been routinely forced to accept patients that are the state’s responsibility. That ties up scarce beds and saddles the institutions with substantial costs.

Melissa Eckstein, president of the Unity Center, which provides psychiatric services for four Portland hospital systems, says Unity is overwhelmed by patients who should be served by OHA.

“Unity Center continues to have some of the highest numbers of civilly committed patients in our state,” Eckstein tells WW. “This is an important distinction, because while civilly committed patients are the smallest number of our admissions, they account for over 50% of our bed days.”

Records show that Oregon courts grant about 550 civil commitments each year (out of about 7,500 requests). But the admittance of civilly committed patients to the state hospital has dropped precipitously. (Five years ago, about one-third of state hospital patients, or more than 200, were civilly committed. The current total is 16.)

In a February motion to intervene in R.T.’s civil commitment case, PeaceHealth argued that OHA had a legal obligation to have R.T. “immediately placed at the Oregon State Hospital or a secured residential treatment facility.”

Lane County Circuit Judge R. Curtis Conover agreed warehousing R.T. at PeaceHealth was neither “medically appropriate or legally sufficient.”

“PeaceHealth Behavioral Health Unit is an acute care psychiatric hospital with an approximate average length of stay of 10 days,” Conover wrote in his decision. “It is not designed for civilly committed individuals to live there for several months at a time, let alone 180 days, particularly when there is an urgent need for those beds.”

The state appealed Conover’s ruling to the Oregon Court of Appeals. On March 14, that court affirmed his decision.

Two days later, Steve Allen, director of behavioral health for the Oregon Health Authority, ordered Lane County Behavioral Health to find a community placement for R.T. immediately.

Lane County placed him in a secured residential treatment facility in Multnomah County.

PeaceHealth declined to comment on R.T.’s case but said the judge’s decision was appropriate. “Our medical centers provide essential acute care for the communities we serve, but they are not places for high-security, long-term residential care,” says Alison Taylor, a PeaceHealth spokeswoman.

The case is already reverberating through Oregon’s mental health system. Soon after PeaceHealth won its case, Providence went to court and successfully made similar arguments for two civilly committed patients it was serving.

Providence declined to discuss those cases but said in a statement that it should not be expected to serve patients civilly committed to state care.

The hospitals argue, and the courts agree, that finding placements is the state’s legal responsibility—and OHA now has the money to make progress.

Most people involved do not think the answer is more capacity at the state hospital. Advocates opposed the construction of the new state hospital in Salem and its satellite facility in Junction City a decade ago, arguing they were more expensive and less beneficial that community-based programs. There are 124 community-based residential behavioral health centers in the state with 986 beds, but they are almost always full.

Funding for such programs has long been inadequate, part of why Oregon ranks near worst in the nation in terms of mental health services.

In February, lawmakers asked the OHA’s Allen about the patient logjam. He attributed the problem to a lack of community placement resources.

That exasperates Disability Rights Oregon’s Lewis, who applauded the Legislature’s decision in 2021 to allocate more than half a billion dollars in new spending on mental health services, only to see OHA “slow-roll” putting that funding to work.

Lewis says Allen was, in effect, blaming county mental health authorities for failing to spend money OHA hadn’t given them.

“Not having the resources is not an excuse for the state to violate the constitution by not timely serving patients,” Lewis says. “It’s incredibly frustrating that money hasn’t gotten spent when there are dozens of people languishing in jail waiting for mental health services.”

Gov. Kate Brown’s spokesman Charles Boyle says she wants the money on the street. “It’s a priority for Gov. Brown to implement these programs as urgently as possible, and she and our office are engaged closely in this process,” Boyle says.

On May 26, OHA announced a schedule for distributing the funds, some of which will go out immediately. OHA director Pat Allen attributes the delay to the need to hire 700 new employees and create systems so the money can be spent most effectively. Allen says it’s too soon to know how many new community beds the funding will create, but he’s optimistic: “The investments the Legislature made will be game-changing.”