A Federal Judge Has Ordered the Release of More Than 100 Patients From the State’s Locked Psychiatric Hospital. No One Is Sure What Happens Next.

There are simply not enough treatment options for people suffering from severe mental illness.

The Oregon State Hospital, the state’s locked psychiatric hospital, abruptly announced three weeks ago that, in response to an order by a federal judge, it would send more than 100 patients back to their respective counties early.

Many of the facility’s patients face criminal charges and are being held until they are stable enough to stand trial.

In interviews, sources familiar with Oregon’s struggling mental health system say the new policy will not resolve the system’s long-standing shortcomings: There are simply not enough treatment options for people suffering from severe mental illness. The emergency release is the latest symptom of a system critics say is wholly inadequate for the mental health challenges Oregon faces.

Kevin Fitts, executive director of the Oregon Mental Health Consumers Association, says early release is a “fiasco.”

“Where do these people go? There’s not enough capacity,” Fitts says. “I’m not talking about a little lack of capacity. I’m talking 20 to 30 percent of what’s needed.”

The hospital didn’t say whom it was going to release, leaving prosecutors upset.

“It’s the most absurd thing in the world that we don’t know,” says Washington County District Attorney Kevin Barton. “And not only that, they won’t tell us.”

Oregon sits near the bottom in rankings of states’ mental health outcomes. Here, getting arrested is the only way for people to get treatment. And, when people fall out of the system, they often get arrested again.

“It’s like squeezing a balloon,” Barton says. “The hospital has been squeezed, and it’s popping out at our end. But there’s nowhere to put these people.”

Jason Renaud of the Mental Health Association of Portland supports the new policy but says it won’t resolve the underlying problems. “A percentage of these people who are being released will be back in jail in a few weeks,” Renaud says.

When such patients fall through the cracks, they make disturbing headlines.

Take, for example, Terri Lynn Zinser, a 54-year-old woman who exited the Oregon State Hospital in April after a four-month stay. She was referred to a local treatment center, Unity Center for Behavioral Health, but left shortly thereafter. The county then lost track of her, court documents show, before she was found curled up under the covers of a child’s bed in a Northeast Portland home last Tuesday. Zinser was charged with burglary and harassment and released.

The state’s mental health care system was decimated by the pandemic. In a presentation to legislators earlier this year by Steve Allen, the state’s behavioral health director, a slide called the losses of community-based residential beds “staggering.” Only 16 Level 1 secure residential treatment beds, the highest level of care available to returning patients, remain in Multnomah County.

In a recorded call with county officials earlier this month, Allen struggled to answer questions about the public safety implications of the new policy. His agency released written answers to questions from county officials and WW earlier this week.

But many questions, including the long-term effects of the policy, remain unanswered. Here’s the ones that are.

Why is the Oregon State Hospital doing this?

Too many people are so severely mentally ill that they need hospitalization, but there are not enough beds. (The hospital’s capacity is currently 705 patients.)

For people charged with crimes, this means jail. Defendants cannot stand trial unless they’re stable enough to “aid and assist” in their own defense. Meanwhile, they wait in jail for a bed to open up at the state hospital so they can be treated.

This process can take months, which judges have found to be unconstitutional. In 2002, Disability Rights Oregon won a court order requiring the hospital to admit people within seven days. For 15 years, the state met that mandate, until “drastic cuts” in mental health services during the recession caused the waitlist to grow, says DRO’s legal director, Emily Cooper.

By 2019, the average wait time was 26 days.

“We continue to be terrified that there are people with mental illness waiting in jail for court-ordered mental health services who are—if not suffering—dying,” Cooper says. She points to the death of 22-year-old Bryce Bybee, who was waiting in Washington County Jail for a bed at the state hospital.

On Aug. 29, U.S. District Judge Michael Mosman ordered state health officials to follow the recommendation of an outside consultant to fix the backlog: release pretrial patients early. While state law previously required the hospital to release defendants within three years, the new order reduces that to a maximum of 90 days for misdemeanors and a year for violent felonies.

The timelines bring Oregon in line with other states, Cooper says. “You can’t just lock people away at the state hospital and throw away the key.”

How many patients does the hospital plan to discharge, and when?

“Approximately 120″ patients were newly eligible for discharge at the time of the order, according to the Oregon Health Authority. They won’t be discharged all at once, however, and counties will be given 30 days’ notice before they are. The first batch of notifications went out last week.

Multnomah County got its first on Friday, says Julie Dodge, Multnomah County’s interim director of behavioral health.

She isn’t concerned about the county experiencing a “rapid influx” of new patients, Dodge says. Still, it’s an unwelcome change for a system struggling to house and care for the patients it already has, she adds. The county has only three available beds in its locked treatment centers.

“We are in this perfect storm,” Dodge says. “It’s going to take time to address it—and we don’t have time.”

Where will the discharged patients go?

It depends, says Judge Nan Waller, who presides over the county’s specialized mental health court, which handles such cases.

Depending on the circumstances, defendants could be turned over to “community restoration” programs or simply let go. In extreme circumstances, prosecutors can ask for a defendant to be declared “extremely dangerous,” and if a judge agrees, they will be returned to the state hospital. But, Waller says, this is very rare.

The court works with the county, nonprofits and insurers to try and find the best treatment option in the community for each defendant. But there are not enough beds. And there’s no requirement that residential treatment centers take someone in. That can make finding placements for people with criminal histories of some offenses, such as arson, difficult if not impossible, Waller says.

“People end up on the streets.”

Why doesn’t Oregon just expand the state hospital?

This would require approval by the Oregon Legislature. The state did recently open several smaller “cottages” at the state hospital’s satellite location in Junction City. But, beyond that, “they have not expressed an interest in expanding the state hospital,” behavioral health director Allen told county officials earlier this month.

State Rep. Rob Nosse (D-Portland), who chairs the House Interim Committee on Behavioral Health, says expanding the hospital is not a short-term solution.

In the meantime, Nosse points to over a billion dollars in new funding for mental health care. But Nosse says it’s going to take at least two years for Multnomah County’s mental health system to catch up with demand.

Although he wishes the county had more time to prepare, he understands the underlying logic of Judge Mosman’s order.

“This is a big deal,” he says. “These people deserve to get through this system faster.”

OK, the state is opening its checkbook. Where’s all that money going?

Higher salaries for workers who care for patients at the state hospital and other treatment facilities, for one thing.

During the pandemic, many employees refused to show up for work at the state hospital, and officials were forced to call in the National Guard. Over the summer, staff routinely work mandated overtime shifts, says David Lynch, a nurse at the hospital and union president.

When asked why it’s difficult to get workers to staff these positions, Lynch has a simple answer: “the violence.”

Earlier this month, Oregon Occupational Safety and Health announced it was issuing three citations to the hospital related to “workplace violence and injuries.”

Lynch says recent pay raises have helped, but the hospital’s new release policy hasn’t.

“It’s going to increase the acuity,” he says, referring to the amount of attention patients require to ensure their safety and the safety of staff. “There will be less time to stabilize them, and turnover will be more frequent.”