Last week, Mayor Ted Wheeler made a Salt & Straw run.
In November, an RV caught fire along Southeast 3rd Avenue in the Central Eastside, knocking out power to the artisanal ice cream maker’s production facility, leading the owner to publicly threaten to leave Portland. Pink Martini frontman-turned-civic advocate Thomas Lauderdale followed up with an email blaming rampant drug use and mental illness on Portland’s streets.
Wheeler did damage control. At an industry-sponsored “listening session” Nov. 29, the mayor borrowed a solution proposed that morning by New York City Mayor Eric Adams: If the severely mentally ill don’t want treatment, lock them up and force it on them.
If only it were that easy. Civil rights issues aside, even if police began sweeping up people along with their tents, there is nowhere to send them for mental health treatment.
The state hospital is full. Thanks to a federal order—and long-standing practice—it accepts few if any civilly committed patients.
Instead, the civilly committed are sent to local hospitals. Those hospitals cannot treat them, they say, and are suing the state because of it.
Civil commitment laws allow authorities to force someone with severe mental illness into treatment. But the circumstances must be extraordinary: The person must be a danger to themself or others, or be unable to care for their “basic personal needs.”
Wheeler, joined by state Rep. Rob Nosse (D-Portland), proposed loosening those restrictions, according to a Portland Business Journal reporter who attended.
“I would support a hard look at the legislative level of our involuntary commitment laws,” Wheeler said.
“I think there might be appetite among my colleagues, Democrat or Republican, to lower the threshold,” Nosse said.
Legislators have been mulling this idea for years, although recent proposals have failed. Regardless, says Amanda Marshall, an Oregon City lawyer who specializes in civil commitment law, it doesn’t address the root of the problem.
“We don’t have the services,” she says. “We have folks on the street that would be willing to get help, but they can’t get it.”
In response to questions from WW, Nosse said his quoted remarks had been “significantly shortened” and that he would not, in fact, support such legislative changes until “we have stood up more beds” at the Oregon State Hospital and at other community mental health providers. A Wheeler spokesman told WW the mayor was concerned about the state’s “severe lack of mental health services” but believes “nothing should be off the table in identifying solutions.”
To understand the connections between Oregon’s broken mental health care system and the conditions on Portland’s streets, don’t go to a ballroom “listening session” or even to 3rd Avenue.
Go to U.S. District Judge Michael Mosman’s courtroom downtown, where the question of who is responsible for Oregon’s ongoing failure to provide basic mental health care services is now being litigated.
Last month, Mosman consolidated two major lawsuits accusing the state of failing to provide timely treatment for severely mentally ill patients.
The first case is more than two decades old and still unresolved—it was filed by disability rights advocates on behalf of people suffering from mental illness stranded in jail. The second, more recent lawsuit was filed by the state’s major hospital systems, which say the solution to the problem has come at their expense.
The legal issues may be complicated, but the problem is simple: The state hospital is full. Instead of expanding it, the state has shrunk it, from more than 800 patients a few decades ago to less than 700 now.
To address the crowding, Mosman has ordered the hospital to prioritize the admission of criminal defendants too ill to be prosecuted (which it was already doing) and begin discharging patients earlier.
The result: Civilly committed patients once filled half the state hospital’s beds. Now they take up only a handful.
With the state hospital not an option, civilly committed people are now sent to local hospitals—who have responded by suing the state, arguing that the burden of caring for these patients is backing up emergency departments and making it harder to treat people voluntarily seeking care.
The state is “abandoning civilly committed individuals in acute care facilities and failing to even attempt to provide them with appropriate treatment during their involuntary detention,” they claim.
To advocates, the focus on how to better compel treatment rather than provide it misses the point.
“You can do this by force,” says Jason Renaud of the Mental Health Association of Portland, “or you can provide good services and people will come willingly. What we haven’t done—the state, the county, and the [community care organizations]—is the latter. And now the city is mad and saying, ‘We’d like to sweep the streets.’”