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It has become a truism in 2025 that the surest way to get mental health care in Oregon is to commit a crime. Yet even this may not be quite right.
“There’s a misconception”—held by judges and advocates alike—“that transferring to the state hospital is in some way a front door to the behavioral health system in Oregon,” says Emily Cooper, legal director of Disability Rights Oregon. In reality, she and others say, care for aid-and-assist patients like Vashon Locust focuses on getting them to the point where they can go to court.
The trouble is getting people into other, more substantial kinds of care. Advocates say the state has long failed to invest sufficiently in treatment for people with mental illness and drug and alcohol addiction, but officials say change is afoot.
“Only when there are enough open beds at Oregon State Hospital and in the community, and a large enough workforce to provide support to those in need, will Oregon’s behavioral health continuum of care be transformed,” says Amber Shoebridge of the Oregon Health Authority, and she adds that the agency’s top priorities track along these two lines.
The state has indeed put hundreds of millions of dollars into building out such treatment capacity in recent years, and officials say they’ve noticed a tangible difference when new capacity comes on line. But a June 2024 study of Oregon commissioned by Gov. Tina Kotek argued far more had to be done. The state, the study projected, would have roughly 4,000 residential treatment beds by late 2025. Its assessment: That figure needs to nearly double.
This seems a tall order. Staffing shortages loom, not to mention hundreds of millions of dollars in new capital costs. But Heather Jefferis, executive director of the Oregon Council on Behavioral Health, argues that relatively modest investments in mental health and addiction services are characterized as “huge, when they aren’t really huge in the scope of a state budget.”
Drawing in large part on federal data, a recent Mental Health America report ranked Oregon 51st out of 50 states and the District of Columbia in terms of the prevalence of mental illness and substance abuse.
Buoyed by a high “access to care” ranking (seventh in the nation), the state’s overall MHA rating came in at 42nd.
Jay Auslander, interim director of operations at Multnomah County’s Behavioral Health Division, describes the outpatient behavioral crisis treatment options in the county and surrounding areas as actually quite robust. There is already capacity for patients in crisis—“especially if someone is willing, is interested, in getting care.”
What of those who are not interested? Multnomah County District Attorney Nathan Vasquez recently announced a new policy to bring criminal charges against those who do not complete treatment at the drug-crime deflection center—a program that’s supposed to divert those found with small drug amounts away from the criminal justice system and toward treatment. (It mostly hasn’t.)
Meanwhile, many expect a new civil commitment law that goes into effect Jan. 1 will make courts and doctors more inclined to commit patients involuntarily to treatment when they are deemed a danger to themselves or others.
Many see the law as a step toward forcefully intervening in tough cases before the criminal justice system must. But not all are pleased. And it’s not just a matter of civil liberties. “It’s not practical,” Cooper says. “There’s literally no room at the inn. You could commit 100 people today. There’s not 100 beds out there.”
