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In recent years, Oregon health officials, desperate to get people with severe mental illness and addiction into scarce residential treatment, have been throwing their weight around.
They made it harder for treatment centers to kick patients out or move them. And they made it harder for treatment centers to turn patients away—even, critics argue, when facilities were simply not equipped to care for their needs.
“What they’ve done is they’ve thrown the doors open,” Heather Jefferis of the Oregon Council for Behavioral Health tells WW. “They don’t allow programs to ensure that the person who is coming to them is the right fit. They just treat everybody the same.”
The Oregon Administrative Rules in dispute are in some cases years in the making, but lately providers—and the politicians listening to them—have been pushing back with notable verve.
In late June, Marion County officials sent a heated missive, accusing the state of endangering patients and staff and undermining treatment center efficiency. This echoed concerns the Oregon Council for Behavioral Health raised in an April letter, reported earlier by KATU-TV, saying the mounting rules made it “exponentially difficult for community providers to operate safely, ethically, and sustainably.”
The Oregon Health Authority, for its part, counters that it is simply making sure facilities screen patients to confirm they are eligible, provide treatment if so and, if not, arrange for the patient to receive that service elsewhere. “Enforcing these rules,” it says in a statement, “helps ensure that everyone who needs residential treatment has the opportunity to receive it.”
Some changes are evidently a response to recent trends. OHA is under severe pressure to open up space at Oregon State Hospital, the state’s highest-level psychiatric institution, which is currently packed with criminal defendants that courts have found incompetent to stand trial until their behavioral health disorders get addressed. The state is seeking to relieve pressure on the hospital—hence the added pressure on other residential treatment facilities.
And OHA suggests some of these facilities have tried to be overly choosy. In a statement to WW, the agency says it “identified a significant increase” in facilities filing notices of emergency involuntary transfers or discharges of patients in response to behaviors that are in fact “common in mental health treatment settings.”
Still, as it seeks to tamp down on this, OHA notes facilities may continue to use the quick involuntary discharge pathway “for continuously and significantly disruptive behavior that threatens the safety of staff, residents, or others.”
Jefferis says any uptick in quick involuntary discharges from residential treatment has another clear basis. Patients with court orders—which are a lot of them—are being forced to go to places they don’t want to, while the state is compelling facilities to accept even patients they do not think are an appropriate clinical fit. “Because providers and patients cannot make a a health care-informed decision on the front end,” she says, “that is increasing the amount of people going to settings that are not a good match.”
The crux of the issue, she says, is that OHA seems focused on placing a patient somewhere rather than helping treatment professionals deliver specialized services.
“This is not just housing,” she says. “It is not just a place to put people. There are treatment settings that are designed to help people get healthier.”
On some fronts, she and her association have reached an accord with OHA.
For reasons that have to do with federal funding, Jefferis says, OHA is very interested in protecting the personal property rights of patients. But when it comes to property like alcohol and weapons, this gets tricky. For some time, Jefferis says, any policies by residential treatment centers to limit patient access to such things faced scrutiny from the state.
This scrutiny, perhaps unsurprisingly, did not go over well with providers. And Jefferis says OHA not long ago moved to accommodate at least one big concern. “They did make the modification on the weapons,” she says. “They said, ‘You can have a policy to say no weapons.’ That was great. We really appreciate that.”
