The road for the Oregon State Hospital in Junction City stretches across an open field, waiting to lead people to the state's newest mental health facility.
State officials have spent $61.8 million preparing the land in the Lane County town 15 miles northwest of Eugene. New water and sewer lines run to the site.
But as with the road, so far they lead nowhere.
There's no new hospital in Junction City yet. And many mental health advocates want to keep it that way.
Gov. John Kitzhaber's proposed 2013-15 budget calls for borrowing $79.4 million to build the hospital, which is already two years behind its original schedule.
Oregon has been undergoing a major effort to bring its mental health system into the modern age. The Oregon State Hospital, built in 1883, in Salem was literally crumbling when the state tore it down.
In its place, legislators approved $458 million for a new 620-bed hospital in Salem, intended to leave behind the days of One Flew Over the Cuckoo's Nest.
But plans for the second hospital in Junction City are perhaps the least-known—and least-scrutinized—part of the state's strategy.
And mental health advocates say building it would add the wrong kind of treatment beds in Oregon, taking the state in the opposite direction from where it should go: toward smaller, less-expensive facilities located near high-population areas—including Portland.
If the Junction City hospital opens (scheduled for 2015), the state would close a 90-bed state hospital campus in Portland and the 60-bed Blue Mountain Recovery Center in Pendleton. Blue Mountain and Portland accept civil commitments, people who pose a danger to themselves or others, not forensic patients, who have been found not guilty of crimes by reason of insanity.
That would leave the state without civil mental health facilities east of the Cascades and no beds in the Portland area, which accounted for nearly half of the state's civil commitments last year
"We don't do that for any other health condition," says Chris Bouneff, executive director of the National Alliance on Mental Illness of Oregon. "Imagine your loved one had a stroke and had to go into some long-term rehabilitation care and was from Portland, and we sent them to Junction City two and a half hours away."
Linda Hammond, interim director of addictions and mental health for the Oregon Health Authority, says the Junction City hospital is necessary to replace the outdated Pendleton facility. The lease for the Portland branch expires in 2015.
Hammond says her agency wants smaller, locally based facilities, but they would take more time to set up than the state has. She estimates establishing a network of community-based care will take years.
"We can't suddenly close Blue Mountain and Portland and put those people out on the street if there is not the infrastructure and services to meet their needs," she says.
The U.S. Department of Justice has put pressure on the state to move away from larger hospitals, so in 2010 state officials cut the capacity of the proposed Junction City hospital to 174, from its original 360.
Overall, the new hospital would add just 22 beds to the state's mental health system, Hammond says.
The long-term plan, she adds, is to hand over the Junction City facility to the state Department of Corrections, which owns the site.
Bouneff and other opponents say they're skeptical that will ever happen.
He says smaller facilities of 16 or fewer beds in locations across the state would save money, allow the state to collect Medicaid reimbursements that it can't with a large hospital, and keep patients nearer their homes.
The lack of good reasons to build a big, new hospital so far from Portland, he adds, has led him to one conclusion: "This is pork, pure and simple."
The Junction City hospital would bring about 2,500 construction jobs to Oregon's economy and 500 to 600 sustained jobs once it opens, says state Rep. Val Hoyle (D-Eugene), whose district includes the hospital site.
But to call it pork for her district is "insulting and wrong," Hoyle says.
The governor's budget, she points out, includes $1 billion for community mental health and addictions treatment—a 43 percent increase from the current budget.
Hoyle calls the plans "80 percent" of what advocates want. "If I didn't think that this was a necessary part of our mental health system, then I wouldn't be fighting for it," she adds.
Kitzhaber and Democratic legislative leaders want to approve the hospital.
Despite their backing, Rep. Carolyn Tomei (D-Milwaukie), chairwoman of the House Human Services and Housing Committee, says the high costs of doubling down on larger institutions rather than providing community care could give lawmakers pause.
"It could be stopped if enough of a swell of the population says, 'Wait, this doesn't make sense,ââ Tomei says. âBut I donât think it will happen.â