The system is broken

The Arizona shooting has pushed mental health services back in the spotlight and reignited debate about civil commitment, the involuntary evaluation and treatment of persons who suffer from mental illness.

There's talk about easing the stringent, long-standing statutes that allow civil commitment only when a mental health expert, then a judge, conclude an individual is a clear danger to himself or others. Others have called for laws mandating that universities report cases of suspected mental illness.

In Oregon, at least, the central issue is not the civil commitment statute, which has stood unchanged since 1973, or a matter of mandatory reporting. It's the fact that too often when a desperate family or someone else seeks help for a loved one or friend, Oregon does not have an answer.

What's needed is timely and appropriate intervention and more treatment options. In a perfect world, all this would be voluntary, but that's not where we live. There still is a place for civil commitment in Oregon.

Oregon has, with no public debate, moved away from civil commitment. In a 2006 study, Dr. Joseph Bloom, professor emeritus at the Oregon Health & Science University Department of Psychiatry, reported that from 1983 to 2003 the number of civil commitments plunged even as the state's population grew by more than a million people. Civil commitment in Oregon is on a path toward "functional extinction," Bloom concluded.

If that trend was Oregon moving to a better community-based mental health care system, the ever-shrinking number of civil commitments would be something to cheer. But it's not. Instead, this trend reflects at least partially a choice Oregon has made to reserve no small number of prison cells — and almost all of its state hospital beds — for persons who commit crimes while suffering with untreated mental illness.

You've seen it: Keaton Otis, a troubled young man whose family tried to get him care but could not. During a routine traffic stop, Otis shot a Portland policeman and then died in a hail of bullets. And Heath Avery, the Portland State University student whose behavior, including delusions and hearing voices, alarmed students, who reported him to campus police. Last August Avery stabbed another student and now faces three years in prison.

Those are isolated cases, but they reveal certain facts. One, is that the Oregon State Hospital now serves the court system, not the community. The vast majority of patients at the hospital were sentenced there. Oregon has chosen prison and long restrictive hospital sentences over timely intervention, civil commitment and community treatment.

It is a tough time for Oregon to fix what's wrong with its mental health system. Mental health is under financial siege across the country. The National Association of State Mental Health Program Directors estimates that at least $2.1 billion has been cut from state mental health budgets over the last three fiscal years.

Oregon, meanwhile, is locked in a debate about where to put its scarce mental health resources. It's making a once-in-a-century investment in a modern new hospital in Salem, and debating whether to build a second new facility in Junction City. Meanwhile, the state is planning to shutter scores of psychiatric beds in Portland and Pendleton.

It's critical that lawmakers and mental health advocates get these decisions right over the next year. Oregonians have seen the failures in their mental health system play out in terribly sad and frightening ways.

There is no one answer, not community mental health programs, not civil commitment, not long-term, expensive incarceration in state hospitals.

But when those phones ring, when a desperate mother with a son like Keaton Otis is on the phone seeking help, Oregon has to have a response. And we ought to agree on this: It should not be a prison cell.

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