Turn, turn, turn

The Oregonian‘s Editorial in Sunday’s paper justly supports spending $800m to build two new state hospitals for people with mental illnesses. It states:

“Yes, that’s a lot of money. But everyone ought to recognize how expensive it’s been for Oregon to neglect its mental health care system over the decades. It has paid those costs, and paid dearly, in the currency of crime, drug and alcohol abuse and ruined lives.”

I appreciate The Oregonian‘s ongoing support for both awareness of problems and funding of treatment for the most vulnerable and lost members of our society. Significantly, though, today’s editorial contains not a whisper about the 1995 closing of Dammasch State Hospital in Wilsonville. The official Oregon Blue Book version of the Agency history of our state’s Addictions and Mental Health Division services states regarding Oregon State Hospital (OHS), “In 1995, OSH opened a Portland campus at Holladay Park Medical Center. At that time, Dammasch State Hospital in Wilsonville was closed and most of the patients and staff were moved to the Holladay Park facility.”

Not exactly. Dammasch had close to 400 beds; Oregon State Hospital’s rented space at Holladay Park has 68. Hard to see how “most” of the patients moved there.

Turn, turn, turn. When Dammasch closed, it was obvious to workers in mental health services that Oregon was left with an inadequate number of safe, secure, professionally staffed beds for people with chronic mental and behavioral problems. The promised “community care” facilities materialized slowly, too few of them with many having too little skilled staffing. More people than can currently live at the State Hospital need highly-supervised, structured living situations – and will likely need that level of assistance for the rest of their lives. They don’t need to be all together in large institutions, but many do need constant monitoring, and to be given each dose of the medication they require to stay functional and safe. That section of the “system” is still missing many puzzle pieces. The new State Hospitals will soon be overcrowded again, unless the components promised since the push to deinstitutionalize mental health care starting in the 1970s are finally organized and funded.

I’m especially happy to see the new push for modern state hospital facilities, though, not only for my patients but also for my husband who will be buried in the rubble of the current state hospital if there’s an earthquake in Salem during his work on one of the forensics units there. Current capacity of Oregon State Hospital is around 700, with almost two-thirds of its patients in the forensic psychiatry program – people who have been found guilty-but-insane in criminal trials. Lots of interesting information on the official Oregon State Hospital site.

But the lack of state hospital beds isn’t the extent of the problem, and building the new facilities in Salem and Junction City is therefore only part of the solution. There are tragedies and holes throughout the “system”. I work in inpatient psychiatry at OHSU, in the basement of the old Multnomah County Hospital. When OHSU presented its Master Plan to the Portland Planning Commission in 2001, my building was identified as having a 0 – 5 year life expectancy. It’s now 2007, and there are no plans to move our patients and staff to a structure that might have a chance of remaining standing in that earthquake we know is coming sooner or later.

And looking at the big picture, an excellent article by Peter Korn published by the Portland Tribune in 2005 notes, “The Portland metropolitan area has 163 psychiatric beds – basically hospital rooms with special security provisions. That is about one-quarter of the beds that existed 10 years ago, even as the number of people who need the beds has gone up.”

Peter Korn concludes: Beds are the tip of iceberg

“The local lack of beds mirrors many crises in the field of mental health, where what appear to be problems often are symptoms. Increasing the number of secure hospital beds for psychiatric patients would give the patients a place to stay, but it wouldn’t relieve the underlying forces that put them in need of the beds in the first place.

“The truth is, it’s not the problem of lost psychiatric beds, it’s the lack of resources in the community where care used to be provided. It’s the community services that get stretched thinner and thinner, and that keeps them from providing the services so these folks don’t have to come to an emergency room.