It’s been many years since Senator Avel Gordly asked the Department of Justice to look into shameful conditions at Oregon State Hospital. She started a series of events that no-one could have predicted and may possibly transform Oregon’s behavioral health system and police services.
Back in 2004, State Senator Avel Gordly sent a letter to the U.S. Department of Justice (USDOJ). She asked that it investigate possible civil rights violations of past and current patients at the Oregon State Hospital (OSH) caused by “serious overcrowding and understaffing.” Almost two years later, the USDOJ notified Governor Kulongoski that it was initiating an investigation of conditions and practices at OSH.
Concerned about a federal take-over of the hospital, the state took major steps to improve OSH including legislative approval of $458.1 million to replace OSH with two new state hospitals, one in Salem and one in Junction City.
In January 2008, USDOJ delivered its finding to the Governor. It found that Oregon was violating the civil rights of OSH residents because of:
- Inadequate protection from harm
- Failure to provide adequate mental health care
- Inappropriate use of seclusion and restraint
- Inadequate nursing care
- Inadequate discharge planning and placement in the most integrated setting
To this day, the state and USDOJ have not come to terms on a settlement of all these findings. State officials say that they have improved OSH without federal interference. Since they released the findings, USDOJ has told the state about its concerns that OSH patients are not getting adequate physical health care. It has also warned the state that building additional hospital beds at the expense of community services would be viewed as a problem.
Meanwhile, in 2009, President Obama launched “The Year of Community Living” in recognition of the tenth anniversary of the Supreme Court’s decision in Olmstead v. L.C. He directed federal agencies to vigorously enforce the civil rights of Americans with disabilities. The USDOJ responded by making enforcement of Olmstead a top priority. In 2010, it announced a national initiative to investigate ADA complaints and enforce the Olmstead “integration mandate” of the ADA.
Then, in early 2011, USDOJ lawyers met with Oregon officials and community partners to renew its investigation of whether Oregon was violating Olmstead. Later that year, it also opened an investigation into the use of force by the Portland Police Bureau (PPB) against people living with mental illness.
This month, both of these investigations have been settled. The Portland settlement contains over 100 changes in policies, practices and procedures that affect police use of force, police training, access to community mental health services, crisis intervention resources, officer accountability, and community oversight. Police are to use more de-escalation techniques and less tazers, a new Crisis Intervention Team and more Mobile Crisis units will be created, and local CCOs are to create new “drop-off centers” for individuals in crisis, and new addictions and mental health-focused subcommittees to pursue long-term improvements to the behavioral health system in seven specified areas, including the expansion of peer services. The settlement also mandates improved investigation and oversight of police use of force and swifter disciplinary procedures.
The USDOJ settlement with the state also addresses crisis intervention, but affects a wider scope of mental health services. Remember that the Olmstead case says that individuals with disabilities have the right to receive public services in the least segregated setting that is appropriate to their care. In a settlement that is as unique as Oregon’s health care transformation process, USDOJ agreed to work with the state “by embedding reform in the design of the State’s health care system.”
This agreement calls for Oregon to collect statewide behavioral health data about services currently being provided in order to assess the nature of those services and the outcomes they achieve. A comprehensive list of data “metrics” are to be collected, reviewed and evaluated by the parties to identify gaps in services and how those gaps can be filled. This process will continue through 2015.
The USDOJ settlements, together with Oregon Health Care Transformation and implementation of the Affordable Care Act, offer a rare opportunity to make major reforms to how the state funds and delivers behavioral health and police services. Success will require full ongoing engagement of advocates, consumers, providers, and public officials as well as lawyers and the judiciary. We need to keep at it over the long haul. According to the agreements, if all goes well, their work will be fully completed in 2017, a mere 13 years after Senator Gordly sent her letter.