VIOLENCE AND REFORM

Recent events highlight how Oregon officials use their authority to forcibly hold and control individuals with serious mental illness. Jails, police, DAs, and hospital staff all complain that they don’t have the tools to keep people safe. It’s clearly time for a change.

A week ago, last Friday morning, I was sitting in a meeting of the Oregon Health Plan’s Metrics and Scoring Committee.  We were considering how to use data to create fiscal incentives for Community Care Organizations (CCOs) to improve public health.  This is, frankly, a bit over my head, but I’m sticking with it.  Oregonians with disabilities are depending on health care transformation to improve their access to medical services and to help them stay healthier in general.  Finding ways to reward CCOs for doing a good job seems like, well, a good job.

While I pondered all of this, I received a text message from a reporter at Oregon Public Broadcasting.  The message asked if I would be on the call-in show that day at noon.  The topic was whether more nurses are needed at Oregon State Hospital.  I agreed, thinking that I would say: “Yes!  More nurses would be very nice.”

Two hours later, when the radio show got underway, a nurse from the hospital spoke about the need for more staff.  Fine.  But she went to say that the patients are dangerous and that staff are unfairly hamstrung by investigations of patient abuse and by limits on how often staff can tie down and lock up patients.

I know that there are some patients that can be very challenging, and even dangerous, to staff.  But I also know that these are a very small percentage of the residents.  (I’ve got the data.)  It seems, however, that some hospital workers cannot resist the temptation to paint all the patients as dangerous and to use this claim to excuse unprofessional and sometimes bullying conduct. The hospital superintendent (i.e. “Management”) was also on the show.  He sidestepped the abuse and restraint issues, saying that the hospital has enough staff but that they need more and better training.

Fast forward a few days to a report in The Oregonian (http://www.oregonlive.com/aloha/index.ssf/2012/09/oregon_state_bar_to_prosecute.html) that a district attorney and criminal defense attorney are being prosecuted for ethics violations by the Oregon State Bar.  They are accused of having a mentally ill man committed to the state hospital from his jail cell using a fictional law.  DRO had earlier investigated this situation because it appeared that the man had been discharged from the state hospital directly to jail where he languished for months without treatment.  We wanted to know why.  You can read our conclusions at: http://www.droregon.org/THE%20INCARCERATION%20OF%20DS%20-%20AN%20INVESTIGATIVE%20REPORT.pdf

It’s common these days for newspaper stories to have a place for the public to comment.  After this article, I noticed that a number of people thought that the mentally ill man was not entitled to any rights, treatment or safety because he was accused of murder.  I also heard from a district attorney in another county who implied that it is unfair for lawyers to be held accountable for their actions when their intentions are good.  The intention here, he submitted, was to keep the public safe.

In today’s Oregonian, we have a third case involving a man with mental illness who gets caught in a dangerous custodial situation.  http://www.oregonlive.com/news/oregonian/steve_duin/index.ssf/2012/09/steve_duin_business_as_usual_a.html

This one involves a man who turned himself in to the authorities because there was a warrant for his arrest.  He had not appeared at a hearing because he was too disorganized to get there.  The authorities put him in jail and would not let him have his medications.  He went into crisis and was beaten and tazered.  Efforts by DRO to work with the county jail to find ways to avoid a recurrence were brushed aside.  It costs too much, they said.  Don’t blame us for a broken mental health system, they said.  You guys threatened to sue us, they said.

These recent events – as well as the recent US Department of Justice condemnation of Portland Police tactics – lead me to a modest (or so I think) suggestion.  Let’s all recognize that mental illness is, and always has been, a part of the human experience.  Let’s admit that this fact will not change by improving some “mental health system” that nobody can describe.  People will continue to have mental health needs and some will go into crisis for a variety of reasons.  So, I think, we must be prepared to respond in the most safe and humane way.

What if health insurance and providers, public human services, schools, police, jails and unions consider how to modify their practices toward a common goal of heading off crisis and minimizing the risk of injury and trauma that comes with crisis?  Oregon’s health care reform efforts are, at least, talking about this.  If this conversation can expand beyond Medicaid to our public and private institutions, we could establish a coordinated approach that not only recognize the reality of mental illness but sees the human, community and fiscal benefits of minimizing the violence, trauma and stigma associated with crisis.

There is no doubt that working in a state hospital is a demanding job.  The responsibility that a district attorney has to maintain public safety is not an easy burden.  The same can be said for operating a county jail.  While these individuals must not avoid accountability for how they use their power over others, they must also be given the tools to use their authority wisely and safely.  Broad systemic reforms that reward outcomes, not defense of funding silos and special interests, are needed.  More money for the “same ‘ol” just ain’t gonna cut it.

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