A mental health system still strapped in restraints


The Oregonian Editorial Board
Oregon State Hospital patients and staff remain locked in a “culture of despair” even as a new hospital rises and the state acts to reverse decades of neglect

Just outside the brick walls of the Oregon State Hospital, where 550 construction workers are building the nation’s newest mental hospital, there’s hammering, heavy machinery and hope.

Inside those walls, though, nothing seems to be working. There’s a growing number of patient assaults, more injuries, greater use of seclusion and restraints, more grinding despair.

How could this be happening? Didn’t the state decide four years ago to spend more than $450 million to replace the wreck of a state hospital that provided the stark backdrop to the movie “One Flew Over the Cuckoo’s Nest”? Didn’t it commit more than $60 million, even during these hard times, to add more than 500 new hospital employees? What about all those promises of a modern, compassionate system of mental health?

It’s not here yet. None of it. The new building on the Salem campus remains a work in progress. Scores of new staff, especially nurses, have arrived, but furloughs ordered across state government wreaked havoc on hospital staffing, and required more than 5,000 hours of overtime in the past month alone. Meanwhile, vulnerable, volatile patients remain crammed four or five to a room in soon-to-be-abandoned buildings.

It’s still a mess, this mental health care system in Oregon. That much was obvious in two legislative oversight hearings in Salem last week. There’s still twice as many criminally insane patients locked in the hospital as the decrepit facility was designed to hold.

Moreover, there’s been no change in state policy that prompts the Psychiatric Security Review Board, the mental health equivalent of the state parole board, to keep patients locked in the hospital for years, even decades, after they could be safely released to far less expensive community mental health facilities. If that policy isn’t changed, within a decade the new hospital will be so overwhelmed by the criminally insane that it will no longer have space for civil commitments of the mentally ill.

You get the sense that Oregon legislators keep waiting to hear that when it comes to mental health, their job is done. But mental health is a linked system, and it’s only as strong as its weakest links. For now, that’s a shortage of community beds and the policy that sends far too many mentally ill criminals to the hospital and never lets them out.

Legislators and Gov. Ted Kulongoski need to agree on this: No more staff furloughs at the state hospital. With the new budget shortfall announced last week, it’s likely that state employees will be sent home more days over the next year. That can’t happen again at the hospital. It caused too much stress and led to too much unrest among patients and too much expensive, exhausting overtime for staff.

Like its patients, the state hospital needs a real fighting chance to get better. The first 120 beds in the new hospital will open late this year, and the remaining 500 will come on line late next year. It will be safer for patients and staff. There will be more privacy, more places to walk, exercise, blow off steam. There will be more green space, more vocational activities. There will be air conditioning and a roof that doesn’t let rain drip, drip, drip into plastic buckets.

Yes, it’s just a building. Yes, it’s what goes on inside those walls that matters. And yes, it was painful to hear a patient tell legislators the hospital is enveloped in a “culture of despair.”

But better days are coming to Oregon’s mental health system and the patients and families it serves. Of course, one can’t see them from the barred windows of the hospital, which is as overcrowded and violent as ever. Yet there’s real change going on out here, where construction crews are working, where more hospital staff are being sought, where new community facilities are opening, where lawmakers vow to re-examine laws that keep patients locked away. The work is far from done, but there’s reason for hope.

Source: http://www.oregonlive.com/opinion/index.ssf/2010/05/a_mental_health_system_still_s.html

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One thought on “A mental health system still strapped in restraints

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