SENTENCED TO THE SIDEWALK: Legislators sharpening focus on reforms to help troubled people

This is part 3 of Salem Reporter’s series “Sentenced to the Sidewalk,” about the failures of Oregon’s mental health and civil commitment system. Part 1 shares the story of Melinda Lou Kayser, a woman who died unsheltered in Salem after being denied commitment. Part 2 explores how gaps in Oregon’s housing and mental health system fail people like Melinda.

On a cold day last November, Jessica Finnegan visited the spot on the sidewalk where her mother’s body had lain the day before.

She asked herself what she could have done differently to save her.

Melinda Lou Kayser died of hypothermia at 62 near the intersection of Northeast Beverly Avenue and Northeast Lancaster Drive a few months after county investigators determined she didn’t qualify to be committed for mental health treatment. Her death came after four decades of chronic homelessness and lifelong challenges with mental illness.

“I rationalize and tell myself there’s not –” Finnegan exhaled, and made a pained noise. “I just feel so bad. She was cold. I hate knowing that.”

Three major gaps in Oregon’s mental health system wrote Kayser’s death sentence: a high, obscure bar to civil commitment, a lack of places to receive long-term care and a lack of supportive housing to help her change the course of her life before it was too late.

Solutions are hotly debated between providers, families and advocates. But there’s a clear consensus that Oregon needs to do better for people with severe mental illnesses.

Legislators this year are again taking up the issue of civil commitment. Several have proposed changes that could make it easier to force people like Kayser dying slowly through neglect to receive mental health treatment. State efforts are also underway to expand the space available to care for people with serious mental illnesses.

They’re spurred by growing advocacy from relatives like Finnegan who have watched loved ones behave dangerously, through neglecting necessities or violence toward themselves or others. Until now, relatives have been largely helpless under Oregon’s laws to intervene.

Legislators are now proposing significant changes to address the monstrous systemic issue. 

Some top pitches may be long shots under a strained statewide budget with leaders indicating they’ll spend conservatively this year. Many proposed changes have been considered before without much progress. 

But Ann-Marie Bandfield, project manager of Marion County’s behavioral health crisis services, said she’s more optimistic about this legislative session than in years past.

“I think we are hopeful that the bar will get lowered,” she said, with stable, clear and equitable criteria. 

She sees the harm that a lack of access to long-term psychiatric care causes.

She’s met the families who want to help their loved ones and can’t. She works alongside the disappointed investigators who wish they could do more. She mourns the patients who recycle through the system over and over again. 

“We don’t want to impinge anybody’s civil rights. We don’t. We are just very worried about the people that we have seen who are so ill and so fragile continuing to be on the streets,” Bandfield said.

Lowering the bar, and adding space

An advancing bill to lower the bar for commitment would allow someone to be forced into long-term treatment based on their recent pattern of behavior, rather than how they act the moment an investigator or a judge visits them. 

It comes from Oregon’s branch of the National Alliance on Mental Illness, or NAMI.

Current law allows commitment to be considered if a judge believes a person’s mental illness makes them a potentially fatal risk to themself or another person at the time of their court appearance.

Their bill, HB 2467, would expand the definitions of what type of harm could lead to a commitment. Judges could consider someone’s past behavior with testimony from a psychiatrist or other behavioral health expert.

It also expands the idea of dangerousness to mean that they will cause “serious physical harm” to themselves in the “near future, even if such behavior is not imminent.”

The goal of that phrasing is to allow commitment before the last possible minute, said KC LeDell, Gov. Tina Kotek’s senior behavioral health policy advisor, during testimony to support the bill.

“The state should only intervene when their actions harm others, or pose a serious risk of death or serious injury to themselves. This bill honors that balance,” LeDell said.

NAMI staff drafted the legislation after discussions among people and family members who had personal experiences with the commitment system, as well as providers, legal experts and elected officials. 

Marion County Circuit Court Judge Audrey Broyles, who has overseen civil commitment cases, said she wants judges to be able to look further back in a person’s history of behavior. Now, she said, judges often have to evaluate people after a brief hospital stay and when they’re temporarily stable.

Chris Bouneff, NAMI Oregon’s executive director, said many of the families they work with have experiences where relatives are dangerously violent or suicidal, rather than someone like Kayser who was unable to care for herself. 

Still, he said their proposal would clarify what an “inability to care for basic personal needs” looks like when considering whether to commit someone.

“What is the level of harm that has to occur in the near future to really trigger that? To give something concrete and tangible for the courts to work from,” Bouneff said. 

The bill adds language allowing the court to consider whether “absent treatment, the person will continue, to a reasonable medical probability, to physically or mentally deteriorate so that the person will become dangerous to self, dangerous to others or unable to provide for the person’s basic personal needs.”

It more precisely defines what “serious physical harm” to themselves means, which is not well defined in existing law and has been interpreted to mean a person will die within days. NAMI’s bill would expand it from fatal risks to include irreversible impairment, the deterioration of health or an organ’s function.

Bouneff said the goal is to allow someone to get mental health treatment without an arrest.

“We’re trying to lower criteria in a strategic manner, where we don’t open up commitment too widely, because that is imprudent,” he said.

The effort is moving forward with support from State Rep. Tom Andersen, a Salem Democrat. He has repeatedly introduced bills to expand the timeframe of behavior judges can consider. His changes have now been incorporated into the NAMI effort, he said.

Andersen was the first to speak in support of the bill during a public hearing in the House Judiciary Committee on April 3, joined by Rep. Kevin Mannix, a Salem Republican. Andersen said NAMI’s bill considers more gaps than his did.

Andersen’s interest in the topic began in the Salem City Council. Oregon State Hospital patients are released in the city without the ability to care for themselves, he said. He said Salem’s issues are reflected across the state.

“We have a moral obligation in our society to take care of people less fortunate than we are,” Andersen said in an interview. He said he’s optimistic about NAMI’s bill, especially with the public testimony supporting it.

Among the speakers was a man whose son could not get committed until he killed his mother. Another was a father who survived being stabbed 13 times by his son.

Another was a Salem-area mom whose son, despite dangerous behavior including wrecking a car, holding a tire iron to her throat and stalking strangers, wasn’t committed until he attacked a police officer during an arrest. She got involved in the legislation through the advocacy group Mothers of the Mentally Ill, which had several families submit testimony.

“I feel guilty. I’m the only one in the group that’s got their family member still alive,” she told Salem Reporter, asking to remain anonymous to protect her son’s privacy. “Civil commitment process needs to be easier. A lot of people aren’t around anymore because there’s not enough room, and it’s too difficult to get it done.”

Several also testified in strong opposition to the bill, saying that the state needs to focus on preventative care and resources to support people’s healing within the community.

Among them was a former patient who said they were committed in 2020 and still experiences negative repercussions. A civil commitment is not a criminal charge, but patients who have been committed can’t own a gun or work a job that requires security clearance, like in the federal government.

Another woman gave a passionate speech opposing the expansion of commitment. She said her daughter was committed 12 times in a row and is now a “shadow of her former self.” She said her daughter is unable to live without assistance with daily tasks, having experienced years of forced and traumatic treatment with no resources to support her ability to live independently afterward.

Salem Housing Authority Director of Development and Strategy Jessica Blakely and Salem Mayor Julie Hoy were among those who submitted written testimony in support of the bill.

Danielle Bethell, chair of the Marion County Board of Commissioners, spoke in support of the bill during the hearing, but asked for additional considerations for counties. She said there needs to be safe transportation options beyond a police car for someone who is committed, and that county investigators need more time to consider cases – up to five days rather than three.

Jimmy Jones, who runs the Mid-Willamette Valley Community Action Agency that provides much of the region’s homeless services, supports lowering the bar for commitment but said it’s a balancing act to ensure civil rights are protected. He submitted testimony in support of NAMI’s bill. 

“(The threshold) has to be lowered, but it shouldn’t be lowered too much,” Jones told Salem Reporter. “Because once you start lowering the line, it gets lowered and lowered and lowered, and then it becomes just a convenient way to get rid of people…We don’t want to go back to that era.”

Adding capacity

There’s broad agreement between legislators, advocates and families that Oregon needs more space to treat people in its psychiatric hospitals, assisted living facilities and community mental health centers.

A 2024 study found that Oregon needs to nearly double its space at inpatient, residential and secure treatment facilities to care for everyone who needs such help.

Last year, a statewide workgroup of law enforcement, mental health care and disability advocacy groups shared 51 recommendations for lawmakers to fix Oregon’s civil commitment system, including adding behavioral health care facilities, local treatment centers and alternatives to emergency rooms and jails for someone in a behavioral health crisis. 

Disability Rights Oregon resists lowering the bar to commitment. Their advocates argue that the system’s capacity is the issue, not its barriers to entry, and that civil commitment can traumatize people without helping them in the long-term.

Tom Stenson, the group’s deputy legal director, worries that conversations, news articles and legislation focus too much on civil commitment rather than the system as a whole. He said people who want to be committed voluntarily are being turned away, let alone those whose families want them to be compelled through the civil commitment process.

“We’re already unable to really serve the volume of people under the current law. And so my fear is, if we focus on changing the law, then we have a bus that’s overloaded and people are spilling out into the aisles. Putting more people on the bus won’t make the bus go faster or run better,” he said. “What we need are more buses.”

The state system will add space to treat hundreds more people over the next year due to investments in past legislative sessions. Gov. Kotek is seeking $90 million this session to build more mental health and substance use treatment services, adding space for 336 more patients across the state, according to her proposed budget.

Putting more people on the bus won’t make the bus go faster or run better.

Tom Stenson, Disability Rights Oregon legal director

Expanding capacity is costly, and legislators are budgeting conservatively this year amid steep federal cuts and economic uncertainty.

Bouneff said during his testimony that he hopes the bill will be passed in conjunction with other bills that would expand capacity for care within the system. Those include a bill asking the Oregon Health Authority to reevaluate funding and discharge processes to add more space locally, and Kotek’s requested funding to develop new facilities.

Judge Broyles said more treatment beds would have the largest impact on the system.

“If I had a magic wand, I would increase the capacity of the state hospital. I would immediately stand up secure residential treatment facilities and residential treatment facilities so there wasn’t a deficit,” she said. 

The region that includes Salem is projected to add space for 40 people in residential treatment by the end of 2025, according to data from the Oregon Health Authority, including 10 spaces added in late 2024. Some of the spaces will be at a new two-story building on 14th St.

Salem will also add 16 places in a new secure residential treatment facility, where patients with persistent, severe mental illnesses are ordered to go by a judge. The new facility plans to open off of Southeast Lancaster Drive this fall.

It’s a start, but well below what the state says is needed. The region needs to double its space for psychiatric patients and to add hundreds more places for people with both mental health and substance use issues, according to the OHA report.

Stenson at Disability Rights Oregon said that the most effective way to treat people is to help them before they get worse.

Bouneff at NAMI agrees, despite the two groups’ opposing views on lowering the bar to commitment. He wants to see more assisted living facilities and intensive supportive housing. 

“You can change all the laws you want, but if the only time you ever intervene is when someone is so acute that we will force them into care, that is all the state will ever have. And you cannot build fast enough to serve that population. It’s impossible,” Bouneff said.

Salem is building more affordable housing, but lacks places to move homeless people with severe mental illnesses who have not reached the level of civil commitment. Such people can thrive in the community if they’re able to get daily help with tasks and responsibilities.

The case management they need is beyond what’s offered in places like Sequoia Crossings, an affordable apartment building designed for people coming off the streets, which has help available on-site. High need remains for spaces more akin to an assisted living facility.

Salem has slim such offerings available to unsheltered people with mental illnesses and disabilities, largely limited to chance openings in overwhelmed adult foster care, group homes and residential treatment facilities.

One such option is Shangri-La, a licensed residential treatment facility for people with severe and persistent mental illness, or intellectual or developmental disabilities.

Shangri-La has space for 15 people in Salem in a supervised home setting, which includes three meals a day, community activities, rides to shop and for appointments and assistance with daily living 24-hours a day, said Bradley Leland, the program’s behavioral health director.

Staff help the residents build a plan for their future, along with navigating challenging tasks like managing social security and health care. The program’s hope is to help them eventually move out to live independently, to the best of their ability.

Most of Shangri-La’s spaces are filled by people being discharged from hospital psychiatric units or Oregon State Hospital, as required by their license, Leland said.

That system is so backed up that when a local homeless shelter calls hoping for a placement for someone who is not dangerous but can’t meet their basic needs without help, Shangri-La often must turn them away.

“There’s no quick, easy path,” Leland said.

He said they plan to expand over the next few years, mostly focusing in Eugene where funding is more certain. He said the state’s funding efforts to help such resources open up feel uncoordinated.

“It’s been a struggle for us. I think the state is a bit of a mess right now, and they’re really trying hard to figure it out and make things better,” he said. “We’re along for the ride.”

“I just knew that she loved me”

Finnegan is still angry about the neglect and abuse she endured as a child raised by a mother with lifelong mental health and addiction issues. But in the end, she couldn’t look away as Kayser suffered on Salem’s streets. 

“She’s my mom. As much as I try not to – try to shut her off — you can’t. It’s your mom,” she said. “I just knew that she loved me.”

A week before Christmas, the yard of Finnegan’s east Salem home was brightened by lights and waving inflatable snowmen. A few toys had been dropped on the lawn mid-playtime and a rope swing swayed in the chilly breeze. The family hopes to move soon so that their energetic dog can have more room to run.

Finnegan now thinks of her own children, so young, yet unthinkably older than Finnegan was when her mother first supplied her with drugs. She knows no one would put a child through that if they were mentally well.

“She just didn’t know how to be a parent,” Finnegan said.

In the fall, Finnegan called local agencies for hours, trying to get her mother committed. 

Since Kayser died, her daughter now calls elected officials, trying to share her mother’s story.

“If I had a lot of money, I would fight to have the civil commitment process changed,” she said. “I just cannot believe that they witnessed someone urinating on themselves, talking to themselves, but because they could answer questions, they wouldn’t get her into the hospital. So I would change that. Do whatever I could to change it. So it didn’t have to happen to other people.”

Contact reporter Abbey McDonald: [email protected] or 503-575-1251.

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