In final days of session, lawmakers combine two controversial mental health bills
Reforms that would make it easier for Oregon judges to involuntarily commit someone to mental health treatment are moving forward in the Oregon Legislature, with a chance of making systemic changes for the first time in years.
The process, called civil commitment, currently requires that someone’s risk of death be “imminent.” Advocates for reforms have said this often means someone on a clear trajectory toward hurting themselves or another person will not be able to get help until they make an attempt, sometimes fatally, to do so.
But, this week, those reforms were combined with another legislative effort to treat more people accused of crimes outside of the Oregon State Hospital, and reduce the amount of time they stay there. Those reforms are aimed at reducing the backlog of people waiting in jails who need behavioral health treatment to be able to understand the charges against them or participate in their defense.
The new bill, HB 2005, borrows identical language from two bills that didn’t share the same supporters. That’s caused concerns among some advocates for civil commitment changes, who say the combination muddies the waters and jeopardizes progress on fixing the state’s broken civil commitment system.
The decision to combine the bills came after a federal judge recently found the state had not been admitting people from jails to the Oregon State Hospital within a seven-day federal deadline to do so. The judge applied a fine of $500 per person for each additional day they spend in jail. So far, the state owes $38,000 for 24 people since the judge’s ruling took effect on June 6, according to OPB.
The new bill is scheduled for a committee vote on Friday afternoon, which The Lund Report noted is a sign that leadership is confident it will pass.
Rep. Jason Kropf, a Bend Democrat who worked with stakeholders on both bills throughout the session, said during a June 16 public hearing that the combined bill represents the hours of work and public hearings already done for the other bills.
“We undertook this work to make sure that we were taking steps forward in how we treat and hopefully help people who struggle with behavioral health and mental health issues, being mindful of each individual’s liberty interests… and being mindful of historic past abuses in our system,” Kropf said. He said the bill adds clarity to the process, and will help move people from the criminal justice system to the behavioral health system.
In his opening remarks, Kropf also shared that the bill came, in part, because of the federal court ruling.
“Much of this work is being mindful of the federal litigation that we’re under when it comes to the aid and assist population in the state hospital, and being responsive to that,” he said, referring to people found unable to assist in their own defense due to a mental illness. He said those sections of the bill will sunset in two years, forcing the state to reevaluate their effectiveness.
The new joint bill received supporting testimony from KC LeDell, Gov. Tina Kotek’s senior behavioral health policy advisor, who said the combined bill will streamline the system and codify the timelines in the federal court rulings which are already in practice. He said the bill will also add new timelines for community restoration, which focuses on legal skills and medication management.
“These are necessary steps to show we are taking our legal obligations in this seriously, to ease the pressure on our community mental health care providers and to make sure that our behavioral health resources are going towards the people who will be best served by them,” LeDell said.
Changes to civil commitment
The hotly debated civil commitment reforms would expand the idea of dangerous to mean that someone will cause “serious physical harm” to themselves in the “near future, even if such behavior is not imminent.” It also allowed judges to look at someone’s recent pattern of behavior to make a determination, rather than how they act the moment they stand in court.
Chris Bouneff, the National Alliance on Mental Illness Oregon’s executive director, said in a Tuesday email that his organization continues to support the civil commitment reforms which they’ve pushed for this session. They’re not taking a position on the other sections, which he said were “all new to NAMI.”
Rejection from civil commitment preceding a tragedy is an issue that has made headlines in recent years. Salem Reporter in April shared the story of Melinda Lou Kayser, a homeless woman with severe mental illness. She died from hypothermia on a Salem sidewalk 11 weeks after Marion County investigators determined she was not eligible under Oregon law to be civilly committed.
The decision came despite a yearslong pattern that Kayser was unable to seek shelter, food or attend to health care needs independently. Investigators determined she was able to care for herself, and not at risk of imminent death. 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 were also major contributing factors to her death.
Supporters of civil commitment reforms in Marion County say those needed changes are now combined with other policies that add or cement problems with Oregon’s beleaguered mental health system.
The bill would codify federal requirements that prevent judges from sending people accused of crimes to the state hospital if they did not physically harm or threaten another person. It would also add time limits to how long someone can stay in community restoration, which is often the only treatment option for such people. It asks that the person manage their own medication, stay sober and return for check-ins at court.
The aim, supporters said, is to treat more people in the community.
Marion County Circuit Court Judge Audrey Broyles, who has overseen many cases involving mental health treatment, said in an interview that those requirements mean people who pose a danger to themselves or others aren’t able to get committed for treatment.
Community restoration works well for some people, but lacks supervision for those who need more support, she said.
Broyles recalled someone sitting in her courtroom that she believed needed a hospital stay. He didn’t qualify because he hadn’t hurt anyone. She believes that such decisions should not be a one-size-fits all policy based on the type of crime.
“He urinated himself, he urinated (on) the bench and the carpet, and he was so sick. But we expected him to engage in community restoration, which was ridiculous,” she said. “The concept that we send people to the hospital – or keep people at the hospital for a set period of time – based only on the charge is really ludicrous. Because it doesn’t look at the person’s needs, the person’s history, the person’s mental state.”
The bill would also set new limits on how long someone can be in a community restoration program, ranging from 90 days to a year depending on the charge. It allows judges to extend that after another visit.
Broyles said Marion County judges already work with the district attorney, criminal defense attorneys and behavioral health providers to try to get people to graduate from community restoration when they’re ready.
“We’re acutely aware that people should not just be strung along if there’s no progress being made or the level of their alleged offenses is fairly inconsequential,” she said. But she said 90 days to treat most people barely scratches the surface.
If more people are pushed out of community restoration before they’re better, they could end up hurting themselves or the community, she said.
“At the end of the day, you can’t sacrifice public safety for not having enough space,” she said. “Everybody will walk home (after passing the bill) and feel good because they’ve got something that’s going to help the state hospital with time limits, and it’s not going to help the community or the individual person.”
Marion County Commissioner Danielle Bethell generally supports the civil commitment changes, but said the combined bill adds more unfunded mandates to counties.
”I’m very frustrated that they took the (federal) order and all that noise from the federal court situation and crammed it into this bill,” Bethell said in an interview. “(That order said) the state is not allowed to force their responsibilities onto counties. This new bill does exactly that.”
She said the added emphasis to community restoration programs would add work for Marion County’s behavioral health workers.
“Which would be fine if that system was robust and supported, which it’s not,” Bethell said.
As of Friday, 42 people are in Marion County’s community restoration programs, according to Health and Human Services Administrator Ryan Matthews. The county has a total of 35 transitional treatment beds, which are also needed for people in diversion programs and who have recently completed a civil commitment.
At peak times, he said they’ve had 70 people in the community restoration program, “which placed a significant strain on staff and housing resources.”
Bethell said that they should have kept the two bills separate, and that the challenges they both pose could have been better addressed that way, but she now believes the focus has been pulled from the people it’s meant to support.
“It’s taken us years of people dying on the streets to even get to a room to have this conversation, and it’s only because there’s a court issue happening against the state hospital that we’re even having that conversation,” she said. “Those legislators right now only care about the fact that they need to get out from underneath that contempt order, and that they need to not be paying $500 a day because the state hospital is in contempt.”
Community restoration support
Supporters of the time limits during the public hearing said that community restoration needs to be implemented more often. They want to limit unnecessary, traumatizing stays and the loss of civil rights that come with an involuntary admittance to the state hospital.
During the hearing, they opposed tying civil commitment reforms to their efforts to expand community treatment.
Reid Kajikawa, a public defender in Lane County, said he believed the lower threshold would overload a system already stretched thin without helping more people. It’s a sentiment shared by Disability Rights Oregon, which opposed both the original civil commitment reform bill and the combined bill.
Kajikawa said he wants the state to treat mental health like a public health issue, and invest in helping people before they get to the point of needing to be forced into treatment. He noted that Lane County recently lost CAHOOTS, a nationally lauded program which brought mental health workers directly to people in crisis rather than police.
Allison Knight of the Oregon Criminal Defense Lawyers Association worked to craft the bill adding community restoration timelines, but took a neutral position on the combined bill. She said during the hearing that she can’t support the civil commitment reforms which would devastate their clients and leave a permanent mark on their life.
She said that’s especially true with the lack of options to treat people before they become seriously ill.
“(Patients and families) have been waiting for community treatment to materialize since the 1960s… I hear that there are these investments, I hear that there is this intention and I am in support of it and I hope that all of that comes to fruition,” Knight said. “For our organization and the people that we serve, we just cannot believe that that’s coming. We’ve been told that for generations.”
Something everyone agreed on was that Oregon does not have enough space to provide mental health treatment at any level. It’s a central theme in the life and death of Kayser, who was unable to access supportive housing or long-term treatment earlier in life to help her change the course of her life before it was too late.
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. Ledell said during his testimony that the state expects to add around 200 beds in the next year.
Kropf, in his closing remarks, said that he’d written down the phrase “progress over perfection.” He emphasized that the combined bill will sunset in two years, and will ask the state to collect data about what works, and what doesn’t.
“This is truly a complicated problem and there’s a shared responsibility,” he said, but there’s been a high level of cooperation. “There’s going to be a level of tension, and I’m actually okay with that. Because I think this group of folks will continue to work together and actually push each other, also. So, I’m fine with that tension. I think that’s healthy.”
Contact reporter Abbey McDonald: [email protected] or 503-575-1251.
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Abbey McDonald joined the Salem Reporter in 2022. She previously worked as the business reporter at The Astorian, where she covered labor issues, health care and social services. A University of Oregon grad, she has also reported for the Malheur Enterprise, The News-Review and Willamette Week.
