Path to sanity a challenging trek for Oregonians

At 2 a.m. while I was on call, a worried mother of a young man asked why her son couldn't be admitted to the new Oregon State Hospital for a little longer stay until he could get well and be safe.

This young man's story is no different from that of many in our state with serious mental illnesses who are unfortunate victims of "Trans-Institutionalization." He has been in and out of emergency rooms, brief stays in psychiatric units, arrested multiple times and has been homeless or stayed in various shelters and incurred many minor legal charges or given court dates that went unattended.

I sensed her anguish. Yet I could not reassure her nor explain all the barriers her son will have to go through in his pathway to sanity though no fault of his.

The state hospital is practically out of reach for most who could benefit, as it has become predominantly a forensic facility and it is easier to get there from jail than the community. For all others, one has to be admitted to an acute care psychiatric hospital under an involuntary hospital hold.

Unfortunately, only around 7.9 percent of those on hospital hold in our state are civilly committed as compared with 17.2 percent in 1996. And the majority of them are released within a few days to join the never ending cycle of trans-institutionalization. Of those who are civilly committed, many still face additional barriers before being considered to the state hospital for extended stay or released while on the wait list for state hospital back to the community with few treatment options.

In Oregon, involuntary civil commitment is narrowly defined and restricted for those persons with mental illness and as a consequence of which are dangerous to self or others, or unable to provide basic personal needs. The majority entering this process get dropped after the hospital hold by the county employed pre-commitment investigators. As such, despite the hold being placed by the emergency room, only a small fraction of them are civilly committed.

There is also variation by the counties in the rates of civil commitment. It is rare to see alternative evidence-based options, including outpatient commitment or mental health treatment court considered to engage the person in their treatment and recovery.

Without civil commitment, entering the state hospital is nearly impossible for this man. He cannot benefit from the additional treatment options that the state hospital can offer at a price tag of nearly $21,000 per person per month. He may be ineligible for many treatment resources in the community that are often rationed to those who are leaving the state hospital.

In Oregon, the likelihood of incarceration versus hospitalization is nearly 3:1 as waiting for the standard of civil commitment often leads to acts of crime. At least he could sleep safely in our emergency room that night.

As I fell asleep, I dreamed of the day when we will have a system that is truly an efficient pathway to sanity.

Satya Chandragiri, M.D., of Salem is a practicing board-certified psychiatrist. He can be reached at (971) 239-1146 or chandrasclinic@qwestoffice.net.