Advocates Urge Legislators to Reform Psychiatric Security Review Board

May 17, 2011 -- Matthew Kirby has seen things he’d rather forget during his stay at the Oregon State Hospital (OSH). These days, though, he has reason for hope.

 

“Things are changing now,” says Kirby, who’s been a patient at the state hospital since 2009. “We have new leadership” – current Superintendent Greg Roberts took the reins at the hospital last October -– “which is excellent.”

 

Indeed, Roberts, who’s nationally recognized for turning around New Jersey’s troubled psychiatric hospital, has been widely praised for his efforts to improve OSH’s medical services and morale in staff and patients alike.

 

A federal mandate drives his decisions. In 2006, the U.S. Department of Justice launched an investigation into conditions at OSH, and in 2008 issued a list of recommendations for transforming the hospital’s structural and social infrastructure. The consequence of noncompliance: potential legal action by the feds.

 

Roberts and OSH leadership also received guidance from a study conducted by Liberty Healthcare Consultation, whose recommendations included “Establish[ing] accountability at all levels of the organization through renewed leadership, clear and decisive lines of authority, and revitalizing personal management.”

 

It’s not just the hospital’s treatment paradigm that’s changed. The decrepit buildings that served as the setting for the 1975 film “One Flew over the Cuckoo’s Nest” – and which subsequently came to symbolize the cold dysfunction of OSH – have been razed. In their place, forklifts and backhoes work furiously to construct new, state-of-the-art facilities for patients and staff with a price tag of $280 million.

 

One building has been completely overhauled and transformed into a “treatment mall,” where patients take enrichment classes in horticulture, cooking and many other topics, and also receive vocational training to help prepare them for their eventual re-entry into society. A recent tour of the treatment mall revealed pristine, spacious hallways and classrooms that more closely resembled a college campus than the cold, institutional OSH of old.

 

Kirby feels the difference.

 

“The focus here is now recovery-oriented, as opposed to the medical paradigm – ‘I’m a clinician, you have this diagnosis, you will take this medication and do this treatment,’” Kirby explains. “It is much more person-centered and individualized.”

 

Kirby’s observations echo the hospital’s revamped mission: “To provide therapeutic, evidence-based, patient-centered treatment focusing on recovery and community reintegration in a safe environment.”

 

But despite the vast improvements within the hospital, Kirby and other patients contend that OSH won’t truly make a turnaround until it reforms the body that controls the hospital’s front door.

 

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The Psychiatric Security Review Board (PSRB), whose members are appointed by the governor, describes its primary responsibility as “assum[ing] jurisdiction over adults found ‘guilty except for insanity’ (GEI) who could pose a substantial danger to adults and youth found ‘responsible for insanity’ who suffer from a ‘serious mental condition’ or any other mental disease or defect who are a substantial danger to others.’”

 

Those recommended for admission into the state hospital are brought before the PSRB for evaluation. Should they be admitted, the PRSB determines the length of their sentence, and when they’ll be eligible for a progress hearing to evaluate their readiness for release.

 

As of May 1, there were 736 individuals under the PSRB’s jurisdiction. Of those, 324 – the GEI population – reside in the Oregon State Hospital (which as of May 11 housed 582 patients); the rest have been “conditionally released” back into the community in various types of residential settings – supported housing, intensive case management settings and the like – both in Oregon and out of state.

 

Like any state human services agency, the PSRB is suffering the adverse effects of reduced staff and increased caseloads that have accompanied recession-induced budget cuts.

 

Mary Claire Buckley, the PSRB’s executive director, told the Ways and Means Subcommittee on Human Services in March that her board was experiencing an increased demand for hearings that it couldn’t meet. As such, she said, “the board only provided timely hearings in 63 percent of cases in 2009.” That means that more than one-third of patients’ hearings were postponed, waived or cancelled.

 

Some say that the PSRB could solve some of its problems both by not admitting as many people to OSH in the first place and by not housing them there for as long.

 

“When you go under the PSRB, you always get the maximum amount of time,” says a patient who uses the pseudonym Emmanuel Goldstein. He’s served three years of his 10-year PSRB sentence for burglary. Clean-cut, well-spoken, and impeccably dressed, Goldstein looks like he’d more at home on an Ivy League campus instead of being locked up for a decade in a mental hospital. He contends that he and many other patients aren’t a danger to themselves and others, and could be served by community mental health programs for far less than the $17,282 per patient per month the state pays for with taxpayer money, according to OSH spokesperson Rebeka Gipson-King.

 

“Because there’s a perception that people with a mental illness are more dangerous than the rest of the population, the PSRB isn’t tasked with healthcare,” says Goldstein. “They are tasked with the protection of society solely. And they’re basing that on this perception that people with mental illness are all Hannibal Lecters’ – the sinister villain played by Anthony Hopkins in “’The Silence of the Lambs.’”

 

As a result, adds Kirby, people like himself are locked up far longer than they would have been had they taken a prison sentence instead of the road to recovery promised them by the PSRB and OSH.

 

“I was charged with burglary 1, which is a Class A felony,” says Kirby. “I had no previous criminal history. I was offered three years’ probation by the district attorney. I could have been in and out of jail in less than a week, but instead my lawyer told me about [the guilty except for insanity plea] and said that it’s like probation except that you receive these various healthcare-oriented sorts of things. And for me, I made the choice to come under the PSRB because I wanted the help for my depression and mental illness, and also my drug addiction. Little did I know that not only I would come to the hospital, but that under the current laws, burglary 1 gets you 20 years under the PSRB.”

 

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In a letter presented to the House Judiciary Committee March 18, Goldstein and other patients advocated for sentencing parity, or sentences issued by the PSRB for OSH patients that are on par with what prison time would be for similar crimes.

 

“The board continues to hold us in an institution past the point our own treatment deems necessary,” the letter says. “Moneys go wasted that could be used to treat a crisis in the community before it becomes a crime.”

 

Harris Matarazzo agrees.

 

A Portland-based attorney who has spent nearly a quarter century representing individuals before the PSRB, Matarazzo testified at the same House Judiciary hearing that current practice “has resulted in misdemeanants either being placed under the PSRB, or sent to the Oregon State Hospital, who did not need to be.”

 

Matarazzo also advocated for more conditional release into community mental health facilities for individuals who don’t pose a danger to themselves or others, as a means of saving the state money and of more appropriately and humanely treating patients with less severe mental illness.

 

He, Goldstein, Kirby and a slew of OSH patients and community mental health providers are pushing for passage of House Bill 3100, which would require a state-certified psychologist or psychiatrist, not the PSRB, to evaluate people before they could plead guilty except for insanity. It also has a provision stating that people who commit misdemeanors would be committed to the state hospital only if they posed a substantial danger to others.

 

The hope is that having mental health professionals in the evaluating roles and serving some misdemeanants through community-based mental health programs will save money – the Legislative Fiscal Office estimates that this legislation could save $300,000 over the next two years – but will also be more effective and empowering for patients wishing to actively pursue recovery.

 

“At the hospital, we park people there for years,” says Chris Bouneff,   executive director of the National Alliance on Mental Illness of Oregon. “We can do more in the community, instead of just custodial care.”

 

House Bill 3100 was referred in late March from the House Judiciary Committee to the Joint Committee on Ways and Means with a do-pass recommendation. It has yet to have a hearing, but Goldstein remains hopeful that legislators will see the need for what it’s proposing.

 

“People with mental illness have a disability,” says Goldstein. “You wouldn’t do this to somebody with diabetes or cancer. There’s an aspect of crime here, and that needs to be addressed, but adjudicating someone past what you would in normal society is unconscionable.”