Psychiatric Security Review Board Reforms Advance

The board will continue having jurisdiction over Measure 11 offenders
By: 
Amanda Waldroupe

June 24, 2011 — After weeks of sitting in a subcommittee, a bill that seeks to make substantive changes to the Psychiatric Security Review Board is headed toward a Senate vote.

Senate Bill 420 always had an uncertain road ahead of it as the bill made its way through the Legislature this session. 

The controversial bill originally sought to strip the Psychiatric Security Review Board of its jurisdiction of Oregon State Hospital patients who committed a crime and were found “guilty except for insanity." It faced opposition from law enforcement, district attorneys and some lawmakers. Mental health advocates championing the bill continually worried it would die.

But after weeks of sitting in a subcommittee of the budget-writing Joint Ways & Means Committee, compromises have been hammered out. It passed out of that committee today and is headed toward a Senate vote.
 
Chris Bouneff, the executive director of Oregon’s chapter of the National Alliance for Mental Illness, said the bill (and its companion bill, House Bill 3100), will make the most substantive reforms to Oregon’s mental health system in years.
 
“We haven’t seen anything of this magnitude in a number of sessions,” he said. “They will help modernize our system.”
 
The bill changes the jurisdictional authority of the Psychiatric Security Review Board (PSRB), the five-member board that has jurisdiction over all mentally ill persons who commit a crime and are found by a court to be “guilty except for insanity,” meaning that the crime would not have occurred if the person wasn’t mentally ill.
 
Essentially acting as a parole board, the PSRB has the power to decide when a patient is ready to be released from the hospital, either to live independently or in a treatment program at the community level.
 
The bill gives the Oregon Health Authority, which oversees the Oregon State Hospital, jurisdiction over hospital patients who commit non-Measure 11 offenses. Those who committed Measure 11 offenses (violent person-on-person crimes such as murder, rape, etc.) will continue to be under the PSRB’s jurisdiction. 
 
Originally, the bill would have given jurisdiction of all patients to the Health Authority. But law enforcement and the Oregon District Attorneys Association strongly objected, arguing that dangerous people would be released from the hospital.
 
A compromise was struck to create a “Tier I” and “Tier II” population. “Tier I” refers to patients who committed Measure 11 offenses; Tier II to non-Measure 11 offenses.
 
As of May 1, there were 736 individuals under the PSRB’s jurisdiction. Of those, 324 reside in the Oregon State Hospital, and the rest have been “conditionally released” to various types of community treatment settings.
 
It is estimated that the PSRB will continue to have jurisdiction over approximately 60 percent of the hospital’s patients. “It’s a huge list,” said Sen. Jackie Winters (D-Salem), who was involved in creating the compromise.
 
Bouneff said that advocates would like to see the proportion of patients under the Health Authority’s jurisdiction be much higher, but conceded “it’s a good compromise.”
 
“You have a large number of people covered under this legislation. We have a good chance to make a dent here,” he said. “It gives us an opportunity to demonstrate that not everyone in the state hospital is supremely dangerous, as painted by some people.”
 
He and other advocates hope the bill will address unnecessarily long hospitalizations experienced by some patients, even though they may no longer need the hospital’s intense level of care after a certain period of time.
 
“There are patients who are considered clinically ready for discharge who don’t need to be in the hospital, but are unable to leave,” said Bob Joondeph, executive director of Disability Rights Oregon. “They can spend months and years in there, frankly.”
 
“You have to have a good, efficient way of getting them out of the hospital, or it’s still used as a warehouse,” Bouneff said. “This creates movement in the system once someone is ready for a different type of care.”
 
The bill received the most discussion out of the 11 bills voted on by the Joint Ways and Means Committee, and was the only one to receive a roll call vote. Nine legislators cast a no vote including Sen. Betsy Johnson (D-Scappoose), who was the only Democrat on that side of the ledger.  
 
“This is a genuinely dangerous bill,” she said, echoing the concerns of district attorneys and law enforcement that people who present a significant danger to society would be released from the hospital.
 
Sen. Alan Bates (D-Ashland) countered Johnson, saying that “the really, truly dangerous people” will continue to be under the jurisdiction of the PSRB and most likely not be released from the hospital.
 
“The thing we’re trying to get to is the people who get to the Oregon State Hospital and sit there for 10, 15 years who were never dangerous to anybody, and who committed low-grade crimes,” Bates said.
 
Another compromise made to Senate Bill 420 is requiring the PSRB and the Health Authority to submit reports to the Legislature twice a year until 2016 that address the implementation and impact of the bill.  
 
“We will be watching very closely to see if there are any unintended consequences,” said Rep. Dennis Richardson (R-Central Point), one of the committee’s co-chairs.
 
House Bill 3100 also passed out of the Ways and Means Committee today. It’s the companion bill to Senate Bill 420, and addresses what people are colloquially referring to as the “front door” of the hospital, or how people are admitted.
 
If it becomes law, the bill will require that a state-certified psychologist or psychiatrist evaluate someone before they make a “guilty except for insanity” plea. Currently, the PSRB decides the evaluator. The bill also includes a provision that people committing misdemeanor-level crimes and Class C felonies be sent to the hospital only if they need such a high level of care.
 
The hope is that there will be more consistency to the process of finding someone “guilty except for insanity,” as well as decrease the number of people entering the hospital. Mary Claire Buckley, the PSRB’s executive director, estimates that 15 to 20 people will be affected by the new law.
 
In addition to reforming how people are admitted to and released from the hospital, this legislation will also address the serious concerns of the federal government about the quality and care at the hospital, Bouneff said. A 2006 federal Department of Justice investigation heavily criticized the hospital, and warned Oregon that if action was not taken, there could be potential legal action.
 
“That is the big cloud hanging over all of this,” Bouneff said, adding that if the state did not act, the federal government could eventually “force our hand.”
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