Oregon Department of Human Services Director's Message
April 9, 2010 DHS Director's messages on the Web
To: All DHS employees
From: Bruce Goldberg, M.D., director

Oregon State Hospital and Community Mental Health Treatment

"The good we secure for ourselves is precarious and uncertain until it is secured for all of us and incorporated into our common life."
~Jane Addams

One of the greatest moments for us at DHS and OHA last year was when the doors to the Eastern Oregon Training Center were closed and the last institutionalized person with disabilities left that facility to live in the community.

I have been thinking about that recently and about how far we have come in some ways as a society and an agency in how we care for our friends, family members and neighbors, and how far we still need to go in others. It weighs particularly on my mind because of an internal investigation released last week relating to the death of a patient at the Oregon State Hospital.

After five months and interviews with 39 witnesses connected to this case, the report concluded that while it was inconclusive as to whether the patient was neglected on the day of his death, his overall care was negligent and the state hospital failed to provide adequate care and treatment.

The report's findings are troubling and disturbing to read. But they also paint, I believe, an honest picture of the work ahead of us. We must renew our commitment to care for patients at the state hospital. We must be rigorous and swift in our improvements and we must not rest until the hospital is a transparent refuge of safety and recovery for those in need. It's time for the next step forward to create a culture of care and excellence at the Oregon State Hospital.

When I think about the hospital I think about the patients and their lives and what brought them to the hospital. And I think about our staff. I feel a responsibility to help our patients get as well as possible and live as independently as they can, close to their homes and those they care about. And I feel a responsibility to make certain that our staff have the expertise, the tools, the training, the facilities and the workforce to make that happen.

I also know the state hospital does not operate as an island alone. When the mental health system works well, OSH is part of a continuum of care. When things are working well people come in, get treated, get better and return to their communities. The reality is that with the right care and support, people with mental illness live independently, hold down jobs and are a part of the fabric of our communities.

That means we must get serious about mental health treatment at the local level. And in Oregon we have to face up to a hard truth: we have failed to provide the care and recovery opportunities people need that could keep them from coming to the hospital in the first place.

And here is another reality we must face: more than half of the patients at the state hospital today came through the criminal justice system, not the health care system. That stains us all.

In Oregon, less than one-third of youth and less than half of adults with mental illness have adequate services available in their local communities. These are the services that provide hope and set a path for recovery, not prison or institutionalization. When people get the help they need they avoid hospitalization or worse.

And while most people who don't get treatment suffer silently in its grips, some do act out or become violent. Then law enforcement is forced to be the safety net for our society's failure.

We are running out of time to address these issues, and frankly, for some people it is already too late. It is too late for the patient who didn't get the care he should have at the state hospital and it is too late for people outside the hospital who in the past have suffered stigma, fear and violence.

But I do see an opportunity for change.

I believe that Oregon will have a state hospital that is focused on safety, recovery, transparency and accountability for all patients. Richard Harris, director of Addictions and Mental Health and I are personally committed to making that happen. I believe that the conversation about community mental health treatment is changing and people are beginning to understand that we cannot solve mental illness by treating it as a crime rather than an illness, pretending it will go away or by building more and more hospitals or prisons.

But we must change from conversation to concrete action and we must do that now.

We must continue facing these hard truths and striving toward solutions at OSH and in our communities. I look forward to the day when OSH is truly a place of healing, when people get the care they need, and criminalizing mental illness will be as inconceivable as institutionalizing people with disabilities. I believe that day will come. It must.

DHS on the web