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DHS news release

This guest opinion was written by Marvin D. Fickle, M.D., Superintendent and chief medical officer of the Oregon State Hospital

For a photograph of Dr. Fickle, contact Nadine Jelsing, (503) 945-5950 or email nadine.jelsing@state.or.us

Length: 475 words

State Hospital confronts difficulties

Sitting in my office overlooking the gracious landscape, with its grand trees and expansive lawns, it’s easy to look past the old buildings slowly crumbling in the bright summer sun. It's been three months since I returned to work at Oregon State Hospital. I spent the intervening five years working in the prison system; that experience has altered my view of what a state institution can do, even in the face of budget cuts and public neglect.

The State Hospital’s problems are not of recent origin; their roots lie shrouded in decades past. It is instructive in demonstrating how our current decisions, made with expediency in mind, have long-lasting implications that will plague our grandchildren.

Recent judicial decisions have complicated conditions at the hospital, as overcrowding gradually increased, and community resources failed to grow equivalently. The first was the federal court decision requiring the hospital to immediately admit persons found unable to assist in their own criminal defense.

There’s also been a marked increase in persons found guilty except for insanity, and placed under Psychiatric Security Review Board (PSRB) jurisdiction. Most of these people end up at the state hospital, often with long sentences.

As difficult as the current situation may look, many people are addressing the problem. The hospital has recently opened a new unit; however, this stopgap measure doesn’t address the issue that we have far too many people in the hospital who should be living in the community. The hospital buildings, all over 50 years old (some date to the 1880’s), are in desperate need of basic repair. Realistically, they are long past the point of cost-effective rehabilitation.

The Oregon Department of Human Services (DHS) has moved ambitiously forward in building a community-based system of housing and treatment for people discharged from the hospital. However, even their best efforts can scarcely meet the growing need for placements of both civilly committed and forensic (PSRB) patients. The rising cost of housing, the objection of some communities to having treatment facilities in the neighborhood, and the technical difficulties of meeting building code, zoning, and licensing requirements, means that opening additional resources takes time.

Despite these impediments, 60 new community beds in various group homes and other private settings have opened since late last year, with more than 200 coming on line by June 2005. This growth, as impressive as it is, will barely keep pace with increasing admissions.

The hospital will continue to look for opportunities to reduce crowding, by decreasing lengths of stay, streamlining discharges, and developing alternatives to readmission. It’s important to remember that OSH is a hospital, not a prison. It is mandated to treat persons with mental illness, not warehouse them in packed warrens.

Recovery from mental illness should be our goal; providing reasonable access to housing, education, employment, and treatment is a fiscally sound policy. Fixing the state hospital is just a small part of that solution.

Marvin D. Fickle, M.D., is the Superintendent and Chief Medical Officer of the Oregon State Hospital.