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DHS news release

State improves services to psychiatric clients


This guest opinion was published by the East Oregonian, Pendleton, on April 18, 2006.


By Bob Nikkel

Even here in Pendleton, news stories about Oregon's state hospital system are largely about replacing the decrepit state hospital facility in Salem, part of which goes back to the days when Buffalo Bill was producing Wild West shows.

But the real excitement lies in what happens inside a state psychiatric hospital, recognizing that few mental-health consumers should spend time behind a hospital's walls.

There's no more stigmatizing place to be than a psychiatric hospital. So when patients can be discharged sooner -- as is happening now at Blue Mountain Recovery Center in Pendleton -- that's good news.

It's good news because life in the community is better for patients, it costs less, and it's exactly the sort of challenge that state government should be meeting.

When patients are civilly committed -- these are patients who are guilty of no crime but pose a danger to self or others -- they often contend they are not mentally ill. And they immediately begin looking for a way out.

In a new model on the state hospital campus in Pendleton, staffers begin by agreeing with patients that a psychiatric hospital isn't the right place for them. And they promise to help them get back to the community where they want to be.

This has hospital staff promptly contacting family members, identifying community housing placements and other supports well ahead of a patient's readiness for discharge. Physicians work hard to get patients' medications right, trying to eliminate negative side effects that prompt patients to stop taking them.

This gives patients hope, a key ingredient in recovery from any illness. Patient seclusion and restraint now are rare and brief. Costs for psychiatric drugs are down.

By contrast, some state hospital patients have faced frustrating months of delays waiting for a community placement to open up, resulting in behavior or escape that lead to longer hospitalization.

Consider the results in Pendleton:

  • The state psychiatric hospital is admitting and discharging patients at a rate two-and-a-half times as fast as before.
  • This opens up state beds for patients waiting for admission from acute-care hospitals where daily costs are twice that of a state hospital.
  • And discharge from a state hospital to the community puts most patients in placements where federal Medicaid dollars pay part of the cost (it doesn't do so for patients in state hospitals).

This is very likely the future of state hospitals in Oregon because it's consistent with our goal to provide high-quality care, to be efficient, and to comply with court decisions requiring that patients who can live successfully in the community not be confined to institutions.

Needless to say, we're monitoring rates at which patients are rehospitalized to ensure that we're on the right track. On the Pendleton campus, only two discharged patients have been readmitted since October and both were successfully reintegrated into community placements.

This isn't a flashy new program. It's the hard, unglamorous work of a state government that's doing what you expect it to do. And it holds exciting promise for further strengthening Oregon's community mental health system.

Bob Nikkel is mental health and addictions administrator in the Oregon Department of Human Services, which operates state psychiatric hospitals in Pendleton, Salem and Portland. He may be contacted at Robert.e.nikkel@state.or.us