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“This is where people live – even if for a brief period of time. It is a community. They deserve to be engaged in decisions that impact the community that they live in,” said Cee Carver, OSH Director of Peer Recovery Services.  

Carver’s department provides direct support to patients during their time in the hospital through services that help them navigate the challenges of being in an institutional setting. One long-time program is the Peer Advocacy Council (PAC) which enables patients to bring forward their own concerns and those of their peers. More recently, the hospital’s leadership team began meeting quarterly, and as of July, bi-monthly, with PAC representatives to hear their concerns and respond to requests with commitment of action or explanation of why the concern could not be addressed.  

The dialogue has brought leadership’s attention to fast track some changes like more variety in the food menu, more social activities outside of designated treatment group time and ensuring all patient units hold unit community meetings where patients have the opportunity to co-lead with staff to discuss concerns, questions and suggestions to improve life on the unit.  

About 40% of patients at OSH are admitted under a guilty except for insanity (GEI) order – which means a judge has determined they were not of a state of mind to understand their criminal responsibility at the time of their crime. The median stay for patients admitted under GEI orders is about 3.5 years, and while at OSH they must meet requirements for discharge set by the Psychiatric Security Review Board (PSRB). Patients under PSRB supervision often may transition into one of OSH’s six Secure Residential Treatment Facility (SRTF) units where the environment and programming are designed to better prepare patients for discharge into a group home – where they will be living with others in a community.  

Changes to the menu and more time to socialize were wins with big impact, said Tashina, who like many of her peers is a resident in one of the SRTF units at the hospital and preparing for discharge.  

“It’s a mood boost when we get to see something new on the menu,” she said. “It’s those little things that are a nice comfort that we sometimes miss. It’s also important that we have more opportunities to socialize. For us to discharge, they want to see that we have good socialization skills, so it helps us to have more opportunities to communicate with people outside of our unit.”  

Sierra Morgan is part of the OSH Peer Recovery Services team and coordinates PAC on both campuses. Some patients serve as PAC facilitators in paid positions while others – like Tashina – participate on a voluntary basis.

Beyond building communication, advocacy and leadership skills, participation in PAC also enables residents to model collaboration, respect and perseverance with PAC members often guiding the culture on their units, Morgan noted.  

“Before I started going to PAC, I didn’t know all of the things that PAC was working on and that the changes that were being made in the hospital were mostly due to PAC and the clients’ voices,” Tashina said.  

PAC has also elevated concerns to groups like Disability Rights Oregon, the Oregon Consumer Advocacy Council, the Governor’s Office, the OSH Advisory Board and advocated for PSRB reforms. 

“Our hospital even being open to the idea that our patients will have a say in the direction of where we’re headed as an organization is a massive step forward in the way we treat our patients,” said Tom Anhalt, OSH-Junction City administrator. As part of his role, Anhalt also is leading the hospital’s “patient experience” initiative to ensure patients are included in decisions that impact their quality of life at the hospital.  

“My hope is that the patient’s voice is heard at the same level as our subject matter experts because when it comes to residing at OSH and the impact of decisions made, the residents are the subject matter experts,” Anhalt said.  

Part of the patient experience initiative has been formalizing a process for patient participation called Meaningful Involvement.

Patient feedback has helped guide changes like the implementation of a cashless system, the integration of more cultural foods and overall menu variety and advising Security staff in their efforts to spend more time on the units to connect with patients as way to help reduce behavioral crises. 

OSH patient, Thad has participated in many workgroups, including the one helping Security staff. 

“They were interested in coming on the units more often to connect with patients,” Thad said. “They don’t want to have an intimidating presence and realized that connection is important to the therapeutic experience.”  

Thad is also on an SRTF unit and has advocated for other changes that he views as helpful to other patients preparing to discharge and transition to a group home in the community.  

“This is not a place people want to be, so I want to do my part to help make it comfortable and a place of healing and to better prepare people for the outside world,” Thad said.  

Making those connections and speaking up – especially for others who may not be at a place in their treatment where they can or feel empowered to – is a way to strengthen community and build each other up, said David, another OSH patient who has been involved in many OSH workgroups.  

“I think a lot of people have lost hope – that doesn’t mean we can’t try to keep it alive,” David said.  

He added that since his recovery journey began in 1978 – after his initial mental health diagnosis – he's sought out ways to advocate and engage on behalf of his peers. He credits exposure to books like “The Four Agreements” during his time at OSH for furthering his understanding of helping others.  

“Often, the issue is not that we don’t understand each other, it’s that we don’t listen,” he said. “That’s the whole goal of anyone around here – to be understood.”

David, Tashina and Thad each acknowledged that concerns or requests brought forward during PAC meetings or in the Meaningful Involvement workgroups may not always lead to action.   

“We’re learning sometimes things die in committee,” David joked.   

Anhalt said when that happens, the reasons why a request isn't feasible is shared with patients and that leadership is working on being more prompt with their responses to PAC and patients who volunteer for Meaningful Involvement workgroups.  

Through PAC, patients will continue to have an opportunity to speak up and share their views.  

“Residents are the unsung heroes of PAC,” Morgan said. “Their courage, consistency, honesty and commitment guide every improvement we make. They continue advocating even when responses are slow or outcomes are uncertain.” 

In 2026, PAC hopes to expand resident leadership opportunities and mentorship programs, as well as move forward other initiatives that impact patients’ quality of life.

Tashina said she hopes to continue to bring forward her peers’ concerns through her ongoing PAC involvement in the new year. Being a part of strengthening her community is important to her and her own personal growth.   

“We’re all just normal people just trying to get by in a mental hospital. Everybody has had a rough day or a difficult time in their past. We’re not scary people,” Tashina said. “I’ve just really enjoyed being a part of something bigger through PAC, and I hope that it will help me be more open to listening to other people’s ideas.”  

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