Please, Not Another Monument

Chris Bouneff

Thank you Oregonian for finally changing your language on your editorial pages when writing about people living with mental illness. After criticizing you in this blog, I wish to express my gratitude for your willingness to examine the words you use to describe people living with illness as just that -- people.

Finally, we get to debate the substance of your editorials rather than be enraged by the discriminatory language you usually use. I wish that I could continue my thanks for the substance of today’s editorial. Alas, your unsound arguments invite sound criticism.

Today, you argued that the state should continue to build a second big-box hospital in Junction City at a cost of at least $220 million per biennium to operate. You cite expert conclusions that we need those beds because we need a “foundation” for our mental health system. Of course, you ignore the fact that those beds, too, will fill up quickly, sucking ever more money out of the community mental health system designed to intervene and treat people so they never need the Oregon State Hospital.

We know so much more about OSH since the “experts” issued their opinion. As you never talked with those of us on the front lines living this every day, I don’t suppose you would know that. So allow me to enlighten you just a bit.

We finally are getting glimpses of who resides there, how people who need OSH can’t get in, and how people who don’t need it anymore can’t get out. We know now that more than 600 beds in a big-box institution that already absorbs half our mental health budget is more than sufficient. We know that “every serious patient forecast” is flawed in that such forecasts are built upon outdated practices that don’t reflect clinical reality or best practices.

We know that building a second hospital isn’t a foundation for a mental health system. All research demonstrates that early intervention and community treatment, bolstered by accessible hospital-level care when needed, is the true foundation. It’s clinically more effective and just happens to be much cheaper. The state estimates that it costs more than $600 per day to house someone at OSH, which is entirely state general fund dollars. In the community, it costs about $160 or so with about two-thirds of that paid by federal matching funds.

We know that we cannot fully staff one hospital. What makes us think we can staff two? Already, clinicians are being poached from community programs, where the waits to see psychiatrists and other therapists have increased from weeks to months.

We know that moving beds from Portland is idiotic. Patients do best when they remain engaged with their families, loved ones and support networks. Why does it make sense to eliminate all acute beds in the state’s largest population center and force families to travel to Salem or Junction City to visit their loved ones? Junction City is particularly inaccessible as it lacks public transportation.

Similarly, if we eliminate acute beds in Pendleton, we leave Eastern and Central Oregon without critical services. What is your solution for those population centers?

And we know that we can’t afford a second big-box institution. At a time when we are seeing actual revenue declines and will be cutting services across the board, what program do you expect to steal at least $220 million from to fund a Junction City hospital? Most likely, those funds will be stolen from community mental health services, ensuring that we fulfill our prophecy of needed big-box beds. If you purposely deny people community services, they will reach a crisis and require someplace such as the Oregon State Hospital. Your approach is akin to asking heart patients to go without preventative care, ensuring more heart attack victims who require expensive hospitalizations.

We don’t need a second costly, big-box hospital. Rather, we need throw out our stereotypes and incorrect assumptions and do what’s best for our communities and for those requiring treatment so they may lead lives in recovery. We need to change our practices so that people don’t languish year after year at the rebuilt Oregon State Hospital in Salem. We need acute beds in Portland. We need smaller regional facilities near other population centers so that acute services are closer to home for all Oregonians. What we don’t need is another monument to outdated thinking.

By Chris Bouneff July 11, 2010