New State Hospital Already Destined to be Closed

In an article, “New state hospital may close,” published in the Bulletin of the Salem’s Central Oregon region,  the Associated Press reported December 3, 2016, that Oregon’s Governor Kate Brown had suggested she had decided or was in the process of deciding to close a new state psychiatric hospital, in the Eugene, OR area, near Junction City. which is the new site of the original Oregon State Hospital.This hospital has a total capacity of 100 beds.

The hospital which has been open only 18 months and cost $130M to build, is slated for possible/probable closure in mid-2018. Its closure was heralded as necessary to save the economically beleaguered state much-needed monies. No real details are given by the state personnel’s’ announcement concerning this drastic move except there is a large budgetary “hole” in the state’s health care departments’ budgets and closing the hospital, which has 422 employees will save the state $34.5M a year.

The article also repeated the vague pledges heard over the last 30 years and especially the last 15 years in the national process of mental health reform, refunding, closing and building state psychiatric hospitals and trying to build the replacement smaller community-based 24-hour care facilities. It is noted in the article, in a not so reassuring manner that Oregon although the Governor “said she’d like to see most patients transferred to smaller community-based mental health facilities, although Oregon has chronically struggled to fund such institutions.”

To state the obvious, these smaller community-based facilities are seen as one of the revolutionary solutions to the problem of “institutionalization.” But they are and will be institutions none the less. The debate falsely framed over the last 50-60 years over the evils of institutionalization have ignored many issues. Far, far more of these community-based centers will be needed in every state. Being smaller, they WILL be more expensive than the larger state hospital model which has dominated rightly or wrongly, this country’s public psychiatric inpatient care for nearly 150 years. They will have lowered standards of care in the very specialized areas of therapy that all are in the realm of “rehabilitation,” which is quite expensive and specialist time intensive.

Their benefits as presently conceived are undeniable. It a state goes from four to eight large state hospitals to a system of smaller centers of care, patients hopefully will be able to be closer to their families.However, for the very severely disturbed, and violent or forensic patients, few of the localized centers will have those high management capabilities and those patients will have to go where the services are. Having the centers more spread out across a state, may increase the number of jobs to be created which hopefully all would agree, “is a good thing,” but will COST MORE. in the state budget that this state and others are trying to shore up facility closures.

Another very good potential benefit in my view is that I would hope the recovery model and a culture of starting from the get-go in the years of creation of these different kinds of centers, will be cultivated so that “mental patients,” persons with these disorders, will have more contact with their families, with the communities’ populations and a middle distance state of “Gheelizing” the long-term care of the chronically mentally ill will come to pass. The reference above is to Gheel (new spelling ‘Geel’) in Belgium where for hundreds of years, families have taken mental ill persons into their homes on a long term basis akin to adoption. This humane approach has been studied and observed over and over again for a hundred years or more and its effectiveness, even before the age of symptom modifying psychiatric medications, has remained obvious and ongoing.

The smaller community-based centers are part of the path to take, but not the only one. States are finding to their frustration, that their populations have increased since the late 1800’s and early 1900’s when the vast majority of state psychiatric hospitals were built. And correspondingly, so have the numbers of the mentally ill since we know that in general psychiatric conditions occur at certain rates in all populations around the world. As our health systems have become better, more scientific and have more to offer in the way of treatments, the need or ‘demand’ for psychiatric treatment has exponentially grown exactly like what has developed in the rest of medicine in the fields of heart disease, pediatrics, geriatric medicine, orthopedics, neurology, oncology, and on and on.

But we have not been on a replacement community-based treatment center building binge to fortify the other side of the lifelong treatment equation. We have started with the easier and cheaper approaches, placements in nursing homes (not the best solution), “transitional living,” to “independent living.” This latter approach is ‘good stuff,’ and the ideal but the reality is that only a minority of the chronically mentally ill appears to be able to handle this kind of independence and responsibilities for themselves. They still need peer counselors, peer coaches, guardians and extremely available supervision very close at hand.

So Oregon’s temporary budgetary correction-step will bear careful watching over the next, say, 10 years at least. My predictions will be that Oregon with have to reopen this facility at some point in the future and have it be the hub for all the many community-based psychiatric care centers. What the states do not want to face are the fundamental economic realities of needing ALL these approaches simultaneously. And all this costs money.

And the smaller care centers are drastically needed. But they are STILL INSTITUTIONS. And it is wise to keep in mind an operational definition of a care institution: a place that can furnish the care and guidance that the person cannot manage well by themselves.

 

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Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

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