In Oregon, there are two routes to mandated treatment for severe mental illness: civil commitment and the criminal justice system. Over the last five years, the civil commitment route has all but vanished, with the number of civil commitment patients admitted to the Oregon State Hospital dropping from hundreds to just 15 in 2023. In contrast, the number of patients admitted on orders for treatment and restoration has increased significantly, reflecting a shift towards mandating treatment only after individuals have committed a crime.
This shift has been driven in part by a court order requiring the Oregon Health Authority (OHA) to prioritize criminal justice cases, leading to a decrease in the number of civil patients admitted. As a result, long-term mental health care is often only available to those who have committed a serious crime, leaving people with acute mental illness cycling in and out of ill-equipped community-based options.
Advocates argue that this system is failing people with severe mental illness and that care should not be predicated on the idea that there must be a victim. They point out that Oregon’s civil commitment standards are so high that they force the justice system to step in as a system of last resort, which is an absurd way of approaching the issue.
Four of Oregon’s largest hospital systems are suing the OHA over the neglect of civil commitment patients, arguing that the state has failed to provide adequate care for people with severe mental illness. A federal judge ruled against the hospital systems, but they are appealing the decision, with a hearing set for May 8th.
The decline in civil commitments in Oregon is part of a larger national trend. According to the Treatment Advocacy Center, the number of state psychiatric hospital beds has been declining for decades, and the proportion of beds occupied by criminal patients has outpaced the percentage of beds occupied by civil patients.
This shift has serious implications for the treatment of people with severe mental illness. When treatment is delayed until after a crime has been committed, it is often more difficult and less effective. In addition, the criminalization of mental illness can lead to stigma and discrimination, making it even harder for people to get the help they need.
Oregon’s mental health treatment system is in need of serious reform. The state must increase its investment in civil commitment and other non-criminal alternatives to ensure that people with severe mental illness get the care they need before they commit a crime.
