Each month, dozens of patients confined at the Oregon State Hospital receive news many have waited years to hear: They don’t need to be there anymore. 

Yet only a few are discharged each month from the state’s most-regimented and costly mental health treatment setting. Instead, state data shows, these patients typically spend months occupying desperately in-demand beds for care that mental health professionals and authorities say they don’t need.

This confounding situation affects patients deemed guilty except for insanity, a group with a unique legal status who are required to undergo mental health treatment instead of prison. Patients deemed ready can receive that treatment outside the state hospital, in group homes and other less-restrictive settings closer to jobs and family. 

But years of underinvestment in the state’s mental health system has left these patients with few options when it’s time to leave the state hospital. 

“You realize, ‘I’m in that limbo stage where all the beds are full,’” a former patient who requested anonymity told Street Roots. “You think people would be mad, but you’re already so numb at that point.”

The problem has persisted even though state officials are aware of it, and after a court-appointed independent monitor flagged processes they found unnecessarily slow the discharge of these patients. On top of that, a federal judge is holding the state in contempt over delays in admitting so-called “aid-and-assist” patients who need treatment to regain the mental capacity to face the charges against them. 

The state hospital has seen a sharp rise in aid-and-assist patients in recent years, who account for more than half of the state hospital population and caught policymakers’ attention. Meanwhile, guilty except for insanity patients are waiting significantly longer to get out of the state hospital. 

“It’s almost as if they don’t exist any longer,” said Dave Boyer, managing attorney for advocacy group Disability Rights Oregon. “They often can’t take college classes or run a small business from behind the walls of the state hospital. Everything that they do is regimented, and they do that for years with very little idea when that might end.”

A bed too far

After years of underfunding, state lawmakers have poured money into building more places Oregonians can get mental health or substance use disorder treatment close to home. 

A 2024 study commissioned by Gov. Tina Kotek found that Oregon was on track to add hundreds of beds in residential treatment facilities, secure residential treatment facilities and residential facilities for substance use disorders. 

The study also found the state would need to roughly double its beds to more than 8,000 to meet the need. The state has continued to fund beds, with those most recently funded becoming available between December this year and January 2028.

“It’s the absence of beds in the community, and it’s the treatment programs and the monitoring that go with it,” said Harris Matarazzo, an attorney who has long represented patients who are found guilty except for insanity.

These patients need to be discharged to facilities with the right staff who can monitor a patient’s medications, he said. Additionally, discharged patients may need medical monitoring to manage the physical side effects of psychotropic medications, he said. 

Travis Atkinson, chief experience officer at health care consulting firm TBD Solutions, said there needs to be lower levels of care for patients after the state hospital in order for them to have lives of meaning and purpose. Keeping someone in the state hospital after they no longer need care would be like keeping someone in a medical hospital after they’ve been treated. 

“You’re starting to keep people in spaces that no longer serve them very well,” he said. “And so it becomes a freedom of movement issue.”

Meanwhile, state hospital patients who have been found guilty except for insanity told Street Roots that the lack of beds in community settings has meant they’ve been left waiting to reconnect with families, businesses and careers. While waiting, they learn to play cribbage, leave college degrees unfinished and miss trout fishing trips. They participate half-heartedly in treatment they say they don’t need. 

Current and former patients said it’s not just the lack of beds but also finding a facility that’s a good fit. Multiple patients expressed a sense of resignation over trying to navigate the discharge process and the lack of resources. 

“It’s certainly been an education in the mental health system,” said a current state hospital patient who requested anonymity. “And in Oregon it is almost broken beyond repair.”

‘I knew that I had changed’

Another former state hospital patient who requested anonymity said he waited over a year to be released to a group home in the Portland area in January. He had already spent four years in the state hospital. He said he needed a facility that could accommodate his medical needs, and he watched as other patients were released ahead of him. 

He said he coped by trusting in God’s will, and that hospital staff made the wait easier with prizes and karaoke. 

He said he is now in a “great home” with a TV in his room and a daily 30-minute pass he uses to see friends and buy groceries. He said he can now keep his dental glue in his room. He said his sister brought him Indian tacos with hamburger, sour cream and lettuce. 

The patient said he comes from a Native community and is looking forward to getting longer passes that will allow him to attend powwows, church and family dinners.  

“I knew that I had changed in the hospital for the better,” he said. 

He said he prayed daily in the state hospital and kept a journal, which he said helped him become a calmer person. He said he usually gets along with people, and if he doesn’t he prays for them.  

While he was in the state hospital, he said there were more aid-and-assist patients, whom he described as unstable. He said one ran around hitting himself in the head. He said others started fights or disrupted programs. He said that guilty except for insanity patients could lose privileges for acting out, while aid-and-assist patients had less incentive. 

“They have nothing to lose, really,” he said. 

Detaining Peter to fine Paul

Aid-and-assist patients spend significantly less time in the state hospital than guilty except for insanity patients. 

The reason for that is a decades-old federal court order mandating that people who are too unwell to aid and assist in their defense be admitted to the state hospital within seven days. 

Disability Rights Oregon revived the litigation in 2019 after the state fell out of compliance with the order. That resulted in a federal judge ordering timelines to treat aid-and-assist patients that range from 90 days to a year, depending on the crime they were accused of. 

The timelines were meant to open up hospital beds and are based on clinical evidence showing how long it takes for “competency restoration,” meaning they are well enough to understand their prosecution but not necessarily rehabilitated. 

State data shows that since 2021, the number of guilty except for insanity patients deemed ready for discharge each month has fluctuated between 20 and 60 people. But the hospital only releases 10 people per month, at most. On average, people are waiting around 200 days to be discharged after they are deemed ready. Sometimes the wait rises above 400 days or drops to around 100. 

In February, data shows that authorities determined that 41 of these patients no longer need care at the hospital. Patients were also waiting 188 days on average between the determination they no longer needed to be at the hospital and when they were discharged. Just three were discharged from the hospital in February — one of whom waited 617 days. 

Boyer, of Disability Rights Oregon, said that if the state could discharge those 41 patients it would ​​free up beds that could be used for aid-and-assist patients. He said that would get the state closer to resolving the federal contempt order, which comes with a fine of $500 per day for every patient held in jail more than seven days for a state hospital bed. The total fines have exceeded $1 million. 

‘Not acceptable’

The litigation has meant more scrutiny of state hospital operations, including a federal judge’s appointment of Dr. Debra Pinals as a “neutral expert” to recommend improvements and monitor progress. 

Before their discharge from the state hospital, guilty except for insanity patients must complete psychological evaluations and planning for how they will continue treatment and remain stable. The process has multiple layers and involves the state hospital, Community Mental Health Programs as well as the Psychiatric Security Review Board, an independent quasi-judicial agency that determines the care settings for patients found guilty except for insanity. 

Pinals wrote in her November 2024 report that the discharge delays guilty except for insanity patients faced were “not acceptable,” adding that the delays openly violated federal prohibitions on the unnecessary institutionalization of people with disabilities. 

In another report from May 2025, Pinals wrote that while the state hospital and the Oregon Health Authority had taken steps to improve the discharge process for these patients, there were still too many delays. She wrote that there was confusion among state leaders about the processes and called for a 20% improvement in discharge times within three months. 

That deadline came and went. The state’s most recent status report submitted in January indicated that the state hospital was still working on meeting that goal. State data also shows patients aren’t moving through the discharge process within recommended timelines.  

Martha Sils, health authority spokesperson, declined to answer most of Street Roots’ questions, citing the ongoing litigation. 

“OSH is committed to providing every patient the right care at the right time to help patients prepare for discharge,” she wrote in an email. 

Pinals has also blamed the delays partially on processes used by the Psychiatric Security Review Board.

Alison Bort, the board’s executive director, wrote in an email that the  “timeframes reflected are not tied to statutory or administrative deadlines, so they are best understood as indicators rather than compliance measures.”

She also wrote that the data does not show the reasons for a delay and is based on a small sample size. 

“Without careful interpretation, the timeframes may appear worse than they are,” she wrote. 

When asked who ultimately bears responsibility when a patient ready for release cannot leave the hospital, both Bort and Sils declined to answer.

This article appears in April 1, 2026.