Oregon lawmakers are mulling over two bills that would make it easier to commit people to in-patient mental health treatment involuntarily.
One of these bills, which would roll back years of litigation that made civil commitments difficult to achieve, has been criticized by some mental health advocates with lived experience. Instead, these advocates are championing separate legislation that would help people in crises before their symptoms escalate to the level that would warrant civil commitment.
To make civil commitments easier, Senate Bill 187 offers new, clearer language defining “dangerous to self or others” — a requirement that must be met.
The civil commitment process is overseen by a judge who decides whether a person alleged to be mentally ill should be required to accept mental health treatment, per the Oregon Health Authority’s definition.
As it stands, a person must pose a danger “imminently.” Critics say this sets the bar for commitment too high, making it difficult to get help before physical harm has occurred. S.B. 187 would broaden the definition of “dangerous” to include those who are “likely to inflict serious physical harm upon self or another person within the next 30 days” and would allow for an individual’s past behavior to be taken more substantially into account.
A second bill, Senate Bill 205, would authorize the court to commit a person to a secure hospital “during pendency of petition to commit person as extremely dangerous person with mental illness.”
While both bills refer to similar processes, they deal with different populations.
S.B. 205 addresses individuals who are facing criminal charges but are unable to aid and assist in their defense — and who under the state’s current statute could be released from the Oregon State Hospital to jail. The law is intended to ensure individuals can stay at the hospital.
S.B. 187 pertains to a much larger population — individuals referred to the legal system by family members or emergency services.
Under the current statute, a court can commit a person to psychiatric care if they pose a danger to themselves or others, but the practice of commitment has largely been guided by case law in appellate courts, narrowing the criteria to a person observably committing harm.
That reliance on case law “does nothing but mislead people who must rely on it as what is actually required for civil commitment,” wrote Josephine County Judge Pat Wolke in his testimony in favor of S.B. 187.
Wolke created and presides over the Josephine County Mental Health Court and has served on the state Legislature’s Workgroup to Decriminalize Mental Illness, which was formed in 2017. That workgroup drafted the bills, as well as two others that died in committee during the last regular session of the Legislature in 2019.
In his testimony in favor of a bill at that time — an earlier attempt to clarify language around “danger to self and others,” as well as on a bill that would have extended the deadline for a commitment hearing — Wolke noted that his son developed a serious mental illness as a college freshman and “by the smallest of margins, he was civilly committed.”
The bills under consideration this session are the result of a years-long push to add clarity to the state’s civil commitment statute. Both bills came out of committees chaired by Sen. Floyd Prozanski (D-Eugene).
“We hear the story of loved ones saying, ‘I’m at the end of my rope. I need help to help my loved ones. They do not recognize that they are having some type of mental episode that needs to be addressed and that they are a danger to themselves or others,” Prozanski told Street Roots.
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S.B. 187 adds more specific language — serious physical harm — and a 30-day time frame for likely harm. It also adds guidance for the type of evidence the court could consider, including past behavior.
But some mental health and civil advocates argue the proposed new criteria for commitment are also subjective in a way that’s likely to get more people committed who might be better helped by other out-patient options.
Arguments for a less forceful approach
“We see civil commitment as an issue of absolute last resort because it can infringe on the civil liberties of people with mental illness, because it can be incredibly traumatic,” said KC Lewis, managing attorney of Disability Rights Oregon’s Mental Health Rights Project. “I think that civil commitment is even used as a workaround for not providing some of those resources.”
As Lewis sees it, people are often committed not because they cannot function in the community but because the community is not providing the resources that allow them to function in the community.
“There’s really no accurate way to predict the dangerousness of a person successfully,” said Michael Hlebechuk, executive director of FolkTime, a nonprofit organization focused on providing peer support for people with mental illness.
Hlebechuk said the bill will have the likely effect of having more people ending up in the system, which can often do more harm than good for people suffering from serious mental illness.
In 2020, Multnomah County committed 225 people to psychiatric care through the civil commitment process — down from 303 in 2019, according to Bill Osborne, the diversion courts manager for Mental Health and Addiction Services.
As Osborne described it, the process works like this: A person has a mental health crisis and comes into contact with police or a hospital. If the physician believes the person poses a danger to themself or others — or isn’t able to meet their basic needs — Osborne’s office gets what’s called a notice of mental illness, or NMI.
Osborne’s office then undertakes an investigation, which must be completed within five days. That process includes an interview with the patient — either in the hospital or through video chat — as well as reviews of medical and police records, interviews with outpatient providers and interviews with family.
If a patient is willing to stay in the hospital and continue treatment, they can do a 14-day diversion, or they can be referred for a civil commitment hearing, Osborne said.
In the end, the number of people who are actually civilly committed is about 10% of the roughly 3,000 cases Osborne’s office evaluates every year.
Critics of the bills say making it easier to commit a person to psychiatric care without adding commensurate funding for mental health beds is a problem.
“The shortage of hospital beds applies sort of lateral pressure to this amendment,” said Jason Renaud, co-founder of the Mental Health Association of Portland.
No fiscal impact statement has been submitted for S.B. 205, and the fiscal impact statement for S.B. 187 is “indeterminate,” according to documentation posted on the state Legislature’s website.
A third bill before the Legislature this session would add funding — and 18 beds — to the mental health system, but not for the type of acute care encompassed in the civil commitment bills.
House Bill 2980 would appropriate $4.5 million from the state’s general fund for peer-run organizations in the Portland metro area, as well as in Southern, Eastern and Central Oregon regions, to operate peer respite centers for people suffering from mental illness.
Kevin Fitts, executive director of the Oregon Mental Health Consumers Association, the principal lobbyist for the bill, told Street Roots he was committed to a psychiatric hospital in 2004 after he broke a neighbor’s window during a paranoid episode in which he thought the neighbors were spying on him.
He said he called his provider and said, “I did something terrible.”
He was taken to a psychiatric ward, he said, where he was slammed on the bed and put in a restraint for five hours — which, far from calming him, made him “want to kill these people.”
“The consequences of forced treatment damages people, breaks people,” Fitts said. “We’re breaking people like wild horses.”
Under H.B. 2980, each center would have six beds and provide up to two weeks of voluntary respite care for individuals.
The idea, Fits said, is to reach people who aren’t necessarily in crisis but who feel “a rough patch” coming on.
“One of the things that peer respite hopes to do is be a little side door to the merry-go-round,” Fitts said. “We need to tell the story of people who are in between — not completely out of control, but not completely safe at home.”
The centers would be peer-led, with peers being people with lived experience with mental illness.
“You meet people, like-minded people. Like Alcoholics Anonymous, sometimes the best remedy is a fellow alcoholic,” Fitts said.
A previous version of the bill died in committee in 2019.
This time around, H.B. 2980’s champions include Multnomah County Commissioner Sharon Meieran and the Oregon Psychiatric Physicians Association.
“I think that the state of Oregon is really at a crossroads with which direction they’re going to move in — in really taking some steps in expanding our community-based services in the state,” Melissa Eckstein, president of Unity Behavioral Health, told Street Roots. “Peer-run services have a different vantage point than other resources in the community. You cannot have a well-defined continuum of care without including peer services in that.”
Eckstein declined to comment on the civil commitment bills.
Before stepping into his role at FolkTime in December, Hlebechuk was the Office of Consumer Activities director at Oregon Health Authority’s Behavioral Health Services, and before that, he was the director of the Peer Recovery Services department at Oregon State Hospital.
He’s also been civilly committed three times, he said — most recently in 1991.
Those experiences made him more distrustful of the system. He also said he’s had kidney disease — requiring a transplant — due to medications he received while under psychiatric supervision.
What worked far better, Hlebechuk said, was “being in the driver’s seat” and having clinicians who met him where he was.
“It isn’t a matter of improving that process. It’s a matter of improving the system. If the system were more welcoming, met people where they are, we would have far fewer individuals who are avoiding treatments,” Hlebechuk said.