CAHOOTS PROVIDES IMMEDIATE ASSISTANCE
BUT CANNOT HOLD MENTALLY ILL CLIENTS
SEVERELY MENTALLY ILL NOT GETTING
MORE HELP UNDER NEW LAW
Crisis workers in Eugene say they are still seeing repeat
cases of severely mentally ill people being discharged
back to the community by the jail and PeaceHealth Sacred
Heart Medical Center University District’s emergency
room, despite a 2015 Oregon bill that changed the
language describing how people can be committed to a
state mental institution.
That’s because House Bill 3347 didn’t really usher in
any new legislation, according to Andrea Williams, one
of two civil commitment investigators for Lane County
Behavioral Health Services.
“In my experience, it’s not really going to change
anything for us as far as how we process holds that come
through the hospital. That provision has always been there.
They’ve just changed the language of it,” Williams says.
She adds that she has not seen a rise in commitment
cases as a result of the bill.
HB 3347, sponsored by Rep. Val Hoyle (D-Eugene),
changed the state statute criteria for how individuals can
be forcibly committed to a state mental institution through
civil commitment. Under the previous law, individuals
with a severe mental illness, physically unable to care for
themselves, had to be in immediate danger of suicide to be
forcibly committed.
The new statute says an individual can be committed if
at risk of serious physical injury or death in the near future,
resulting from an inability to meet their basic needs.
“We thought it [HB 3347] would help out and impact some
of the clients we serve. Some of those folks aren’t necessarily
suicidal or homicidal, but are having such significant mental
health problems they are walking around underdressed for
the weather, walking their feet down to the bone, generating
police calls in the community because they can’t take care of
themselves or get food for themselves,” says Ben Brubaker,
volunteer coordinator at White Bird Clinic.
However, the bill only changed the language for a civil
commitment by a county mental health investigator, and
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June 30, 2016 • eugeneweekly.com
does not apply to the separate, more short-term “psychiatric
holds,” which Sacred Heart emergency doctors can use on
a patient.
Williams said only 3 to 5 percent of people with
psychiatric holds at Sacred Heart are recommended for a
civil commitment to a state institution.
When it comes to HB 3347, the problem of homeless
clients cycling in and out of the Sacred Heart emergency
room with severe mental health issues doesn’t really apply.
But it does raise the question of why doctors at the Sacred
Heart Emergency Room don’t exercise more psychiatric
holds on severely mentally ill patients going through a
psychotic break.
‘If screaming, moaning and yelling at
passersby is the only coping skill they
have on a regular basis, that individual
isn’t able to get their basic needs met.’
— Ben Brubaker, White Bird Clinic
Last week, Brubaker says, a man with schizophrenia
was screaming, “I’ll kill you!” at passersby as he walked
through downtown Eugene, generating multiple calls to
911 from the community. On arriving, officers couldn’t
do much to intervene because the individual “clearly had
limited mobility” and would never be able to act on his
threats, Brubaker says.
“If screaming, moaning and yelling at passersby is
the only coping skill they have on a regular basis, that
individual isn’t able to get their basic needs met,” Brubaker
says. “That individual could be picked up by CAHOOTS
[Crisis Assistance Helping Out On The Streets] taken to the
ER, but if they test positive for meth or other substances,
or if the hospital decides they are too difficult to get an
assessment of, they will oftentimes be discharged.”
Substance abuse, particularly of methamphetamines,
is often a reason for mentally ill people to be discharged
without a psychiatric hold, as it is difficult for physicians
to tell if the drugs or mental illness are causing an inability
to care for themselves.
This is why Hoyle and Brubaker say they believe the
county needs an easier access mid-level psychiatric care
unit for Lane County to help fill in the gaps. The new
Oregon State Hospital in Junction City only takes forcibly
committed patients at the approval of a Lane County
Circuit Court judge and the approval of a mental health
investigator, such as Williams.
Lane County has recently opened Hourglass
Community Crisis Center, which provides short-term
mental health crisis assesment and stabilization.
PeaceHealth said in a prepared statement to EW:
“While many homeless people are mentally ill — not
all of them are. There are a host of other factors, such as
substance abuse, financial instability and other issues.
The solution must be commensurately comprehensive and
multi-faceted.”
Hoyle tells EW that she met with PeaceHealth repre-
sentatives in Eugene last week to discuss this very issue.
“I went to talk with people at PeaceHealth yesterday.
They’re frustrated they get people coming in and out of
the ER and they are like, ‘What can we do? We don’t
want to let people back out into the street but feel like our
options are limited as well.’ I personally see both sides,”
Hoyle says.
Hoyle proposed HB 3347 in the Oregon Legislature
last year after struggling to help Lane County crisis
workers take Susan Hughes, a starving woman living in a
rat-infested tent, to the state mental hospital. At the time, a
Lane County mental health investigator would not commit
Hughes because she was not in immediate risk of dying.
Lane County’s interpretation of the state statute on civil
commitments tends to be defined more narrowly than
Marion or Multnomah counties, Hoyle says.
“If she had been in Multnomah or Marion County, she
would have been committed,” she adds.
Hoyle says the bill was intended to be used in only the
most extreme circumstances, and is not intended to take
away a person’s civil liberties. — Jeslyn Lemke
photo courtesy wbr press