January 20 2019
My patient's mental health deteriorated after a sheriff returned the bloodstained handgun his father used to commit suicide. A middle-aged veteran, this man was depressed and experiencing PTSD symptoms. He had a lot on his plate – caring for a sick and aging mother, disabled adult son, disability due to chronic pain.
In crisis, he frequently found himself in various local emergency rooms. To the staff, he came across as angry and belligerent. He was branded as "med seeker," and physicians discontinued his medication. He was forced to obtain pain pills on the black market.
Shortly after the suicide, his mother and sister passed away in the same week. No one came forward to help with funeral expenses. He used the last of his savings to arrange their last rites. He was struggling and wanted help, but he couldn't access a local detox, rehabilitation or dual-diagnosis treatment program. A Portland-based walk-in clinic denied him treatment several times when he attempted to enroll, saying he didn't meet the admission criteria.
Oregon is failing mental health patients. We severely lack acute crisis beds, having less than half the recommended number for our state. Yet the Oregon Health Authority (OHA) is actively preventing a private facility from opening in Wilsonville due to concerns raised by a politically influential union and powerful hospital systems. According to Senate President Peter Courtney, this "turf war" exists within mental health policy circles in Oregon. As advocacy groups, unions and hospitals battle to protect their own narrow interests, the casualties are our most vulnerable.
I didn't see my patient for six months. I frantically tried to reach him, fearing the worst. Would he be another casualty of this political "turf war?"
My fears were relieved when, one day, the man showed up in my waiting room looking well-rested. A pastor who runs a halfway house had helped him. He signed up for the Oregon Health Plan, started a Suboxone treatment prescribed by a physician and is now rebuilding his savings. He plans to move out of the halfway house and into a studio.
I've practiced psychiatry in Oregon for 17 years. Stories like these are far too common. I'm hopeful that this story will have a silver lining, but I have treated many patients who weren't as fortunate. It's nearly impossible to recover without help.
In February, the Oregon Legislature approved a $20 million investment in mental health housing. It's a modest step, and it's not enough. When a patient's crisis causes them to be a danger to themselves or others, only providing housing and outpatient support is a public health risk. They need acute crisis inpatient care, a resource we sorely lack.
The OHA has an opportunity to change course, and the proposed private psychiatric hospital in Wilsonville is a good place to start. The agency, with the labor unions and hospital systems, should drop the "turf war" and remember that the consequences of inaction prove fatal every day.