Feds, Oregon agree on community mental health fix

SALEM — Oregon and the federal government agreed on changes to the state's community mental health system that could resolve a federal investigation that began nearly six years ago, documents indicate.

Lawyers from the U.S. Department of Justice told Oregon officials in a March 13 letter that the agreement paves the way for changes that will "improve the lives of thousands of Oregonians," the Salem Statesman Journal reported.

The newspaper obtained copies of the letter and a March 23 response from the state from the Oregon Department of Justice under the state public records law.

The correspondence describes a proposal to have federal officials, and mental health experts they hire, work with the state to identify and plug gaps in community mental health. Some mental health advocates have long complained the state spends significantly on the Oregon State Hospital at the expense of community-based programs like housing, case management, crisis services, drop-in centers and living skills training.

"We are hopeful that our work together will address the gaps in, and improve the quality of, the community system for persons with mental illness during the coming years," said the federal letter signed by Jonathan Smith, chief of the Special Litigation Section of the U.S. Justice Department, and S. Amanda Marshall, the U.S. attorney for Oregon.

Federal involvement in Oregon's mental health system could last for several years, the letter says, but the federal investigation could be resolved without legal action against the state if the reforms materialize as envisioned.

"It is contemplated that this process will successfully resolve our investigation once an array of essential community services are in place and positive outcomes are being achieved on agreed-upon metrics," the lawyers wrote.

U.S. Justice Department investigators began probing Oregon's mental health system in 2006 and issued a scathing report in 2008 that detailed flaws at the main mental hospital in Salem. The report came as the state was gearing up to replace the outdated and unsafe institution with a new $280 million hospital — an institution that became fully operational this month.

Federal authorities notified the state in 2010 that they were widening the civil rights investigation from the psychiatric hospital to examine state-funded community mental health programs and services.

Oregon's push to overhaul state-funded health care and improve coordination of physical and mental health, led by Gov. John Kitzhaber and Oregon Health Authority Director Bruce Goldberg, "provides a unique opportunity for the state and the Civil Rights Division to work together to address our concerns by embedding reform in the design of the health care system," the federal letter says.

In a March 23 response to the federal officials, Oregon lawyer John Dunbar, head of the state Justice Department's Special Litigation Unit, expressed optimism about moving forward, along with some concerns. He said the document "appears to overstate the state's commitments," and he took issue with some of the reform metrics outlined by federal authorities.

"We should be able to straighten these issues out, but I wanted to make sure we were all on the same page so that misunderstandings don't develop," Dunbar wrote.

Chris Bouneff, executive director of NAMI Oregon, a chapter of the National Alliance on Mental Illness, told the Statesman Journal it would take time to digest the correspondence and draw a conclusion, but "at a rough first glance, the progress seems positive."

Bouneff said he was put off, though, by Oregon's objections to some of the reform measurements sought by the feds.

"One glaring omission on Oregon's side is the state's unwillingness to accept certain process measures that are widely credited with improving outcomes," he said.

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