Underground Railroad in our Midst
Editorial for the Oregonian, published November 1, 2007
Most Oregonians would be surprised to learn that an underground railroad is still in operation in our state. Like its Civil War counterpart, it often operates late at night and moves its human cargo out of view.
The difference, however, is that this human cargo consists of the mentally ill, individuals being held involuntarily after being deemed dangerous to themselves or others. And their destination isn’t freedom, but a hospital somewhere in the state –sometimes a hundred miles or more from their homes –that happens to have an empty psychiatric bed.
Being held against one’s will, loaded into a locked ambulance and taken from Portland to Salem, Corvallis, Eugene or even Coos Bay would prove unsettling for anyone. Consider how traumatic the experience would be to someone suffering from depression, thoughts of suicide, paranoia, delusions or hallucinations. Not to mention that they’re being removed from whatever circle of support they may have in their home community. Even on casual examination, this practice appears to violate the age-old tenet of the healing professions: Above all, do no harm.
How did this come to be? Well, strangely, it’s a product of actions taken to improve the plight of the mentally ill. When the Oregon involuntary civil commitment statute was revised in 1973, the intent was to enhance the protection of individual rights. Changes to the law included the right to counsel, the establishment of a specific burden of proof, a requirement for a swift, independent investigation when a person is held involuntarily, and the provision that he or she must be hospitalized only in a state-approved psychiatric facility.
It’s primarily that last provision, intended to ensure that any person on involuntary mental hold will be treated in a facility that meets strict standards, that’s driving the current problem. And it’s made worse by a drastic reduction in available psychiatric beds.
While the transfer issue was addressed in the 1973 revision of the law, it’s doubtful that any legislator at the time could foresee that by 2007 the number of psychiatric beds in Oregon would be significantly reduced while the state’s population growth accelerated. Or that a shortage of beds would result in a system that routinely shuttles the mentally ill around the state while hospital social workers search for yet another open bed for the many more people on involuntary holds still waiting in their emergency rooms. Or that civil commitment cases would be dismissed and individuals released to the streets, solely because crucial witnesses are unable to travel the time and distance between the patients’ remote hospitals and the courts in their home counties.
This system, in effect, is tearing itself apart to follow the rules. And the price is ultimately paid by the mentally ill individuals it was designed to protect. People who may quickly improve in a local hospital with their established circle of support, but who lapse again in an unfamiliar environment. People who may have been successfully committed if hospitalized locally, but who are released by the courts for procedural reasons. The list goes on.
In my work as a civil commitment investigator, I’m seeing what should be a quality system of care becoming a system of blind adherence to outdated statutes, at the expense of the people I’m legally tasked with protecting. And I’m afraid it will change only when the public begins to wonder who’s in the ambulance that’s driving past them on the road at night, where they might be heading, and why this has to be.
