PORTLAND, Ore. — Leading advocates for people with mental illness in Oregon say the state needs to expand its criteria for civil commitment — the process for forced psychiatric treatment outside of the criminal justice system — in order to prevent dangerous situations.
KGW has previously reported at length how Oregon has effectively criminalized severe mental illness through high standards for forced mental health care — often waiting for an individual to commit a crime before mandating treatment.
The National Alliance on Mental Illness (NAMI) Oregon, a chapter of the nationwide advocacy organization, created a workgroup to recommend "modest changes" to Oregon's laws to increase the likelihood of civil commitments before people with severe mental illness could harm themselves or others.
Chris Bouneff, executive director of NAMI Oregon, shared a background and proposal with KGW. Bouneff said the next step is to get the recommendations drafted into a bill for consideration in the upcoming 2025 legislative session.
"We have to acknowledge that you pass this law, the world doesn't change overnight," Bouneff told KGW. "It doesn't get better on the streets of Portland ... we're not solving the homeless crisis. We're really solving a health care crisis, and that health care crisis is people have to commit a crime today before we'll do something — and guess what, they are, and the state hospital is full of it ... Why should someone have to commit a crime? That's ridiculous, right?"
Oregon's current civil commitment statute requires people with severe mental illness to be a "danger to self" or "danger to others" to justify forced treatment, but it doesn't define these terms and has left them open to judicial interpretation.
The NAMI Oregon workgroup's proposal would further define civil commitments standards, allowing a judge to consider whether a person is likely to inflict serious physical harm upon themselves or another person within the next 30 days.
The proposal would also further define when someone should be civilly committed when they're "unable to provide for basic personal needs."
It would also direct the court to consider past behavior that resulted in significant physical harm to self or others, and past patterns of mental health deterioration that contributed to repeated hospitalization for psychiatric care.
Under the current law, some patients are frequently admitted to a hospital for mental health treatment, refuse care, and then are released when doctors determine that they don't meet current standards for forced psychiatric care.
"At minimum, the court shall consider — when assessing the relevance of the person’s past behavior — how recently the past behavior occurred and the frequency and severity of the past behavior," the proposal document says.
Proposed changes to Oregon's standards for civil commitment are not universally approved. Leaders with Disability Rights Oregon, another organization that advocates for people with mental illness, have pushed back against ideas that would make it easier to override someone's right to deny healthcare.
And opponents are not without good reason for concern. Oregon has not precisely provided a shining example of mental health care in the past.
"You cannot look at Oregon's history and say we ever did this well — and in fact, we abused people. We abused people so much, the United States Department of Justice came in here and said, 'You are violating their civil rights,'" Bouneff acknowledged. "There is nowhere in our past that you can look back and say we exercised the power of the state to the benefit of the people we were committing, that doesn't exist."
Even so, Bouneff said he thinks involuntary mental health care can be done right.
"If I didn't believe that there were some modicum of hope, I suppose I'd give up, retire and go become a hermit somewhere," he said. "I do think, you know, the time is right in Oregon that this needs to happen. We just have sort of reached that point. I mean there seems to be broad consensus that we want to do something."
The NAMI Oregon workgroup included individuals and family members with lived mental illness experience, medical providers, judicial and legal officials, elected officials and others, according to the background document.
A different workgroup, initially convened by the Oregon Judicial Department in 2022, has also been studying Oregon's laws to recommend legislative changes to civil commitment standards. However, that "Commitment to Change" workgroup has repeatedly missed its deadlines and is delayed in producing a list of recommendations to lawmakers.
The OJD workgroup is rescheduling its August 9 meeting to sometime in September as it reviews a list of 88 ideas "still under consideration," according to an OJD communications officer.
The CTC workgroup set out to "take time and full examination" of Oregon's laws to find consensus, intending to engage all "stakeholders" and report to the Chief Justice — a broader scope than the NAMI Oregon group's focus.
"The OJD agreed to the workgroup's request to continue its work to provide a more useful work product for the Chief Justice and ultimately for the legislature," the communications officer wrote in an email to KGW.
With the Oregon Health Authority prioritizing criminal "aid and assist" cases over civil commitments, the NAMI Oregon workgroup said it recognizes any law change to lower civil commitment standards would require more psychiatric beds across the state — something state leaders also acknowledge.
To that point, NAMI Oregon created a second workgroup earlier this year to focus on the investments needed for civil commitment patients. The organization expects that workgroup to finish its work in September and share recommendations and priorities for the 2025 legislature.