This won't change until the progressive stranglehold on state government (and on county and local government in the Portland metro area) is broken. Where are the centrist candidates?
What an opportunity for nuance on accountability. As an ex-con, recovered heroin addict, long term resident of Portland's central city and fellow retiree, Norm and I agree on much related to mental illness. Last night, I asked for PSR to be sent to help a black man lying on the sidewalk screaming "help me". with his belongings scattered around him. I engaged with him, and he asked for an ambulance, telling me he was suicidal. He showed me his wrist, which he hold me he had cut. There were a few drops of blood on the sidewalk, but I could see his cuts were superficial but I called 911, just in case. After about five minutes of questioning, the dispatcher sent PPB (3) and an ambulance because I did not watch him cut his wrists, even though I assured her he was not violent and needed an assessment first.
Norm is absolutely correct about the lack of resources, but it is also the lack us using the limited resources we do have. Living where I do, it is a rare day when I don't witness at least on encounter like last night, but usually during the day and someone has already called for help. If not, I will. Last night there were others around, but this has become so normalized at night, than none that I talked to had already called. The dispatcher protocol is very unhelpful and requires a long list of often repeated questions and a complete lack of the situational awareness of the caller. As a result, the wrong people are often the first responders and the first responders are taken away from much more urgent duties. The Ambulances are transporting those they don't need to to Emergency rooms that can do little to help while at the same time damaging the efficiency of our health care and public safety system. If we are going to fund Portland Street Response, use them. I have several observations coming out of my four years as an advocate for behavioral health treatment.
Treatment for addiction and mental health often needs to be "jump started" against the will of the addict or the person with mental illness. This does not necessarily need to involve jail, prison or even Police. It can be a civil commitment, not to warehouse, but the assess, plan and start an individualized treatment process.
Where a violent crime or serious property or sex/bias or drug distribution crime is involved, punishment should be a consideration with treatment. The emphasis on punishment should relate to the seriousness of the crime.
Prison is not conducive to "rehabilitation". The longer the term and the harder the prison environment, the more likely rehabilitation will be unsuccessful. You just harden and institutionalize the individual. Prison is also expensive, which is why there was a bipartisan effort to get away from the "three strikes" rule. Punishment is expensive. I was sentenced to 2-10 years for possession. I served two in a medium security where I was housed in a dorm with 20 other inmates. We had high fences with barbed wire and gun towers, but no gangs and overt racial animosities. That would earn you a trip to maximum security. After two years I received a one year parole date and was sent to fight wildfires in one of California's many fire camps, run by the Department of Corrections but in coordination with CalFire. In the winter we "raked the forest" (limbed up trees within 200 feet of roadways and cleaned the understory). Sound familiar? There were no fences. Just bed checks. Those that "escaped" went back to maxumum security with years tacked on. All of us had parole dates and were earning a little money and learning a job skill that is even more critical today in all three West Coast states.
Oregon and Multnomah County have systematically set up a system of laws, advisory groups, behavioral health staff and guiding principles that are explicitly anti-prosecution, jail, prison or anything that smacks of coercion or "accountability" for behavioral health illness and crimes related to it. This is especially true for those who identify as LGBTQ+ or minority racial or ethnic groups. Attention to this is appropriate due to discrimination. I have witnessed this process play out under both Brown and Kotek, Hardesty and Schmidt and Kafoury and Pederson. It is reflected in the empty beds at Inverness "jail", the lack of adequate Public Defenders, the quick release of addicts arrested for open use and the County's deflection system. It is visible in my conversations with City and County staff. But, speaking as a recovered addict some coercion and accountability is useful, often essential for recovery irrespective of race, ethnicity, sexual orientation or gender identification. It just has to be aimed at recovery of the individual. As a white man, the best I can be is a "recovering racist", but I try to treat everyone with the respect they deserve. I understand addiction, and that is what we are trying to treat.
We need to recognize that it is the people of the state, City and County who fund and use the services. We are a progressive state with a tax structure to match. No consumption tax like Washington and California. AI says (It makes mistakes) that nationally 60% are net consumers of taxes (receive in benefits more than they pay in taxes) and 40% are net payers. A progressive tax structure is beneficial in creating more equity among people, but it also depends on how efficiently we use the money net payers provide to solve the problems of the state. I do not believe net payers would be moving out of our state if we were efficiently solving the three issues that the people want; reduction in homelessness, job creation (and population growth) and public safety. Behavioral health is an integral part of each. To me, it is obvious that unless we can agree to efficiently solve the problems the net payers want to address, we will have declining revenues to solve any problem.
It is hard to read this from an attorney, a member of a profession, that to my mind has much to do with the impracticality of administering care to those with severe mental illnesses. Still, there is a lot to like about this article. I agree that the loosening of civil commitment standards under HB 2005 if not accompanied by many more psychiatric beds, is a folly. I disagree with the focus though on the state hospital. Really what seems to irk Mr. Fink, is that he can't find a way to get people who are obviously a danger to others, off the street, whether in jail, prison, or a mental institution. The problem, to my mind, is that sending to the state hospital might be convenient for prosecutors, using the state hospital to incarcerate, with in custody, hospital beds, as it is termed, the laws as written and administered, rarely serve people of Oregon. I have performed many aid and assist evaluations and see that the interminable efforts to return to competence, are often way too prolonged. I am fully in favor of capping these efforts but would like them capped much more aggressively. These cases are the reason the state hospital is unavailable to others who don't have legal charges. Underlying all of this though, is Mr. Finks, main theme, that there is a very strong cultural resistance to punishment in Oregon. I just wish he would articulate that these interminable efforts to return to competence individuals is often a product of that resistance to hold people accountable by appealing to their mental infirmity. It takes a special brand of eccentricity to think that we need to spend so much of our resources on improving competence, often for months and months, when it is simply a matter of psychosis relatively easily treatable with medication, or education, which is also pretty basic. It would be better for everyone, if we just kept these people in jail, had forensic psychiatrists medicate them, talk to them, a social worker to explain the legal system to them, and get them in court for trial within a month, rather than expending ridiculous sums essentially avoiding the possibility of punishment or coercion as he prefers. The vast majority of my profession have bought into the whole avoidance of punishment concept, embracing insanity defenses, incompetence issues, and frankly many of them are making vast sums of money providing expert testimony doing so. But a few of us, either don't have to, or choose not to, do the legal professions dirty work in this area. Mental health law needs a big redesign, as it has created a mess for the public in the form of wasting money and time that could be spent better elsewhere.
Excellent analysis, Mr. Frink. A must read for those of us concerned with what is happening on our streets.
From your lips to God's ears . . .
This won't change until the progressive stranglehold on state government (and on county and local government in the Portland metro area) is broken. Where are the centrist candidates?
Great thoughtful post!
What an opportunity for nuance on accountability. As an ex-con, recovered heroin addict, long term resident of Portland's central city and fellow retiree, Norm and I agree on much related to mental illness. Last night, I asked for PSR to be sent to help a black man lying on the sidewalk screaming "help me". with his belongings scattered around him. I engaged with him, and he asked for an ambulance, telling me he was suicidal. He showed me his wrist, which he hold me he had cut. There were a few drops of blood on the sidewalk, but I could see his cuts were superficial but I called 911, just in case. After about five minutes of questioning, the dispatcher sent PPB (3) and an ambulance because I did not watch him cut his wrists, even though I assured her he was not violent and needed an assessment first.
Norm is absolutely correct about the lack of resources, but it is also the lack us using the limited resources we do have. Living where I do, it is a rare day when I don't witness at least on encounter like last night, but usually during the day and someone has already called for help. If not, I will. Last night there were others around, but this has become so normalized at night, than none that I talked to had already called. The dispatcher protocol is very unhelpful and requires a long list of often repeated questions and a complete lack of the situational awareness of the caller. As a result, the wrong people are often the first responders and the first responders are taken away from much more urgent duties. The Ambulances are transporting those they don't need to to Emergency rooms that can do little to help while at the same time damaging the efficiency of our health care and public safety system. If we are going to fund Portland Street Response, use them. I have several observations coming out of my four years as an advocate for behavioral health treatment.
Treatment for addiction and mental health often needs to be "jump started" against the will of the addict or the person with mental illness. This does not necessarily need to involve jail, prison or even Police. It can be a civil commitment, not to warehouse, but the assess, plan and start an individualized treatment process.
Where a violent crime or serious property or sex/bias or drug distribution crime is involved, punishment should be a consideration with treatment. The emphasis on punishment should relate to the seriousness of the crime.
Prison is not conducive to "rehabilitation". The longer the term and the harder the prison environment, the more likely rehabilitation will be unsuccessful. You just harden and institutionalize the individual. Prison is also expensive, which is why there was a bipartisan effort to get away from the "three strikes" rule. Punishment is expensive. I was sentenced to 2-10 years for possession. I served two in a medium security where I was housed in a dorm with 20 other inmates. We had high fences with barbed wire and gun towers, but no gangs and overt racial animosities. That would earn you a trip to maximum security. After two years I received a one year parole date and was sent to fight wildfires in one of California's many fire camps, run by the Department of Corrections but in coordination with CalFire. In the winter we "raked the forest" (limbed up trees within 200 feet of roadways and cleaned the understory). Sound familiar? There were no fences. Just bed checks. Those that "escaped" went back to maxumum security with years tacked on. All of us had parole dates and were earning a little money and learning a job skill that is even more critical today in all three West Coast states.
Oregon and Multnomah County have systematically set up a system of laws, advisory groups, behavioral health staff and guiding principles that are explicitly anti-prosecution, jail, prison or anything that smacks of coercion or "accountability" for behavioral health illness and crimes related to it. This is especially true for those who identify as LGBTQ+ or minority racial or ethnic groups. Attention to this is appropriate due to discrimination. I have witnessed this process play out under both Brown and Kotek, Hardesty and Schmidt and Kafoury and Pederson. It is reflected in the empty beds at Inverness "jail", the lack of adequate Public Defenders, the quick release of addicts arrested for open use and the County's deflection system. It is visible in my conversations with City and County staff. But, speaking as a recovered addict some coercion and accountability is useful, often essential for recovery irrespective of race, ethnicity, sexual orientation or gender identification. It just has to be aimed at recovery of the individual. As a white man, the best I can be is a "recovering racist", but I try to treat everyone with the respect they deserve. I understand addiction, and that is what we are trying to treat.
We need to recognize that it is the people of the state, City and County who fund and use the services. We are a progressive state with a tax structure to match. No consumption tax like Washington and California. AI says (It makes mistakes) that nationally 60% are net consumers of taxes (receive in benefits more than they pay in taxes) and 40% are net payers. A progressive tax structure is beneficial in creating more equity among people, but it also depends on how efficiently we use the money net payers provide to solve the problems of the state. I do not believe net payers would be moving out of our state if we were efficiently solving the three issues that the people want; reduction in homelessness, job creation (and population growth) and public safety. Behavioral health is an integral part of each. To me, it is obvious that unless we can agree to efficiently solve the problems the net payers want to address, we will have declining revenues to solve any problem.
It is hard to read this from an attorney, a member of a profession, that to my mind has much to do with the impracticality of administering care to those with severe mental illnesses. Still, there is a lot to like about this article. I agree that the loosening of civil commitment standards under HB 2005 if not accompanied by many more psychiatric beds, is a folly. I disagree with the focus though on the state hospital. Really what seems to irk Mr. Fink, is that he can't find a way to get people who are obviously a danger to others, off the street, whether in jail, prison, or a mental institution. The problem, to my mind, is that sending to the state hospital might be convenient for prosecutors, using the state hospital to incarcerate, with in custody, hospital beds, as it is termed, the laws as written and administered, rarely serve people of Oregon. I have performed many aid and assist evaluations and see that the interminable efforts to return to competence, are often way too prolonged. I am fully in favor of capping these efforts but would like them capped much more aggressively. These cases are the reason the state hospital is unavailable to others who don't have legal charges. Underlying all of this though, is Mr. Finks, main theme, that there is a very strong cultural resistance to punishment in Oregon. I just wish he would articulate that these interminable efforts to return to competence individuals is often a product of that resistance to hold people accountable by appealing to their mental infirmity. It takes a special brand of eccentricity to think that we need to spend so much of our resources on improving competence, often for months and months, when it is simply a matter of psychosis relatively easily treatable with medication, or education, which is also pretty basic. It would be better for everyone, if we just kept these people in jail, had forensic psychiatrists medicate them, talk to them, a social worker to explain the legal system to them, and get them in court for trial within a month, rather than expending ridiculous sums essentially avoiding the possibility of punishment or coercion as he prefers. The vast majority of my profession have bought into the whole avoidance of punishment concept, embracing insanity defenses, incompetence issues, and frankly many of them are making vast sums of money providing expert testimony doing so. But a few of us, either don't have to, or choose not to, do the legal professions dirty work in this area. Mental health law needs a big redesign, as it has created a mess for the public in the form of wasting money and time that could be spent better elsewhere.