We appreciate your follow-up to “A Broken System” and have provided answers to your questions below. It’s clear that you are both personally and professionally passionate about this issue, which is an issue not well understood by many. Building better understanding across our community is key to making the changes we know are necessary and overdue to a statewide system that is neither adequate in scope nor adequately funded. We hope your second article will be more accurate and help paint a clearer picture of this statewide issue.

The problem is multi-faceted and dates as far back as the 1960s when the current aid and assist model was developed. Indeed it is not solely an Oregon issue. The Supreme Court made a landmark decision in 199 in Olmstead v L.C. , finding that “institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable of or unworthy of participating in community life.” Second, “confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.” This decision came to Oregon in a big way in 2013 when the US Department of Justice began to seriously question Oregon’s aged infrastructure. As a result, there was not only new investment in re-constructing Oregon’s State Hospital in both Salem and Junction City, but the development of the Oregon Performance Plan, which dictated a number of policy and operational changes that Oregon agreed to undertake.

It was at this time that Oregon counties, including Lane, began to work with the Oregon Health Authority, the State Hospital (a Division of OHA) and the Legislature to focus on a number of fronts to decrease commitments, reduce time spent in local jail, and build community based treatment infrastructure.

This said, we still face challenges in getting the system adequately funded by the State. It does not reflect what most mental health professionals would consider best practice today. It is, however, the program we must work within until a statewide solution is implemented. As you alluded to in your first article, a complete overhaul of the current system is likely the most effective response, but this requires funding and the change must be made statewide – not just in Lane County.

Although Lane County alone does not have the authority to overhaul the statewide aid and assist program, we have been active advocates of change. Under Oregon Law, Lane County is the Mental Health Authority, and we belong to the Oregon Association of Community Mental Health Programs. Our County has been identified, along with Multnomah, Coos, and Washington Counties, as a “high sending” county and as a result we have gotten some special funding via the Oregon Emergency Board. Most recently, in December of 2018 the Oregon Emergency Board made a unique investment that allowed us to reconfigure one of the “cottages” at the Junction City Hospital to create a residential treatment center. And during the 2019 Legislature, we participated in the development of SB 24 which created additional sideboards around the procedures in statute that address fitness to proceed. On the budget side of things the state appropriated $7.6M for community restoration services and an additional $1.75M to the Oregon Judicial Department to better resource court staff when fitness to proceed procedures are needed. Unfortunately, Counties also took what amounted to a $12.5M cut to their efforts to serve the non-Medicaid population for services related to civil commitment and guilty except for insanity services. The Legislature directed OHA to work with the Department of Administrative Services to better address caseload forecasting and, for the first time, include Aid and Assist cases in that forecasting. We are participating in that effort and hope it results in more resources this biennium, but more realistically will have impact during the 21-23 biennium. We are actively attempting to build a community based infrastructure in alignment with the Oregon Performance Plan but as you can imagine there are significant funding and liability issues that must be in place for a system like that to function properly.

On a local level, the County has made significant investments of its own general fund in housing and crisis services.

Finally, in your efforts to simplify the system into a digestible story, it was not made clear what the boundaries of Lane County’s authority are over the system as a whole or within both circuit and municipal courts specifically. We do not have authority over the decisions made by circuit or municipal court judges, rather we make recommendations. The references to “Lane County officials” in regard to both City and County staff were easy enough for you and us to follow based on our greater familiarity with the system, but led to confusion for some in the community.

If you truly want to help make change in this system by increasing awareness of the issue, we would like to help as long as the information shared is accurate and comprehensive of the challenges faced statewide – including funding, legislation, the ongoing stigma that surrounds mental health, and the need for support for community-based treatment options.

• Why have the city and county increased the number of defendants who have been sent by 238 percent since 2013? What is being done to lower the rate at which courts send people to the state hospital?

We cannot speak on behalf of the City and its municipal court. Please approach them directly if you have questions about their practices. Generally, it has become increasingly difficult to get people into services because criteria has grown more strict. That has become the main route to getting clients into the hospital, with the hope that they get the services that they need. The County has facilitated forums where stakeholders meet, review data, fiscal impact, and opportunities to get stakeholders engaged in identifying viable solutions outside of sending people to the State Hospital.

• What is your response to learning that the municipal court sent at least 76 people to the state hospital since 2014?

Please remember, the municipal court is not under the authority of Lane County and questions about decision-making at the municipal court level should be directed to the municipal court.

• What do you think is being done well, and what do you think needs to be improved about aid and assist? What are the concrete steps that can or will be taken to make those improvements?

There is a growing understanding throughout our community that the Jail is not the ideal place to provide mental health services, especially for those with low-level misdemeanors, and a growing recognition that other options are needed. While staff at the Jail have done an excellent job over the last few years expanding mental health care resources for inmates, they are the first to acknowledge that those improvements do not replace the need for a more comprehensive system throughout our community and the State of Oregon. Please remember that once a person is jailed, their Medicaid benefits are suspended, and all of their health care costs become the responsibility of the County. This is federal policy and Lane County has been active in federal advocacy to amend those policies as well.

Improvements including an increase in preventative measures (the ability to intervene before someone hits a crisis point and ends up in jail), community-based treatment options, and continuing to increase the collaboration among public safety agencies are all important. Of course, funding is necessary to make meaningful progress on many of these improvements. As you are likely aware by now, adequate funding is a challenge in relation to many issues in our community.

• Were you aware that defendants were being kept in jail longer than is legal for them to be kept?

You spoke with Sheriff Harrold earlier this week and it’s our understanding that he addressed this question at length.

• What steps are being taken to make sure defendants’ civil rights will no longer be violated?

You spoke with Sheriff Harrold earlier this week and it’s our understanding that he addressed this question at length.

• How will aid and assist in Eugene and Lane County change with the implementation of SB 24, which requires community restoration for defendants in municipal court or who have only misdemeanors unless they are acutely mentally ill and dangerous?

There are currently groups evaluating the implementation required by, and implications of, the bill. Ultimately, we hope the bill accomplishes the goal we all share: to reduce the number of people sent to the State Hospital and increase community-based solutions. This said, like most Legislation there have already been issues identified with that bill which we expect the 2020 Legislative Assembly to take up. SB 973 is a measure from the 2019 Legislative Assembly that you should look at. It created a new $10M grant program to target these particular individuals and we hope to be successful in applying for those funds, in particular we are interested in bolstering activities that help supervise these individuals while they are in the community.

• What is currently being done to start a crisis center in Lane County? What are the barriers to starting a crisis center here? What other resources are or will be available to people with severe mental illness or substance use disorders, or both?

Lane County is currently working with multiple partners to determine what a crisis center will look like in Lane County. The Board of Commissioners has set aside $1 million as startup money for this project. The workgroup should have a proposal to present to the Board of Commissioners by the end of the year.

In addition to the work toward a longer stay crisis center, there have been discussions around more mobile engagement teams that could work on meeting people where they are and engaging them in services.

Lane County opened (and continues to fund) a short stay crisis center, the Hourglass Community Crisis Center, a few years ago. Hourglass has been successful in meeting short-term needs in our community; however, the longer stay crisis center will strengthen what is currently a weak area of our public safety system.

Other efforts that Lane County has undertaken with partners – including the FUSE Program (Frequent User System Engagement), the upcoming Commons on MLK, work toward a public shelter, the increase in Dawn to Dawn beds, financial support of various permanent supportive housing projects, and more –all work toward providing the safety net our community needs to better serve those experiencing mental health crises and those who are in need of treatment.

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