Mental health care revise in works.

Byline: Bill Bishop The Register-Guard

A statewide study finds that about 9 percent of jail inmates are seriously mentally ill - 507 out of 5,938 inmates on the day of the study last year.

But mental health experts say other numbers may be more relevant to the public: dollars.

Jails are an expensive place to treat the mentally ill, who are prone to arrest for minor offenses such as illegal camping, trespassing or public drinking, says Sig Dickman, health services manager at the Lane County Jail.

Dickman and other mental health and corrections experts say there is a better - and less expensive - way.

They envision a network of community programs to prevent mentally ill people from needing intensive treatment, coupled with a state hospital system for those who do, and with an after-care system to help patients remain in the community after discharge.

That is the goal of a bipartisan legislative effort spearheaded by Gov. Ted Kulongoski to replace the state's dilapidated state psychiatric hospital system and to build new community networks, according to Madeline Olson, deputy assistant director of the state Department of Human Resources.

The plan will build a 620-bed hospital in the north, a 360-bed hospital in the south and two 16-bed hospitals to serve Eastern Oregon. An array of community services would be set up to reduce the number of mentally ill people who recycle through the hospital and jail systems.

The first hospital won't be finished until 2011 at the earliest.

It's a big-ticket idea; cost estimates are not yet available. And the deal will depend on continued support by policy-makers and the public, who are understandably weary of hearing about troubled government programs, Olson says.

"There is an overload of bad news. It feels to people like there's an endless pit of demand," she says. "People are very concerned that policy-makers will lose their will and invest in only a piece of this."

If that happens, the cost savings of the proposed state-community network won't materialize, she says.

"The general public doesn't understand it very well. People in mental health do," says Dr. George Suckow, a forensic psychiatrist with more than 45 years of experience, including several years as director of the Oregon State Hospital.

"You're going to spend money on people somewhere. If you don't spend it in a hospital, you're going to spend it in a jail," he says. "People are not going away. Their problems are not going away."

At the Lane County Jail, for example, the cost for inmates' psychiatric medication has doubled during the past two years - consuming 45 percent of the total budget for all medicines last month and costing at least four times as much as any other class of drug, including those for HIV/AIDS, antibiotics and seizure medications, Dickman says.

The increase is because of rising demand, not rising drug costs. The county has a multiyear purchasing contract for its medicines, she notes. The increased cost can be traced to cutbacks in the Oregon Health Plan and to reduced federal funding for nonprofit services that help mentally ill people get medication, find housing and hold jobs in the community, she says.

Jail managers don't have a lot of options to cut their costs.

The law requires jails to provide all inmates with the "community standard" of medical care, Dickman says. When a mentally ill person is booked in, jail authorities must ensure he is cared for. On average, a mentally ill inmate costs one-third more than the average inmate, according to the state study.

Some chronically mentally ill people use the jail as their personal safety net, says Terry Fields, one of two mental health specialists at the Lane County Jail. "Some mentally ill people have figured that out, that they get the best care here," Fields says. "Our doctor becomes your doctor."

The state survey found that most mentally ill inmates pose no significant risk to the public, says Bob Nikkel, mental health and addictions administrator for the state Department of Human Services, which did the jail study.

"It's troubling that jail managers told us inmates who are mentally ill go to jail more often, spend more time in jail for the same crimes and are more likely to be physically or sexually assaulted than other inmates. Nearly half the jails reported that these inmates receive no community mental health services while behind bars," Nikkel says. "Most would benefit from treatment and do not belong in jail."