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Homeless and Severely Mentally Ill Population in Oregon

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Homeless and Severely Mentally Ill Population in Oregon A Dysfunctional System: Policy Recommendations for the Adult (18-65) Homeless and Severely Mentally Ill Population in Oregon by Donielle Miller A THESIS submitted to Oregon State University Honors College in partial fulfillment of the requirements for the degree of Honors Baccalaureate of Science in Biology (Honors Associate) Presented December 4, 2018 Commencement June 2019 AN ABSTRACT OF THE THESIS OF Donielle Miller for the degree of Honors Baccalaureate of Science in Biology presented on December 4, 2018. Title: A Dysfunctional System: Policy Recommendations for the Adult (18-65) Homeless and Severely Mentally Ill Population in Oregon. Abstract approved:_____________________________________________________ Courtney Campbell Adults with severe and persistent mental illness (SPMI) are overrepresented in the homeless population, and Oregon’s homeless population has expanded in recent years. In the 1950s, the mentally ill were moved out of the state hospitals and into the community. However, due to a lack of support services in the community many of these individuals have not thrived outside of the institution. This has created a system oriented toward crisis, where individuals with SPMI frequent emergency rooms and jails. The lack of affordable housing in Oregon has exacerbated these problems by making it difficult for individuals to obtain one of the most basic necessities, a place to call home. The United States Department of Justice entered into negotiation with Oregon Health Authority after finding Oregon’s service insufficient, and the resulting agreement called the Oregon Performance Plan was published in 2016. Since then, the state has continued to struggle to provide services for one of its most vulnerable groups, the adult (18-65) homeless population with severe and persistent mental illness. Key Words: Severe and persistent mental illness, homeless, policy, affordable housing, criminalization Corresponding e-mail address: [email protected] ©Copyright by Donielle Miller December 4, 2018 A Dysfunctional System: Policy Recommendations for the Adult (18-65) Homeless and Severely Mentally Ill Population in Oregon by Donielle Miller A THESIS submitted to Oregon State University Honors College in partial fulfillment of the requirements for the degree of Honors Baccalaureate of Science in Biology (Honors Associate) Presented December 4, 2018 Commencement June 2019 Honors Baccalaureate of Science in Biology project of Donielle Miller presented on December 4, 2018. APPROVED: _____________________________________________________________________ Courtney Campbell, Mentor, representing School of History, Philosophy, and Religion _____________________________________________________________________ Brett Burkhardt, Committee Member, representing School of Public Policy _____________________________________________________________________ Jennifer McDermond, Committee Member, representing Corvallis Housing First _____________________________________________________________________ Toni Doolen, Dean, Oregon State University Honors College I understand that my project will become part of the permanent collection of Oregon State University, Honors College. My signature below authorizes release of my project to any reader upon request. _____________________________________________________________________ Donielle Miller, Author Acknowledgements This thesis is dedicated to my family, the members who have waged hard-fought battles against mental illness and addiction and have won, the ones who have lost, those still fighting, and all who have supported them. Special thanks to my Uncle Michael for sharing your experiences with me and for inspiring me to explore the topic of mental health. I would like the acknowledge the clients and staff of Corvallis Housing First whom I had the opportunity to volunteer with, especially Jennifer McDermond who has provided great insight into the issues explored in this project. I couldn’t be more grateful to my parents for affording me the opportunity to follow my dreams of going to college and encouraging me every step of the way, and my brothers Jacson and Justin for always going above and beyond to be supportive of my endeavors. I appreciate the patience and support of my husband Josh as I have spent hours researching and writing. Thanks to Dr. Raymond Tricker for introducing me to the social and political aspects of mental illness and for your input on this project. Thank you to Dr. Courtney Campbell for providing resources about the ethical implications of laws and for seeing this through with me until the end. TABLE OF CONTENTS Introduction ………………………………………………………………………………… 1 Statement of the Problem………………………………………………………………….1 Background………………………………………………………………………………..9 Moral Treatment………………………………………………………………9 Eugenics-The Beginning of a Dark Period…………………………………..12 Treatment of Mental Illness in Oregon: Historical Perspective……………...15 Limitations of the Study………………………………………………………………….26 Literature Review………………………………………………………………………......27 Defining the Population: Oregon’s Adult (18-65) Homeless and Severely Mentally Ill Population………………………………………………………………………………..27 Deficiencies in Oregon…………………………………………………………………..29 Oregon’s Housing Crisis……………………………………………………..29 Mental Health Care Provider Shortage………………………………………44 Emergency Department Boarding……………………………………………45 Re-institutionalization in Jails and Prisons…………………………………..49 Current Policy Concepts in Oregon…………………………………………………...…51 The Oregon Performance Plan…………………………………………...…..51 The Behavioral Health Collaborative……………………………………..…54 Certificate of Need Law……………………………………………….……..56 Oregon’s Statewide Housing Plan…………………………………...………61 Evidence-Based Practices……………………………………………………………..…63 Housing First Approach……………………………………………………...64 Permanent Supportive Housing……………………………………………...70 Supported Employment/Competitive Integrated Employment………………72 Assertive Community Treatment…………………………………………….77 Trauma Informed Care………………………………………………….……78 Mobile Crisis Services………………………………………………….……80 Criminal Diversion/Sequential Intercept Model……………………………..81 Regulations as Barriers to Affordable Housing …………………………………………84 Literature Review in Summary ………………………………………………………….88 Discussion of Research Questions…………………………………………………...…….90 How do adult (18-65) homeless and severely mentally ill individuals fare in Oregon’s current mental health system?............................................................................................91 What housing resources are available to the adult (18-65) homeless and severely mentally ill population in Oregon?...................................................................................................95 Is the adult (18-65) homeless and mentally ill population being criminalized in Oregon?..............................................................................................................................98 Policy Recommendations…………………………………….……………………………102 Conclusions……………………………………………………………………..………….112 Personal Statement…………………………………………………………………….….114 References………………………………………………………………………………….117 1 Running head: A DYSFUNCTIONAL SYSTEM A Dysfunctional System: Policy Recommendations for the Adult (18-65) Homeless and Severely Mentally Ill Population in Oregon Introduction Statement of the Problem On the night of January 7, 2017, a disoriented Karen Batts removed her clothing and died of hypothermia on the floor of a parking garage in Portland, Oregon. The 52-year-old was a former high school honors student, outgoing cheerleader, and college graduate (Anderson, 2017). Unfortunately, she succumbed to schizophrenia as a young adult and failed to keep regular contact with her family, eventually becoming homeless. Karen's story is one that has become all too common in Oregon. According to a 2015 report by Multnomah County Chair Deborah Kafoury and Executive Director of the non-profit Street Roots, Israel Bayer, deaths among the homeless tripled from 2011-2015. In 2017 several high-profile deaths caught the attention of policymakers and the public, Karen's heartbreaking death among them. Just a few months before her death, she had been evicted from a low-income housing facility for seniors called Oak Apartments because she owed $338 in past due rent (KGW Staff, 2017). Other losses included a child born to a mentally ill and homeless mother which died within hours due to exposure. The mother was found barefoot and disheveled at a Portland bus stop holding the baby in her coat and later told police the child was a result of an immaculate conception (Jaquiss, 2017). Twenty-nine-year-old Zachary Young was living in a wooded area outside of Portland when he passed away due to the frigid weather (Harbarger, 2017). 2 A DYSFUNCTIONAL SYSTEM Severe mental illness and homelessness often overlap in Oregon. As a result, individuals reach crisis states. These people require frequent treatment in the emergency room and increasingly interact with law enforcement. These trends allude to underlying problems in Oregon’s mental health care system and housing industry; they require attention as public health and humanitarian issues. In 2017, Mental Health America (MHA) ranked Oregon 2nd in the nation for prevalence of mental illness among adult citizens. For access to mental health care services, MHA ranked Oregon 21st. The 2017 Department of Housing and Urban Development (HUD) point-in-time (PIT) report authored by Henry, Watt, Rosenthal, and Shivji indicated that the homeless count in Oregon increased 6% from
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