Oregon’s courthouse doors are open to all. Every day, people who are experiencing serious mental illness and substance use disorders come before the courts. Some are individuals facing criminal charges who are unable to aid and assist in their own defense. Some may have criminal cases due to behavior stemming from a mental health or substance use disorder. Some may have been found guilty except for insanity. Some may be committed because they pose an immediate danger to themselves or others or are unable to meet their basic needs. Others are parents struggling to retain or regain custody of their children. Many have co-occurring mental health and substance use disorders.
Courts rely on Oregon’s behavioral health system to connect individuals with appropriate behavioral health treatment and support services. Unfortunately, the justice system and the behavioral health system were not designed to communicate and collaborate with each other. Consequently, courts direct people to services, but those services may not exist in the community, or exist but are not designed to meet the needs of justice involved people who live in extremely marginalized circumstances. When appropriate services are unavailable, the justice system becomes a de facto behavioral health management system that becomes overloaded with people in crisis who could be better served through coordinated and directly managed care. The result is that emergency rooms, local behavioral health units, the Oregon State Hospital, and jails become relentless circular highways for people with serious behavioral health challenges who enter the court system – creating greater financial cost to taxpayers, increased risks to public safety, and harm to individuals' well-being.
Stated plainly, we are in a behavioral health crisis, and individuals in the justice system are among the most significantly affected. The Oregon State Hospital is at capacity, and counties lack appropriate behavioral health services to meet the continuum of needs in the community. Most civil commitment petitions are dismissed because individuals do not meet the high legal threshold, and many of those individuals do not receive the behavioral health services they need. We are experiencing a workforce crisis in the behavioral health professions, made worse by the COVID 19 pandemic. The roles and responsibilities of state agencies, courts, and local governments are often unclear, leaving individuals to navigate a complex system without finding the right door to the services they require.
We can do better. We can build an integrated person-centered behavioral health and justice system. Adequate funding is important and necessary, but funding alone will not be enough to provide a rational, cost effective and humane alternative to what we have now. The Behavioral Health Summit presents an opportunity to step back from our individual system lenses and view our systems collectively, to identify the values and processes that underlie our systems and suggest new structures that can support a person-centered partnership.