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'It's not just Portland': How high standards for forced mental health care affect care in rural Oregon

In a follow-up to KGW's 'Uncommitted' investigative series, Eastern Oregon leaders share the gaps they see in mental health care due to civil commitment standards.

HEPPNER, Ore. — In Morrow County, a rural county of about 13,000 people in Eastern Oregon, District Attorney Justin Nelson handles civil commitment cases — determining whether people with severe mental illness should be forced to receive mental health care.

As part of that role, Nelson talks with families who tell him their loved ones are acting dangerously or considering committing suicide because of their mental illness.

Frequently, Nelson says he can't do anything.

"It's not enough for a person to say 'there are railroad tracks right here, I'm going to go and kill myself.' The court will say that's not enough [for civil commitment]," Nelson said. "It's the person being out there, laying on the tracks with the train coming at them — that's enough for imminent harm to self."

RELATED: Uncommitted: How high standards are fueling a cycle that can fail people with serious mental illness

Nelson said these conversations with concerned family members are often devastating. He repeatedly explains Oregon's standards for forced mental health treatment if a person with mental illness rejects it.

"You have to tell them 'I'm sorry, I know your family member is talking about killing themselves, but they need to be closer to it,'" Nelson said. "How can you tell a family member that?"

What's left is a system with frustrating gaps that fails to help people with severe mental illness, Nelson said, even when doctors and behavioral health workers strongly recommend it.

"I don't think it's appropriate to wait until that person is on the railroad tracks with a train coming at them before you scoop them up and save them, we should be able to do it sooner," Nelson said.

Credit: Allison Moulton (KGW)
DA Justin Nelson works out of the courthouse in Heppner, a city in Eastern Oregon.

Nelson reached out after watching KGW's multi-part investigative series 'Uncommitted', which explores the civil commitment process and limitations for involuntary care.

He said the standards for forced care are too high.

"This is not a Portland issue, this is a statewide issue," Nelson said. 

And he believes fewer people would be in jail if they had received mental healthcare before being arrested.

"We're waiting for these people to commit a crime before we can help them. That seems wrong," Nelson said.

Linda Mills, who's worked as a mental health investigator in Eastern Oregon for more than 30 years, agreed that expanded access to civil commitment is needed.

She said people in the rural communities that she covers understand that commitment cases aren't reserved for the larger cities.

"You do not believe that if you live here, it's an acute problem here, and people know," Mills said.

OTHER STORIES: Oregon State Hospital faces dilemma with judge's order to discharge patients early

Mills said she is often called to work with a person experiencing a mental health crisis who is then placed on a temporary hold for medical evaluation. Most people are released because they either refuse care, don't meet state standards for civil commitment or agree to a treatment plan.

Mill said she frequently encounters these people again, when they're apparently experiencing another mental health crisis, and the cycle continues.

"It's led to a huge population of mentally ill people who are not receiving the treatment they need, and the treatment that if they were lucid that they would want," she said.

She said it can also be more difficult to access long-term mental health housing in rural Oregon, and she's started telling frustrated family members to write to state legislators and encourage them to lower civil commitment standards.

OTHER STORIES: Oregon will be the 1st state to receive federal support for mental health crisis teams

"It's sad with all the gains we've made in knowledge about mental health and how to intervene and help over the last 20 years, that we can't do that with the people who need it most," Mills said. "So many times when they finally do get treatment they'll say to me 'I wish somebody would have been able to force me to [get treatment]'…sometimes people remember their psychosis, and they know they needed help."

Nelson said he visited the Oregon State Hospital and other facilities to see what the commitment process looks like before advocating for lowered standards.

"You can get an idea that back in time, a person could be committed for anything and it’s too easy for someone to be committed," Nelson said. "They can get in the state hospital, the key gets thrown away and they’re stuck in the system. I can just say, that’s not the experience we have here."

He said state mental health workers try to move people to lower levels of care as soon as possible — a sentiment that county investigators echoed in Uncommitted.

Watch the original Uncommitted investigation:

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