A state work group studying how Oregon civilly commits people experiencing serious mental illness gave 51 recommendations to lawmakers to consider for the 2025 legislative session.

The recommendations, backed by the group representing several state agencies and nonprofits, aim to make the process more accessible, more effective and more equitable.

One of the group’s members, the Oregon chapter of the National Alliance on Mental Illness, is also leading a push to implement a more controversial change that the state has considered over the years — making it easier for a judge to civilly commit a person who is found to be a danger to themselves or others due to mental illness.

A bill that the group is helping to author would change current law in several ways. One is allowing a judge to consider a person’s past suicide attempts and potential to harm themselves or others within 30 days, rather than immediately, when assessing that person’s risk. Another is clarifying the definition of danger to self. Chris Bouneff, executive director of Oregon NAMI, said the state’s existing criteria are so narrow that they exclude people who are vulnerable to self-harm or are unable to care for themselves.

Without treatment, some people wind up facing criminal charges, where they are ordered into care after being deemed not competent to stand trial. Others spiral into physical harm to themselves or others. InvestigateWest recently reported the story of one Bend woman, who experienced psychotic illness and suicidal ideations, and despite multiple contacts with her community’s crisis system, was left alone when she refused care. She died by suicide in June.

Bouneff says his organization encounters people in similar situations on a weekly basis.

“We are committing people today. We’re just doing it through the criminal justice system,” he said. “We have a very surgical goal, which is to take people who are so acute that we’re committing them only after they’re arrested, and we want to spare people from encountering the law enforcement system.”

The NAMI-backed bill is far from the first of its kind. Similar legislation was introduced in 2019, 2021 and most recently in 2024; each bill died in committee after garnering passionate testimony both in favor and in opposition. The pitfalls involved with forcing someone into care have slowed momentum to broaden the use of involuntary care, though calls for change have increased as more people experienced mental health crises.

Groups differ on approach

Even among the state work group, which spent the last two years studying civil commitment and potential solutions, members remained somewhat split on whether modifying the criteria is the right move.

Other advocates who were part of that group with Oregon NAMI criticize attempts to expand civil commitment as misguided, a symptom of overemphasis on involuntary treatment that will place more demands on an already-stressed system.

“Right now, when somebody is waiting in an emergency room for weeks, that’s not treatment,” said Meghan Moyer, public policy director for Disability Rights Oregon. “They’re not getting treatment. They are often chemically and physically restrained, often on a hospital bed in a hallway. And that’s right now, that’s today’s application of statute, and I get very nervous when you increase that. What does that look like?”

State data underscore Bouneff’s point that severe mental health issues are increasingly being dealt with within the criminal justice system. The number of people ordered into mental health treatment solely to participate in a criminal case has “reached crisis levels,” according to the Oregon Health Authority: The number of people under such an order increased by 250% from 2000 to 2019. Conversely, the number of people being civilly committed has fallen over the last several decades.

Oregon’s civil commitment laws, most of which were crafted in the 1970s, aren’t far out of line with other states. Instead, rulings on appealed civil commitments have increasingly narrowed the scope of who qualifies, some researchers have found.

The Oregon Health Authority is also under pressure to deal with civilly committed people who aren’t able to access the state hospital. In 2022, four of the state’s largest hospital systems sued the agency, claiming the state is violating the rights of people with severe mental illness by shunting civil commitments back to their hospitals, which they say are not equipped to provide long-term psychiatric care. The suit was thrown out but revived this summer by the 9th U.S. Circuit Court of Appeals.

Bouneff said his group acknowledges the critical shortage of resources and supports efforts to bolster available beds to serve people who are civilly committed. Bouneff said a different work group that Oregon’s NAMI convened at the beginning of the year is continuing to work on ways to support greater availability of services.

“I don’t think NAMI would be supportive, in the end, of any change to civil commitment criteria if we don’t have that other piece,” Bouneff said. “Because you will have achieved absolutely nothing.”

State ramps up support

Oregon has made some investments in behavioral health capacity in recent years. In 2021, lawmakers allocated $130 million to increase community-based residential space for people requiring intensive care due to serious mental illness. That money was part of a $1.3 billion behavioral health package passed that year.

The state’s capacity of mental health beds has increased since then. According to the Oregon Health Authority, 986 beds are available around the state, and another 267 beds are still in development for a total of 1,253. But secure residential beds, many of which are used for civil commitments, are more scarce: 230 that the state is projected to need are not yet in development.

Oregon’s shortage of resources to serve people who are civilly committed is a problem widely acknowledged, which is why NAMI isn’t the only group scrutinizing the system. It was one of 20 agencies, nonprofits and departments represented in the Commitment to Change work group, which published a report on Nov. 1 summarizing its work and providing recommendations for lawmakers to consider as the 2025 session approaches.

The 51 recommendations that received consensus from all stakeholders include some specific, actionable steps for the Legislature to take, such as requiring continued training for civil commitment investigators. Other recommendations are broader concepts that could take shape in various ways.

The group unanimously supported expanding access to treatment during civil commitments and as people transition out of civil commitments. Support for expanding criteria to civilly commit people, however, was slightly more mixed, with groups like NAMI and Mothers of the Mentally Ill in favor, Disability Rights Oregon and the Oregon Association of Hospitals and Health Systems opposed, and other state agencies saying it would depend on other factors.

Multnomah County Circuit Judge Nan Waller, who runs the county’s mental health court and represented the state’s judicial branch on the work group, said the group took a broad approach in order to give lawmakers a nuanced look at all the factors that affect both civil commitment’s accessibility and its effectiveness.

“Oregon’s commitment system is not serving the purpose for which it was intended, to protect many vulnerable people in our communities,” she said in an email. “As a judge I have seen the stories play out in my courtroom, stories of despair when individuals have no access to the treatment and support they need or are unwilling or lacking in motivation to engage in treatment.

“My hope is that the Legislature will use the report to take action that is desperately needed to improve a system that is failing to meet both the needs of people with serious mental health disorders and the needs of the communities in which they live,” she said.

At least one Oregon lawmaker said he plans to be involved with legislation to modify civil commitment criteria: Rep. Tom Andersen, D-Salem, who made the most recent attempt in 2024.

Andersen said he thought his bill failed to advance because it was a short legislative session, used primarily for budget tweaks and other smaller moves. In the longer session, he said he anticipates more opportunity to work out disagreements.

“Legislative wheels grind slowly but finely,” he said. “There’s a myriad of issues surrounding civil commitment, and the goal of the Legislature is to work together to make sure we can provide the necessary treatment and also have the ability to spend money to address it.”

This story was originally published Nov. 14, 2024 by InvestigateWest. Kaylee Tornay covers labor, youth and health care issues. Reach her at 503-877-4108 or kaylee@invw.org.