At a Crossroads for Care

“K,” a local resident, shares something in common with one in four Oregonians: they are among those who have a mental health condition.

They’re also currently homeless and residing at the Lighthouse Navigation Center. Under Oregon’s existing system, these circumstances make them more likely to end up in jail than in treatment. This year, state legislators worked to change a system that has historically sent people like K, who goes by their nickname to protect their privacy, to jail instead of getting them the help they need.

“We should be lifting each other up,” says K. “Isn’t that what it means to be an American, to lift a person next to you instead of putting them down?”

It’s a question that cuts to the heart of Oregon’s mental health crisis, where nearly one in four adults report mental health issues, yet the state ranks at the bottom nationally for mental health care access. Among Oregon adults in custody, 77% have mental illness, according to the Oregon Department of Corrections.

Deschutes County has an average of 199 inmates daily in Deschutes County, says Jason Carr, public information officer for the Deschutes County Sheriff’s Office. That amounts to roughly 144 local inmates every day who also experience mental health conditions — and whose needs may not best be met in jail.

Two-path system

Whether the mental illness is lifelong or newly experienced, treatment can often mean the difference between independence and intervention. Oregon has only two paths for requiring people with mental illness to get treatment.

The first path is civil commitment, where doctors and a judge can order treatment if someone poses an imminent threat to themselves or others.

The second path involves the criminal justice system. The Oregon Department of Corrections provides medical, dental, mental health and pharmacy services to all adults in custody. If the person in custody is found unable to help with their own defense due to mental illness, they can enter Aid and Assist, the state’s competency restoration program. This program aims to help them participate in their own defense and can take place in the community or at the Oregon State Hospital.

At the Oregon State Hospital, 62% of individuals were committed for Aid and Assist and people with multiple arrests “were also three times more likely than the general population to have been committed to the Oregon State Hospital,” found a study by Oregon Health & Science University. The hospital has given priority to Aid and Assist patients to meet court-ordered seven-day deadlines. As a result, OHSU observed, “some civil commitment patients waiting for a bed to become available have experienced boarding at a non-psychiatric hospital for a month or longer, delaying needed treatment.”

People with multiple arrests are three times more likely to end up in the Oregon State Hospital.
Courtesy: U.S. Marshal’s Service

Barriers to care

“When we did away with institutionalization, we didn’t come up with an alternative that fit the need, so we see folks cycle through the criminal justice system or the hospital systems, and neither of those systems are designed or even equipped to help with those ongoing mental health challenges — and yet they’re kind of our best alternative options right now,” said Naomi Blair, director of the Lighthouse Navigation Center.

On Aug. 6, Gov. Tina Kotek signed four bills aimed at addressing some of these major issues. The bipartisan legislation includes House Bills 2005, 2059, 2024 and 3321, all designed to address the state’s ongoing behavioral health crisis. House Rep. Jason Kropf of Bend (D-OR54) was instrumental in securing passage of these bills.

House Bill 2005 updates legal procedures for civil commitment, removing the requirement that potential harm be “imminent” — a strict standard that advocates say has blocked necessary commitments. The bill allows judges to consider past or future behavior when assessing whether someone is dangerous. House Bill 2059 backs this up with $65 million to expand treatment capacity, funding 200 additional beds over the next two years alongside the Governor’s existing goal of adding 465 new treatment beds by 2026.

Current capacity needs to grow by approximately 3,000 additional residential treatment beds over the next several years, according to the Oregon Health Authority. The legislation also addresses staffing shortages through House Bill 2024, which supports mental health workers with $6 million in grants for recruitment and retention, plus improved workplace safety standards. Finally, House Bill 3321 focuses on prevention by tasking the Alcohol and Drug Policy Commission with creating a youth-focused substance abuse prevention plan, backed by $1 million.

“Broadening that definition of imminency, reducing the threshold, will allow the courts and our hospitals, and our staff to potentially find that somebody meets that criteria for a risk to themselves or others in more situations than it would have in the past,” says Evan Namkung, Deschutes County Behavioral Health Forensic and Acute Services program manager, who has seen more severe mental health symptoms and illnesses among clients in recent years, particularly with those experiencing psychosis, partly due to current street drugs.

Case manager at the Lighthouse Navigation Center, Sam Ewing, has seen the importance of mental health support. “There are people in our day room right now that are not able to (progress), you would have to literally force them to take medication, right? And what does that look like? So institutions that are specifically focused on mental health, if they are done well, some of these people in our day room right now would actually probably benefit.”

State lowers bar for civil commitment

Unlike the criminal system, civil commitment connects people to long-term services including housing, said Casey Munck, programs director at National Alliance on Mental Health in Central Oregon. NAMI supported HB 2005, which lowers the criteria for civil commitment. The legislation goes into effect Jan. 1, 2026. NAMI expects fewer arrests under the new law because it creates a treatment pathway that previously didn’t exist.

Namkung of Deschutes County is hopeful but hesitant.

“I think civil commitment is — at its best — a proactive step to get somebody help. If you don’t get that person help proactively, what happens is that they wind up with criminal charges and then they wind up being forced to get treatment through the Aid and Assist process. By then it’s become a criminal process, which is sort of the worst possible outcome.”

Namkung worries that while more people will meet the new civil commitment criteria, there still won’t be enough community resources to properly place them. Until community services catch up with demand, he says, the system will remain flawed.

The state faces chronic workforce shortages across the mental health system. There simply aren’t enough resources or staff at state hospitals or in local communities to restore the increasing number of defendants unable to aid in their own defense. Beyond the legislation, Gov. Kotek formed the Behavioral Health Talent Council to identify workforce solutions by January.

Criminal justice system creates costly revolving door

Ultimately, many people are funneled into the criminal justice system. “Using the criminal justice system for mental illness is not effective for the person or the community. Incarceration often exacerbates a person’s mental illness due to the trauma a fragile person experiences in those environments with law enforcement who don’t often have adequate training,” said Casey Munck, programs director at NAMI Central Oregon.

The criminal justice approach creates issues. The first is the immediate impact: After individuals are released, they often return to living unhoused and sometimes commit new crimes, creating a revolving door that criminalizes illness rather than treating it at its root. This dysfunction comes at enormous cost. Oregon spends $42,664 annually to incarcerate an adult, according to the Department of Corrections.

Munck has found that the restoration process doesn’t fix the criminalization of mental illness. “The Aid and Assist program in Oregon has not been working in a way that resulted in folks getting compassionate care and treatment for their mental illness. Aid and Assist isn’t intended to help or support someone. The entire goal of Aid and Assist restoration is to get someone well enough to process them through the criminal justice system. That’s it.”

Local behavioral health officials see this pattern repeated throughout the system, posing an ongoing, complex problem.

“Our system just isn’t set up to support these folks that are often born into these challenges and need that assistance. They need supportive services, and so my concern is that we might be penalizing them even more when they’re already struggling and then adding layers of trauma on top and then even further stigmatizing folks that are facing houselessness or mental health challenges. That’s not gonna meet the need — that’s gonna further exacerbate it,” said Blair of the Lighthouse Navigation Center.

“Ultimately, we’re talking about clients who are all part of the same system. They just revolve through different aspects of it, and so those cuts and those shortfalls still can wind up affecting them. It just might happen in a different area,” said Namkung.

Stability requires a community support network

“If you aren’t able to have access to medication or even have the support from family, friends and people in your community, trying to get that mental illness in check and be able to then contribute back to society and be able to have a job and hold down a job, and then be able to get housing — all of those things — you have to be stable to some extent in order for you to be able to continue throughout life,” said Lighthouse case manager Sam Ewing.

The community support Ewing describes is precisely what’s lacking in Oregon’s current system. Both treatment paths lack early intervention and preventative services. An Oregon Health Authority study found that people in the system typically come from low-income backgrounds. Many lack high school diplomas and frequently have histories of homelessness. These factors suggest that problems often begin with inadequate social support during childhood and adolescence, before mental health crises develop.

According to Lighthouse director Naomi Blair, “We do need to improve our system and create spaces that are dedicated specifically to caring for these high-level needs.”

The personal impact of this approach becomes clear when talking to people who’ve experienced it. Lighthouse client and local resident, K, knows this struggle firsthand. “I’ve struggled with addictions and mental health issues for most of my life, and not knowing how to accept help and have long term tools and get around my recovery and maintaining my mental health has been a big, big struggle. I grew up in the system, so it’s been one system — and institutionalized mindset — after another for me.”

Still, K praises the support they have been offered, saying that case management has “helped me stay focused on my goals and provide resources to where I can go to maintain and allow me to rebuild my character by helping me set goals that are realistic and so I’m not chasing smoke, which was very helpful to be able to actually utilize the systems that are in place.”

This article appears in the Source August 21, 2025.