Last August, on a clear, sunny day, a group of elected officials and health experts gathered at St. Charles Medical Center in Bend for a presentation on emergency services for youth experiencing a mental health crisis in Central Oregon.
The information they left with was bleak. Emergency departments at all St. Charles hospitals in Central Oregon are seeing an increase in young people experiencing mental health crises, and while ED staff can keep patients safe from physical harm when they’re admitted, the departments are not equipped to treat them long-term.
Instead, for days and even weeks at a time, a person under the age of 18 sits in an emergency department bed on 24/7 watch, while hoping a spot at an in-patient residential care facility several hours away will open. The nearest beds are in Portland, Salem and Eugene. In Central Oregon, there aren’t any facilities that provide respite or inpatient residential care for youth experiencing psychosis or who are at grave risk of harming themselves or others.It’s a disparity in services that experts in the region say contributes to Deschutes County’s outsized suicide rate for youth, which is twice as high as statewide numbers and three times as high as youth nationally. Suicide is the leading cause of death among 10- to 17-year-olds in Deschutes County, responsible for 58% of deaths in that age group.
Rep. Emerson Levy (D-OR53), who represents parts of Deschutes County, was at the August roundtable at St. Charles. She left the presentation that day with heavy worries and a renewed sense of urgency to introduce legislation to address the problem. This year she plans to reintroduce a bill that would establish regional care psychiatric facilities for youth. It’s drafted from a similar bill that failed to make it out of the Joint Committee on Ways and Means two years ago and, even if passed, wouldn’t fully fund a facility. Building and running a facility would require buy-in from multiple levels of government and a coalition of support among health care providers. Representatives from St. Charles and Deschutes County officials say they’ve been working out the details for a Central Oregon center for the last few years. The final piece of the puzzle is funding.
“I just think we’re not doing right by our families,” Levy said. “I might get in trouble for saying that, but I really think we’re failing them.”
And, as the region’s population grows, so, too, does the number of young people needing a service that doesn’t exist.
In the Emergency Department
Six years ago, Veronica Smith’s* young daughter made her first suicide attempt. It was a shock to the family, as the then 13-year-old had never shown signs of suicidal ideation before, and the Smiths were a close family.
“We’re a family that eats dinner every night together,” Smith said. “We’re a family that every night like clockwork, we play a game called ‘High-Low’ where we talk about a high of our day, and a low of our day. She never indicated to us that anything had happened, or that anything was going on.”
Upon finding their daughter unresponsive on the bathroom floor, the Smiths were thrown into a crisis that they had no framework for navigating. In the emergency department at St. Charles in Bend, their daughter was treated for her physical trauma, but once stabilized she was sent home with instructions to her parents to keep a close eye on her. Smith says they were not connected with a therapist or referred to anyone for further care.
To provide around-the-clock care, Smith quit her job and became hypervigilant of her daughter’s every move. She and her husband lived in constant fear. Despite those efforts, a few months later they were in the emergency department again, following a second attempt.
This time, they were told about a litany of services, but all were out of reach.
“Now, all of a sudden, it’s important,” she recalled. “And now, all of a sudden, everybody’s like, ‘Well, we have these services. We don’t have them here, but we have residential treatment programs. But they’re over the mountain, and there are no beds.'”
Once again, Smith’s daughter was sent home with instructions to watch her closely. They got her into an outpatient treatment program that Smith said helped a bit, but wasn’t the exact right fit. Over time, and with stops and starts, her daughter healed and is thriving in college today, Smith said.
Smith now works for Deschutes County, helping and advocating for families going through similar situations. She says she joined the County to try to ensure that no family experiences what hers went through. Initially, she worked with families to empower them to speak up about their needs and express whether they felt comfortable taking a potentially suicidal child home. In her current role, she refers families to facilities for in-patient care – programs that are still out of reach for many on the other side of the Cascades.
“I work with single moms who don’t have a car to drive there every day,” Smith said. “I work with single moms who have three jobs. And you know, the residential program would be like, ‘Well, visiting hours are on Wednesday at 1 o’clock,’ and the mom is like, ‘I have three other kids and two jobs, I can’t get there.'”
A Growing Need
What the Smiths went through years ago is happening to more families today in Central Oregon than before, and the outcomes haven’t changed much. When evaluating its emergency department data, St. Charles found that the number of youths staying in the emergency department longer than 24 hours has increased yearly since 2021 – hitting a historic high in 2024. And it’s a problem unique to youth: The same emergency room data showed that the average length of a stay, in hours, is highest for those under 18.
Lindsey Overstreet is a licensed clinical social worker and head of Pediatric Behavioral Health at Mosaic Community Health. In her role, she sometimes refers patients to the emergency department for psychosis, being a potential safety threat to themselves or others and other acute mental health crisis concerns. Overstreet said while there are plenty of resources and services to support mental health before it gets to needing emergency care, the lack of a nearby, dedicated residential treatment facility for those under 18 years old is dangerous and can further traumatize the child in crisis and their family.
Statewide, there are only around 40 beds available for inpatient psychiatric care for youth. It can take so long for a spot to open that a child may claim to feel better just to get out of the emergency department.
“We know of youth who have been there for many weeks because they cannot be safe at home,” Overstreet said. “There is no room for them at one of the facilities in the [Willamette] Valley, and so unfortunately, I think a lot of times, the youth just say, ‘I’m not suicidal anymore’ in order to be able to be released – even if that’s not necessarily true. And while we have incredible clinicians who are evaluating them, if they [the youth in crisis] are adamant that they’re no longer suicidal, and those are the words they’re telling them, then they’re not going to be detained in that unit anymore.”
In 2023, when Deschutes County released its suicide trend report, it acknowledged the problem in stark terms. “In ED settings, youth receive minimal behavioral health services, and the ED is not equipped to provide the level of care that is needed to help youth address their behavioral health needs, in turn, lowering our ability to prevent suicide in the Central Oregon region,” the report read.
Molly Wells Darling, the senior behavioral health director at St. Charles, says the hospital is doing its best to help the youth who come to the emergency department in crisis, and she stresses that absent specialized services, the emergency department remains the best — and only — place to bring a child in distress.“It’s incredibly hard for the youth, and it’s hard for the caregivers too,” Wells Darling said. “Because the caregivers know that this isn’t what we want to be doing, in terms of serving our youth. They certainly do the best that they can. But, ideally, the youth would be in a crisis stabilization unit or a hospital with expansive youth services.”
In Deschutes County, urgent care-type services are available for children and adults through the County’s Stabilization Center in Bend. The center is open 24/7 and staffed with clinicians who can assess a person in crisis and make referrals for treatment or other services. For adults, there are dedicated short-term respite recliners available for up to 23 hours at a time as temporary, safe spaces to rest, de-escalate and regain some control over their emotions and behaviors. It also gives caregivers a break from the intensity of trying to manage the crisis. And while youth can come to the center at any time, they are not eligible to use the respite space.
“It would be great to open some form of respite for youth because sometimes crises require inpatient, but what we found in our adult continuum of care is that we need some in-between levels of care,” said Nicole VonLaven, the County’s program manager for behavioral health crisis services. “And I think for youth, particularly, a respite space would be wildly helpful.”
VonLaven said the Stabilization Center along with the community-based crisis team that responds to emergencies called into 911 or 988, school-based health centers and the intensive in-home mental health treatment program offered through Youth Villages have all been great additions to acute care in the region. But the gap in care at the highest-need end of the spectrum still yawns.
Building on this side of the mountain
More expansive services are what Wells Darling at St. Charles is hoping to bring to Central Oregon in partnership with Deschutes, Jefferson and Crook County’s health departments, as well as PacificSource and Greater Oregon Behavioral Health Inc., a part of the Eastern Oregon Coordinated Care Organization. Wells Darling said the group started working on the logistics for a facility about a year and a half ago, following the failure of state legislation in 2023 to develop regional residential psychiatric care facilities for youth in underserved areas throughout Oregon.
The coalition also includes Deschutes County Commissioner Phil Chang, who hosted the August roundtable at St. Charles to draw attention to the gap in care. Chang said he thinks the political will is there to support and pass a bill this year at the state level to create regional facilities. Part of why it didn’t move forward in 2023, he said, was because that was the year Republicans in the state senate participated in a six-week-long walkout, the longest in state history.
“I would blame the death of the bill in 2023 on the walkouts,” Chang said. “When people finally came back, they were only able to triage some of the most urgent, biggest, most critical things. There was a ton of legislation, good legislation, that just fell by the way.”
Now, Chang is hopeful the bill passes and that the work that’s been done since then to develop a model of care for the area will mean that if approved and funded – possibly through congressionally directed funding – a facility could be built relatively quickly.
Any federal money would require the support of a member of Congress, known as Congressionally Directed Spending in the Senate and Community Project Funding in the House. When reached for comment, representatives for Oregon Senators Ron Wyden (D-OR) and Jeff Merkley (D-OR) said that youth mental health services are a concern for the senators and that each is willing to work with local representatives to find a solution, like a dedicated facility.
“I hear consistently in town halls and visits to classrooms all across the state how severe the mental health crisis is for young Oregonians, paired with the acute lack of placement options for these children,” Wyden wrote in a statement to the Source Weekly. “I will work with anybody at the local level in Central Oregon to find common-sense solutions like a mental health facility that could treat these young Oregonians with common decency.”
Likewise, Merkley’s office said the senator is aware of the severe shortage of mental health resources for youth and is open to helping secure funding for an in-care facility through congressionally directed spending. In addition, Merkley’s press secretary, Molly Prescott, wrote in an email that the senator is developing legislation of his own to address the need.
“His office is tracking what is being proposed on a state and local level as the senator is gearing up to introduce legislation soon that is targeted to address this exact challenge facing the region and many other communities across America,” Prescott wrote.
Meanwhile, without a facility nearby, parents of children in crisis are still driving over the mountains for care – if they’re lucky enough that a bed opens. And, even in that “best-case scenario,” there is no best choice..
Smith remembers one mom she worked with who didn’t have reliable transportation but managed to get a ride for her and her son to a facility in the Willamette Valley. When they arrived at the treatment center, the mom, Smith said, was shocked to see barbed wire around the place and was told by staff there that for her son’s best outcome, she’d need to participate fully in care by attending in-person therapy. However, as a single mom with a fulltime job, other children to care for and no car, she didn’t know how she was going to make that happen.
“I remember her telling me, she was sitting in the car just crying,” Smith said. “And she’s sitting next to her son who needs this, and they turned around and drove away because she just couldn’t come to terms with what the residential program was asking of her as a parent at the participation level. Saying to her, ‘Go home, three hours away, and then tomorrow, be back here by one.'”
*Names and some details have been changed to protect the family’s privacy.
This article appears in The Source Weekly January 23, 2025.
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