The Oregonian, by Rick Attig and Doug Bates

A room stacked with the unclaimed remains of patients symbolizes what's wrong with the Oregon State Hospital

By Rick Attig and Doug Bates

[T]he administrators and staff at today's Oregon State Hospital aren't the bad guys. They're pretty much doing the best they can with deplorable resources provided by a state with a long history of giving short shrift to its mentally ill.

Eva York died in a bathtub in 1896 at the Oregon Asylum for the Insane. After an inquest, which absolved the hospital staff of any blame, no one claimed her corpse, so she was buried in the asylum cemetery and forgotten.

Eighteen years later Eva's remains were exhumed, cremated, placed in a copper urn and forgotten all over again. Today the corroding canister containing her ashes sits on a plain pine shelf in what's called the "Cremains Room" at the 122-year-old Salem institution, now known as the Oregon State Hospital.

Eva York is one of about 5,000 patients whose cremains are neatly stacked in that stark, lonely room like cans of paint in a well-stocked hardware store. Her story one of the rare stories that can be told, thanks to the inquest into her death makes her a perfect symbol for what's wrong with the way Oregonians treat some of the most frail among us. The 2005 Legislature, which convenes Monday, must address this shameful truth.

The state hospital was a dumping ground in Eva's day, and to some extent it still is today. Even its administrators admit they're housing patients who don't belong there.

Wards are overcrowded. Staffing is inadequate. Patients whose psychoses have been stabilized by medication are being warehoused in the hospital for lack of smaller community-based mental health centers that would be far better for them.

The grim, sprawling hospital is no place for juveniles, yet Oregon houses about a dozen frightened, troubled kids there. Some of the girls, often prior victims of sexual abuse, pull their mattresses out into hallways to sleep in safe view of staff. During the day, adolescents pass time outdoors in plain view, through concertina and barbed wire, of maximum-security adult patients.

These kids are left there, however, because Oregon has no proper facility for them. There's really nowhere else they can go.

Out of sight, out of mind. It's an age-old story of neglect for Oregon's most unfortunate. In fact, it was Eva York's story more than a century ago.

Today we know far more about Eva than any of her forgotten companions in the Cremains Room. That's because her death led to a story in Salem's Daily Capital Journal on Nov. 25, 1896.

Eva was a 36-year-old Marion County woman who probably wasn't even mentally ill. According to the old newspaper clipping, she was an epileptic, confined to the hospital's asylum-era epileptic ward five years before her death. In those days her malady, like depression and alcoholism, was viewed as akin to insanity.

Eva died between 2 and 3 p.m. on a Tuesday, "bath day" in the epileptic ward. While left unattended in a tub, she had a seizure and died from it, a coroner ruled. He found no evidence of drowning. An inquest jury declared the hospital to be "in no way responsible."

The news account went on to say the hospital telegraphed word of Eva's death to "a brother residing near Hubbard." Her remains, however, were never claimed.

The entire asylum cemetery was exhumed in 1913-14 when the state decided it needed the land. Many of the headstones were unceremoniously dumped on a nearby hilltop. All unclaimed remains, including Eva's, were cremated and stored in a basement.

By 1976 that bleak collection of urns exceeded 5,000. That year, in a long overdue act of respect, they were placed underground in a modest memorial on the hospital grounds. But water seeped into the vaults, damaging the copper containers and destroying most of their paper labels. A few years ago, the cash-strapped institution unearthed the urns and stashed them in the Cremains Room, next to the incinerator where all the patients had been cremated.

If Eva York is a symbol of Oregon neglect, the hospital itself its physical hulk is a full-blown metaphor. The tub that she died in is still there, gathering mold and rat droppings in an abandoned wing that's creepier than any haunted house one might imagine.

Occupied spaces of the hospital are cheerier only by comparison. They comprise a foreboding, ramshackle collection of additions to the original 1883 structure along with several decrepit satellite buildings, the newest of which is more than a half-century old.

Patients spend their hours locked in jam-packed day rooms connected by long, dreary corridors to their prisonlike sleeping quarters, crammed with more bodies than they were designed for. They gaze out windows covered with oppressive security screens, and they stare at visitors coming and going on balky, creaky old elevators. No wonder the makers of "One Flew Over the Cuckoo's Nest," the Oscar-winning movie based on Ken Kesey's novel, chose to film it at the Oregon State Hospital. It was a fright 30 years ago, and the place still looks the same today.

Unlike the cinematic "Cuckoo's Nest" villains, however, the administrators and staff at today's Oregon State Hospital aren't the bad guys. They're pretty much doing the best they can with deplorable resources provided by a state with a long history of giving short shrift to its mentally ill.

Those running the institution, in fact, say they want change. They also voice support for a fledgling movement in the Legislature to create that change.

One man Senate President Peter Courtney, D-Salem lit the flame. Fed up with the state pouring money and crowding patients into the hospital, he engineered a $467,000 emergency appropriation last month to start a process that ought to lead to replacement of Oregon's disgraceful relic.

That emergency money will pay for stopgap measures to relieve overcrowding. It also will launch work on a master plan that will give lawmakers a blueprint for a new, more humane way of caring for these patients.

On Monday, when the 2005 Oregon Legislature convenes, all 90 members should mark May 16 on their desk calendars. That's the deadline for presentation of this blueprint. It will likely call for a years-long project requiring tens of millions of dollars to build a smaller, modern hospital and an enlarged network of community mental health centers that would be less costly to operate and more effective at treating patients.

Every legislator must commit right now to moving Oregon mental health care out of the dark shadows of its 19th-century roots. And while they're at it, they should spend some money on a suitably dignified memorial for the earthly remains of Eva York and her fellow lost souls in the Cremains Room.

© 2005 The Oregonian

By Rick Attig and Doug Bates

After 12 years in Oregon's mental hospital, a woman finds the right kind of care, but much more is needed

Cora Burnell says she remembers looking out a window at the Oregon State Hospital and seeing Jack Nicholson during the filming of "One Flew Over the Cuckoo's Nest" in 1975.

"In the movie, he was the crazy one. He got part of his brain taken out," Burnell says. "The big Indian, he was the strong one. And the nurse what was her name? she scared me."

Burnell's memory sometimes plays cruel tricks on her. She wasn't really there during the filming. She was 13 then and had just been diagnosed with schizoaffective disorder. But she's seen "Cuckoo's Nest" and has an intimate knowledge of the 122-year-old hospital where the movie was shot. She was locked up there for 12 years in a ward she describes as "a terrible place real creepy, but not as bad as in the movie."

Today, at 43, Burnell can attest to the need for tearing down the oppressive relic where the movie was made and replacing it with a smaller modern hospital and an expanded network of community-based treatment homes.

Burnell lives today in an ideal such place. She's one of five residents of Homestreet, a lovely old two-story house with a big wraparound porch in Hillsboro. The nonprofit treatment facility is a model of what modern mental health care ought to look like.

Yet hundreds of patients such as Burnell have been forced to remain too long in the dreary hospital, despite mounting evidence that long-term institutionalization does the mentally ill more harm than good. The problem: For too many years Oregon has failed to keep up with the national trend to community-based services while clinging to its aging "cuckoo's nest."

Burnell was 21 when she was sent there after stabbing a man in Portland during an episode of psychosis and substance abuse. She credits the hospital with stabilizing her disorder but thinks she made little progress during her long stay in the forensics ward.

"There was no Nurse Ratched," she says. "The nurses were real nice. So were the doctors. But the staff was not helpful. I think they were overworked."

She remembers the ward as much too crowded, "not clean enough" and utterly lacking in privacy. She never felt completely safe during her 12-year tenure or subsequent rehospitalizations.

Burnell feels just the opposite about her new life at Homestreet. Its staff of four goes far beyond just making sure the residents take their "meds." She and her housemates receive treatment at a level they could never dream of getting at the Salem institution.

Burnell, for example, has learned how to cook French toast and Italian pasta. She is receiving lessons in grocery shopping, personal hygiene, housekeeping, money management and coping skills. She has been shown how to catch the nearby MAX train for trips to Beaverton and Portland.

Within two years, Burnell is expected to make the transition to more independent living. On her bedroom wall at Homestreet, she says, hangs a picture of that dream "a beautiful, beautiful home" where she can live on her own. The picture shows a bright, cheerful apartment, she says, with privacy and plenty of space for Cinnamon Bear and the rest of her prized stuffed animals.

Homestreet and other forms of community-based treatment are not just more beneficial for most patients. They also are more cost-effective. The average monthly cost for a patient at the state hospital is $11,000, all of it out of Oregon's general fund with no federal match. Medicaid won't pay for patient care in state mental hospitals. But a month for Burnell at Homestreet costs the state only $3,375, and Medicaid picks up 62 percent of that.

To their credit, Oregon mental health officials are working hard to add community beds. But they also acknowledge that the Salem hospital still holds scores of patients who have been cleared for group-home treatment but have nowhere to go. The 2005 Legislature must get moving to help provide these resources.

Until then, it's to Oregon's shame that these patients remain warehoused in a decrepit institution. They are today's version of the forgotten patients whose canisters of unclaimed ashes are still stacked on shelves with no proper memorial in the hospital's grim "Cremains Room," where the standing photo for this series was taken.

On Monday, Oregon legislators will have a novel opportunity to experience something akin to what Burnell endures if her illness isn't under control. The National Alliance for the Mentally Ill is setting up a "virtual hallucination machine" in the Capitol to help lawmakers grasp the severe effects of schizophrenia and other such disorders.

Legislators should come away committed to support Senate Bill 222, which would broaden the range of community housing options for people such as Cora Burnell. And if the simulated hallucinations don't sway them, the lawmakers should visit her at Homestreet and see firsthand what ought to be the vision of mental health care in Oregon.

They won't actually find a picture on her wall showing the "beautiful, beautiful home" she talks about. It's only in her mind. But it's a picture that a humane Oregon should make real for all of the state's most vulnerable citizens.

© 2005 The Oregonian

By Rick Attig and Doug Bates

Oregon still allows insurers to discriminate against mental illness; there's a better, more compassionate way

Kris Anderson, a single mom in Salem, opens her mail and discovers another rejection notice from her insurance company. She slumps to her knees, then looks up to see her 9-year-old son, who suffers from bipolar disorder, charging at her with a hammer.

A slight, 14-year-old Portland boy, Jake Steckly, sits in a Capitol hearing room and bravely tells lawmakers how his brother's mental illness and his father's substance abuse wiped out his family financially, destroyed his parents' marriage and made him want to run away. When the boy begins to sob while describing visiting his dad in a drug treatment program his mom paid for with her credit card, tears trickle down the faces of legislators.

The pain, unfairness and even the danger of Oregon's discriminatory insurance system is plain to see. Yet many Oregon leaders keep looking the other way. Even when Boyd Owens, a suicidal man with a 10-inch-long knife, forced his way onto the Senate floor, coincidentally choosing the same day mental health advocates had come to the Capitol for "Mental Health Day," all the nervous chatter among lawmakers afterward was about increased security.

Security for them, of course. But not for the tens of thousands of Oregon families struggling with severe mental illnesses such as schizophrenia, bipolar disorder and clinical depression.

Oregon is one of the few states that still do not require mental-health parity in insurance. Thirty-five other states already have some form of a law preventing insurers from putting more restrictions, such as spending caps and hospitalization limits, on treatment of mental illness than for physical ailments. Neighboring Washington is preparing to pass a parity law its House recently approved a parity bill by an overwhelming 67-25 vote.

There is a distant but real connection between this lack of insurance parity and the crisis at the Oregon State Hospital, a decrepit facility overflowing with patients. Oregon has a mental-health system that shifts the bulk of the costs to taxpayers, and all but invites its residents to get worse, to suffer more, to grow more desperate and dangerous, before they can get care.

Oregon has an insurance system that forces a mother like Anderson to beg and beg and beg for benefits for her troubled son. Even after her son was granted another 10 hours of care, and she and her doctor agreed to string it out with hurried, 10-minute visits, another letter soon arrived, explaining that Anderson was now, once and for all, out of benefits. She had missed the fine print, which read 10 hours, or 10 doctor visits, whichever came first.

Oregon's system is both cruel and discriminatory. Insurers do not tell a patient with a kidney disease that they will pay for 10 trips to the hospital for dialysis, but no more, ever. Yet when voices began to thunder inside the head of Kathy Larrabee's teenage son, and she took him to a Portland hospital where he was diagnosed with paranoid schizophrenia, she discovered her son was entitled to 10 days of inpatient treatment over his entire lifetime.

The 17-year-old boy came home from the hospital after two weeks, but promptly tried to commit suicide and was rehospitalized. Today, five years later, Larrabee's son is doing well on medication and enrolled at Portland State University, but Larrabee and her husband are still paying off tens of thousands of dollars in medical charges, even after selling a business and their former home overlooking Newport's bayfront.

Oregon has an insurance system that provided Jake Steckly's dad such a scant lifetime benefit for drug abuse treatment that it was exhausted before Jake was even born. This state still pretends that people with addictions, depression or even schizophrenia can be declared cured when the insurance coverage runs out in a few days.

To their credit, many Oregon leaders recognize the damage caused by this state's unfair health policy. Senate President Peter Courtney has given his parity bill the title of Senate Bill 1, and says, "There's no more important bill to me." Gov. Ted Kulongoski, whose task force on mental illness listed parity as its No. 1 legislative priority, supports the legislation.

Yet the insurance industry and powerful business groups, including Associated Oregon Industries, oppose mental health parity. So do Republican leaders in the Oregon House.

Parity foes say they fear an insurance mandate would increase costs and prompt some employers to stop offering health benefits entirely. That is a reasonable concern, but it's not borne out in the actual experience of states that have required parity for years.

Oregon also now has some of its own experience with parity: In 2003, the Oregon Public Employees' Benefit Board acquired mental-health parity for state employees including members of the Legislature and their dependents. In the first year, premium costs increased by less than one-half of 1 percent.

Meanwhile, denying mental health care doesn't lead to savings, it leads to more illness, absenteeism, crime, homelessness and poverty. Several studies cited by the National Mental Health Association show that costs of untreated mental illnesses to businesses, government and families nationally exceed $110 billion a year.

Oregon is not better off depriving the mentally ill of care, or pushing families into bankruptcy and onto public assistance. One of the cruelest effects of the state's current policy is that some parents are forced to give the state custody of their mentally ill children in order to get them care. That is one of Kris Anderson's worst fears. "My story isn't that bad yet," she says. "But my son is young, and we've exhausted most of the benefits available to him. I know what might lie ahead for us."

It should never come to that. Oregonians with mental illness should be cared for with the same urgency and compassion as those with physical ailments.

Jake Steckly remembers legislators wiping tears from their eyes, and standing and applauding his testimony. They were moved but only so far. That was 18 months ago, and a parity bill still has not yet come to a floor vote in either the Oregon House or Senate.

Steckly is 15 now, a sophomore at Lincoln High School. He's willing to go to Salem to testify again, if it would help. But this boy who's been through so much already has a fair question: "What else are they waiting to hear?"

© 2005 The Oregonian

Here's an invitation to Gov. Ted Kulongoski to visit the Oregon State Hospital and see for himself its sorry state

By Rick Attig and Doug Bates

Governor, it's been 30 years since you last toured the Oregon State Hospital.

You need to see it today.

Take this as an invitation, not a criticism. You clearly already understand that a mental health crisis lies behind the haunted-looking facade of the 19th-century J Building, the gray, exhausted face of Oregon's neglected hospital in Salem.

The hospital is only a mile down Center Street from your office at the Capitol. It is a pleasant walk at least until you take your first step into an abandoned wing. Then the heavy doors clang shut. Sunlight fades. Pigeon droppings crunch beneath your shoes.

From then on, every step you take down the long, echoing hallways of the Oregon State Hospital is a hard one.

In the abandoned hospital wing, you walk past graveyards of old office furniture, a battered upright piano, a corroding X-ray machine and piles of antiquated bed pans. A pigeon carcass lies in the middle of the room on water-stained carpet.

You step warily into a cavernous communal shower plumbed with just one handle to regulate water for all. No modesty shields separate toilets still filthy from the day they were last used. Bathtubs are stuffed with old chair cushions.

Peeling, rot and decay are everywhere. The smell of mold overpowers you. Dried rodent feces crackle underfoot, along with disintegrating asbestos floor tiles and fallen ceiling plaster.

When you look out the barred windows, you see swaths of lawn cordoned off. It's to protect people on the ground from being hit by falling pieces of roofing.

You know the history, governor. A task force urged Oregon to abandon the J Building and most of the other structures at the hospital nearly 20 years ago. Instead, the state has kept pouring money and patients into this place, opening new wards in buildings that should have been torn down long ago.

The fresh layers of plaster, like the yellow smiley faces, the plastic butterflies and the cheerful murals of birds painted on the walls, can't begin to paper over the awful conditions throughout the hospital.

It doesn't get much better when you see the occupied wards.

Governor, take the 200-foot-long walk through the maximum security ward for the most violent of the state's criminally insane. This bleak stretch of dark cells built more than a century ago is more frightening more inhumane than any place still in use in Oregon's prisons.

And this is called a hospital.

Peek in the attic spaces above the remodeled wards. Take a look at the white 5-gallon buckets tipped on their sides. When it rains, staff members trot upstairs to place the buckets under the leaks gushing into the hospital buildings.

Water puddles all along the several miles of spooky underground tunnels that link buildings along the 144 acres of hospital grounds. The tunnels go to an inadequately equipped central kitchen, where orderlies blast-freeze the cooked food, then ship it underground to various hospital buildings, where it is reheated and served.

Disturbing, painful images greet you around every corner. There's a large room crammed with mechanical fans most of the hospital has no air conditioning and no insulation. The place gets sweltering hot in the summer.

A room with a pool looks so sad and stark it's impossible to imagine anyone happily splashing in the water. A small room where patients are interviewed could hardly be any more austere, containing nothing but a table, two chairs and an empty water pitcher.

A soda machine stands in one corner of the hospital, the happy portrait of people guzzling Coke weirdly juxtaposed against the razor wire atop a security fence.

The newest building on the hospital grounds is the "50 Building," which coincidentally is a half-century old this year. It's worth a visit, governor. The elevator creaks and groans just to slowly make it up two floors. The wards are terribly overcrowded: Rooms designed for two patients contain at least three, sometimes four or even five. This is where Oregon expects its mentally ill to get well.

There's one last stop, governor. Visit the Cremains Building, where there's an abandoned morgue, crematorium and dented copper canisters containing the unclaimed cremains of 3,490 people who died at the hospital.

The battered cans are lined up on dusty shelves in a small square room. Somebody stuck a creepy plastic sticker of a human eye on one wall of the small building it seems to follow you wherever you step around the room.

Governor, you have shown you understand what's wrong with Oregon's mental health system. You set up a task force on mental health and have endorsed its findings, including moving to more community care and requiring insurers to cover more treatment for mental illnesses. You acted decisively to close the hospital's adolescent ward after this newspaper reported the abuse of teenage patients there.

But you need to see this place. Senate President Peter Courtney, D-Salem, recently toured the decrepit hospital and came away determined to do something about it. Several other legislators also have visited the hospital. The media have swarmed the place.

Yet you have not been inside these dreary walls since you were a young Democratic legislator three decades ago. The years haven't been kind to the hospital or to the thousands of patients who have walked the hospital's long hallways since you were here.

In May, the Legislature will receive a master plan to replace the hospital. Given the state's budget problems, lawmakers will be tempted to leave the costly replacement of the hospital, and the development of more small community mental health facilities, to yet another day.

That would be a tragedy, governor.

Any way you look at it.

© 2005 The Oregonian

Washington state's nondiscriminatory mental-health laws and first-rate hospital show how far Oregon lags

By Rick Attig and Doug Bates

A stately Douglas fir stands sentinel over grave No. 2324, where Mary Burgess was buried in 1934 at age 60. Nearby, a songbird tends its nest in a lovely locust tree, leafing out nicely in the spring sunshine. The clean, quiet cemetery provides a respectful final place of repose for Burgess and 3,217 other patients who died between 1876 and 1953 at Washington state's sprawling mental institution at Steilacoom.

How profoundly different this peaceful scene is from its counterpart south of the Columbia River. If Mary Burgess had died at the Oregon State Hospital in Salem, her cremated remains would be stored today in a corroding metal can stacked with more than 3,000 others in an all-but-forgotten "Cremains Room," locked securely out of public sight and mind. Just as that grim room provides a metaphor for the neglect of Oregon's mental institution, the bucolic cemetery in Steilacoom symbolizes Washington's far superior attention to the needs of the mentally ill.

Decades of Oregon leaders have allowed the 122-year-old Salem facility to deteriorate into an overcrowded, depressing wreck of a hospital. Washington leaders, meanwhile, have assiduously maintained their 134-year-old Steilacoom facility. Today, it's a mental health showplace. Its oldest structures stand as monuments to historical preservation, and its $50 million in state-of-the-art new wards serve patients humanely as a tribute to Washingtonians' compassion.

By comparison, the Salem hospital is a decrepit warehouse. Some wards have three, four, even five patients crammed into rooms designed for only two. Corridors and common areas are darker and more prison-like than many actual prisons. Plastic rain buckets line the attic of the hospital's "newest" building, now a half-century old.

Oregon leaders should check out their dreary facility in Salem, then tour Western State Hospital at Steilacoom.

First, they'll be struck by the meticulous preservation of the hospital's original buildings, dating back to 1871. Then they'll notice the newer wings the cheery, daylight-filled geriatrics ward, opened in 1981, and the spartan but humanely designed new forensics ward, opened in 2001 for people found guilty of crimes but judged to be insane.

The place is secure, but unlike Oregon's institution, this one has no concertina wire, no bars over windows, no crowded cell-like rooms. "It's a hospital setting, not a prison setting," explains Andrew Phillips, chief executive.

Washington's enlightenment on the subject extends beyond the facilities at Steilacoom. Lawmakers in Olympia joined a national groundswell in March by passing a mental-health parity bill, requiring insurers to treat mental illness the same as physical illness.

When Gov. Christine Gregoire signed Washington's bill, it left Oregon among only 16 states still allowing discrimination against the mentally ill for lack of insurance parity laws.

Washington legislators jumped even further ahead of their Oregon counterparts this month by advancing a sweeping reform of the state's approach to mental illness and chemical dependency. The bill could cost up to $140 million but would save a projected $80 billion over 20 years in jail costs, hospital expenses, law enforcement and social services by integrating screening and treatment for mental illness and for drug and alcohol addiction.

In Oregon, the Legislature shows signs of waking from its slumber on the subject. Senate President Peter Courtney, D-Salem, has initiated a long-overdue analysis of the future of the state hospital. A proposed master plan is to be unveiled in May. And Courtney introduced a mental-health parity bill that passed 23-6, backed by all Senate Democrats and five Republicans. The bill, however, remains bottled up without a hearing in the Republican-controlled House, where leaders still ignore how successful and cost-effective such laws have proved in most other states.

These foot-draggers should meet Olympia health-care lobbyist Randy Revelle, who helped lead the triumphant campaign for parity in Washington. He provided a rallying cry of sorts with an indelicate but honest anecdote, reported in almost every Washington newspaper, referring to the two medications in his briefcase. One, for diarrhea, was fully covered by his health-insurance policy; the other, for his bipolar disorder, wasn't covered at all.

"My health plan," he said, "values my ass more than my brain."

Revelle's frank public speeches about his personal struggle with mental illness and its stigma have brought many a Washington audience to its feet. Today, discriminatory treatment of the mentally ill is on the way out in his state.

Oregon has enlightened legislators who want to follow Washington's lead. But others stand in the way, apparently unconcerned that important facets of Oregon mental health remain shamefully stuck in a previous century.

This Legislature should pass a mental-health parity bill. It also should get to work on replacing its deplorable state hospital and helping to provide a proper memorial for those neglected souls in the Cremains Room.

For inspiration, a trip north on Interstate 5 might help, for a look at the dignified grave site of Mary Burgess in the more compassionate state next door.

© 2005 The Oregonian

Oregon has its own version of the power-obsessed icon, and you need look no further than the Capitol in Salem

By Rick Attig and Doug Bates

Thirty years ago, during filming of "One Flew Over the Cuckoo's Nest" at the Oregon State Hospital, it was already a foreboding, deteriorating place.

That's how Louise Fletcher remembers it. Each morning during the 1975 shoot, just driving up to the Salem institution helped prepare her to inhabit the role of the authoritarian Nurse Ratched.

"It was raining usually, and kind of sad and gloomy," the actress recalled in an interview last week. "So by the time I got to the hospital, I was in the mood."

Her performance, acclaimed as "frightening, riveting" by The New York Times, earned her the Academy Award for best actress. Her icy nurse also became a cinematic icon, ranking fifth on the American Film Institute's list of the top 100 movie villains of all time.

Three decades later, the complex character Fletcher brought to life on the screen remains relevant in Oregon. Her Nurse Ratched symbolizes the way this state treats its mentally ill. "We've all known ruthless people like Mildred Ratched," Fletcher said. "They have no give, no take. They feel empowered to say, 'We know what's best for you.' It's all about power."

You won't find Oregon's Nurse Ratched at the state hospital. Look instead a few blocks away at the Capitol. There, decades of legislators have done great harm while arrogantly assuming they were doing the right thing. Like the fictional nurse, many Oregon lawmakers have been blinded by ideological inflexibility and a destructive need for control. Along the way, they have grossly neglected the state's mental health system.

The 122-year-old dump of a hospital is only the most visible evidence, with its overcrowded wards and crumbling wing that engineers say could topple on 100 criminally insane patients in the next strong earthquake. Equally shameful is what most Oregonians will never see: The cutbacks in funding for medications and mental health services, the shortage of small community group homes for patients, the cramming of hundreds of severely mentally ill criminals into jails and prisons. This neglect has been going on for many years.

But it's the current legislative session that exposes Oregon's Nurse Ratched at her power-obsessed worst. House Republicans have bottled up a vital, compassionate bill to place Oregon among the majority of states providing health insurance parity for the mentally ill. For countless families, Senate Bill 1 would ease the hell of mental illness.

For GOP leaders, however, the bill is just a cynical bargaining chip. As the "Cuckoo's Nest" actress said, "It's all about power." This Legislature can still redeem itself in its few remaining days. It should pass SB1. It should make sure its final budget includes funding for the second phase of a master plan for replacing the state hospital. And it should find some seed money for proper interment of more than 3,000 canisters of unclaimed cremains of deceased patients, now locked away in a dismal storage room.

"I hope they do something," said Fletcher, who was surprised to learn that the old hospital used as the "Cuckoo's Nest" set was still housing patients. Oregon's mentally ill have never had much of a voice. That's why it's so oddly refreshing to hear Nurse Ratched, of all people, speaking up in their behalf.

© 2005 The Oregonian

As Salem lawmakers ponder the state hospital's future, Kansas provides a practical model for doing things right

By Rick Attig and Doug Bates

Oregon legislators should meet Whispering Bob.

Better yet, they should see his home on the plains of Pawnee County in western Kansas. There, the aging wards at Larned State Hospital are rattletraps, just as grim and depressing as the Oregon State Hospital in Salem. When an editor from The Oregonian toured the Kansas facility last week, one staff member in a decrepit wing referred to the surroundings as "the cuckoo's nest" a disparagement that's clearly not Oregon's alone.

But Kansas will soon leave Oregon far behind. In July, Larned State Hospital will open a sprawling new state-of-the-art psychiatric complex for Whispering Bob and up to 250 other mentally ill men and women who have committed crimes.

The people of Kansas are building the new hospital as much for themselves as for patients such as Bob. He is a very ill, strange man whom a lot of fearful citizens probably wouldn't want living next door. Bob speaks only in barely audible whispers. Since the day he arrived at the hospital a year ago, the staff has been greatly frustrated in trying to get him to alter his self-defeating, creepy behavior.

Legislators in Topeka understand that 98 percent of patients such as Bob will eventually return to the communities of Kansas. That helps explain why these mostly Republican lawmakers voted unanimously to spend $45 million to build a better psychiatric hospital. They're convinced it will lead to better treatment, which will lead to less crime and recidivism when these patients are discharged to places such as Wichita, Hutchinson and Salina.

Compared with Oregon, Kansas is an extremely conservative state. Thus its decision to issue bonds and spend state building funds bears repeating: There wasn't a single negative vote.

Altogether, Kansas is investing about $100 million on projects at Larned. This includes a new juvenile correctional and mental health complex, and massive remodeling of old wings for use by the state's much-heralded sexual-predator treatment program.

Oregon Gov. Ted Kulongoski and legislators in Salem should think hard about all this on Monday. That's when the governor and both chambers of the Legislature will receive a formal master plan laying out options for replacing the 121-year-old state hospital in Salem. Those options ought to include something very much like the new state security hospital opening soon in Kansas.

Though impressive in scale and design, it's purposefully as plain as the pancake-flat landscape surrounding it.

"The only red brick you'll see is at the entrance," says Bob Mann, the hospital's program director. "The rest is painted cement block. We went for space over aesthetics."

That priority is evident everywhere in the 300,000-square-foot complex. Mann is passionate in his belief that patients such as Whispering Bob can't receive adequate treatment in the relentlessly crowded quarters that now exist with up to six patients bunking together in jammed rooms.

"It's hard to help patients isolate themselves when it's that crowded," Mann said. "Mentally ill people have to have access to privacy. Not too much of it, of course, but if you're hearing voices, you need to be able to get away from the stimuli that are causing it."

That's why every patient at the new Isaac Ray State Security Complex will have a private room with a toilet.

Patients will spend most of their waking hours, however, in shared areas classrooms, gymnasium, library, dining areas, chapel, exercise room, day hall and a huge vocational-training wing. All of these areas are flooded with daylight through secure, unbreakable windows, not a prison bar in sight.

Nor is there any barbed or concertina wire to be seen outdoors on the big softball field and grassy picnic area. It's in the center of things, securely ringed by all the indoor accommodations.

The complex includes well-equipped medical facilities an infirmary, a clinic, a pharmacy, radiology department and laboratory that also will serve patients from the neighboring juvenile facility and a small state prison that was built 10 years ago at Larned to house prisoners with mental health issues.

The new hospital doesn't feel like a prison, though it borrows somewhat from modern corrections design, particularly in the hub-and-spoke layout of the living areas. But what a change it is from the old quarters, where it's hard to imagine a fragile patient such as Whispering Bob feeling safe enough to begin recovering. The old forensics building is a place so crowded and stress-inducing that on the morning The Oregonian visited, one overwraught patient caused a big stir by defecating on his breakfast tray.

"And that was comparatively a minor incident," said John Reid, the counseling psychologist who had to deal with the morning's unpleasantness. He said the jammed, dreary, obsolete facilities make patient and staff safety such an issue it gets in the way of treatment.

Mann echoed that. "The building and the treatment are not separate," he said.

Kansas is working to modernize its treatment as well as its hospital. This means moving from what Mann calls a traditional containment model for patient care to a recovery-based model.

Whispering Bob provides a good example. Peggy Wetjen, who coordinates Larned's social learning program, said the hospital can't help Bob unless it adapts to a "rehabilitation environment," getting away from the typical old power struggles with patients. She has spent months encouraging staff people to take a different approach to Bob. Ordering him to speak up doesn't work. Nor does threatening or getting angry with him.

She wants the staff to interact with him in a different way. She seeks to remove him from the victim role by creating small incentives, by modeling a less power-based form of behavior and by making him feel safer.

Wetjen's eyes lit up when she related what happened a short while ago. At a group therapy meeting, Whispering Bob stunned everyone in the room by suddenly speaking up in a normal, audible voice. It was just that once, but she now has great hope for his recovery after the move to the new hospital.

In Kansas, some people support this investment out of sympathy for unfortunates such as Bob. Others support it out of fear of the old, unrehabilitated whisperer moving in next door. Either way, it's the right thing to do.

And not just in Kansas.

© 2005 The Oregonian

Neglect is no longer an option: Oregon is now on notice that its rickety, overcrowded hospital could collapse

By Rick Attig and Doug Bates

Pam Gore and the other patients locked in the 41 Building of the Oregon State Hospital spent Monday thinking about the walls collapsing in an earthquake. On Tuesday, a bathroom pipe burst in the building, ceiling tiles crumbled and water gushed down walls.

"This is mental health treatment?" Gore asked a visitor Wednesday.

It is in Oregon. But this state is now on notice that its 122-year-old mental hospital is decrepit, overwhelmed by too many patients and dangerous. A team of hospital building experts said in a formal report that if an earthquake shakes the Salem area, the 41 Building that Pam Gore shares with 100 other criminally insane patients will collapse.

So it's over. Oregon can no longer avert its eyes from the deep problems at the state hospital and throughout its underfunded system of mental health care. The report delivered Monday to Gov. Ted Kulongoski and the Legislature described a hospital riddled with seismic, fire and electrical problems that could come crashing down on the heads of patients and staff at any time.

Oregon must have a new state hospital and an expanded network of community mental health facilities. It also must reform a judicial system that eagerly ships the criminally insane off to the state hospital, but only reluctantly allows them to ever leave it.

Without change, the report said, any new hospital Oregon builds will be overcrowded on the day it opens. This state must not exchange its worn-out warehouse for the criminally insane with a larger, brand-new warehouse.

It will take some time to design a new state hospital, determine its size, who should be housed there and where it should be built. Kulongoski, who toured the hospital complex last week, and legislative leaders have agreed to spend $350,000 on Phase 2 of the hospital master plan presented Monday.

They must not stop there. The real news here is that finally, after all these years, there is real political and public momentum behind a drive to replace the hospital and improve care in Oregon. There is much more that lawmakers could do right now for Pam Gore and others like her. Legislators should:

* Put more money and muscle into developing small community group homes for the mentally ill. No matter what kind of hospital Oregon builds, it will need more community beds.

* Approve Senate Bill 1, which would ban insurers from discriminating against those with mental illness. Insurance parity is the law in most other states. It's not in Oregon, where the mentally ill are pushed into crisis and toward the most expensive care of all, the state hospital.

* Create a memorial and a dignified resting place for the cremains of more than 3,000 patients left in dented copper containers at the hospital.

* Most important, keep moving on a new hospital. Lawmakers should appoint a special interim committee and approve bonds to fund the design and site work of a new hospital when the second phase of the master plan is finished in February. This can't wait for the 2007 Legislature.

The patients in the 41 Building know all about waiting for Oregon to fix its neglected hospital and to open community beds. Gore has spent five years and seven months living by the slow tick, tick, tick of the clock in a poorly ventilated hospital with no air conditioning, where the most prized possessions are electric fans. "We call it hospital time," she says.

Oregon has to move now. It cannot just wait for the next report, the next year or the next legislative session.

It can't do this on hospital time.

© 2005 The Oregonian

Lawmakers are running out of time to pass insurance parity and stop discrimination against the mentally ill

By Rick Attig and Doug Bates

Senate Bill 1, providing health insurance parity for mentally ill Oregonians, is caught in the deal-making of the last days of the Legislative Assembly. If this sausage-making is hard for the public to stomach, imagine how it looks to the exhausted families that have spent themselves into bankruptcy trying to get care for their mentally ill children.

If House Republicans get Senate Democrats to swap a capital gains tax cut for parity, Kathleen Ris could get to keep her son, rather than endure again the pain and humiliation of signing over his custody to the state, just to get him the health care that he needs.

Or, if House Speaker Karen Minnis gets the Senate to trade parity for her school funding plan, Sonja Tanner could get help the next time her son's mental illness flares, and he grabs a knife and vows to kill a boy having a birthday party across the street.

"It is nauseating," says Ris. "It just makes me sick. They think my son's health and his life are so trivial that this is just another bill to swap."

Senate Bill 1 would prohibit insurers from discriminating against people suffering from diseases of the brain. It is not just another bill; it is a long-overdue recognition of mental illness as a condition, not a stigma. It is a declaration that Oregon families should not have to lose everything, even custody of their children, to the hell of a mental illness.

Thirty-five other states already have some form of a law preventing insurers from putting more restrictions, such as spending caps and hospitalization limits, on mental illness than on other diseases. This compassionate, forward-thinking state should not be the last to eliminate discrimination against the mentally ill.

Opponents claim that insurance parity will drive up insurance premiums to businesses, and force many to drop health care insurance altogether. It is a fair concern, but it does not square with years of actual experience in other states. Study after study has demonstrated that providing equal coverage for mental illnesses results in less than a 1 percent increase in health premiums.

Every poll shows that Americans strongly believe in insurance parity. It is not a partisan issue not in neighboring Washington, which overwhelmingly approved parity this year, and not in the Oregon Senate, where SB1 passed 24-5.

Yet GOP leaders have locked Senate Bill 1 up in committee, and won't bring it to the floor for a vote. For House leaders, the parity bill is the ultimate trade bait because it is Senate President Peter Courtney's top priority.

These lawmakers cannot seem to see beyond their political calculations or the cold actuarial analysis that has prompted some business lobbies in Salem to fight the bill. They should talk to their own neighbors who are struggling with mental illness and suffering discrimination from insurers.

Ris and Tanner live near the east Multnomah County district that House Speaker Minnis represents. Ris' son is 14; Tanner's is 16. Both women tell heartbreaking stories of long battles to get mental health care for their boys.

Ris and her husband have remortgaged their home, wiped out their savings and spent nearly $100,000 on his care. For years their lives have been a blur of emergency rooms, psychiatric wards and fights with insurers.

Once when her son was hospitalized Ris got into a bitter argument trying to persuade her insurer to cover treatment in an inpatient day facility. "I was just trying to find a place for him when he got out the hospital, a place where he wouldn't kill himself, or me," she said.

Four hours later, she says, the hospital called and informed her it was discharging her son. The insurer had cut off payments to the hospital. The explanation: If Ris' son was well enough for day treatment, he must not need 24-hour hospital care. "I learned not to argue with them," she says.

Last year, Ris and her husband had little choice but to sign partial custody of their son over to the state, which would make him eligible for inpatient care. "It was so humiliating," she said. "It made us feel like we weren't capable, not good parents." They have since regained full custody of their boy, but she says they may again have to relinquish custody: "He's starting to slide."

Tanner has testified to the Legislature about the need for parity, but she didn't tell lawmakers everything. The single mom didn't tell them how her son "has threatened to kill so many children I can't even begin to name them." She didn't tell them about spending her last dollar on his care, how the gas company shut off service, sometimes for weeks, and she heated water in a microwave to wash dishes.

Tanner didn't tell them about all the years she kept her kitchen knives locked in a toolbox on the counter, or about how she found cash in an unsigned envelope in her mailbox on her birthday, and stood in her driveway crying.

Tanner's son is eligible for a total of 15 days of inpatient care. When the troubled boy burns through that treatment "it goes fast," his mom said he is out of care. He must go home.

Only about 15 days are left in this session. If this Legislature fails to stop the discrimination against the mentally ill, if all the cynical trade deals collapse, those who are responsible will have used up all their time in the Capitol. Their failure will follow them home.

© 2005 The Oregonian