Oregon Public Broadcasting

What happens when the only psychiatric unit in a rural county closes?  It happened in Roseburg, Oregon recently.

The closure left the city of about 21,000 people with a big gap in services for the mentally ill.  And as correspondent Chris Lehman reports, the shut down could have a ripple effect across the entire region.

Mercy Medical Center in Roseburg

Scott Mendelson was a psychiatrist in the Behavioral Health Unit at Mercy Medical Center until the day it closed last October.  He says he loved every minute of his more than seven years there.

Scott Mendelson: “I thought then and I still think now that it was the best psychiatric unit in the state of Oregon.”

But even if it was the best, it wasn’t making money.  Hospital officials said cutbacks in state funding meant they couldn’t make ends meet on the 28-bed unit.

Mendelson says the imminent shutdown brought talk of doom and gloom in the community.

Scott Mendelson:  “There were people who thought that the sky would fall when this happened. I didn’t the think the sky would fall and it hasn’t fallen.  There’s just a little bit more suffering and death in Douglas County.”

That’s what happens when people on the edge feel like they have no place to turn.

The Mercy Medical Center emergency room is still accepting people in mental health crisis.  But now, those people are held for at most a few days.  Then, they’re either discharged or sent to other hospitals, sometimes as far away as Boise, Idaho.

Douglas County Health Director Peggy Kennerly says that’s not only inconvenient, it’s a hurdle in the road back to wellness.

Peggy Kennerly:  “They may not get that same sort of ability to continue with relationships with their family and friends, that support they bring.  Developing a care plan is much more difficult, because we’re doing it long distance, so people tend to like to stay in the community because it’s an easier adjustment when they get out than coming out of a unit someplace else.”

And sending people out of town has another drawback:  It puts additional pressure on a mental health system that’s already stretched to the limits.

Peggy Kennerly:  “Other hospitals in other counties really depended on Mercy Behavioral Health Unit to send their overflow, so for them, that’s a lot of beds to lose in a system, 28 beds.  The system isn’t that big that can afford 28 beds to be gone.”

In fact, the closure in Roseburg means a loss of nearly ten percent of the short term mental health beds in the state.

Typically people in short-term care are sent home after about a week or transferred to a long-term care facility.  The problem is, there’s a waitlist to get into those long-term facilities, especially the ones run by the state.

Robin Henderson: “We’ve been functioning as a system in crisis with this waitlist problem now, for probably five to six years.” 

Robin Henderson is head of the psychiatric unit at St. Charles Medical Center in Bend.  She chairs a committee of her fellow psych unit directors around the state.  She says the backlog creates an extra burden on hospitals.

Robin Henderson:  “When you’re looking at folks who are waitlisted, sometimes the state is able to pay for those folks, sometimes depending on the situation, they legally are not, or the funding is not there.”

That’s one of the main reasons why the psych unit in Roseburg closed.  It used to serve 1200 patients a year. Now officials are trying to minimize the impact of the shutdown.

People like police officers and librarians are receiving additional training on how to recognize mental health problems in the people they deal with.

But Roseburg Police Sergeant Aaron Dunbar says that extra knowledge can only do so much without the resources to back it up.  He says officers have to be more selective about who they take to the emergency room.

Aaron Dunbar:  “We’re kind of at the point where, unless they have a plan -- ‘I’m going to kill myself, this is how I’m going to do it, I’m going to do it in this kind of time frame’ -- you know, real specifics on a suicidal threat, people just aren’t being held.”

Of course, not everyone affected by the shutdown is suicidal.  Some just need ongoing psychiatric care, the kind provided by Scott Mendelson.  He says he often runs into his former patients around town,

Scott Mendelson:  “Sometimes they tell me that they’re having a difficult time; that they haven’t been able to find anyone to see them; that they don’t know what they’re going to do.  They ask me for advice and I’m at a loss to tell them what they can do for themselves.”

They can’t see Mendelson, because he’s got a new job at the VA Medical Center, where he doesn’t see patients from the general public.

Help with reporting this story came from people in our Public Insight Network. PIN members are helping us cover the news by sharing their knowledge and experience.   If you'd like to contribute your knowledge, you can learn more about the Public Insight Network on our web site - opb.org/publicinsight.