In August, Clatsop County Sheriff's deputies arrested a man who refused to speak. He urinated and defecated on the floors and walls of his cell, and on himself. He wouldn't let the jail nurse examine him. He spent more than a month in the jail.
Jerry Schell, a Clatsop Behavioral Healthcare crisis counselor, came to the jail to evaluate the man three times. But because the man wouldn't speak, Schell couldn't make the evaluation. Schell said it's difficult to give people involuntary treatment or hospitalization.
A county jail cell is no place to house a mentally ill person, county leaders say.
The problem is that hospitals don't have the facilities to hold the mentally ill detainees. So when police detain the mentally ill, they end up confined in a jail cell.
Joell Archibald, Clatsop County director of Health and Human Services, found a piece of the answer.
She is applying to the state for "Jail Diversion Money" - funds the Legislature has set aside to care for the mentally ill by keeping them out of jails and preventing them from cycling back into jails after they leave.
She is asking for $34,142 over the next biennium to reduce the number of mentally ill people serving time in local jails.
She is also asking Salem for $17,509 to help manage cases over the biennium by:
? reducing the number of people diverted by county jails to Oregon state hospitals;
? buying medications for use after jail discharge;
? managing cases with courts and parole officers;
? supporting housing services;
? referring clients to Alcoholics Anonymous and other recovery support groups.
"This has been a problem for the county for such a long time. It was driven to the attention of the Public Safety Coordinating Council," Archibald said. She said the state cited Clatsop County and Clatsop Behavioral Healthcare last year for not having a hold room. CBH contracts with the county to do evaluations of jail detainees.
County commissioners are frustrated; judges are frustrated; law enforcement is frustrated; and county health workers are frustrated.
In June, the PSCC along with representatives from law enforcement agencies, Columbia Memorial Hospital and Providence Seaside Hospital met with a state official, who said holding the mentally ill in jail cells - and possibly with other inmates - creates a greater liability issue than putting them in a hospital.
"Neither hospital wants that responsibility singly, so it makes sense to do both," Archibald said. "We can help try to solve these problems with resources, issues and demands, but ultimately, the hospitals need to own these issues."
But the hospitals have issues of their own.
"We're not a certified facility, and we're not in the process of becoming a certified facility because of the expense," said Steve Buckelew, CMH director of marketing.
He said the hospital is growing, and can't afford the expense of building and operating a hold room. The hospital already has new facilities under construction and an inpatient/outpatient clinic on the planning board.
But when the emergency room expands, there are plans to include a hold room.
Buckelew said Bill Thorn, CMH chief operating officer, went through the process and expense of installing a certified hold room while he was with Legacy Mount Hood Medical Center.
"You have to build a separate room for holding," Buckelew said. "It's cost. It's what you have to go through to do it.
"It's a room for one."
"For us, it would be new construction. We literally use every square foot of what we've got," said Bill Sexton, Providence Seaside Hospital's chief executive for the North Coast service area.
He said staffing would be a problem too. Even if the hospital had one person working around the clock to staff a hold room, that's three full-time employees. That doesn't include support staff.
Sexton said safeguards are a concern for hospitals too. In the case of a violent detainee, the hospital has to protect staff, other patients and the general public.
He said the need for facilities for the mentally ill isn't exclusive to Clatsop County. It's a nationwide problem. Sexton said most normal medical resources don't cover mental health issues.
Michael Morris said hospitals take the attitude that they need to have a safe place in their hospitals for individuals with mental illness. Morris is the quality improvement and certifications manager for Oregon's addictions and mental health division.
"Some hospitals have just decided that this is the right thing to do, to have a hold room until they can find a safe place for the mentally ill," he said.
He said Tillamook County General Hospital - which had been resistant to the idea - installed a hold room.
Frank Hanna-Williams, executive director of Tillamook Family Counseling Center, was instrumental in bringing the hold room.
He said the process had a lot to do with having registered nurses on staff.
"The hospital hasn't built anything," he said. "It's not a building or a wing."
Hanna-Williams said emergency room physicians work with mental health providers. He said people with mental illness are going to go to emergency rooms for care regardless of whether there is a hold room or not.
"I think one of the other things we face is that the conditions reach disastrous levels before we react to them," Sexton said. "Then they are more expensive to deal with."
Nancy Winters, CBH director, said it's expensive for hospitals not to have hold rooms.
"To serve the community well, we need these services in this area," she said. "A lot of these people are sitting in their emergency rooms.
"It's not good care."