Oregon State Hospital
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1 Oregon State Hospital Presented to the House Health Care Committee November 16, 2015 Lynne Saxton, OHA Director Greg Roberts, Oregon State Hospital Superintendent
2 Vision and mission Vision We are Oregon s adult psychiatric hospital that inspires hope, promotes safety and supports recovery for all Mission To provide therapeutic, evidence-based, patientcentered treatment focusing on recovery and community reintegration all in a safe environment 2
3 State hospital services Intensive psychiatric treatment for adults with severe mental illness who are civilly or criminally committed for mental health treatment So far in 2015, Oregon State Hospital has cared for 1,376 people who could not be served in the community Hospital level of care: 24-hour on-site nursing, psychiatric, and other credentialed medical staff, treatment planning, pharmacy, laboratory, food and nutritional services, vocational and educational services Services help patients achieve a level of functioning that allows them to successfully transition back to the community 3
4 Who we serve Civil program Patients civilly committed or voluntarily committed by a guardian Those who are dangerous to themselves or others, or who are unable to provide for their own basic needs due to their mental illness Neuropsychiatric program Patients who require a hospital level of care for dementia, organic brain injury or other mental illness, often with significant co-occurring medical issues 4
5 Guilty except for insanity (GEI) Who we serve People who committed a crime related to their mental illness. Depending on the nature of their crime, patients are under the jurisdiction of: Psychiatric Security Review Board (PSRB, Tier 1) Oregon State Hospital Review Panel (SHRP, Tier 2) Aid and assist (.370) Ordered to the hospital by circuit and municipal courts under Oregon law (ORS ) for mental health treatment that will enable them to understand the criminal charges against them and to assist in their own defense 5
6 Treatment malls Centralized active treatment many opportunities in one place Twenty hours during weekdays Mimic work or school-day routines Help patients learn to manage illness and build skills Groups selected to meet patients needs and interests Focus on preparation for community reintegration 6
7 Treatment mall groups - examples Vocational rehabilitation Food service Furniture making Grounds keeping Supported education Art therapy Music therapy Mindfulness Peer-delivered service Co-occurring disorders Legal skills Dual diagnosis Community volunteering 7
8 Where we started
9 Timeline 2005 Oregon State Hospital Master Plan 2006 First treatment mall opens 2007 Legislature approves Salem and Junction City 2008 USDOJ findings 2010 Liberty Healthcare Report Excellence Project begins 2011 First patients move into new Salem facility 2012 Salem campus fully operational 2014 Blue Mountain Recovery Center closes 2015 Portland campus closes, Junction City campus opens 9
10 Where we are now Salem campus
11 Where we are now Junction City campus
12 Census Oregon State Hospital (OSH) and Blue Mountain Recovery Center (BMRC) July 2013 through October 2015 Patient type Guilty except for insanity (includes juvenile PSRB) Avg. daily census Admissions Discharges Median days at hospital* Aid and assist (ORS ) Civil (civil commitment, voluntary, voluntary by guardian) Neuropsychiatric/Geriatric Other (corrections, hospital hold, other) Total *Median days at hospital based on patients currently at OSH as of 12/31/2014 *Median days at hospital based on current patients as of 10/31/ ,993 2,
13 Census (trends) Total population OSH monthly patient populations since 2010 (Based on the census count on the last day of each month) 13
14 Census (trends) Guilty except for insanity (GEI) Guilty except for insanity (ORS ) patient monthly population since 2010 (Based on the census count on the last day of each month) 14
15 Census (trends) Civil Civil (ORS ) Patient monthly population since 2010 (Based on the census count on the last day of each month) Blue Mountain Recovery Center transition 15
16 Census (trends) Aid and Assist OSH Aid and Assist (ORS ) patient monthly census Since 2010 with two-year projection based on seasonal trends
17 17 Salaries, taxes and benefits 81% of Oregon State Hospital s Legislatively Approved Budget Total staff budgeted 2224 for both campuses Staff who provide direct care 1572 (71%) Nurses Treatment care plan specialists Psychiatrists Social workers Psychologists Rehabilitation/occupational specialists Unit staffing is based on: Safety Staffing 24/7 onsite care Level of care (acuity) severity of symptoms, how much care patients need Commitment type Civil, Guilty Except for Insanity, Aid and Assist Agreements between hospital and union leadership
18 Where we are going Staff training Trauma informed care Collaborative problem solving Short term assessment of risk treatability (START) Case formulation Treatment care planning Safe communication Psychiatric emergency response teams (PERT) Safe containment 18
19 Improving Federal and other revenue Optimizing infrastructure Hiring and developing staff for identification of billable services Modernizing billing system Partnering with community mental health and Medicaid policy team Improving documentation of medical need and services Opportunities Expand certification to more units through Centers for Medicare and Medicaid Services (CMS) Increase ability to bill Medicaid for administrative services Add state hospital inpatient psychiatric services coverage through coordinated care organizations (CCOs) 19
20 Priorities Raising system-wide expectations to focus on the right care, right place, right time Reduce or eliminate the civil waitlist Reduce the length of stay for patients who are civilly committed Discharge patients who have been civilly committed within 30 days of being determined ready to place/transition Decrease the number of people admitted under ORS
21 21 Thank you
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