Portland mayor suggests easing process to involuntarily commit people with mental health struggles

Portland Mayor Ted Wheeler wants it to be easier to force people living on the streets into hospitals — even if they have not committed a crime.

“When I see people walking through the elements without appropriate attire, often naked, they are freezing to death, they are exposed to the elements … I don’t even know if they know where they are or who they are,” Wheeler told a room full of business owners recently, “They need help and they need compassion.”

Wheeler’s comments came at a meeting to discuss crime in Portland’s Central Eastside. The mayor held the forum after the owner of Portland’s well-known ice cream brand Salt & Straw threatened to leave the city and amid his own effort to get tougher on public camping. He was asked directly at the forum whether he would support hospitalizing more people involuntarily.

Wheeler prepped the audience, saying he would be “resoundingly excoriated” for his comments.

But, yes, he continued, he believes it’s time to consider lowering the threshold for civil commitments and force the city’s most vulnerable to get mental health help against their will. Right now, a person can only be civilly committed by a judge’s order and if they pose an urgent danger to themselves or others and are unable to care for their basic needs.

The audience applauded the mayor’s call, a striking response in a city that has historically prided itself on its compassionate and empathetic approach to helping the unhoused and those struggling with addiction and mental health issues.

“We are in the middle of a shift from where the majority of people who were once sympathetic to the homeless are now angry,” said Jason Renaud, with the Mental Health Association of Portland. “And people are angry at the homeless and blame them. It’s a shift that comes from the county, the city and the state not doing anything about this problem, to the point where people get mad.”

Wheeler’s plan to tackle the growing crisis on the streets includes a “90-day reset” in the industrial eastside of the city, which would boost the number of law enforcement in the area and likely result in more homeless camp sweeps. It’s a similar approach to what was used in Portland’s Old Town neighborhood earlier this year and a strategy some have criticized as compounding the problem.

Kaia Sand, the executive director of Street Roots, wrote: “It’s hard not to feel exasperated at the shortsightedness, at best, and cruelty, at worst.”

Wheeler and colleagues on the Portland City Council are also working to ban unsanctioned camping and force houseless residents into large city-run encampments that have yet to be built.

“All of us need to recognize that our mental health and substance abuse treatment services in Oregon are woefully inadequate,” the mayor’s spokesman said in a email to OPB following up on his Central Eastside remarks. “The mayor believes nothing should be off the table in identifying solutions.”

Street campers on Southwest 13th Avenue in Portland are cleared from the area on April 12, 2022. The camp had been home to a group between the ages of 18 and 24. Many used the services across the street at Outside In, a nonprofit the campers said they relied on for showers, laundry and occasional medical appointments.

Street campers on Southwest 13th Avenue in Portland are cleared from the area on April 12, 2022. The camp had been home to a group between the ages of 18 and 24. Many used the services across the street at Outside In, a nonprofit the campers said they relied on for showers, laundry and occasional medical appointments.

Rebecca Ellis / OPB

A high standard

The process to civilly commit a person is not easy in Oregon; part of that is by design and part of that is because of systemwide failures facing the state.

Changing the process and lowering the standard for committing people would be a Herculean task both logistically and politically. It would require changing state laws and solving both a staffing shortage among both health care workers and law enforcement officers and a lack of capacity at the state mental hospital and residential treatment facilities.

More broadly, changing the commitment laws would require a philosophical reckoning as well: deciding whether this is the way Oregon wants to tackle the mental health and homeless crisis.

Terry Schroeder, a civil commitment coordinator with the Oregon Health Authority, has been working in this arena for more than four decades. Civil commitments, he said, were never intended to solve the problems society is facing.

“It provides a false sense of something is going to change by saying that …” he said, adding, commitments were never meant “to address the homeless and drug addictions and the other kind of social issues we have.”

The idea of forcing people into institutions has gained more attention recently, both with the increased number of people living on the streets and the move recently by New York City Mayor Eric Adams to direct police to hospitalize people they deemed mentally ill even if they pose no threat to others.

It’s not a new idea: During the 19th Century, institutions were created to house an increasing number of people suffering from mental illness. People were often locked away, for life, in dismal and horrific settings.

In the early 1960s, President John Kennedy said in his State of the Union that the “abandonment of the mentally ill … to the grim mercy of custodial institutions too often inflicts on them and their families a needless cruelty.”

Eventually, as the nation moved toward closing large, state-run mental institutions in the 1960s, laws were created to protect people’s civil rights. Civil commitment is currently meant to be a last-resort option. A person can only be committed without their consent if a judge decides they’re a danger to themselves or others, that the danger is imminent, that they can’t take care of their basic needs — and that all other options to help have been exhausted.

Dave Boyer, a managing attorney for the Mental Health Rights Project with Disability Rights Oregon, said he believes the real issue remains funding services to help people, rather than forcibly taking them off the street. He would like to see more resources to help people before they reach a crisis point.

“The money they are spending to criminalize mental illness or increase the population at hospitals could be better spent on community health care, affordable transitional housing, transportation services, the things that actually benefit people with disabilities and keep them out of much more expensive facilities,” he said.

Washington County District Attorney Kevin Barton said many people who fail to meet the standard for civil commitment end up in jail — and are forced in mental health treatment later only so they can participate in their own defense.

“The standard in Oregon is unreachable in many cases,” he said. Lowering the standard, he suggested, would enable people to receive treatment earlier — and keep some people out of the criminal justice system.

Very few people who are civilly committed go to the state hospital, where there is an ongoing problem with lack of beds. In 2021, only four people were civilly committed to the state hospital, according to data from the Oregon Health Authority. Most people are housed in regular hospitals.

“They serve out their commitment at the hospitals at a full, private hospital rate that is billed to the state’s general fund,” said Renaud, with the Mental Health Association of Portland, noting the cost is much higher than many alternatives.

Oregon’s largest hospital systems are currently suing the state for not providing adequate care for mentally ill patients, saying the state has put more stress on hospitals and forced them to house people for months in space not meant for those struggling with mental health disorders.

In 2020 and 2021, 571 and 517 people were committed in Oregon, according to the state. Those numbers represented about 7{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} of all the civil commitment cases closed in those years. The vast majority of those people were sent to community hospitals.

Multnomah County Circuit Court Judge Nan Waller, the presiding judge of the mental health court and competency dockets, said the state needs to bolster the entire continuum of care.

Waller told state lawmakers it’s nearly impossible to find the right place to send people.

“I can’t get anyone into a secure residential treatment facility at all,” Waller recently told state lawmakers. “There are no placements.”

Rep. Rob Nosse, a Democrat from Portland, said the question of lowering the threshold to commit people arises nearly every legislative session. He said he’s not opposed to examining the issue, but echoed Waller’s suggestion that figuring out how to build capacity and offer more care that wouldn’t entail civilly committing people should be the first priority.

On a recent cold afternoon in downtown Portland, Joshua Rasmussen, a 42-year-old unsheltered man, talked about the prospect of being civilly committed. Rasmussen, who acknowledged using crystal meth occasionally, said a person has to be ready for a recovery program to work.

“It’s not a very good solution, it’s just a band-aid,” he said. “They think they’ll fix it, but it will come back up and they will be back right to where they were. Because you can’t force people into anything, at least in my mind.”

Amelia Templeton contributed to this report.