<<Many of Portland’s least fortunate live in tents pitched on sidewalks or in aging campers parked in small convoys behind grocery stores.
High housing costs and financial adversity are the primary root causes behind the burgeoning population on the streets; only about one in three people who are homeless in Portland report having a mental illness or a substance use disorder, or both.
But the combination of homelessness with substance use or untreated mental illnesses has led to a lot of very public tragedies.
People with schizophrenia, for example, have died of hypothermia on the city’s streets. Residents have given birth out in the open, to premature infants who did not survive. Methamphetamine, cheaper and more harmful than it used to be, is creating a heightened risk of overdose and psychosis.
Mental illness can be part of the story of how a person ends up homeless — or part of the price of survival on the streets, where sleep and safety are scarce. Unsheltered residents in Portland die thirty years earlier than the average American, according to county data.
These grim realities have ratcheted up the pressure on politicians to do something.
In Oregon, some politicians, including Portland mayor Ted Wheeler, have proposed changing civil commitment law, so doctors have more leeway to compel treatment for patients who are too sick to know they need care.
Without such changes, they argue, people with untreated addictions or mental illnesses are stuck cycling between the streets, county jails, and state psychiatric hospitals.
“I think we can do better by people than allowing them to flounder,” says Janelle Bynum, a state legislator who represents suburbs east of Portland.
Bynum was the sole Democrat to sign on to a pair of bills, introduced by Republicans earlier this year, that would expand the criteria for involuntary commitment in Oregon. “My intention was to signal how cruel I think our current system is,” she says.>>
<<A Republican proposal to add substance use disorders as grounds for involuntary treatment has stalled in the state’s Democratically-controlled legislature.
Most Democrats are instead focused on the severe lack of treatment capacity and the state’s inability to serve either the large number of people who want mental health treatment, or those who have already been involuntarily committed under current law.
All over Oregon, there are long waiting lists. For example, for substance use disorders, experts say the statewide capacity in prevention, treatment, and recovery services is roughly half of what’s needed.
Oregon currently has two state-run psychiatric hospitals, which together comprise just under 600 beds total. And over the last 10 years, more of those beds have been needed for another population: people transferred from county jails because they are too mentally ill to understand the charges against them. As a result, patients who would be referred due to a civil commitment cannot get a bed in the state hospitals.
In addition, there’s a shortage of beds in community care settings such as nursing homes, adult foster homes, or residential treatment facilities.>>
<<The situation has become so dire that last fall, three of Oregon’s largest hospital systems sued the state over its failure to find placements for civilly committed patients.
Robin Henderson is the behavioral health director for Providence Oregon, one of the hospital systems that filed suit. Henderson says expanding the criteria for civil commitment won’t solve the problem of where to send people for treatment and long-term recovery.>>
<<“We really don’t have a plan for people, a very small number of people who pose the hardest societal, ethical, questions: people who can’t care for themselves,” Henderson says.>>
<<Nationwide, rents have risen more quickly than people’s incomes in the last twenty years, and those soaring rents are having a disparate impact on people who rely on a fixed income such as monthly disability payments.
In the West, cities like Portland, San Francisco, and Los Angeles have all seen sharp surges in housing costs.
Washington County, west of Portland, is home to the global headquarters for Nike. The average monthly rent for greater Portland, including Washington County, rose from about $800 in 2010 to just under $1,400 in 2021.
Chance Wooley works for Washington County, supervising services for people being investigated for a possible civil commitment. Wooley says the gap between high housing costs and disability payments is pushing people with serious mental illnesses into homelessness.
When he started in this job, 20 years ago, it was much easier to transition people from a treatment home into independent housing, Wooley says.
Back then, a person living on a monthly disability check could afford to pay the rent on a studio apartment and still have enough left over for groceries and utilities.
“That’s not a reality any more,” Wooley says. The state’s new governor, Tina Kotek, has chosen to push forward on two fronts: more housing aid, as well as more treatment beds for psychiatric and substance use disorders.
Oregon is also pioneering an approach that tries to tackle both housing and health simultaneously. The new pilot program, launching in 2024, will make Oregon the first state in the nation to use Medicaid money to pay for housing costs.
The funds, previously limited to medical care, can now be spent on supports such as rental assistance for people who are homeless and participating in mental health or addiction treatment.>>