Oregon Reviews Commitment Laws as Suicides Slip Through Cracks

After his wife left him, Richard Hasha couldn’t stop pacing, couldn’t eat, couldn’t sleep.

He told a friend to take his guns away, and deputies who were called to his home spent hours talking him out of suicide so they could drive him to the hospital for help.

“Are you suicidal?” the emergency room doctor asked.

“I don’t think so,” Hasha replied. “The only thing I love more than my wife is life itself.”

Over the deputies’ objections, the burly, 43-year-old pipe welder was put back in the squad car and sent home.

Five days later, Hasha sealed his front door with packing tape, emptied three bottles of prescription drugs and washed the lethal mixture down with 80-proof Chivas Regal scotch.

“It shouldn’t have happened,” said Jesse Hearne, who came in several hours after the June 1 suicide and found his brother sprawled on the floor, clutching the phone. “They should’ve put him in a neutral place until he was safe, until he had time to think things out.”

Advocates for the mentally ill say Hasha is among a growing number of Oregonians who slip through the system because they don’t meet the narrow criteria making them eligible for immediate psychiatric care.

“There isn’t anyplace we could spend money in government that would have greater impact on quality of life than in this area,” said Mark Gardner, special counsel to state Atty. Gen. Hardy Myers. “If there is anywhere government should have a role in our lives, this is it.”

Gardner leads a task force formed last fall to examine the state’s civil commitment laws and help draft legislation for change.

As it stands now, only those judged to be an immediate threat to themselves or others or who are unable to provide for their basic needs can legally be committed without their consent.

The review was prompted by a case in which a family tried in vain to get services for their mentally ill daughter, who refused help and eventually died of neglect last year in her Portland apartment.

Many say tragic outcomes are becoming more common as mental health resources are stretched and managed care continues to emphasize the bottom line--a trend mirrored across the nation.

With the phaseout of state mental institutions, hospital emergency rooms have become increasingly responsible for psychiatric emergencies. Most have a trained physician or social worker on call to make the evaluations. But for those like Hasha who don’t meet the state committal criteria, a release or referral is often not enough.

“We frequently hear reports of problems with emergency rooms,” said Tamara Hancock, president of the Oregon chapter of the National Alliance for the Mentally Ill. “They’re not set up to deal with a psychiatric crisis. Someone on the edge of being suicidal is likely to be prioritized fairly low.”

But even brought in under police holds, patients can say the right thing that will result in their release, said Bob Joondeph, executive director of the Oregon Advocacy Center, which represents people with disabilities.

“A lot of times the person at that point says, ‘I feel better. I don’t want to kill myself,’ ” he said. “If a person can come up with that kind of thing, generally they are let go. They sound rational. They say they are not going to do it and they have a plan in place should the situation come up again.”

What’s lacking, he said, is some sort of safe haven that could serve as a middle ground.

“Right now the choice is all or nothing,” Joondeph said. “Either you’re in for the whole nine yards or you go home.”

In several recent incidents, going home has had tragic consequences. In April 1997, Emily Comeaux, a 37-year-old mental health worker, shot and killed herself at a Portland crisis center, saying she couldn’t wait any longer for help.

“Sometimes it takes a death to make a major change in a corrupt and incompetent system,” she wrote in her suicide note.

And last November, Washington County deputies responded to reports of a suicidal man in Aloha. After they disarmed Wayne Paul Winkelman and took him to an emergency room under a police hold, he was released. He shot himself in the head the next morning.

“We recognize they have to prioritize their cases, but it’s frustrating,” said Washington County sheriff’s Lt. Rich Hildreth. “We think these people need help. Otherwise we wouldn’t have gone to the extreme of putting the person in custody.”

He said repeat encounters with the mentally ill are common. In Hasha’s case, police were called in twice in his final days to check on his welfare. Winkelman had been talked out of suicide three times by police over a four-year period.

“It’s frustrating for officers,” said Portland police Officer Sara Westbrook, coordinator of the city’s crisis intervention team. “They’ve become the direct service workers for the chronically mentally ill.”

Portland is unique in that it has the Providence Crisis Triage Center, a psychiatric emergency room where police holds can be taken and ensured an evaluation. More than 100 officers have been trained in how to deal with the mentally ill.

But such programs aren’t practical in smaller communities, where resources are thin and training isn’t as readily available. Experts say there is no simple solution to fill the gaps.

For the state task force--which includes a wide range of interests, from civil liberties lawyers to ethics professors--the only consensus so far is that mental health services are underfunded, Gardner said.

Westbrook and others would like to see earlier intervention, before it comes down to an emergency room drop-off. They say more education could help erase misconceptions about the mentally ill that are reflected in insurance coverage.

And some say broadening the involuntary commitment criteria could help those whose mental state prevents them from making rational decisions.

Gardner, a former judge who sat on the bench for 17 years and heard many civil commitment cases, said he’s seen the tremendous difference treatment can make--”from barely existing to a point where they can lead extremely productive lives.”

But any move to increase commitments is sure to be opposed among staunch supporters of civil liberties.

“It’s really important to remember that we live in a free society,” Gardner said. “People get pretty nervous when the state starts stepping in and depriving people of their liberty unless it’s for a very good reason.”

For Hearne, his brother’s life is reason enough.

“Every time I shut my eyes I see him laying there,” he said. “All he needed was to be taken in and counseled. I can’t help thinking he got robbed. And I got robbed too.”