A state work group studying how Oregon civilly commits people experiencing serious mental illness gave 51 recommendations to lawmakers to consider for the 2025 legislative session.
The recommendations, backed by the group representing several state agencies and nonprofits, aim to make the process more accessible, more effective and more equitable.
One of the group鈥檚 members, the Oregon chapter of the National Alliance on Mental Illness, is also leading a push to implement a more controversial change that the state has considered over the years: making it easier for a judge to civilly commit a person who is found to be a danger to themselves or others due to mental illness.
A bill that the group is helping to author would change current law in several ways. One is allowing a judge to consider a person鈥檚 past suicide attempts and potential to harm themselves or others within 30 days, rather than immediately, when assessing that person鈥檚 risk. Another is clarifying the definition of danger to self. Chris Bouneff, executive director of Oregon NAMI, said the state鈥檚 existing criteria are so narrow that they exclude people who are vulnerable to self-harm or are unable to care for themselves.
Without treatment, some people wind up facing criminal charges, where they are ordered into care after being deemed not competent to stand trial. Others spiral into physical harm to themselves or others. InvestigateWest recently reported , who experienced psychotic illness and suicidal ideations, and despite multiple contacts with her community鈥檚 crisis system, was left alone when she refused care. She died by suicide in June.
Bouneff says his organization encounters people in similar situations on a weekly basis.
鈥淲e are committing people today. We鈥檙e just doing it through the criminal justice system,鈥� he said. 鈥淲e have a very surgical goal, which is to take people who are so acute that we鈥檙e committing them only after they鈥檙e arrested, and we want to spare people from encountering the law enforcement system.鈥�
The NAMI-backed bill is far from the first of its kind. Similar legislation was introduced in 2019, 2021 and most recently in 2024; each bill died in committee after garnering passionate testimony both in favor and in opposition. The pitfalls involved with forcing someone into care have slowed momentum to broaden the use of involuntary care, though calls for change have increased as more people experienced mental health crises.
Even among the state work group, which spent the last two years studying civil commitment and potential solutions, members remained somewhat split on whether modifying the criteria is the right move.
Other advocates who were part of that group with Oregon NAMI criticize attempts to expand civil commitment as misguided, a symptom of overemphasis on involuntary treatment that will place more demands on an already-stressed system.
鈥淩ight now, when somebody is waiting in an emergency room for weeks, that鈥檚 not treatment,鈥� said Meghan Moyer, public policy director for Disability Rights Oregon. 鈥淭hey鈥檙e not getting treatment. They are often chemically and physically restrained, often on a hospital bed in a hallway. And that鈥檚 right now, that鈥檚 today鈥檚 application of statute, and I get very nervous when you increase that. What does that look like?鈥�
State data underscore Bouneff鈥檚 point that severe mental health issues are increasingly being dealt with within the criminal justice system. The number of people ordered into mental health treatment solely to participate in a criminal case has 鈥渞eached crisis levels,鈥� according to the Oregon Health Authority: The number of people under such an order increased by 250% from 2000 to 2019. Conversely, the number of people being civilly committed has fallen over the last several decades.
Oregon鈥檚 civil commitment laws, most of which were crafted in the 1970s, aren鈥檛 far out of line with other states. Instead, rulings on appealed civil commitments have increasingly narrowed the scope of who qualifies, .
Today, only 5% of the patients at the Oregon State hospital, the public psychiatric hospital managed by the Oregon Health Authority, are there under civil commitment. The rest are there because they have a criminal charge. The agency has been working to comply with a federal court order directing it to admit people within seven days of a court finding that they are unable to assist in their own defense.
The Oregon Health Authority is also under pressure to deal with civilly committed people who aren鈥檛 able to access the state hospital. In 2022, four of the state鈥檚 largest hospital systems , claiming the state is violating the rights of people with severe mental illness by shunting civil commitments back to their hospitals, which they say are not equipped to provide long-term psychiatric care. The suit was thrown out but by the 9th U.S. Circuit Court of Appeals.
Bouneff said his group acknowledges the critical shortage of resources and supports efforts to bolster available beds to serve people who are civilly committed. Bouneff said a different work group that Oregon鈥檚 NAMI convened at the beginning of the year is continuing to work on ways to support greater availability of services.
鈥淚 don鈥檛 think NAMI would be supportive, in the end, of any change to civil commitment criteria if we don鈥檛 have that other piece,鈥� Bouneff said. 鈥淏ecause you will have achieved absolutely nothing.鈥�
Oregon has made some investments in behavioral health capacity in recent years. In 2021, lawmakers to increase community-based residential space for people requiring intensive care due to serious mental illness. That money was part of a $1.3 billion behavioral health package passed that year.
The state鈥檚 capacity of mental health beds has increased since then. , 986 beds are available around the state, and another 267 beds are still in development for a total of 1,253. But secure residential beds, many of which are used for civil commitments, are more scarce: 230 that the state is are not yet in development.
Oregon鈥檚 shortage of resources to serve people who are civilly committed is a problem widely acknowledged, which is why NAMI isn鈥檛 the only group scrutinizing the system. It was one of 20 agencies, nonprofits and departments represented in the Commitment to Change work group, which on Nov. 1 summarizing its work and providing recommendations for lawmakers to consider as the 2025 session approaches.
The 51 recommendations that received consensus from all stakeholders include some specific, actionable steps for the Legislature to take, such as requiring continued training for civil commitment investigators. Other recommendations are broader concepts that could take shape in various ways.
The group unanimously supported expanding access to treatment during civil commitments and as people transition out of civil commitments. Support for expanding criteria to civilly commit people, however, was slightly more mixed, with groups like NAMI and Mothers of the Mentally Ill in favor, Disability Rights Oregon and the Oregon Association of Hospitals and Health Systems opposed, and other state agencies saying it would depend on other factors.
Multnomah County Circuit Judge Nan Waller, who runs the county鈥檚 mental health court and represented the state鈥檚 judicial branch on the work group, said the group took a broad approach in order to give lawmakers a nuanced look at all the factors that affect both civil commitment鈥檚 accessibility and its effectiveness.
鈥淥regon鈥檚 commitment system is not serving the purpose for which it was intended, to protect many vulnerable people in our communities,鈥� she said in an email. 鈥淎s a judge I have seen the stories play out in my courtroom, stories of despair when individuals have no access to the treatment and support they need or are unwilling or lacking in motivation to engage in treatment.
鈥淢y hope is that the Legislature will use the report to take action that is desperately needed to improve a system that is failing to meet both the needs of people with serious mental health disorders and the needs of the communities in which they live,鈥� she said.
At least one Oregon lawmaker said he plans to be involved with legislation to modify civil commitment criteria: Rep. Tom Andersen, D-Salem, who in 2024.
Andersen said he thought his bill failed to advance because it was a short legislative session, used primarily for budget tweaks and other smaller moves. In the longer session, he said he anticipates more opportunity to work out disagreements.
鈥淟egislative wheels grind slowly but finely,鈥� he said. 鈥淭here鈥檚 a myriad of issues surrounding civil commitment, and the goal of the Legislature is to work together to make sure we can provide the necessary treatment and also have the ability to spend money to address it.鈥�
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