In Portland, some people seeking help at a hospital will be treated by a doctor and leave with a long-term plan to address their specific health needs. Others might get the cops called on them.

A new report by Disability Rights Oregon (DRO) reviews every instance—over the course of one year—where officers with the Portland Police Bureau (PPB) were called to one of six local hospitals to address what hospital staff call an “unwanted” person. In police terms, these are people who appear to be violating Oregon’s criminal trespass law by not leaving the hospital after being asked to leave.

The majority of the 142 cases inspected by DRO involved people who were seeking health care or who had just been discharged from care at the hospital. Most of those arrested after being discharged identified as homeless. Thirty percent of all reports included someone who was seeking mental health care and 74 percent of the cases involved someone who wasn’t posing any kind of physical threat.

The vast majority of these incidents (94 percent) ended in a person’s arrest.

The DRO report illustrates how hospitals have become yet another entry point into the criminal justice system for some of Portland’s most vulnerable citizens. And how, in a city with a dearth of affordable housing and a growing population with unmet mental health needs, jail has become a catch-all for people in distress.

“We always hear that people with mental health needs or who are homeless just don’t want our help,” says Sarah Radcliffe, the DRO attorney who authored the report. “But these cases show people who sought help, and refused to leave the place where they thought they could get help… only to be arrested.”

In many of the cases outlined by DRO, people refuse to leave the hospital because they simply have nowhere else to go. “I’m not leaving, I’m not going out in the cold,” said one person quoted in a PPB report. Several people charged with trespassing said they’d rather go to jail than return to sleeping on the street or in a shelter. “I have no medication, food, or even shoes,” another person charged with trespassing told a police officer. “Take me back to fucking jail.”

Other police reports reviewed by DRO describe a subject who is clearly suffering from a mental illness. One man, identified as Charles in the DRO study, entered Providence Hospital’s emergency department for having suicidal thoughts. When he was discharged, the police report says, Charles had “a fit,” prompting security guards to taser and handcuff him.

Charles later told officers he was talking to the voices in his head. Despite being at a hospital that treated psychiatric patients, Charles was arrested for trespassing and booked into the Multnomah County Jail.

Another patient with schizophrenia named Jessica was taken to jail after falling asleep in the Providence emergency department due to a psychiatric condition called catatonia, which renders a person immobile. Police believed she was only pretending to be asleep, and took her to jail. After one week in jail without access to mental healthcare, Jessica returned home to find an eviction notice on her door and her dog impounded. She told DRO that this experience permanently tainted her relationship with the healthcare system.

“Our lives and our dignity have inherent value,” Jessica is quoted in the DRO report. "We deserve to be treated like anyone else and to receive medical treatment when we need it."

Portland police are trained to divert non-dangerous people with clear mental health needs toward health care rather than jail. Yet in so many of these cases, officers who respond to someone in clear mental distress chose to remove that person from a medical facility.

The DRO recommends that, “Police should not respond to calls for mental health related behaviors at a mental health treatment facility."

“These are precisely the types of situations that hospital clinicians and social workers are trained to handle," the report reads.

This doesn’t mean these people won’t eventually be treated for their mental illness. But it’ll come at a greater cost to their own health—and to the Oregon taxpayer.

The DRO report describes several cases where a person with mental health needs is arrested at a hospital, taken to jail, and then deemed unable to stand trial because of their mental illness. In those cases, the defendant is shuttled off to the state psychiatric hospital until a judge believes they are psychologically stable enough to "aid and assist" in their own legal defense.

“The irony that someone would be arrested when trying to access mental health care, only for a judge to say they have enough mental health issues that they can’t aid in their own defense is huge,” says Radcliffe. “We’re putting people through unnecessary trauma at the public’s expense.”

A stay at the Oregon State Hospital (OSH) costs Oregon taxpayers approximately $1,300 per patient per day. An average stay is between 70 and 80 days.

DRO argues that if a person’s mental needs are met further upstream—say, when they enter a local hospital seeking help—the state could save millions of dollars and prioritize OSH beds for people who truly have no other option.

Oregon is already feeling the effects of its over-reliance on the overcrowded state hospital. Earlier this month, a Washington County judge found that the state is violating a court order by forcing mentally ill Oregonians to languish in jail until an OSH bed becomes available.

The report suggests that all six of Portland’s major hospitals may be breaking federal and state law by routinely calling the cops on discharged patients.

Under federal Medicaid law, hospitals are required to create an adequate discharge plan for all patients “who are likely to suffer adverse health consequences upon discharge.” Oregon law gets more specific: A 2017 bill requires all patients who sought mental health care at a hospital receive a “long-term needs assessment,” which addresses the patient’s housing situation, income, and other social impacts on their future health.

“Hospitals should not pass a challenging patient off to security staff in lieu of providing discharge planning or behavioral healthcare,” the DRO report reads.

There are some hospital-sponsored programs that are working to improve the discharge process for homeless or mentally unstable adults. The nonprofit Central City Council, for example, has partnered with local hospitals to offer temporary housing and recovery care for 1,000 homeless patients since 2005. And in 2016, several local hospitals invested in a larger Central City Concern project to build 38 housing units for homeless Portlanders with health care needs. The slated units will offer on-site addiction treatment programs, pain management, palliative care, and behavioral health care.

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‘That’s what it looks like when hospitals recognize the social determinants of health,” says Radcliffe.

Yet, these same hospitals continue to funnel homeless and mentally ill Portlanders into the criminal justice system. Radcliffe hopes the DRO report shows medical providers who swear to “do not harm” how one call to a police officer could irreparably harm an individual's future.

“Before digging into this, it seemed like there was a broad consensus in the medical community around decriminalizing mental illness,” says Radcliffe. “But the hospital system is directly contributing to this criminalization.”