Oregon Blue Book: Addictions and Mental Health Division

Addictions and Mental Health Division: Agency History

Also see:
Selected Mental Institution Histories
Columbia Park Hospital and Training Center
Eastern Oregon Hospital
Fairview Training Center
Oregon State Hospital (2009 - PDF)

The general history below was written in 1999.

Introduction
The Mental Health and Developmental Disabilities Division (MHDDSD) was created in 1961. It was given the responsibility for programs, policies, community services, and public institutions serving persons of all ages with developmental disabilities and mental or emotional disturbances. It was also responsible for services to adults with serious and persistent mental illnesses requiring long-term and/or specialized treatment. It currently employs approximately 3,500 persons in its central offices, hospitals, training centers and residential and vocational programs. More than 100,000 Oregonians are served by programs managed or regulated by the Division. It operates under the authority of ORS 179, ORS 426, ORS 427 and ORS 430, and the current biennial budget is more than $860 million.

The Division contracts with county-level Community Mental Health Programs (CMHP) and service providers at the community level across the state for most direct services. In addition, the Division administers the Oregon State Hospital, Fairview Training Center, Eastern Oregon Training Center, and Eastern Oregon Psychiatric Center. It also operates its own group homes for individuals with developmental disabilities.

History
Government-supported care of the mentally ill in Oregon began with the formation of the provisional government in 1843. The care of "lunatics" was contracted to private individuals who bid to care for them. Any justice of the peace could conduct a sanity hearing and declare someone a lunatic.

In 1862, the state Legislative Assembly authorized the governor to award a contract to a private institution to care for the state's insane persons. This contract was awarded to the Hawthorne Asylum in East Portland. The Hawthorne Asylum (also known as the Oregon Hospital for the Insane) cared for the state's mentally ill from 1864 to 1883.

In 1880, the Legislative Assembly appropriated money for construction of a state hospital for the insane in Salem. Three chief state officers (Governor, Secretary of State, and State Treasurer) constituted a new board (unnamed until 1901) to supervise the construction of the institution. In October of 1883, 372 patients were transferred from the Hawthorne Asylum to the new state asylum. The operation and staffing was expanded and revised through legislation between 1883 and 1913. In 1913 the Asylum was renamed the Oregon State Hospital.

In 1901, the three chief officers became a Board of Asylum Commissioners to oversee state institutions for the mentally retarded or mentally ill. In 1907, the Legislative Assembly created the State Institution for the Feeble-Minded. The institution's purpose was to train and care for feeble-minded, idiotic, and epileptic persons. This institution was renamed Fairview Hospital and Training Center in 1933 and to Fairview Training Center in 1979.

The Board of Asylum Commissioners was replaced by the Board of Control in 1913 to provide centralized administration of all state institutions.

The 1951 Legislative Assembly authorized the building of another state mental hospital to be constructed within 20 miles of the Multnomah County Courthouse in Portland. The F. H. Dammasch State Hospital opened in 1961 in Wilsonville. It was to provide acute psychiatric hospital care to people in the Portland metropolitan area.

In 1959, the Legislative Assembly created another institution by converting a state tuberculosis hospital into the Mid-Columbia Home. Located in The Dalles, the facility provided long term care for older adult mentally retarded persons. In 1961, it was renamed the Columbia Park State Home and in 1965, was renamed the Columbia Park Hospital and Training Center. The facility was closed in 1973.

In 1958, OSH population peaked at 3,545 patients, but during the 1960's and 70's a national "de-institutionalization movement" resulted in significant drops in population. By 1979, OSH had only about 500 patients and its role had changed to a specialty hospital serving the whole state. It operated four clinical programs -- forensic psychiatric, gero-psychiatric/ medical services, child and adolescent, and adult psychiatry. In 1995, OSH opened a Portland campus at Holladay Park Medical Center. At that time, Damasch State Hospital in Wilsonville was closed and most of the patients and staff were moved to the Holladay Park facility.

Eastern Oregon Expansion
Voters approved an initiative in 1910 creating the Eastern Oregon Insane Asylum (later renamed the Eastern Oregon State Hospital). This institution opened in 1913 in Pendleton. In 1965, the Eastern Oregon Hospital began providing services to developmentally disabled as well as mentally ill patients, and was renamed the Eastern Oregon Hospital and Training Center. In 1985, the hospital was reorganized and became two separate institutions. The Eastern Oregon Psychiatric Center was to provide care and treatment for mentally ill persons, and the Eastern Oregon Training Center was to provide care, treatment, and training for mentally retarded persons.

Board of Eugenics
In 1917, the Legislative Assembly created the State Board of Eugenics. The Board examined the mental and physical condition of institutionalized individuals who could produce offspring inheriting inferior or antisocial traits. The Board made orders directing the superintendent of the institution in which the inmate was confined to perform sterilization. In 1967, the Legislative Assembly created more restrictive provisions for ordering sterilization and changed the name to State Board of Social Protection. The board was transferred to the Health Division in 1971 and abolished in 1983.

Alcohol and Drug Programs
In 1943, the Temperance and Rehabilitation Division was created in the Oregon Liquor Control Commission to educate the public on alcohol issues and establish a rehabilitation clinic. This Division's duties were transferred to the newly created Mental Health Division in 1961 and narcotics were added to the concerns of the program in 1967. Its name and responsibilities have been revised periodically and it now operates in the DHR Administrator's Office as the Office of Alcohol and Drug Abuse Programs.

Mental Health and Developmental Disability Services Division
In 1961, the Mental Health Division was created within the Board of Control to consolidate all direct services in the fields of mental health and alcohol education, as well as oversight of the state institutions. It was to assist community mental health clinics, promote public education and conduct research. The state hospitals and training centers, the Board of Health, and the Liquor Commission were transferred to the Division.

In 1969, when the Board of Control was abolished the Mental Health Division was placed under the office of the Governor. Two years later, it was placed in the newly created Department of Human Resources. In 1985, the alcohol and drug program was transferred to the Director's Office of the Department of Human Resources.

In the 1980's, the federal Health Care Financing Administration (HCFA) and the U.S. Justice Department (USDOJ) conducted reviews and investigations of Fairview Training Center regarding civil rights concerns. In 1985, USDOJ found major civil rights violations and life-threatening conditions, and filed suit along with the Association of Retarded Citizens (ARC) and parents of Fairview residents. Within a year, HCFA cut off Medicaid funding over safety, staffing and treatment issues. The state responded by increasing state funding for more qualified staff and began to develop more community-based programs for the disabled. Aggressive measures were undertaken to improve the policies and practices at Fairview and Medicaid funds were restored in 1987.

In 1988, HCFA revisited the institution and verified that some of the immediate problems had been corrected, yet decided to cut off Medicaid funds again due to concerns about "active treatment" plans. During 1989-91 Fairview funding was increased, downsizing was proposed, and community placement programs were developed. Since 1989, Fairview has operated under a USDOJ "Consent Decree" which requires a Long Term Plan for Developmental Disabilities Services. The Long Term Plan calls for transferring all residents to community based residential and vocational programs and closing Fairview by July 2000.

In 1989, the Legislative Assembly changed the name of the Division to the Mental Health and Developmental Disabilities Division, giving it responsibility for programs for people with developmental disabilities. In 1991, responsibility and funding for mental health services to children 18-21 were transferred to the Division from the Children's Services Division. In 1997, mental health benefits were made available to all persons eligible for the Oregon Health Plan under a federal Title XIX Medicaid Waiver.

Current Mental Health and Developmental Disability Services Division Programs
The Mental Health and Developmental Disability Services Division currently has two major direct service program areas-the Office of Mental Health Services and the Office of Developmental Disability Services. The Division manages the Oregon State Hospital and Fairview Training Center in Salem and the Eastern Oregon Psychiatric Center and the Eastern Oregon Training Center in Pendleton. The superintendents of the institutions report directly to the Division administrator.

The Administrator's Office is responsible for planning, policy development, and oversight of Division programs and services. Programs within the Administrator's Office include the Office of Client Rights and the Mental Health Corrections Program.

The Office of Finance provides fiscal and support services, and performs program related functions. Programs include Community Contracts, Audit and Evaluation, Federal Resources, Institutional Revenue, Budget, and Staff Support and General Services.

The Office of Mental Health Services oversees a continuum of services and care including crisis services, local acute care, clinic based and outpatient care, state hospital referral, supported housing and employment. Programs include Community Services; Extended Care; Quality Assurance; Medical Director; Planning and Projects Development; Mental Health Planning and Management Advisory Council; Budget, Data and Operations; Contract and Budget Coordination; and Office Operations and Support.

The Office of Developmental Disability Services oversees a system of community based programs for individuals with developmental disabilities including residential care, vocational/employment assistance, family support, and crisis/diversion services. Programs include Administration, Protective Services, Contracts, Licensing and Certification, Information and Data, Training, Self-Directed Supports, Medicaid Twenty-Hour Personal Care, Employment/Alternatives to Employment, Development Team, 24-Hour Residential Facilities, Vocational Programs, Diversion/Crisis, Diagnosis and Evaluation, Medical Director, and Housing.

The Division is assisted by several advisory boards and councils. The Mental Health Advisory Board, created in 1961, studies the problems of mental health and makes recommendations for the development of policies and procedures within the state mental health programs. The Developmental Disabilities Council was created in 1971, is mandated by federal law to advocate for the rights of developmentally disabled people. The Council allocates federal grants, monitors, coordinates and evaluates state, federal and local programs for the developmentally disabled, and makes recommends about legislation. The State Training Center Review Board was created in 1979 to review decisions of the Diagnosis and Evaluation Service regarding admission to training centers. It also performs annual reviews of state training center plans of care for each resident.

Selected Chronology
1864 Hawthorne Asylum contracted to care for the state's mentally ill.

1883 Oregon Insane Asylum established.

1907 State Institution for the Feeble-Minded opened.

1913 Eastern Oregon Hospital opened.

Oregon Insane Asylum renamed Oregon State Hospital.

1917 Board of Eugenics created to order sterilization of institutionalized persons who could produce offspring inheriting inferior or anti-social traits.

1933 State Institution for Feeble-Minded renamed Fairview Hospital and Training Center.

1958 Combined state hospital census peaked at 5,000. Fairview Training Center population

about 3,000. State population 1.7 million.

1961 Mental Health Division established to consolidate all mental health and alcohol related services, operate institutions and help counties develop community services. Dammasch State Hospital opened.

1979 State hospital average daily census 1,100. State population 2.5 million.

1981 Community-based services established as primary system of care for persons with developmental disabilities.

1983 Board of Social Protection (formerly Board of Eugenics) abolished.

1985 Alcohol and drug programs transferred to the Office of Director, Department of Human Resources.

1986 U.S. Department of Justice filed suit over civil rights at Fairview Training Center.

1989 Mental Health Division renamed Mental Health and Developmental Disabilities Services Division. State agrees to reduce Fairview population, improve services, and develop community-based services to replace Fairview.

1995 Dammasch State Hospital closed. Patients and staff transferred to Oregon State Hospital, Portland. Community mental health services expanded.

1997 Mental health services included in Oregon Health Plan.

1999 Fairview population below 300. Patients being moved to community residential facilities according to the Long Range Plan.

2000 Fairview scheduled to close.

Bibliography
Administrative Overview, Fairview Training Center. Terry Baxter, 1994.

Administrative Overview, Mental Health and Developmental Disability Services Division, Greg Williams, 1987.

Administrative Overview, Mental Health and Developmental Disability Services Division. Tim Backer, 1996.

Administrative Overview, Oregon State Hospital. Tim Backer, 1996.

Government and Mental Health Policy: A Structural Analysis. Gerald N. Grob, Milbank Quarterly, 1994.

History of Care of Insane in the State of Oregon. O. Larsell, Oregon Historical Quarterly, December 1945.

Legislatively Adopted Budget. Mental Health and Developmental Disability Services Division, 1995-97.

Long Range Plan for Developmental Disability Services. Mental Health and Developmental Disability Services Division, July 1996.

Mental Health and Developmental Disability Services Division website: http://www.hr.state.or.us/mhdd

Oregon Blue Book, 1999-2000.

Oregon Laws: OL 1862, Pg 23, 53; OL 1907 Ch 83; OL 1917 Ch 279; OL 1951 Ch 195; OL 1959 Ch 588; OL 1961 Ch 706; OL 1967 Chs 263, 441; OL 1969 Chs 199, 597; OL 1971 Ch 650; OL 1973 Ch 740; OL 1977 Ch 87; OL 1979 Ch 683; OL 1983 Chs 460, 505; OL 1989 Ch 116; OL 1991 Ch 753; OL 1993 Ch 767; OL 1995 Ch 806.

Oregon Revised Statutes, Chapters 179, 410, 426, 427, 430, 1997.

Overview of the Public Mental Health System in Oregon. Mental Health and Developmental Disability Services Division, July 1997.

Presentation to the Joint Committee on Ways and Means, Human Resources Subcommittee, 1997 Legislative Assembly.

Primary Agency Statutes and Administrative Rules
ORS 179. Administration of State Institutions.

ORS 426. Mentally Ill and Sexually Dangerous

ORS 427. Mentally Retarded; Developmentally Disabled

ORS 428. Nonresident Mentally Ill or Deficient

ORS 430. Administration of Alcohol and Drug Abuse Programs

OAR 309. Mental Health and Developmental Disability Services Division Administrative Rules.