ColumbiaCare supports the initiative to increase community integration by designing, developing, and operating residential treatment facilities and service programs for people with mental illness. Community integration and a complete continuum of care allows those with a mental illness to access the most clinically appropriate and least restrictive level of care based on individual readiness and need. It allows for flexible movement from more institutional settings to integrated community settings that provide adequate supports and treatment services, and which promote increased self-sufficiency, well being and health. In addition to moving away from the “warehousing” of the mentally ill , community-based residential treatment facilities can provide better care in a dramatically less expensive treatment environment, saving taxpayer dollars.

ColumbiaCare is not alone in our belief that community integration makes good treatment sense. It is also supported at the national level by the President’s New Freedom Commission on Mental Health , and at the state level as demonstrated by the Oregon State Hospital Framework Master Plan and Oregon’s new Recovery Model.  (See Press Release: Governor Kulongoski and Legislature Receive Phase-Two Report on Oregon Mental Health System)

It is also clearly mandated by the Americans with Disabilities Act, as demonstrated by the Supreme Court’s Olmstead v. L.C. Decision. The ‘integration mandate’ of the Americans with Disabilities Act requires public agencies to provide services “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” The high court upheld that mandate, ruling that Georgia’s department of human resources could not segregate two women with mental disabilities in a state psychiatric hospital long after the agency’s own treatment professionals had recommended their transfer to community care. All states must now comply with the decision.  

A Continuum of Care for Structured/Specialized Residential Services Includes the Following:

Long-Term Hospitalization
The Oregon State Hospital, with campuses in Salem and Portland, is the state’s primary state-run psychiatric facility for adults. The State Hospital delivers inpatient psychiatric and medical care to patients through Forensic Psychiatric Services for patients who are judged guilty except for insanity and Psychiatric Recovery Services for civilly committed patients.

Short-Term Crisis Resolution Centers (CRCs)
CRCs are state licensed, locked or non-locked community-based facilities with a service capacity for 6 or more adults with mental illness. CRCs are an important link in the continuity of care between long term hospitalization and completely independent living. They can serve as a less restrictive and more clinically appropriate treatment option for persons who are in psychiatric crisis but who do not need the medical capabilities of an acute care hospital, and can also result in significant cost savings.

Secure Residential Treatment Facilities (SRTF)
SRTFs are state licensed, community-based, locked facilities that restrict a residents exit from the facility or its grounds through the use of approved locking devices on resident exit doors, gates or other closures for the purpose of protecting the public. This level of care may be prescribed for clinical purposes and for the protection of the residents living there. SRTFs may serve those under the jurisdiction of the Psychiatric Security Review Board, civilly committed clients who are stepping-down from the state hospital, and occasionally those who are voluntarily seeking and in need of this level of care and do not need to be committed to state hospitalization, or any combination thereof. Each SRTF is specifically designed, constructed and staffed based on the population served.

Residential Treatment Facilities (RTF)
RTFs are state licensed, non-locked, community-based facilities with a service capacity for 6 or more adults with mental illness. RTFs may serve those under the jurisdiction of the Psychiatric Security Review Board, civilly committed clients stepping down from the state hospital, or any combination thereof. Each RTF is specifically designed (or modified), constructed and staffed based on the population served.

Residential Treatment Homes (RTH)
RTHs are state licensed, non-locked, community-based homes with a service capacity of 5 or less adults with mental illness. RTHs may serve those under the jurisdiction of the Psychiatric Security Review Board, civilly committed clients stepping down from the state hospital, or any combination thereof. Each RTH is specifically designed (or modified), constructed and staffed based on the population served.

Adult Foster Homes (AFH)
AFHs are state licensed (by Addictions and Mental Health Division, Seniors and People with Disability), community-based homes that with a services capacity for 5 or fewer adults. AFHs may serve individuals with mental illness, developmental disabilities, or the elderly or disabled.

Enhanced Care Services Programs (ECF)
An ECF is a program in a residential care facility, nursing facility or foster home licensed by Seniors and Peoples with Disabilities (SPD) in which mental health is provided.

Supportive and Transitional Housing
In addition to structured or specialized residential services, Supportive Housing programs are generally unlicensed and provide supported independent living and other minimally structured settings where services and housing are made available to persons with mental illness, and can include the following:
• “Site-specific supported housing” or “SSH” means apartments, single rooms and/or homes designated for occupancy by persons with mental illness and sponsored by a mental health agency that provides supportive services to residents.
• “Integrated supported housing” or “ISH” means services provided to persons with mental illness that assist them to acquire and maintain affordable apartments or shared homes available through the open housing market. These services are often provided through a mental health program’s community support or case management services.
• “Transitional housing” or “TH” means a housing program that provides on site support services for up to two years for persons who are transitioning to community living after being homeless or hospitalized.
• “Room and board” or “R+B” means the provision of shelter and meals in exchange for payment.
• “Safe haven” or “SH” means a residential program providing “low demand” support services to persons with mental illness who were previously living on the streets or other places not meant for habitation.

Independent Living
Independent living is an achievable goal for individuals with mental illness, and the continued development of low-income and fair housing is such an important component in the residential continuum.

Standards and Accountability

The community integration process must be developed and maintained in a responsible and professional manner, in a way that also promotes community safety, education and involvement, and according to applicable federal, state and policy, rule and local law.

The Department of Human Services, Mental Health and Developmental Disability Services sets standards for residential facilities through Oregon Administrative Rule which “prescribe how services will be provided in safe, secure and homelike environments that recognize the dignity, individuality and right to self-determination of each resident”

Oregon’s Extended Care Management Unit (ECMU) manages the flow of consumers between acute and extended care services using high clinical standards of care, and serves to maximize the efficacy and efficiency of state and federal resources devoted to treatment and placement of consumers in alternatives to the state hospital.

The Psychiatric Security Review Board (PSRB) has the responsibility and “authority to commit a person to a state hospital designated by the Department of Human Services; conditionally release a person from a state hospital to a community-based program with close monitoring and supervision; discharge a person from its jurisdiction; and, when appropriate, revoke the conditional release of a person under its jurisdiction and order the person’s return to a state hospital pending a full hearing before the board.”