Most people with serious mental illness do not meet Oregon’s standards for involuntary treatment. Even when someone does, long-term care can be overwhelming.
OREGON CITY, Ore.—Janet Meister woke up listening to a voicemail her grown son Brett left her during a mental health crisis.
“You are the dumbest ***** to ever walk the planet,” Brett Meister said in the voicemail. “And I’m going to torture you so bad ***** before I kill you, mark my words.”
Meister, who recently retired from her job at Clash of the Masses Community College, played the voicemail during an interview with KGW in her backyard, explaining how it reflects the deterioration of Brett’s mental state as he comes off medication.
“Okay, so it’s not good,” said Meister, fighting back tears. “Now, six weeks later, he leaves me this message.”
She pressed play on her tablet.
“Hello mom, I was calling because I’m excited to tell you … I think we found the right medication combination to deal with my chemical imbalance,” said Brett Meister in the voicemail. “You know how they say it takes many years before you find the right medicine… I think it’s great news and I’m very happy. Anyway, love, good night, goodbye.”
Meister, now smiling, attributed what had changed in six weeks to involuntary treatment.
“So quite the difference, huh,” she said. “I like it better in the second one.”
Brett Meister is 41, who was diagnosed with a schizophrenia disorder – said his mother as “a perfect combination of bipolar and schizophrenia.”
She said he started showing signs of severe mental illness about two decades ago, around 20 years old.
“We have our good months and then we have our bad years and that’s what it’s been like,” Meister said. “As a parent, you never want to give up, and you don’t want to lose hope, but I’m losing hope and I’m scared to death right now.”
At the heart of Brett Meister’s story is a life experience with forced treatment for mental illness.
Brett has been civilly committed four separate times. Doctors, evaluators and a judge determined that his mental illness posed a serious threat to himself or others and sent him to the Oregon State Hospital for up to six months of involuntary care each time.
KGW previously reported on Oregon’s high standards for forced mental health treatment through the “Uncommitted” series.
Many people who refuse voluntary treatment are released from hospitals and end up homeless with debilitating mental illness. They are not able to seek care on their own, but they cannot be forced into it.
Brett Meister’s story offers a different perspective on the mental health crisis – an example of someone who often met state standards for involuntary treatment, but was unable to get the long-term care he needed.
“The civil commitment hold is only good for six months and during that time he has to take medication,” said Janet Meister. “But as soon as those six months are up, the pills go down the drain or in the trash or whatever and the clock starts ticking. Then, he gets sick again. It’s a terrible vicious cycle that we haven’t found the magic cure to break.”
Sometimes, Brett Meister lived with family or friends. He lives in a group home or subsidized housing, sometimes facing eviction. He stayed in hospitals, treatment facilities, prisons and state institutions. Lately, he’s been living in a van or somewhere on the streets.
At the time of this interview with KGW, Janet Meister did not know where her son Brett was. Since then, she and Brett’s father have been able to find him.
She said he was being evaluated at the Unity Center for Behavioral Healthcare, but this time an investigator ruled he did not meet state standards for civil commitment, so Brett was released.
After years of experience with her son, including an incident where Brett was charged with fourth-degree assault for breaking his mother’s ribs, Janet said she believes treatment for people like her son should be mandatory, not optional.
“Brett should never have been off medication,” she said. “He is not safe in the community, and the community is not safe with him in the community.”
Part of the problem for people like Brett — there’s often nowhere to go for treatment.
Oregon State Hospital is accepting fewer and fewer civil commitment patients each year, giving priority to people facing criminal charges.
As a result, Oregon’s four largest health systems – Providence, Legacy, PeaceHealth and St. Charles – after suing the state health authority. Hospitals say they are forced to keep seriously mentally ill patients for months in rooms not built for long-term care.
However, a a judge recently refused hospital systems’ latest bid in the lawsuit, again siding with the Oregon Health Authority.
Even when admitted to OSH for civil commitment and involuntary treatment, options can be limited upon release. Without the ability to force people like Brett to continue medication, step-down facilities are not sustainable for long, Janet Meister said.
However, most people who are identified with severe mental illness symptoms do not reach that point.
In Meister’s home in Clackamas County, doctors filed 3,116 “Notices of Mental Illness” over the five years between 2018 and 2022. NMIs are medical recommendations for involuntary care.
After county investigators reviewed the NMIs to see if the person met standards for involuntary treatment for mental illness, only 11% of those cases reached a judicial hearing, and 8% resulted in a civil commitment.
About 9 times out of 10 times a doctor recommended involuntary care for severe mental illness symptoms in Clackamas County, the patient was released because he did not meet state thresholds or by agreeing to a voluntary treatment plan.
Janet Meister said, from her own perspective, mandatory treatment was the most compassionate way for her son Brett.
“Indeed, what is happening to him now is inhumane,” she said. “I completely understand the families that have to walk away, because it takes your life.”
In the past when Brett was receiving treatment at the Oregon State Hospital, he would go on “trips” with family members.
Janet shared photos of the trips, remembering to fish, to the Oregon Coast, to the zoo, to the Columbia River Gorge and to various restaurants.
“It’s funny when he’s in good shape,” she said. “He’s a funny guy and he’s fun to be around.”
She thanked mental health workers for their courage, strength and continued patience in a difficult but much-needed industry, adding that Brett has improved with each civic commitment, but overall his mental health has been gradually deteriorating over 20 years.
“You know, it gets better but it doesn’t get better like it did three years ago,” Meister said. “We have a crisis.”
Regarding statewide efforts to make changes to the mental health system and the civil commitment process, the Oregon Department of the Judiciary continues to host a “Commitment to Change” working group that meets monthly.
The group began meeting in October 2022 and plans to produce a report of recommendations for statewide changes by April 2024.
In the state legislature, proposed bills to change civil commitment thresholds stalled in committee in the most recent legislative session.
A state representative told KGW that the chair of the behavioral health and budget committees appears to have chosen to invest in the current mental health care system, which they said has deteriorated over the years, rather than address legal issues or make major changes.