By Peter H. Fenton

Mental institutions have a shameful history in Oregon. It was a great relief when the main wing of the state hospital in Salem was torn down in 2008. But is mainstreaming the mentally ill by placing them in private facilities in residential neighborhoods an improvement for the patients -- and the community at large?

Not necessarily, based on my experience working at a group home for the developmentally disabled in the southern Willamette Valley. From late 2011 through spring 2012, I was employed as a part-time caregiver, dispensing meds, cooking meals and monitoring the behavior of five young adult males living in a pleasant home on a middle-class street.

The clients, as they are called, included a schizophrenic with accompanying bipolar disorder and a pair of sex offenders who had each served time behind bars. I got to know them pretty well. Surprisingly enough, they were personable guys -- Ducks fans, video game buffs -- and a pleasure to simply, well, shoot the bull with.

On good days, that is. Bad days, which arrived like lightning bolts, were another matter. Bad days were accompanied by the omnipresent threat of physical danger -- to the individual, his fellow clients, paid staff, and, of most concern, the next-door neighbors and even unsuspecting shopping mall patrons.

Take "Rashid," the schizophrenic. Rashid is a gentle soul, with a talent for pithy, tweet-like observations. Yet he has smashed windows at the group home, assaulted staff and housemates and is so agitated by the real world that he's been thrown out of nearly every fast-food joint, every video game store, every mall within 20 miles. Rashid is not permitted to leave the group home on his own, yet he's fled many times, sleeping on the streets until he creates a disturbance and is brought back to repeat the cycle all over again.

Rashid is a likable guy, yet his every move requires monitoring. And he's not alone. During my stint at the group home, clients vandalized house property, returned from the community drunk or on drugs, assaulted each other and staff, attempted to jump out of a moving car, inappropriately touched a citizen, engaged in online harassment and committed a sex act in a family neighborhood in broad daylight.

There are, of course, potential consequences for bad behavior. A serious infraction can send a client to a more secure facility, including prison. But therein lies what I believe to be the fatal flaw of deinstitutionalization: A group home is essentially a small business with the proprietor's income based on the number of clients in the beds. Losing a client because of his/her bad behavior reduces that income -- and clients are difficult to replace. So there is an economic incentive to look the other way when rules or even laws are broken. Reporting every incident is bad for business.

I am far from an expert on mental health care, but I hope the real experts are aware that the growing privatization of mental health care is not without risk.



Peter Fenton is author of the memoir Dinner for Rashid: My Too-Short Stint as a Mental Health Caregiver (Kindle, $2.99). He lives in Eugene.

