On a chilly October night last year, 59-year-old Douglas Saxe rampaged through his supported living apartment complex. He flooded floors, broke power meters and stole safety equipment from the ShelterCare apartment where he was once known as the “best tenant.”

But he had lost his therapist and quit taking his medications. Now, Saxe was in the midst of a furious mental episode. A few hours later, police arrested him for disorderly conduct, criminal mischief and theft.

Saxe was a veteran struggling with PTSD, according to his brother. Before accessing ShelterCare’s services, he had racked up 16 low-level charges at the Eugene Municipal Court. But this was Saxe’s first run-in with police in a decade, court records show.

The Eugene Municipal Court sent Saxe to the Oregon State Hospital (OSH), where he was held for the next 75 days.

That’s because a judge ruled him mentally unfit to stand trial.

What happened to Douglas Saxe highlights the troubling way in which Eugene’s municipal court has handled many defendants like him.

Defendants like Saxe are part of the aid-and-assist system. That means a judge has found them too mentally ill to aid in their own defense, so the county and state provide just enough mental health treatment to prepare them for court.

These defendants are often held in jail for weeks before being transported to OSH, violating their constitutional rights for due process. They can be held in jail and at the state hospital far longer than if they had been convicted of the crimes they’ve been charged with. Many defendants languish in jail or the hospital, away from support services in the community.

But these defendants are not necessarily treated for mental illness — they’re just educated about the justice system. Many of the defendants continue to cycle in and out of jails and courts.

Lane County sends more people to OSH for trial fitness treatment than just about anywhere in Oregon.

• Eugene and Lane County officials have dramatically stepped up their reliance on sending people charged with low-level crimes to OSH, increasing the burden on the state’s mental health system. Since the 2013 fiscal year, state hospital data shows other Oregon courts statewide have increased the number of defendants they send to OSH by 55 percent. Lane County’s increase in that same period: 238 percent.

• We sampled court and jail records for 34 aid-and-assist defendants facing charges in the Lane County Circuit and Eugene Municipal courts. More than half were kept in jail longer than federal judges say is legal.

• Eugene Municipal Court often cuts corners by skipping mental health assessments for defendants. Of the 34 cases we examined, 18 were for defendants sent to the state hospital by the Eugene Municipal Court. Only three were evaluated by a state-certified psychiatrist before being declared unfit for trial, records show. A former Eugene Municipal Court judge says she was told not to order local forensic evaluations because they cost too much money.

Enlarge Medical Segregation Unit, Lane County Jail Photo By Todd Cooper

Rebeka Gipson-King, OSH spokesperson, says it costs $1,325 a day to house and care for an aid-and-assist defendant. Our analysis shows Lane County cost Oregon taxpayers more than $15.8 million last year alone for such care. The people sent by Lane County are increasingly charged only with misdemeanors like trespassing and disorderly conduct — a common result of homelessness.

OSH now faces an overcrowding crisis, and new state legislation sponsored by OSH requires Lane County to find a way to prioritize restorative in-community services for mentally ill defendants among tight budgets and limited mental health and housing services.

Meanwhile, Lane County’s mentally ill and homeless people become trapped inside inconsistent and overburdened justice systems. “People can really fall apart pretty quickly,” says Sarah Radcliffe, a lawyer with Disability Rights Oregon. “Being confined in jail for prolonged periods definitely comes at a high cost to the individual.”

The Oregonian revealed the crisis in January: a revolving-door justice system that institutionalizes defendants charged with small-time crimes that often should have earned them little more than a ticket.

The investigation, by reporter Gordon Friedman, showed how Oregon taxpayers have spent more than $165 million in the past six years churning a system that rarely provides long-term help for these defendants, many of whom have mental illness, lack a permanent place to live — or both.

The Catalyst Journalism Project at the University of Oregon School of Journalism and Communication assisted with the reporting of The Oregonian’s story by identifying people sent to the state hospital from Lane County. After the story appeared, we continued to investigate.

The Oregonian’s story said Lane County’s nine municipal courts have sent 46 people to the state hospital in the past five years.

In reality, it’s far worse.

We have now identified 76 defendants who have been sent to the state hospital from the Eugene Municipal Court alone since 2014 — far more than officials have previously acknowledged.

Lane County sent defendants to OSH at a higher average rate than any of Oregon’s 10 largest counties for the last five years. During the 2018 fiscal year alone, courts in Lane County sent defendants to the state hospital nearly twice as often as the rest of the state.

Many defendants return to the streets, where they may be re-arrested and cycle through the expensive and ineffective restoration process again. About one in six people sent to the state hospital on aid and assist were readmitted within 360 days in 2017 and 2018, OSH records show.

“Whatever problem they had hasn’t gone away,” says Tony Rosta, Eugene Municipal Court public defender. “That’s the frustrating thing for most people in the criminal justice system.”

Lane County and Eugene do not have enough mental health services, so the courts make do with state-funded aid and assist, straining the state hospital. Defendants pay the ultimate cost.

“I just see this problem is continuing to grow,” says Lane County District Attorney Patty Perlow, “and our response has not been adequate.”

Enlarge Patty Perlow, Lane County District Attorney Photo By Todd Cooper

Feeding an Ineffective System

Anyone charged with a crime has a constitutional right to participate in his or her own defense — but they must be mentally well enough to do so. Defense attorneys must notify the court if they are unable to communicate with their clients due to possible mental illness. Judges can order mental health evaluations or simply declare defendants unfit to stand trial.

Some defendants are evaluated by state-certified psychiatrists before a judge rules them unfit. Others are not.

Defendants then get treatment. Some get that outside of custody under the supervision of the court and Lane County Behavioral Health (LCBH), called “community restoration.” Others are sent to the state hospital in Salem.

In both cases, the treatment isn’t aimed at long-term help. Defendants aren’t guaranteed therapy or even medication — the defendant can refuse both. Instead, the aid-and-assist system is designed simply to prepare them for trial.

“It is strictly an educational process to teach the person what the criminal justice system is, what their lawyer does, the charges against them, what a judge does,” Perlow says.

A defendant might go through treatment and still not be fit to stand trial. In that case, a prosecutor can ask a judge to compel the defendant to receive medication. “If the judge says no forced medication, then the case is over,” Perlow says. “The defendant walks out the door, and oftentimes with no plan.”

Why Here?

One possibility for the rise in aid-and-assist cases in Lane County might be the increase of mental illness and substance use in the unhoused population.

About one in three of the estimated 2,165 unhoused people in the county reported suffering from a mental illness in 2019, according to the Lane County Point-in-Time survey, an annual count of the homeless population. That ratio has more than tripled in the past six years. Since 2015, the rate of unhoused people reporting that substance use prevented them from getting housing more than doubled.

“I think the increase in drug use and the opioid epidemic that we have has contributed significantly to the amount of mentally ill people we have on the street,” says Andrea Williams, supervisor of LCBH forensic programs, which help people with a diagnosed mental illness in the criminal justice system.

But these increases in substance use and mental illness among the homeless are not unique to this area — other cities are facing the same challenge. However, our findings raise a serious question: Why has Eugene and Lane County been sending more and more defendants to the state hospital and doing so at such an alarming rate?

We asked Eugene Mayor Lucy Vinis, retiring City Manager Jon Ruiz, Eugene Municipal Court administrator Cheryl Stone and the court’s presiding judge Greg Gill.

They declined repeated requests to answer our questions directly or discuss how the Municipal Court is dealing with the mentally ill. Instead, these officials issued a joint statement provided by city spokesperson Laura Hammond.

“Eugene Municipal Court is the largest municipal court in the state,” they say. “When comparing proportions, it’s important to consider the volume of individuals seen at Municipal Court versus other municipalities.”

But even considering Eugene Municipal Court’s size, Lane County’s dramatically increased reliance on state-funded aid and assist indicates something is missing in local mental health and court programs.

Perlow says lack of resources contributes to the increase, pointing to the closure of the Lane County Jail’s psychiatric hospital in 2004. She also says Lane County Public Defenders hired a lawyer specifically to handle aid-and-assist cases. “If you have someone specifically looking for that population, the number will go up,” she says.

Williams says while Lane County has programs to treat mental illness and programs to treat substance abuse, it has few that treat both — and it’s difficult to treat one without treating the other.

Ruiz said in an emailed statement that the city courts face a rise in cases involving the homeless and mentally ill. “It is one of the reasons our court has looked for alternative court programs like Mental Health Court and Community Court that focus on connecting people to services rather than continuing the cycle of arrests or citations,” he says.

These court diversion programs aren’t accessible to defendants on aid and assist because even the most flexible programs require them to be fit for trial, though the city says defendants who are ineligible can still be connected to the same community services such as White Bird.

But records show Community Court is not reducing the recidivism rate of defendants who end up back in municipal court, as Eugene Weekly reported in January in “An Unsuccessful Solution.”

Cutting Costs

Our reporting found one possible explanation: Without anywhere else to send defendants, local officials have increasingly relied on OSH — shifting the financial burden to state taxpayers while cutting the city’s costs.

Many courts, including the Lane County Circuit Court, send defendants to the state hospital for forensic evaluations (standardized mental health assessments completed by psychiatrists who have been certified by a state board) to determine their fitness. But these evaluations need to be coordinated by at least three government agencies and it can take weeks due to overcrowding at the state hospital.

The Eugene Municipal Court has often skipped this step.

Aid-and-assist defendants can only be held at the jail or at the state hospital for the maximum length of their possible sentences, up to three years. Misdemeanors bring lighter sentences than felonies, so those charged with them can’t be held for long, Williams says. “There’s a short window of time that they have to determine fitness,” she says.

So the Eugene Municipal Court often declares defendants unfit without that evaluation and sends them straight to the state hospital for treatment. Judges seek assessments where they can find them; defendants will sometimes get basic mental health assessments from the jail’s medical staff or LCBH, but many times, judges will send them straight to the state hospital or community-based care.

Enlarge Former Judge Mary Mori Photo By Todd Cooper

Judges can choose to send defendants to local mental health providers for private forensic evaluations instead. Mary Mori, a former judge at the Eugene Municipal Court who says she was the first at the court to order defendants to OSH more than a decade ago, says at times she and other judges wanted to order these evaluations. But she says they were told not to do so because evaluations would cost the city too much money.

“We were told in no uncertain terms that we weren’t going to be able to do that because of the cost,” says Mori, who left the court in 2016. “The city’s budget for the Municipal Court cannot accommodate the evaluations.”

Mori declined to say who stopped her from ordering the evaluations, saying it didn’t matter because the city just couldn’t afford it.

In its statement, the city says it does pay for evaluations out of the general Municipal Court budget — but money for evaluations is not a specific item in the budget — and that it ordered forensic evaluations for approximately 37 defendants between 2014 and 2018, though it says not all were completed. During that time, the court estimates it sent 72 defendants to OSH. So far this year, judges have ordered approximately 39 evaluations, jumping from just two in 2014, according to an email from city spokesperson Hammond.

But of the 18 Eugene Municipal Court cases we examined, only three defendants received forensic evaluations, according to the documents. These cases ranged from years 2017 to 2019; years when the city says the court began ordering more evaluations.

The city says the Municipal Court set aside $75,000 for fitness evaluations from the new Community Safety payroll tax passed by the City Council in June 2019. A state-certified evaluator with Trillium, a local CCO, also recently offered to do free psychological evaluations. “We utilize this option when possible,” the city says.

LCBH’s Williams says sometimes behavioral health will step in and pay for an evaluation when it’s unclear whether a defendant is really unfit.

“I think it’s everyone’s right to be evaluated,” Williams says. She says she thinks the difference in evaluations between the Eugene Municipal Court and the Lane County Circuit Court is unfair.

New state legislation passed this summer, changing the requirements for evaluating defendants with misdemeanors, which could bring some consistency to the process. While Senate Bill 24 does not require forensic evaluations, it requires LCBH to assess defendants’ dangerousness and illness severity.

Mori says her decision to send municipal defendants to the state hospital frustrated OSH administrators, and she understands their position. “It’s really expensive, and it’s clogging up the system,” Mori says.

She defends the practice. “I do think Lane County does send appropriate individuals, in terms of the manifestation of the disease, up to Salem,” Mori says. “You can’t just throw them in jail, and I can’t keep dismissing the charges because that person is just going to keep getting in trouble.”

While aid-and-assist defendants may have mental health issues, their behavior can still be troubling to residents in Eugene and Lane County. When their behavior becomes criminal, the justice system says they must be held responsible.

“It might be getting arrested that enables somebody to receive some mental health treatment they might not otherwise receive,” Eugene Police Department Lt. Doug Mozan says. “Why should we wait until someone is so desperate or is in such dire conditions that they commit a felony to send them to the kind of treatment they need to get stable?”

Enlarge Clint Riley Photo By Todd Cooper

Unjust and Inhumane

Because OSH is often full, defendants can deteriorate in jail, waiting for a bed at the hospital. Inmates are sometimes locked in medical segregation cells because their mental illness makes them a danger to themselves or others, Lane County Jail Captain Clint Riley says.

Disability Rights Oregon lawyer Radcliffe says that because jails don’t have the level of staff or the capacity to provide mental health care like a hospital, solitary confinement is often the default — which makes inmates’ conditions worse.

Defendants in 18 of the 34 cases we examined spent time in medical segregation. Nine were isolated for a week or more in total.

Both Radcliffe and Riley say the Lane County Jail is working with Disability Rights Oregon to improve conditions, especially for those with mental illnesses, by reducing segregation time, increasing out-of-cell time and opening a mental health unit.

But jail should be the last option for mentally ill individuals, Riley says. “It’s traumatizing to everyone involved,” he says.

A 2003 ruling by the Ninth Circuit U.S. Court of Appeals declared that leaving a mentally ill defendant in jail for long periods of time violates the right to due process and is “unjust and inhumane,” often causing suffering and worsening symptoms. OSH must now admit defendants within seven days of the judge’s order.

“That’s not been happening because there’s absolutely no beds,” Williams says. Lane County defendants are routinely having this right violated.

In 20 of the 34 cases we examined, defendants were left in jail beyond the seven-day limit. Almost a third waited more than two weeks, and three spent nearly a month in jail before being sent for treatment.

It’s a statewide problem, too. The Oregonian’s investigation found 202 cases in which it took more than seven days to transport a defendant to the state hospital since January 2018. Their analysis showed that 63 percent of them had only been charged with misdemeanors.

OSH spokesperson Gipson-King says OSH has been in compliance with the seven-day limit since July 25, and will be for the “foreseeable future.” She says it reached this goal by hiring new forensic evaluators, speeding up the discharge process for aid-and-assist defendants who no longer need hospital-level care and ensuring that contracts with community mental health programs like LCBH include in-community aid and assist and diversion programs, among other things.

But even when someone is moved to the hospital on time, the seven-day clock doesn’t start running until after they’ve been evaluated and officially declared unfit to stand trial by a judge.

“Meanwhile they’re at the jail languishing or waiting for a bed to go up there just to get evaluated, come back and then get treatment,” Mori says, “although it’s not considered [mental health] treatment.”

Court-ordered, extended hospitalization can lead to loss of housing, custody of children, jobs and other community supports, Radcliffe says.

“When people are discharged from the state hospital, if they’re there on an aid-and-assist order, they’re just discharged back to jail and then from jail to the streets,” Radcliffe says. “So whatever they had going into that process they don’t have anymore.” They’re often worse off than they were before, she says.

Community Restoration: A Broken Solution

One way to deal with the rising number of defendants at the state hospital is to treat people locally — called “community restoration.” Community restoration is aid-and-assist treatment, but defendants are placed in supported housing, and they receive the treatments through local programs such as LCBH or Sponsors. Defendants on community restoration are required to be supervised by law, but they usually aren’t locked down or watched at all times, Williams says.

Community restoration connects defendants with housing programs, doctors and counseling services that will still be available after their cases close, Radcliffe says. “They can start building up all of those services that they need rather than going to the state hospital where you’re confined for however many months and then just dumped back to the street with nothing,” she says.

The state is pressuring courts in Lane County to decrease their rates of admittance to the state hospital. The Oregon Legislative Emergency Board gave LCBH more than $900,000 to operate 16 more beds specifically for community restoration in 2019, Gipson-King says.

As a result, LCBH expanded its community restoration capacity. Between October and December 2018, there were six people on community restoration in Lane County, according to state records. By March 2019, there were 25.

But frequently, community restoration isn’t enough. It has expectations that many defendants can’t meet, says EPD’s Mozan. “Then we end up back at square one in terms of accountability,” he says.

According to Eugene Municipal Court records, 25 people have been placed on community restoration since 2016, but 13 of them had to be sent to the state hospital anyway.

“Somebody’s mental health issue isn’t necessarily reflected in the crime they’ve committed,” Perlow says. “They could be a low-level crime but a person in an acute mental state that really needs a hospital level of care.”

Gipson-King says a person’s mental illness can improve or worsen and the system should respond, moving them from community restoration to hospitalization or vice-versa.

Mori says one of the biggest frustrations she had with the system was that defendants on community restoration sometimes “disappear,” and no one would go looking for them. Often, people won’t be heard from again until they are re-arrested, at which point they’re usually sent to the state hospital, she says.

“It happens all the time,” Mori says. “People just don’t show up, and there’s no way of tracking them down, and we don’t have a good system for letting people know that we’re looking for them.”

Five people on community restoration had active warrants issued for their arrest from the Eugene Municipal Court in June 2019, court records show.

Treatment, in both community restoration and at the state hospital, is voluntary, and many people choose not to enter treatment. Public defender Rosta says if defendants refuse to participate, there’s not much they can do. “Many of them don’t want to acknowledge they’re mentally ill,” he says.

Williams’ forensic team wants to develop an outreach program to keep track of people in community restoration when they “fall off the radar,” she says. “We need to intercede before they get revoked and get put back at the state hospital,” she says.

Senate Bill 24 will complicate community restoration because the new legislation allows courts to send misdemeanor defendants to OSH only if they are both dangerous to themselves or others and they need hospital level care. It also requires them to continually review whether appropriate community services are available.

This cuts down on aid-and-assist admissions to OSH but doesn’t solve the problem in Lane County.

“The biggest challenge moving forward is going to be implementing the team of local evaluators in an effective manner and in support of keeping up with the volume of cases that we tend to have in our county,” says Jay Hall, senior prosecutor for the Lane County District Attorney.

Part of LCBH’s new community restoration funding also opened a secure residential facility for aid-and-assist defendants at the Junction City mental hospital campus, which doesn’t otherwise provide aid-and-assist treatment. Defendants access many of the services they would get in community restoration but in a secure environment.

A Possible Solution On The Way

Any solution begins with Lane County officials standing up and taking responsibility for the growing burden the local courts are placing on mentally ill defendants and the state’s taxpayers. So far, that hasn’t happened.

But incremental changes have begun. “A lot of times we have to wait until the crisis has risen to that level — and it has risen to that level,” Williams says. “So, now there’s more things happening. That’s just the way the system works sometimes.”

Law enforcement, justice and mental health professionals have been discussing solutions for years at the Mental Health Summit, a monthly meeting initiated by Mori six years ago to help Eugene and Lane County’s mental health programs coordinate and problem-solve between the existing programs.

“Why don’t we work really, really hard when they come back [from OSH] to try and get them into this community for long-term, stable care?” Mori says.

The 2020 Lane County budget set aside $1 million as seed money for a 24-hour crisis center where people can stay while they stabilize and connect to community services. Police need a place besides the jail to take arrested individuals displaying symptoms of mental illness, Riley says.

“We need a crisis center so police on the street have resources that are more humane,” Riley says. “Right now there’s no place to take them in the community.”

The money will not cover the cost of the center, but Lane County spokesperson Devon Ashbridge says the seed money is intended to spur serious discussion about building a crisis center that could also serve as a jail diversion center in Lane County.

“Funding is always a challenge, so you need to just forget that and figure out what you can do with what you have,” says Lane County Commissioner Pat Farr.

Paying the Price

After Douglas Saxe suffered a mental break and trashed his apartment building, the Eugene Municipal Court put him through the aid-and-assist system last fall. Saxe’s destructive episode cost him his home, according to court documents. He was evicted Nov. 8, while he was still held in the Lane County Jail. A Eugene Municipal Court judge declared him unfit the next day.

At the state hospital, Saxe was “restored to fitness” — made able to understand his criminal charges — and he returned to the county jail to face them. He was released from the Lane County Jail onto the streets three days later on Feb. 1.

At court that day, Saxe was given a plea deal. Thirty days of jail were considered served. A judge ordered Saxe to pay $2,500 out of a $20,021.16 settlement in victim’s restitution for the destruction he caused in October 2018. He would be liable for the other $17,621.16 if he didn’t keep up with a payment plan, according to the court judgment.

That afternoon, Saxe stood at the edge of a cement rail on the fourth floor of the Overpark garage in downtown Eugene, still wearing his court clothes — a green jacket, yellow button-down, grey pants and black shoes.

Saxe fell backwards, his green jacket flapping. Witnesses didn’t hear Saxe cry out or see his limbs flail; they only heard a horrendous thud as he crashed, face-up, into the street below.

A security guard tried to revive him, but Saxe was dead the moment he hit the ground.

The medical examiner ruled Saxe’s death a suicide. Investigators at the scene found a folded piece of paper in his jacket pocket: the release agreement and judgment issued by the Eugene Municipal Court earlier that day.

This story was developed as part of the Catalyst Journalism Project at the University of Oregon School of Journalism and Communication. Catalyst brings together investigative reporting and solutions journalism to spark action and response to Oregon’s most perplexing issues. To learn more visit journalism.uoregon.edu/catalyst or follow the project on Twitter @UO_catalyst.

Clarification/Correction

This story originally reported that Douglas Saxe’s restitution was ordered to ShelterCare, however according to the restitution agreement it was ordered to Norcross, the insurance adjustor and to Homes for Good, the low-income housing nonprofit that owns Hawthorn Apartments.