Oregon’s top health official wrote to Gov. Kate Brown on Friday, alerting her to a “capacity crisis” at the Oregon State Hospital as demand for trial fitness treatment escalates unabated.

The official, Oregon Health Authority Director Patrick Allen, also issued directives intended to slow the flood of defendants to the psychiatric hospital in Salem.

“This demand,” Allen wrote to Brown, “coincides with a statewide housing crisis and increased arrests of people who are homeless and mentally ill.”

Brown, speaking on the long simmering issue for the first time Friday, said in a statement that problems at the mental hospital will not let up until policymakers stop “criminalizing the homeless and mentally ill.”

“I urge the Legislature to approve funding during this session to expand housing and mental health treatment at the local level to get people off the streets and into safe and stable homes,” the governor said.

The Oregon State Hospital has reached capacity as the number of mentally ill defendants needing trial fitness treatment has doubled since 2012. About 60 percent are homeless, according to state figures.

The Oregon State Hospital in Salem. (Paul Carter/The Register-Guard via AP)AP

An analysis by The Oregonian/OregonLive found many of those defendants are charged with low-end misdemeanors and municipal violations for sleeping or using the bathroom in public, alarming passersby, stealing food, or openly drinking alcohol.

No matter how serious the charge, each of these defendants has a constitutional right to assist in their defense. Many are jailed until being admitted to Oregon State Hospital on a judge’s treatment orders.

Once healthy, the arrestees return to court where they often plead guilty, are released on probation, become homeless again and are re-arrested, the newsroom found in its yearlong inquiry. Oregon taxpayers have spent more than $500 million on trial fitness treatment at the state psychiatric hospital since 2012.

In addition to being expensive, the trial fitness process – called “aid and assist” in legal circles –causes mentally ill people accused of minor crimes to be jailed far longer than if they had been healthy.

Many endure weeks or months in a county lockup before undergoing months of treatment at the Oregon State Hospital – at a cost of $1,324 a day – for offenses that result in little or no jail time upon conviction. Some even go through the process only to have their charges dropped by prosecutors in the end.

The influx of cases has caused a psychiatric hospital waitlist that lengthens jail time even more. The Oregonian/OregonLive found more than 200 cases where a person ordered for trial fitness treatment sat in jail beyond a court-mandated seven-day deadline.

A lack of hospital space, laxity among sheriff’s offices responsible for driving defendants to the Salem hospital, and negligence among court workers who misplaced admissions paperwork or forgot to file it all contribute to the delays, which judges have found trample on ill defendants’ constitutional rights.

Rising patient numbers also overwhelm employees of the understaffed hospital, who are working overtime to fill needed shifts. Overtime expenditures at the hospital averaged $641,115 a month last year, according to data provided by the employees’ union.

Crowding at the hospital has led to state and federal court action. A Washington County judge issued an unprecedented contempt ruling against the hospital this week for ignoring his admission orders; the ruling spurred lawmakers to announce a reform effort. Brown said in her statement that she has been working with lawmakers on that initiative.

Attorneys are also seeking to enforce the 2002 federal ruling that established the admission deadlines, and a hearing is scheduled for next week. A similar case in Washington state led to an $85 million fine against the state and a settlement that mandated ongoing health care reforms.

Under Allen’s directives, hospital officials are to prioritize admission for defendants needing “competency restoration” treatment, discharge patients faster who don’t need “hospital-level care,” and lobby for a $7.6 million appropriation that would boost treatment center budgets.

If approved, three-fourths that appropriation would fund community-based treatment services in Multnomah, Lane and Coos counties, which have the highest per-capita use of the mental hospital, a spokeswoman said. Another $2.4 million would fund “regional residential treatment services," the spokeswoman said, which allow counties to pool their treatment budgets.

Health leaders were also told to study whether defendants may be treated at the Northwest Regional Re-entry Center, a Portland facility helping offenders transition out of prison. Officials will also study whether $7.5 million leftover from decommissioning Dammasch State Hospital may fund local treatment centers.

Chris Bouneff, director of the National Alliance on Mental Illness chapter in Oregon, worries the directives are piecemeal. They address the crisis at hand, but not its cause, he said.

“We are in this situation primarily because the state refuses to seriously address behavioral health care,” Bouneff said.

-- Gordon R. Friedman

GFriedman@Oregonian.com