Personally Speaking: How the shortage of state hospital beds led to my son’s criminalization

by Marla Knauss

In May 2023, I rescinded the restraining order against my son, who has schizophrenia. I didn’t want him to be discharged into homelessness, and the psychiatric hospital wouldn’t keep him long enough to enable recovery. I made the difficult decision to originally file the restraining order because, following his discharge from the psychiatric hospital, he was floridly psychotic and had begun self-medicating with fentanyl. I was terrified for his safety and mine. I was helpless to stop the tragedy unfolding in my home.

When I tried to advocate for admission to a state hospital for a longer stay, my son’s outpatient provider told me I was “in a tough spot.” Oregon State Hospital accepts very few civilly committed patients, and there was no way he was getting in. I was instructed to wait until he broke the law, so he could get one of those coveted beds through the criminal legal system. If I was “lucky,” he would attack me, so he could be arrested and get that process started.

After he came home, he regularly hit me and abused me emotionally. The abuse worsened as he became sicker. I let this behavior go on, because I knew the police had to catch him in the act of assaulting me if he was ever going to get treatment. When he finally pinned me down and started punching, I managed to wriggle free and seized the opportunity to call 911. My son was arrested and taken to jail.

My son, 25, has no insight that he is ill and needs treatment, a symptom of his illness known as anosognosia. His community providers know almost nothing about that symptom or how to treat his complex illness. Even when he’s been willing to engage with providers, they have been poorly equipped to support him. The medications they provided didn’t work — even when he took them as prescribed.

After my son was arrested, my nightmare escalated. I had to testify before a grand jury against my son. I knew my sweet boy would never hurt me if he was in his right mind. The mental health system enabled his addled brain to become sicker and sicker until they could lock him up, and then they made me the bad guy. The courts couldn’t adjudicate his case, though, because an evaluation determined he wasn’t fit to stand trial. On an “aid and assist order,” Oregon’s term for competency restoration, he finally went to the state hospital.

During his stay at Oregon State Hospital, he finally got the correct medication and decent care for the first time in his 10-year journey with schizophrenia. He was hospitalized for about 180 days, which still wasn’t long enough. While he made a little bit of sense when he came out, his journey hasn’t gone particularly well since then, because long-term residential care is what he needs, and it just isn’t available.

My son needed inpatient care and robust interventions much sooner to prevent trauma, criminalization of his illness, and the injuries to both my physical self and our relationship. I believe his current needs would be less if he’d been able to access an inpatient bed at the state hospital much sooner. He experiences brain damage, drug abuse, and a much more treatment-resistant form of schizophrenia, because early interventions were denied.

Staff at Oregon State Hospital told me that my son’s illness is very advanced and that they cannot believe how much I’ve endured in trying to care for my son. I will never give up my fight for better care for my son and others. I shouldn’t be the only one trying.