Thank you for loving these people and for doing your best for them. I'm sure you've saved more lives than you know. Turning a battleship around is slow, tedious work.
I don't think addressing accountability issues and passivity is the only way forward here. For people who have near death overdoses from narcotics there should be mandatory abstinence in a secure facility for 45 days. This seems like the appropriate medical intervention given the circumstances. That is what I would want if it was my mother, daughter, wife, father, son, friend, and I think most people would wish that as well. We can't make them change ultimately, but we can at least give them some mental clarity without drugs for a significant period and perhaps they will become more personally and socially responsible and take up voluntary treatment in mental health or other more socially conforming ways. Society does have rights to ensure safety, civility, and beauty in the public square which unfortunately is missing in areas of the city.
Maybe Kevin can explain the law there for “Involuntary Commitment/Detention”, here, in Virginia, it may last a day or two - then the detained person is entitled to a hearing & the government must produce witnesses and they rarely show up.
Kevin has done a great job in explaining why a voluntary commitment of any amount of time would not fit into the “substance use disorder person’s daily need to self-administer. Maybe he could refer to his RIP photos & estimate the percentage of how many he believes would have signed-up for 45 days of withdrawal.
In Oregon, involuntary civil commitment is a legal process allowing a judge to mandate psychiatric treatment for adults experiencing uncontrolled symptoms. It is considered a last resort and is strictly limited to individuals who are an imminent danger to themselves or others, or who are unable to provide for their basic personal needs.The involuntary commitment process generally follows a specific series of stages and criteria under Oregon Revised Statutes (ORS 426).1. The Pre-Commitment Hold (Emergency Hold)Before being formally committed, an individual can be placed on an emergency mental health hold.Who can initiate: Law enforcement, a pre-commitment investigator, or a licensed independent practitioner can place a person in custody to transport them to an emergency care facility for evaluation.Duration: An individual cannot be held involuntarily for longer than 5 judicial days (excluding weekends and holidays) without a court hearing.2. Investigation and EvaluationOnce a civil commitment petition is filed, an investigator from the local Community Mental Health Program (CMHP) conducts an investigation. The investigator evaluates the individual's mental state, safety, and history, and then makes one of three recommendations:Dismiss the case without a hearing.Offer a diversion program (where the individual agrees to voluntary outpatient or facility-based treatment).Proceed to a civil commitment hearing.3. Civil Commitment HearingIf a hearing takes place, the person has a legal right to attend and is provided appointed legal counsel at state expense.The Criteria: To commit an individual, a judge must find by "clear and convincing evidence" that the person has a mental disorder and, because of that disorder, is dangerous to themselves/others or unable to meet their basic needs.Substance Use: A person cannot be civilly committed for a substance use disorder alone. The danger must exist independently of the substance use.4. Outcomes and DurationIf the judge determines the criteria are met, the individual is committed to the custody of the Oregon Health Authority (OHA).Duration: A commitment order can last for up to 180 days (or up to 1 year for intellectual/developmental disabilities).Least Restrictive Setting: The state's goal is always to treat individuals in the least restrictive environment possible. This means individuals are frequently transitioned to community treatment facilities or discharged to voluntary treatment as soon as they are stabilized, rather than staying in a hospital for the full 180 days.5. Rights During CommitmentIndividuals under involuntary commitment retain numerous rights, including the right to a written treatment plan, the right to keep personal possessions, and the right to communicate with an attorney. For a full breakdown of rights and guidelines, consult the Disability Rights Oregon Mental Health Holds Resource.
Unfortunately the current laws are failing both the public and the severely mentally ill. The laws need changing. The best way is civil commitment proceedings within 12 hours after ER admission, hearings on site in the hospital, representation for the patient and the state, and if commitment then treatment at the same hospital. The current procedures are totally inadequate to these public emergencies. In addition a substituted judgement consent by the judge pr other third party. Limiting the duration to a maximum of six weeks. This would drive more acute care hospital beds in local hospitals.
As importantly civil commitment should balance the liberty interests of the severely mentally with societal interests for public safety, civility, and beauty. It would also recognize the right to intervene when it would be inhumane not to do so.
McMenamins was built in 1911 and was the Multnomah County Poor Farm, not a mental health facility. It housed and fed indigent residents who worked on surrounding lands.
There is a perfect storm of political smugness, a refusal to face reality and over-reacting in other places.
Oregon is so sure its "tolerance" is the right path that its politicians have allowed the state to become a cesspool of the worst drugs possible - meth and fentanyl. By first abolishing all criminal penalties, the fires of addiction were blown up, and the situation now (speaking as someone currently working as a prosecutor) is little better. Possession of any drug is an "unclassified misdemeanor," meaning a judge is forbidden to levy any jail or fines. It would be ludicrous if it wasn't so tragic.
At the same time, the over-reaction to drug abuse in the 90s was to essentially stop many doctors from ever prescribing opioid painkillers. Many doctors are legitimately terrified that what was for a long time normal medical practice could result in loss of their license, at best. While the vast majority of the people on the street need a lot more than just a prescription, anyone in that population who could benefit is almost certainly going to go untreated. Methadone, which has been proven to work for opioid addiction, is extremely difficult to prescribe.
Finally Oregon's devotion to allowing people the right to destroy their lives without governmental intervention has resulted in the involuntary commitment laws becoming near impossible. Oregon's law specifically excludes drug addiction as a basis, and many families are told that until their crazed family member actually stabs someone, the state cannot intervene.
I live out here. Your review was one of the most true pieces of work on the matter I have seen. I've been on the streets since 11/2015. My story is long and this is not the forum. I'd just like you to know that I'm pretty sure I'm dying out here, no matter how or what I try. There is always some block. Some wall I'm asked to scale, yet it is ridiculously high and impossible to climb. Yet I keep going, convinced that I have more to offer in this life.
This lands hard because it names something many people working near homelessness know but struggle to say plainly: visibility is not the same as care. A person can be seen by hundreds of eyes and still be functionally abandoned.
I appreciate the insistence on trust-building and long-term follow-through. In recovery and shelter ministry, I keep seeing that the first real intervention is often not a program but presence that does not disappear. Still, presence has to become practical: treatment access, housing pathways, accountability, and people willing to keep showing up after the first conversation.
Mercy cannot remain passive and still call itself mercy.
Kevin, your witness is powerful, and that's the reason we subscribe. We can't get this anywhere else, so we want to support you. I hope everyone who reads this article is also a subscriber.
This book review about "madness" in America shows how inhumane the mental health industrial complex always has been and continues to be.
Summary of public post
Schizophrenia outcomes in the US today match 1900 levels despite modern treatments. Patients in India, Nigeria, and Colombia recover at twice the rate, linked to lower neuroleptic (aka antipsychotic medications,) use.
A 1994 Harvard meta-analysis showed worsening long-term outcomes during the era of promoted breakthrough medications.
• Robert Whitaker's "Mad in America" (2002) documents this history using FOIA, journals, and records; followed by "Anatomy of an Epidemic" (2010) extending to other drugs.
• Dopamine hypothesis was abandoned by its proponent but promoted by pharma ads; atypical antipsychotics hailed as breakthroughs.
• Book covers symptom suppression leading to chronicity, buried Soteria findings, ignored WHO studies, and Open Dialogue successes in Lapland with high recovery and low medication.
• Includes record of experiments that worsen psychosis along with historical treatments such as lobotomies.
The rest of the summary — well worth the price of subscription — is for paid subscribers. It includes analogy, one-minute elevator explanation, 12-point summary, Q&As, and Golden Nugget.
Valid points. But consider this: What is our responsibility to the "homeless" who continually chose drugs and refuse "programs" to help them. At some point, is it valid to say to the refuseniks that society has done all that it can and do no more.
Well, a high percentage of our homeless crisis is due to addiction. I would fund detox, recovery programs, and assertive outreach to get people clean and help them become self-sufficient.
I did this work in WA. It was fruitless to fault social services. They were severely underfunded. I went after the state. I brought legislation to make the state the at fault party when housing was not available. Of course it went nowhere, but it moved the conversation. I have been out for almost eight years and it's just gotten worse. We concentrated on a housing only option, which didn't work for far too many people.
If you had to pick one root cause of homelessness, what would it be? I understand there are many variables at play - but just wondering if there is one consistent issue or root factor.
So incredibly tragic. Thank you for reporting these heartbreaking stories. If only the answers were simple and didn't involve throwing more money into a system that clearly has failed.
Kevin or others in the field, we have two questions. Would appreciate your experiences along with any links to reliable statistics:
1. Do you know what percent of addicted Oregon homeless started with marijuana?
2. Did the rate of addiction / homelessness go up, down, or stay the same after Oregon allowed medical marijuana then recreational recreational marijuana?
As the mother of a homeless woman I really appreciate the work you do.
Thank you for loving these people and for doing your best for them. I'm sure you've saved more lives than you know. Turning a battleship around is slow, tedious work.
I don't think addressing accountability issues and passivity is the only way forward here. For people who have near death overdoses from narcotics there should be mandatory abstinence in a secure facility for 45 days. This seems like the appropriate medical intervention given the circumstances. That is what I would want if it was my mother, daughter, wife, father, son, friend, and I think most people would wish that as well. We can't make them change ultimately, but we can at least give them some mental clarity without drugs for a significant period and perhaps they will become more personally and socially responsible and take up voluntary treatment in mental health or other more socially conforming ways. Society does have rights to ensure safety, civility, and beauty in the public square which unfortunately is missing in areas of the city.
Maybe Kevin can explain the law there for “Involuntary Commitment/Detention”, here, in Virginia, it may last a day or two - then the detained person is entitled to a hearing & the government must produce witnesses and they rarely show up.
Kevin has done a great job in explaining why a voluntary commitment of any amount of time would not fit into the “substance use disorder person’s daily need to self-administer. Maybe he could refer to his RIP photos & estimate the percentage of how many he believes would have signed-up for 45 days of withdrawal.
This is from AI
In Oregon, involuntary civil commitment is a legal process allowing a judge to mandate psychiatric treatment for adults experiencing uncontrolled symptoms. It is considered a last resort and is strictly limited to individuals who are an imminent danger to themselves or others, or who are unable to provide for their basic personal needs.The involuntary commitment process generally follows a specific series of stages and criteria under Oregon Revised Statutes (ORS 426).1. The Pre-Commitment Hold (Emergency Hold)Before being formally committed, an individual can be placed on an emergency mental health hold.Who can initiate: Law enforcement, a pre-commitment investigator, or a licensed independent practitioner can place a person in custody to transport them to an emergency care facility for evaluation.Duration: An individual cannot be held involuntarily for longer than 5 judicial days (excluding weekends and holidays) without a court hearing.2. Investigation and EvaluationOnce a civil commitment petition is filed, an investigator from the local Community Mental Health Program (CMHP) conducts an investigation. The investigator evaluates the individual's mental state, safety, and history, and then makes one of three recommendations:Dismiss the case without a hearing.Offer a diversion program (where the individual agrees to voluntary outpatient or facility-based treatment).Proceed to a civil commitment hearing.3. Civil Commitment HearingIf a hearing takes place, the person has a legal right to attend and is provided appointed legal counsel at state expense.The Criteria: To commit an individual, a judge must find by "clear and convincing evidence" that the person has a mental disorder and, because of that disorder, is dangerous to themselves/others or unable to meet their basic needs.Substance Use: A person cannot be civilly committed for a substance use disorder alone. The danger must exist independently of the substance use.4. Outcomes and DurationIf the judge determines the criteria are met, the individual is committed to the custody of the Oregon Health Authority (OHA).Duration: A commitment order can last for up to 180 days (or up to 1 year for intellectual/developmental disabilities).Least Restrictive Setting: The state's goal is always to treat individuals in the least restrictive environment possible. This means individuals are frequently transitioned to community treatment facilities or discharged to voluntary treatment as soon as they are stabilized, rather than staying in a hospital for the full 180 days.5. Rights During CommitmentIndividuals under involuntary commitment retain numerous rights, including the right to a written treatment plan, the right to keep personal possessions, and the right to communicate with an attorney. For a full breakdown of rights and guidelines, consult the Disability Rights Oregon Mental Health Holds Resource.
Unfortunately the current laws are failing both the public and the severely mentally ill. The laws need changing. The best way is civil commitment proceedings within 12 hours after ER admission, hearings on site in the hospital, representation for the patient and the state, and if commitment then treatment at the same hospital. The current procedures are totally inadequate to these public emergencies. In addition a substituted judgement consent by the judge pr other third party. Limiting the duration to a maximum of six weeks. This would drive more acute care hospital beds in local hospitals.
As importantly civil commitment should balance the liberty interests of the severely mentally with societal interests for public safety, civility, and beauty. It would also recognize the right to intervene when it would be inhumane not to do so.
We did that once. The artifacts of that well proven program can be found at McMenamin’s Edgefield.
McMenamins was built in 1911 and was the Multnomah County Poor Farm, not a mental health facility. It housed and fed indigent residents who worked on surrounding lands.
Well said, Kevin.
There is a perfect storm of political smugness, a refusal to face reality and over-reacting in other places.
Oregon is so sure its "tolerance" is the right path that its politicians have allowed the state to become a cesspool of the worst drugs possible - meth and fentanyl. By first abolishing all criminal penalties, the fires of addiction were blown up, and the situation now (speaking as someone currently working as a prosecutor) is little better. Possession of any drug is an "unclassified misdemeanor," meaning a judge is forbidden to levy any jail or fines. It would be ludicrous if it wasn't so tragic.
At the same time, the over-reaction to drug abuse in the 90s was to essentially stop many doctors from ever prescribing opioid painkillers. Many doctors are legitimately terrified that what was for a long time normal medical practice could result in loss of their license, at best. While the vast majority of the people on the street need a lot more than just a prescription, anyone in that population who could benefit is almost certainly going to go untreated. Methadone, which has been proven to work for opioid addiction, is extremely difficult to prescribe.
Finally Oregon's devotion to allowing people the right to destroy their lives without governmental intervention has resulted in the involuntary commitment laws becoming near impossible. Oregon's law specifically excludes drug addiction as a basis, and many families are told that until their crazed family member actually stabs someone, the state cannot intervene.
I live out here. Your review was one of the most true pieces of work on the matter I have seen. I've been on the streets since 11/2015. My story is long and this is not the forum. I'd just like you to know that I'm pretty sure I'm dying out here, no matter how or what I try. There is always some block. Some wall I'm asked to scale, yet it is ridiculously high and impossible to climb. Yet I keep going, convinced that I have more to offer in this life.
This lands hard because it names something many people working near homelessness know but struggle to say plainly: visibility is not the same as care. A person can be seen by hundreds of eyes and still be functionally abandoned.
I appreciate the insistence on trust-building and long-term follow-through. In recovery and shelter ministry, I keep seeing that the first real intervention is often not a program but presence that does not disappear. Still, presence has to become practical: treatment access, housing pathways, accountability, and people willing to keep showing up after the first conversation.
Mercy cannot remain passive and still call itself mercy.
Kevin, your witness is powerful, and that's the reason we subscribe. We can't get this anywhere else, so we want to support you. I hope everyone who reads this article is also a subscriber.
Mad in America (2002). By Robert Whitaker - 30 Q&As - Book Summary. By Unbekoming (06/30/26). https://unbekoming.substack.com/p/mad-in-america-2002
This book review about "madness" in America shows how inhumane the mental health industrial complex always has been and continues to be.
Summary of public post
Schizophrenia outcomes in the US today match 1900 levels despite modern treatments. Patients in India, Nigeria, and Colombia recover at twice the rate, linked to lower neuroleptic (aka antipsychotic medications,) use.
A 1994 Harvard meta-analysis showed worsening long-term outcomes during the era of promoted breakthrough medications.
• Robert Whitaker's "Mad in America" (2002) documents this history using FOIA, journals, and records; followed by "Anatomy of an Epidemic" (2010) extending to other drugs.
• Dopamine hypothesis was abandoned by its proponent but promoted by pharma ads; atypical antipsychotics hailed as breakthroughs.
• Book covers symptom suppression leading to chronicity, buried Soteria findings, ignored WHO studies, and Open Dialogue successes in Lapland with high recovery and low medication.
• Includes record of experiments that worsen psychosis along with historical treatments such as lobotomies.
The rest of the summary — well worth the price of subscription — is for paid subscribers. It includes analogy, one-minute elevator explanation, 12-point summary, Q&As, and Golden Nugget.
Valid points. But consider this: What is our responsibility to the "homeless" who continually chose drugs and refuse "programs" to help them. At some point, is it valid to say to the refuseniks that society has done all that it can and do no more.
If you had 10 mil or 100 mil, how would use it to quickly help the homeless? Please don’t say rent them an apartment.
Well, a high percentage of our homeless crisis is due to addiction. I would fund detox, recovery programs, and assertive outreach to get people clean and help them become self-sufficient.
I did this work in WA. It was fruitless to fault social services. They were severely underfunded. I went after the state. I brought legislation to make the state the at fault party when housing was not available. Of course it went nowhere, but it moved the conversation. I have been out for almost eight years and it's just gotten worse. We concentrated on a housing only option, which didn't work for far too many people.
If you had to pick one root cause of homelessness, what would it be? I understand there are many variables at play - but just wondering if there is one consistent issue or root factor.
Couldn't you have at least covered the person lying dead in the street.
Is there a concentration of drugs sold around the Bottle Drop places? Is there any effort to hinder the sale of drugs in these areas? If not, WHY NOT?
So incredibly tragic. Thank you for reporting these heartbreaking stories. If only the answers were simple and didn't involve throwing more money into a system that clearly has failed.
Kevin or others in the field, we have two questions. Would appreciate your experiences along with any links to reliable statistics:
1. Do you know what percent of addicted Oregon homeless started with marijuana?
2. Did the rate of addiction / homelessness go up, down, or stay the same after Oregon allowed medical marijuana then recreational recreational marijuana?
Thank you for any information you can provide.