A Humanitarian Crisis Driven by a Failed Behavioral Health “System” (Op-Ed)

Authored by Dr. Andy Mendenhall, CCC President and CEO

The recent ruling by U.S. District Judge Adrienne Nelson, combined with limited access to the Oregon State Hospital (OSH), highlights a fundamental reality: Oregon’s behavioral health system is failing many of our most acutely ill and vulnerable residents. That failure is also a major contributing factor to the state’s homelessness crisis.

For decades, Oregon has lacked a behavioral health system capable of meeting the needs of people living with severe and persistent mental illness. The result is a growing humanitarian crisis in which too many individuals cycle between homelessness, emergency rooms, jails, shelters, and short-term treatment settings. Many lack insight into their illness and do not have the legal capacity to make informed decisions about their care.

In fall 2025, CCC published Engaged Supportive Housing: Sustainable Models for Housing and Clinical Services in Supportive Housing to highlight the challenges supportive housing providers face when residents’ behavioral health needs go unmet. The report adds the perspective of frontline homeless service providers to findings from a 2024 Oregon Health Authority (OHA)-commissioned analysis of behavioral health facility capacity and unmet need.

The evidence is clear. Oregon’s mental health system remains fragmented across multiple agencies and organizations, with no unified infrastructure for planning, coordination, or data sharing. A 2025 Secretary of State audit found that Oregon Health Authority (OHA) must coordinate with more than thirty entities, making crisis response and systemwide accountability exceptionally difficult.

At CCC, staff see these consequences every day.

Residents whose mental illnesses go untreated often become too unstable to remain safely housed and return to homelessness. Some eventually receive treatment only after entering the carceral system. Yet people living with serious mental illness are far more likely to be victims of violence than perpetrators.

Oregon consistently ranks among the worst states in the nation for mental health outcomes, driven by both a high prevalence of mental illness and inadequate access to care. Too many Oregonians cannot obtain treatment until they are already in crisis. When their conditions deteriorate and more intensive services become necessary, the state lacks sufficient specialty outpatient programs, residential treatment capacity, and inpatient psychiatric beds. A 2024 legislative report concluded that a “lack of access to facility-based care in Oregon led to long wait-times and a mismatch between the level of care needed and the care received.”

Even when individuals successfully complete treatment, many return to housing situations that lack the support necessary to maintain stability and recovery. Without adequate clinical services and supportive housing, the cycle often repeats.

Oregon should be expanding access to treatment and strengthening the continuum of behavioral health care—not reducing pathways to care for people whose illnesses prevent them from seeking help voluntarily. A system that cannot meet the needs of its most vulnerable residents will continue to leave too many people trapped in cycles of illness, homelessness, and crisis.

If Oregon is serious about reducing homelessness and improving community well-being, it must invest in a behavioral health system capable of delivering treatment, stability, and safety. Compassion requires more than good intentions—it requires the infrastructure necessary to care for those who need it most.