Noel Moor with Bolt, her dog.

WARRENTON — Five days after Noel Moor was discharged from Cedar Hills Hospital, a mental health treatment facility in Portland, she put her beloved Chihuahua, Bolt, in the oven of her Warrenton home.

The little dog’s death horrified Moor’s family and friends and led to her arrest for aggravated animal abuse. Her fiance and mother watched the sweet young woman they love stumble toward a psychotic break, but with their heartache, there is also anger and frustration.

After she left Cedar Hills in March, Moor walked away from the crisis respite center in Warrenton that was supposed to be her safe landing. She was found naked at Rite Aid. She was taken to Columbia Memorial Hospital in Astoria after several outbursts, but was released each time.

Mental health staff explained to the family that Moor did not pose an imminent danger to herself or others, the standard under Oregon law to pursue commitment to a mental hospital. By the time her fiance finally convinced them she was out of control, it was too late.

“She had to do something horrible for you guys to figure out that she is very, very, very sick,” Melanie Ryan, Moor’s mother, told mental health staff in an anguished phone conversation after Bolt’s death.

Administrators at Clatsop Behavioral Healthcare, Columbia Memorial and Cedar Hills declined to comment on Moor’s care, citing legal restrictions meant to safeguard privacy. But accounts from her family and court filings show the uncertainty over the exact cause of Moor’s mental health challenges.

Her case is an example of the complexity of dealing with mental health and addiction, a web that can feel especially hopeless in Clatsop County and other rural communities where treatment options are limited.

“The worst part of this work is to watch people become more ill and to feel helpless to do anything,” Amy Baker, the executive director of Clatsop Behavioral Healthcare, the county’s mental health contractor, said in a statement. “I understand completely the frustrations families and clients experience, because we often feel it too.

“We wait for opportunities to insert ourselves and to help individuals get back on track. We also see miracles of growth and recovery every day.”

Ryan hoped her daughter might be one of those miracles.

Eight-and-a-half years ago, while in drug rehabilitation in Astoria for heroin, Moor left, threw a brick through a downtown window, and wandered around naked until she was picked up by police, her mother said. She spent several months afterward in mental hospitals.

But no similar episodes surfaced over the past several years. Moor, 28, is on disability, her mother and fiance said, and appeared to be taking prescribed medications for bipolar disorder and opioid cravings.

Bipolar disorder, according to the National Institute of Mental Health, can cause unusual shifts in mood, energy and the ability to carry out daily tasks.

Last spring, her mother said, Moor was taken off the antipsychotic medication she had been using in favor of something else because of weight gain. Her mother said she noticed a small difference in her behavior in September, but was not concerned because she thought her daughter was keeping her appointments with Clatsop Behavioral Healthcare.

Over the past few months, though, Ryan feared Moor was unraveling. Her daughter showed extreme paranoia that culminated in an attack on Mitch Peak, her fiance, and her placement in Cedar Hills.

As far as Ryan and Peak knew, they said, Moor was not abusing illegal drugs.

In a consultation report to help the Circuit Court determine whether Moor was able to aid and assist in her defense on the felony animal abuse charge, Clatsop Behavioral Healthcare drew a starker picture.

Moor, the report found, had been unable to comply with medications or abstain from substances. She had also canceled or missed several therapy sessions and medication-management appointments since last summer.

“It is very difficult to diagnose and treat bipolar and psychotic symptoms when substance use is occurring, as origin of symptoms is difficult to determine,” the report advised.

For her mother and fiance, the most obvious, uncharacteristic thing about Moor’s behavior was acting out against her dog.

Bolt, a 7-year-old male Chihuahua, was her companion and a star of her Facebook page. “She loved that dog with her life,” her mother said in an email.

Moor thought an ex-boyfriend was inside the dog, her mother and fiance said. She also told her fiance she thought her ex-boyfriend was inside him, too.

In mental health interviews after her arrest, court filings show, she was at times delusional — “I’m God” — and seemingly aware of what happened — “I feel horrible about killing my dog.”

Citing privacy laws, Cedar Hills said it could not disclose any information about patients. “We can share, however, that it is the policy of Cedar Hills Hospital to assess every patient on the day of discharge to ensure that they are safe to discharge and that the discharge disposition is appropriate for that patient,” Libby Hutter, the Portland hospital’s chief executive officer, said in an email.

Clatsop Behavioral Healthcare can place holds on patients at Columbia Memorial. But the mental health agency — which came under intense scrutiny after a woman in crisis jumped off the Astoria Bridge in 2015 — has tried to clarify its role.

Baker said Clatsop Behavioral Healthcare does not decide when patients are released from the hospital. “We do not make decisions about who is kept and who is discharged from emergency departments,” she said. “We provide consultations to the hospitals.”

Nicole Williams, the chief operating officer at Columbia Memorial, said in a statement that “our hearts go out to the people and families in our community who are dealing with mental health issues.” She explained that when patients arrive in the emergency room, the hospital’s first responsibility is to treat any emergency medical conditions. If a patient is experiencing a possible mental health crisis, the hospital collaborates with Clatsop Behavioral Healthcare on whether they are an imminent danger to themselves or others.

“Patients may be held for transfer to an inpatient mental health facility only if they meet strict federal and state criteria for involuntary commitment and have been deemed by the courts to be at imminent risk,” Williams said. “All patients with mental health concerns are released with a discharge safety plan that includes follow-up with a mental health professional.”

The process can be exasperating for police officers, who are often called to intervene when people are in crisis, and excruciating for families, who often have no place else to turn when their loved ones are in trouble.

Peak, Moor’s fiance, described a harrowing back-and-forth with Warrenton police, mental health and hospital staff over Moor’s care that involved several trips to Columbia Memorial around the St. Patrick’s Day weekend. After one last violent encounter with Moor at home, Peak said he took all the knives and his guns out of the house and, with the help of police, pressed mental health staff to place Moor on a hold.

Anxious, Peak parked by the Warrenton Mini Mart while police located Moor on the street and again brought her to the hospital. When he got back home, he said smelled something burning and found Bolt inside the oven.

Moor was moved from the hospital to the county jail the next day.

Macon Benoit, Moor’s attorney, asked the Circuit Court to find Moor unable to aid and assist in her defense based primarily on Clatsop Behavioral Healthcare’s consultation report. Judge Paula Brownhill ruled in late March that Moor lacked the fitness to proceed and committed her to the Oregon State Hospital for treatment and evaluation. A court hearing on the status of her capacity to stand trial is set for May.

Ryan and Peak do not think Moor was ready for discharge from Cedar Hills to the crisis respite center, which does not have secure beds to prevent her from walking out. They believe there were enough warning signs in the days before Bolt’s death to keep her at Columbia Memorial until a mental health option could be found.

“This was a clear case of the system letting her down when she went to them for help,” Ryan said in an email. “I let her down too. I should have seen and or acted on the signs sooner.”

Peak, a log truck driver, said he researched mental health since his relationship with Moor so he could better understand what she is going through. He did what anyone would do when they see someone they love in crisis. He tried to get her help.

“She’s a sweetheart,” he said. “She’s got a bigger heart than anybody I know.”