Mental Health Association of Portland

Oregon's independent and impartial mental health advocate

Albany schools invest in mental health

Posted by admin2 on April 24th, 2014

An editorial from the Albany Democrat-Herald, April 24, 2014

Despite the obvious good news contained in the budget proposal for Albany schools, the news actually gets better when you peer into some of the details.

Linn County Court House Albany, OR

Linn County Court House Albany, OR

Administrators with the Greater Albany Public Schools district released the first draft of their budget proposal this week. The big news, of course, is that the budget could allow Albany schools to hire more than two dozen additional teachers along with more counselors, coaches and club advisers.

Any way you slice it, that’s good news.

The extra staff members are being made possible by a boost in state funding for the second half of the two-year budget cycle and a recalculation of how the state allocates funding for students deemed to be “in poverty.” That recalculation ended up benefiting Albany schools.

Look a little bit deeper into the details of the budget and you find more good news: The proposed budget demonstrates a renewed commitment to identify and possibly treat mental health issues before they have the chance to explode into tragedy.

The proposed budget calls for the equivalent of another full counseling position, split between South Albany and West Albany high schools, and combined with other resources to create two additional full-time counselors at each high school.

District officials said the counselors will be responsible for “improving our crisis prevention capacity” in terms of students who may have behavioral or emotional issues.

The proposed budget also contains $40,000 in funding to train classified staff in behavior intervention and to provide temporary support to develop behavior plans for students who might be at risk of an emotional crisis.

Those are smart moves.

We’ve spent a lot of time justifiably worried about the big gaps in our mental health system, especially when it comes to the services available to young people.

Now, Albany school officials have elected to spend some of their fiscal good fortune to help try to plug those gaps.

We won’t try to pretend that these additional resources will fix every problem or catch every student at risk of falling through the cracks.

But they should help to at least narrow some of the gaps. This is how we start to unwind the damage caused by decades of underfunding our mental health system – a few dollars at a time. And if even one student finds the help he needs thanks to these additional resources, this relatively small investment will pay off – handsomely – many times over.

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Oregon meth deaths at highest point since 2000

Posted by admin2 on April 24th, 2014

From Salem Statesman Journal, April 24, 2014

The Oregon State Medical Examiner has released 2013 statistics for drug-related deaths, finding that methamphetamine deaths are on the rise statewide.

Overdose report by county, 2013

Overdose report by county, 2013

But other drugs, like heroin and cocaine, have declined.

More than 200 people died in Oregon in 2013 due to drugs, nearly the same number of deaths reported in 2012.

The majority of all drug-related deaths, 55 percent, were related to the use of methamphetamine. The number of people dying from this drug has increased 32 percent since 2012 and is the highest recorded number of deaths since 2000.

Heroin-related deaths, however, decreased 25 percent since 2012, when the number of heroin-related deaths was reportedly the highest it had been since 2000.

Cocaine-related deaths were down another 35 percent and have been the lowest number reported since the beginning of 2000.

According to the medical examiner, the majority of methamphetamine-related deaths were actually not overdoses, but due to some other event like a car crash or a drowning.

Forty-five percent of the drug-related deaths occurring statewide happened in Multnomah County.

In the press release from the medical examiner, Marion County was highlighted as one county that saw notable decreases in the number of drug-related deaths. Deaths decreased from 19 in 2012 to only six in 2013.


Oregon State Medical Examiner Dr. Karen Gunson released 2013 drug-related death statistics reflecting one fewer death from last year and a near 7 percent drop from 2012 when deaths reached their highest level since 2000.

Preliminary drug-related death statistics showed the lowest number of Cocaine-related deaths and highest number of Methamphetamine-related deaths since 2000.

Drug-related death statistics indicate 222 deaths in 2013, down less than one percent from 223 deaths reported in 2012. These deaths are associated with the use of Heroin, Cocaine, Methamphetamine, or a combination use of those drugs. Three years ago in 2011, Oregon reported the highest number of drug-related deaths when 240 people needlessly died from the abuse of illicit drugs.

A review of last year’s 222 reported deaths and their frequency of use reflected:

* 123 Methamphetamine-related deaths, a 32 percent increase over the previous year’s reported 93 deaths and the highest recorded since the beginning of 2000. More than 55 percent of all drug-related deaths were associated with methamphetamine use. Multnomah County noted a 62 percent increase in this category with 45 recorded deaths, up from 28 deaths last year.

* Heroin-related deaths (111) were a 25 percent decrease from the previous year’s reported 147 deaths, which was the highest number since the beginning of 2000. More than half (65) of heroin-related deaths happened in Multnomah County, and Clackamas County recorded 13 deaths which is an increase from last year’s eight recorded deaths in this category.

* Cocaine-related deaths (12) were the fewest recorded since the beginning of 2000 and a 35 percent decrease from the previous year’s 19 reported deaths. The highest number was reported in 2000 when 69 people died from illicit use in this category. Cocaine-related deaths occurred only in Multnomah (9), Lincoln, Malheur, and Yamhill counties.

* Combination of drug use deaths (26) dropped 20 percent and was the second fewest since the beginning of 2000.

Dr. Gunson noted the majority of methamphetamine-related deaths are not overdoses but actually related to some other event such as traffic crashed, drowning or other traumatic event. Methamphetamine use is also linked to seizures and sudden elevation in blood pressure which can cause strokes and heart attacks.

Forty-five percent of drug-related deaths in 2013 happened in Multnomah County, a drop of one death compared to last year’s 103 deaths.

Counties with notable increases include:

* Clackamas County: 13 (2012) to 17 (2013) – thirteen were heroin-related
* Columbia County: 1 (2012) to 4 (2013) – three were methamphetamine-related
* Coos County: 4 (2012) to 8 (2013) – six were methamphetamine-related
* Josephine County: 1 (2012) to 4 (2013) – three were methamphetamine-related
* Lane County: 15 (2012) to 20 (2013) – thirteen were methamphetamine-related
* Linn County: 1 (2012) to 6 (2013) – five were methamphetamine-related
* Polk & Umatilla County: 0 (2012) to 3 (2013) – five of their 6 combined deaths were methamphetamine-related

Counties with notable decreases include:

* Clatsop County: 4 (2012) to 1 (2013)
* Jackson County: 19 (2012) to 11 (2013) – seven were heroin-related
* Marion County: 19 (2012) to 6 (2013) – five were methamphetamine-related
* Washington County: 17 (2012) to 12 (2013) – nine were methamphetamine-related

Oxycodone use surpassed methadone in topping the list of major drug prescription deaths. In 2013, the 150 opioid-related deaths in three noted categories dropped from 170 in 2012 and 193 in 2011. Decreases in methadone-related deaths accounted for the yearly decreases. The noted prescription drug categories are:

* Methadone-related deaths dropped from 78 (2012) to 58 (2013)
* Oxycodone-related deaths dropped from 66 (2012) to 60 (2013)
* Hydrocodone-related deaths rose from 26 (2012) to 32 (2013)

Note that prescription drug overdose death statistics are statewide and not included with the information provided on the State Medical Examiner’s website charts.

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Mary Monnat Takes the Road Less Traveled

Posted by admin2 on April 24th, 2014

From The Lund Report, April 24, 2014

Mary Monnat, president and CEO of LifeWorks NW, isn’t known as a quitter.

Portland Commissioner Nick Fish with Mary Monnat

Portland Commissioner Nick Fish with Mary Monnat

In her 30-plus years at LifeWorks NW, the mental health and addiction prevention and treatment organization has grown from 50 staff members treating a few thousand clients per year to a tri-county operation with over 600 employees serving 17,000 individuals annually.

Monnat’s career as a passionate advocate for mentally ill and addicted individuals started at a personal crossroads.

After graduating from Notre Dame, she applied and was accepted to three law schools. A dream come true?

“I didn’t want to go,” said Monnat, smiling broadly in her sunlit Beaverton office, set among cabin-like buildings shrouded by trees.

She asked for and was granted deferments from all three schools and “took a year off to live simply and do community work with Holy Cross Associates.”

After walking away from law school, Monnat came to Portland, “out to save the world,” she said, and began working at DePaul Treatment Centers, a nonprofit provider of chemical dependency services.

“The experience saved me,” said Monnat. “I was taken by the recovery process and how it could transform people’s lives.”

Personal experience shaped Monnat’s revelation.

“I came from a family with serious addiction and depression problems – a classically addicted family,” she said.

Though many young people would try to forget such a difficult past, “I wanted to broaden my understanding of mental health,” she said. “I had an ‘Aha’ moment that addiction runs in families, but so does recovery.”

Monnat got to know Jeanne Rivers of Central City Concern, who drove a Hooper Detox van, retrieving publicly intoxicated people to spend the night in Hooper’s care rather than in jail.

At the time, DePaul Treatment Center and other programs accepted only male patients. But Monnat and Rivers witnessed mentally ill and addicted women and their children living on the streets.

“We knew where the women were and started a track for skid-row women,” said Monnat.

She joined LifeWorks in 1983 as a chemical dependency and mental health specialist, moved through various management positions and became president and CEO in 1998.

The organization, which served only Washington County in the early ‘80s, grew to include Clackamas and Multnomah counties and now has dozens of offices and programs throughout Portland metro. “We are in 20 medical clinics now,” said Monnat. “Our goal is to help support primary care” and provide a continuum of support.

Who does LifeWorks serve?

“It’s across the lifespan,” said Monnat. “From prebirth treatment of mothers for mental health and addiction, to adults with dementia.”

Its prevention services support healthy parenting, school success, juvenile crime prevention, life skills development and substance abuse prevention.

Its mental health programs offer counseling for anxiety, depression, past trauma, family relationship issues, challenges during adolescence, parenting difficulties and Alzheimer’s disease.

Addiction counseling encompasses alcohol abuse, methamphetamine and other drug use, problem gambling, and dependence on prescription or over-the-counter medications.

“We serve those on Oregon Health Plan and the uninsured,” said Monnat – people who lack the resources to get the treatment they need.

Referrals come from a variety of sources.

“It might be a child welfare worker, a probation and parole officer, a doctor’s office, family members or even the person in need,” said Monnat.

“We have a centralized intake number (503-645-9010). Just call us and we will help.”

Women and children are the focus of LifeWorks’ Project Network, a nationally recognized program that works with mentally ill and addicted women toward a goal of becoming clean and sober, reuniting with their children, and transitioning to permanent, supported housing.

In just a few months, Monnat will realize one of her organization’s long-sought goals. The Center for Hope and Recovery will open in late July, the result of a partnership between Lifeworks NW and Home Forward (formerly the Housing Authority of Portland).

The $8.5 million facility and neighboring apartments in northeast Portland will provide treatment and substance-free family housing, predominantly for African-American women and children.

“It will have 45 beds for pregnant, addicted women and five homes for step-down services, in a supportive neighborhood,” said Monnat.

Thinking about the changes in attitudes, funding and treatment of mental health and addiction that she’s witnessed in the last 30 years, Monnat says, “I have more hope now than I ever have.”

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Psych Central signs on to help defeat pro-force, anti-rights House bill, HR 3717, the “Helping Families in Mental Health Crisis Act”

Posted by Jenny on April 21st, 2014

By Jenny Westberg, Portland Mental Health Examiner, April 21, 2014

if-its-forced-its-not-treatmentAn anti-civil rights bill that purports to fix the “broken mental health system” but would actually gut that system has picked up a new and formidable opponent. Psych Central — and the more than 350,000 Americans it represents – last week came out strongly against HR 3717, the so-called “Helping Families in Mental Health Crisis Act.”

Psych Central joins a chorus of dissenters, including the National Coalition for Mental Health Recovery (NCMHR), a coalition of 32 statewide organizations and others representing individuals with mental illness. Others opposed to the bill include the National Disability Rights Network (NDRN), the National Council on Independent Living, the American Association of People with Disabilities, and the Bazelon Center for Mental Health Law.

NCMHR, NDRN and the Bazelon Center noted that HR 3717 “does not represent the mainstream of national thought, practice and research.”

Pro-coercion, anti-privacy

At the core of the bill, introduced by Rep. Tim Murphy (R-PA) late last year and heard by a House subcommittee April 3, is force and coercion in mental health care. If enacted, HR 3717 would expand the criteria for involuntary commitment and extend the reach of Assisted Outpatient Treatment, which facilitates forcible treatment in the community. NCMHR notes that involuntary outpatient commitment is a high-cost intervention with no evidence it works.

The act would even use coercive tactics against non-patients, such as state legislatures, which would be required to pass forced-treatment laws, whether or not their citizens want them.

It would also decimate personal privacy. Under the bill, if a hospitalized person designated “seriously mentally ill” did not consent to information sharing with their caregiver, their caregiver would automatically be named personal representative and get all the information anyway.

Defunding the defenders

The bill also guts SAMHSA and cripples state Protection and Advocacy organizations created to defend the rights of disabled persons. Locally, that’s Disability Rights Oregon (DRO), which has powerfully acted on behalf of persons with psychiatric disabilities many times. The proposed legislation would silence DRO, slash its funding and prevent it from filing class action suits on behalf of people with mental illness.

Bob Joondeph, DRO’s executive director, called the bill an attack on the hard-won rights established by the Americans With Disabilities Act (ADA), an attempt “to change our country’s mental health policy from encouraging recovery to taking control of others’ lives.”

“The text of the ADA sets out its core goals as equality of opportunity, full participation, independent living and economic self-sufficiency,” Joondeph said. “Among the problems that the ADA was specifically enacted to address are ‘institutionalization,’ ‘overprotective rules and policies,’ ‘isolation’ and ‘segregation.’ But Rep. Murphy…would more likely characterize the real problem as people with disabilities lacking obedience to authority.”

“I can’t and won’t support it”

Beckie Child, a doctoral student and adjunct faculty member at Portland State University, said flatly, “I oppose HR 3717. There are so many problems with HR 3717 that I can’t and won’t support any aspect of it.”

The recent subcommittee hearing repeatedly linked mental illness and violence, but Child noted, “Psychiatry’s ability to predict who will become violent has never been good and it has not improved. The reality is that we cannot predict who will become violent.”

She added, “The reality is that the mental health system is not all that great at engaging people. The only people who will benefit from this bill if it were to become law are psychiatrists and the organizations that provide services to people that are subject to its provisions.“

HR 3717 is not intended to benefit persons with mental illness, according to Psych Central, which explains: “You can kind of tell this isn’t a bill directed at patients and helping patients in the mental health system simply by its name, ‘The Helping Families In Mental Health Crisis Act.’ You see that there — families. Not people with mental illness. This is about helping families deal with a family member who has an apparent mental illness — not about helping the actual people with a mental illness.”

NAMI keeps it blurry

But the most prominent “family” mental health organization, NAMI, has been coy about giving a straightforward opinion on the bill. Chris Bouneff, executive director of NAMI Oregon, referred me to a letter from NAMI National from last December that avoids nailing down a position, with some parts of the bill labeled “positive” and others as “more controversial.” Although several local NAMIs have spoken out for (and less often, against) the bill, Bouneff said, “As this is federal legislation, the national organization is the one that sets NAMI positions with input from NAMI members and state and local chapters.”

Daniel Fisher, M.D., Ph.D., a founder of NCMHR, said the legislation would dismantle evidence-based, voluntary, peer-run services that promote recovery. “These services have a proven track record in helping people stay out of the hospital and live successfully in the community. Because hospitalization is far more expensive and has far worse outcomes than these effective, and cost-efficient, community-based services, this bill would cost more money for worse outcomes,” he said.

“Even worse,” Fisher added, “the bill greatly promotes stigma and discrimination by its unfounded and damaging connection between mental illness and violence.”

Psych Central sums it up: “It stinks for everyone – especially patients.”

♦♦♦

What You Can Do Today to Help Stop HR 3717

As of April 20, HR 3717, the “Helping Families in Mental Health Crisis Act,” had 74 co-sponsors. So far, none of Oregon’s Representatives have signed on.

It is very important this bill gets as few as possible co-sponsors. Call your Representative today and ask him or her NOT to co-sponsor the bill. Here’s how:

1. To find your representative, go to http://www.opencongress.org/people/zipcodelookup and enter your address and/or Zip code. Click the name of your Representative, and look for the phone number of the D.C. office. You may have to scroll down.

2. When you call, tell the person answering the phone the following message (or write your own – just remember to keep it brief):

“I live in Representative (name)’s district. He (or she) should NOT cosponsor HR 3717 (Rep. Tim Murphy’s mental health bill) because it is bad for constituents. This bill promotes coercive treatment, increases stigma, weakens protections for vulnerable people, and terminates critical mental health programs that help people recover from serious mental illness.”

3. Ask the person that answers the phone to give your message to the staff member that handles health issues for the Representative.

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Al Forthan Memorial Scholarships help teens with families gripped by addiction

Posted by admin2 on April 18th, 2014

From the Portland Tribune, April 17, 2014

When Greg Stone decided to start a scholarship fund for teens suffering from addiction, he didn’t do the obvious — give grants to teens who were recovering alcoholics or drug addicts. Instead Stone decided the fund would provide college money for teens growing up with parents or guardians who were addicts.

Al Forthan

Al Forthan

Stone, the longtime director of the Men’s Residential Center run by Volunteers of America in Northeast Portland, grew up with a father who was both an alcoholic and violent. His background could have sent him down the same path. It didn’t. “That motivated me to be of service,” he says.

So when Stone became inspired to set up the Al Forthan Memorial Scholarship eight years ago (more about that later), his choice for winnowing down a long list of potential recipients to the one Oregon teen who would get a $10,000 scholarship each year made perfect sense.

“There are a hundred kids out there who have had a bad life,” Stone says. “We’re really trying to honor and support kids who come from these families where life has not been fair to them, but they have become extremely resilient at surviving and giving back.”

This year’s winner will be introduced April 30 at the VOA’s annual banquet, which is open to the public. The scholarship fund has grown so that this year, in addition to the Forthan scholarship, 37 other teens who entered the competition will receive college scholarships ranging from $500 to $4,000.

Now about that inspiration. Fifty years ago, Forthan was one of those teens from a disadvantaged background. He graduated from Jefferson High School in 1963 and became a major player in the Northeast Portland drug-dealing community, according to Stone. Stone says Forthan served nine separate prison sentences and had a long-time heroin addiction.

In 1992, Forthan came to Stone’s rehab center — as do all of its residents who are Multnomah County probationers and parolees — as part of a court order. He got clean, and then he got educated. He earned Portland Community College certification as an alcohol and drug counselor, and he became the first former client to work at the VOA center, counseling addicts there for 10 years before his death in 2006, 14 years clean and sober.

Forthan was an iconic figure at the men’s center, laboring up the steps to the second-floor dorm rooms, oxygen tank at his side. Three days before he died, Stone says, Forthan, in hospice care, led a bedside Narcotics Anonymous meeting with about 10 addicts, his usual group of recovering black men.

That same night, Stone went home and had the idea to start the college scholarship fund to honor Forthan’s legacy, and his journey.

“Education is the great equalizer for kids who don’t have a fair shake in life,” Stone says. “Watching Al speak and seeing him change his own life, I saw that.”

Applicants for the Forthan scholarship — this year there were 83 — are required to write essays explaining not only their achievements and the barriers they have had to overcome, but also how they have started giving back to their communities. Stone says he wasn’t simply looking for hard-luck stories, but a way to distinguish those who already have shown the grit to get past a childhood lived amid addiction.

This year’s Forthan winner, who asked that his name be withheld, already has volunteered 192 hours translating Spanish at a medical clinic, 560 hours as a teen outdoor leader at a summer science camp, and 340 hours as a volunteer math tutor. Accepted at Oregon State University, he needed money to live on campus. His alcoholic father would “squeeze my arm really hard and hit and kick me when he got angry. He would also tell me he wished I wasn’t in his life,” according to his application.

That father has been absent from his life for years and does not pay child support; his mother is disabled.

Here is an excerpt from his application: “I tried to be the best in football, basketball, wrestling, weightlifting, cross country, and track and field. I tried to be the best violinist in the orchestras I participated in. I spent my free time and weekends studying hard, so I could get straight A’s in all my classes. Yet no matter how much I accomplished, I never felt like I could prove myself. I realized that I had an irrational anxiety: If I wasn’t the best, I was worth nothing at all.

“As some time passed, I reflected on my life, including my childhood, and I discovered the roots of my anxiety. My father instilled a fear in me that I was worthless, and I might get beaten or killed. I felt scared while thinking of the past, but I realized that my anxiety was irrational since my father was now out of my life. I finally began to appreciate all the activities and academic work I have done. I realized that I could help other people, that I could figure things out, and that I could shape a better world for myself. I have overcome the fear that my father inflicted on me as a child, and I will continue to contribute to the well being of the world and the people around me through volunteering, music, and academic study.”

Stone figures that if Forthan could listen to the young man about to receive a scholarship in his name on April 30, he’d be nodding his head in approval.

The VOA awards banquet for Al Forthan scholarship winners will be held 5 p.m. April 30, at the New Song Community Church, 220 N.E. Russell St. The event is free, but those planning to attend should make reservations through kyates@voaor.org or call 503-802-0299.

Donations to the scholarship fund can be made at the banquet, or at voaor.org.

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Recommendations for including persons with mental illness in public policy discussions

Posted by admin2 on April 12th, 2014

DOWNLOAD & DISTRIBUTE – Recommendations for including persons with mental illness in public policy discussions (PDF)

Persons with mental illness are the most discriminated against persons in this or any other nation, now or at any time in history. They are routinely and legally discriminated against in housing, in law, in education, in the workplace, in churches and synagogues, and most everywhere else. Their NAACP hasn’t been formed. Their Martin Luther King hasn’t been born.

The perspective of persons with mental illness goes missing from public policy discussions because of discrimination routinely ignored by civil servants, politicians, judges, and other facilitators of public discourse.

This discrimination can end – but not without protected inclusion, which, as defined by the Americans with Disabilities Act, means providing an accommodation.

Different disabilities require different accommodations. Few are cheap or easy. Accommodating people with a hearing disability may require ASL interpreters or captioning at public events. Accommodating people with ambulatory disabilities commonly requires elevators, ramps and wider hallways.  Not cheap or easy – but federal law.

In Oregon about 160,899 persons have a hearing disability. About 256,000 have trouble getting around and/or up and down stairs. Mental illness, as measured by the federal government and not including addictions, overwhelms all other disabilities combined; in Oregon the number is 780,000.

Lack of inclusion of persons with mental illness in public policy discussions and decisions is a key reason public mental health systems have routinely poor outcomes.

Your organization or governmental agency should have a policy which clearly describes and defines what a disability accommodation for mental illness looks like, and how to respond when someone requests an accommodation for mental illness. If your organization or agency doesn’t have such a policy, ask your executive to create one. If they need guidance, contact the Mental Health Association of Portland for a list of consultants who can help formulate this policy for your organization.

What makes an effective accommodation for a person with mental illness, allowing them to participate in a public policy committee, an agency board of directors, or an oversight committee?

Mental illness is not a single condition or constant state. There are many different diagnosis, and many levels of disability due to each diagnosis. Thus, there is no one recommended accommodation suitable for all persons with mental illness.

Instead, an effective accommodation for a person with mental illness is discovered – and often deployed – through routine communication with an experienced, trained, integrated and committed support staff member.

A public policy accommodation for a person with mental illness is access to staff with the following qualities.

Routine Communication style should be defined by the participant, available in any form and at any time, but time limited by mutual agreement. Communication must be respectful – both ways.

Experienced Support staff members must have had personal experience as a client of a public mental health agency within the past five years.

Trained Support staff members must be certified Peer Support Specialists.

Integrated Understanding the issues is key. Support staff must be integrated in committee work. They must know committee members and be able to contact them on behalf of the participant. They must understand the committee governance, policies and processes. They must read, understand and be able to explain all subjects discussed and all documents distributed.

Commitment Staff should plan to spend approximately an hour one-on-one with each participant for each hour in a public or private meeting, and an additional hour for each document distributed to committee members. Staff should not spend more time than this.

 
DON’T assume a person with a disability needs or wants an accommodation. A person may have a disability and not wish to have an accommodation, or they may not need one. It is the disabled person’s responsibility to ask for an accommodation.

DON’T be unprepared. Government agencies are required by 1990 federal law to provide an accommodation upon request – not a month or a week or a day later. Upon request means now.


Disability statistics from disabilitystatistics.org

Suggested reading: Mental Health in the Workplace: Situation Analyses, United States, Part 2: The Role of Government and Social Partners (Cornell University ILR School), pp. 26-40:

For a list of consultants who can advise your organization about formulating a policy for inclusion of persons with mental illness in public policy discussions, send a request to info@mentalhealthportland.org.

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Private study finds lower Medicaid costs for residents of Bud Clark Commons

Posted by admin2 on April 10th, 2014

From the Oregonian, April 10, 2014

Monthly health care costs for Medicaid recipients who live at the Bud Clark Commons in Portland plummeted 55 percent after moving into the alcohol-and-drug-tolerant public housing project, according to a new study.

But those savings were inflated by 9 percentage points because two high-needs residents apparently died almost immediately after moving in.

Home Forward, the housing authority that operates the commons, funded the $50,000 study. The report touts its findings as an indication that supportive housing had a “profound and ongoing impact on health care costs” for the people who live there.

READ – Integrated Housing & Health; a Health-Focused Evaluation of The Apartments at Bud Clark Commons (PDF)

The study found across-the-board cost reductions for people who moved into the 130-unit studio apartment project, said Bill Wright, associate director for research of the group that conducted the study.

But Wright cautioned there is not a cause-and-effect relationship between living in the commons and lower health care costs.

“Moving in was associated with a reduction,” he said. “That doesn’t mean it’s a direct cause.”

Read the rest of this article here.

READ – Health care study explores the impact of housing on health care use, costs and outcomes, press release from Health Share Oregon


Report Conclusions

COST SAVINGS

Residents with Medicaid coverage saw significant reductions in medical costs after moving into BCC: the average resident saw a reduction of over $13,000 in annual claims, an amount greater than the estimated $11,600 it costs annually to house a resident at BCC.

Importantly, this reduction in claims was maintained into and beyond the second year of residency, suggesting that supportive housing had a profound and ongoing impact on health care costs for those living at BCC. We examined historical, pre-BCC claims data for residents to determine whether some reduction in costs might have been expected in this population even in the absence of housing.

We did not find evidence of a natural “regression to the mean” in costs for the population BCC serves; indeed, their health care costs steadily rose for the 2.5 years prior to moving into BCC, peaked just prior to move-in, and then immediately fell to a much lower level after move-in. In the absence of a formal experimental “control group” to compare out-comes, this represents the best available evidence that cost reductions are likely attributable to the acquisition of housing and would not have been expected to happen in its absence.

SHIFTS IN UTILIZATION

We examined utilization data in order to understand the mechanism by which costs were reduced. We found evidence that residents maintained connections to outpatient behavioral health, primary care, and pharmacy after moving in, but saw significant declines in inpatient and ED utilization. This suggests that cost savings among the BCC residents came from efficiently managing health care in appropriate settings, helping to reduce acute health crises and avoid more expensive types of utilization.

We also examined self-reported utilization data in order to determine if similar patterns held true for non-Medicaid residents. We found patterns in the self-report data that matched those in the claims: continued engagement in outpatient care accompanied by a reduction in acute events.

Hospitals absorb significant uncompensated care costs for such events. Given these costs, the “true” savings associated with housing at BCC are likely considerably higher than our Medicaid-only estimate.

ACCESS, HEALTH, & TRAUMA

Residents saw significant declines in unmet health care needs, and significant improvements in self-reported physical and mental health, after moving into BCC. There was also a significant increase in overall happiness.

Trauma histories were very common among BCC residents; even after moving in many residents still face traumatic events in their lives. Understanding the link between trauma survivorship and health care utilization/costs will be a key component of caring effectively for this population.

CHALLENGES

Our interviews with residents also revealed some challenges of the supportive housing model. Some residents told us that getting clean and sober was actually more difficult than they expected in an environment where others are still actively using. Others mentioned feeling unsafe or threatened by others living in the building, which sometimes hampered their involvement in social activities or use of other services. New strategies to overcome these challenges will help residents fully engage in the BCC model.

IMPLICATIONS FOR REFORM

These results suggest that health care reformers would be well served to think carefully about the relationship between housing and health, particularly in vulnerable populations such as those served by BCC. Among those in our study, getting into stable housing resulted in a significant reduction in total health care costs; these savings were greater than the estimated annual cost of housing someone at BCC, do not appear likely to have reflected natural regression to the mean, and were maintained over time. Housing also im- proved self reported health outcomes. In this acutely ill and vulnerable population, supportive housing was effectively a health care intervention, and it appears to have worked.

Additional research can help replicate and substantiate these findings. For now, however, these results suggest that Oregon’s commitment toward a broader view of health care — one that thinks beyond service delivery and encompasses the social determinants of health — may have real potential to help bend the cost curve. Policy and funding pathways to support and expand such models should be strongly considered as part of Oregon’s ongoing transformation effort.

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Portland police sexual abuse victims’ advocate says mental illness, homelessness increase risk of being victimized

Posted by Jenny on April 10th, 2014

Portland Tribune, April 10, 2014

Susan Lehman talks with a formerly homeless woman who was victimized multiple times while living on the streets

Susan Lehman talks with a formerly homeless woman who was victimized multiple times while living on the streets

There are days, more than a few, when Susan Lehman feels, if not torn, at least tugged by the possibility of what could be done. Lehman works as a Portland Police Bureau sex abuse victim advocate. Her job is to help women who have been raped.

On the job, she is as likely to hug a teenage girl who has been sexually abused as she is to spend an entire afternoon lining up shelter for a victim who is homeless. At night, she occasionally finds herself in tears, having successfully maintained the professional barriers her job requires, saving emotional reaction for her private time. And sometimes, in her private moments, Lehman gives way to the feelings she is not allowed to voice on the job.

“I have thought to myself, I would like to get this bad guy off the street,” Lehman says.

Lehman is one of two victim advocates hired five years ago by the Portland Police Bureau after a 2007 city audit determined that Portland had a remarkably low rate of conviction in sexual assault cases. Too many victimized women, the audit noted, were not coming forward to work with police, and not following through to testify after their assailant was arrested.

It was hoped that advocates working with assaulted women might help prosecutors achieve a higher conviction rate, as more victims learned to trust the criminal justice system. Lehman knows this. But she also knows that her first loyalty is to the women (and very occasionally men) she tries to help after they have been assaulted. Which is why during the daytime she so often has to keep her thoughts about what she’d like to happen to the bad guys to herself.

Nationally, only a small percentage of victimized women — estimated at less than 1 in 10 — brave the full process that leads to a conviction. Lehman could, if she were of a mind to, influence some hesitant victims to work with police and testify in court. But she never does. Not even close.

“I have never thought I hope the victim changes her mind,” Lehman says. “It is such an intensely emotional process that I wouldn’t want someone to do that who isn’t thoroughly prepared.”

In February, the Portland City Auditor issued a report assessing the current state of the police response to sexual assault. The report said that there have been significant improvements since the scathing 2007 audit.

Victims in Portland now can report sex assaults anonymously using a Jane Doe rape kit. That means police can start an investigation, and if the victim later decides to testify, the evidence will be available. All of the major Portland hospital emergency departments now have those rape kits and are able to use them; previously only the emergency department at Oregon Health and Science University could do so. And victim advocates such as Lehman are available to victims when they report rapes or when they are interviewed by detectives.

These changes have been occurring nationally as well. And yet, the data surrounding sex assault cases still puzzles experts, including some within the Portland police. First, statistics appear to show that in the last two years, women have become less willing to report rapes. Nationally, 28 percent of victims reported sexual assaults to authorities in 2012, down from 56 percent a decade earlier. Some experts say the last two years may have been an aberration, because previously reporting rates had been rising. But in addition, according to the latest Portland police data, police here are clearing fewer sex assault cases than they did six years ago.

After the 2007 audit, the rape clearance rate for Portland police jumped to 55 percent (in 2008) from around 30 percent. It has declined each year since.

Experts — nationally and in Portland — say that victims need and benefit from the support of advocates. They have assumed that advocates working with victims would increase the rate of convictions. And that as word got out about the support, more victims might be willing to report sexual assaults.

“I think they absolutely drive the clearance rate up,” says Sgt. Pete Mahuna, who heads the Portland police sex crimes unit. Mahuna is convinced more victims testify because they have the support of an advocate. In 2013, victims reported 194 rapes to Portland police. Fifty-six of those cases ended up suspended, almost all because the victim was unwilling to pursue prosecution. Unfortunately, Portland police do not have comparable data from the years before they began using victim advocates.

Mandy Davis, clinical director of the Trauma Informed Care Project at Portland State University’s School of Social Work, says Lehman’s willingness to see to the needs of victims is crucial in helping them get through the criminal justice process, and she’s pretty certain having Lehman on hand increases the chances victims will testify against their attackers.

“She is phenomenal,” Davis says. “She is what all advocates should be like.”

But the tension inherent in the work done by women such as Susan Lehman makes it impossible to know if Davis and Mahuna are right. Lehman and the police bureau’s other advocate, Slavica Jovonavich, work with 650 to 700 women a year. Another a half-dozen or so cases each year involve men, whose reporting rate is even lower than that of women.

Separating abused, abuser

More than 80 percent of sexual assault cases in Portland involve women Lehman describes as extremely vulnerable. Most are homeless or very poor, many suffer from addictions or mental illness. Most know the men who rape them, if only from the streets. So Lehman’s first form of victim assistance, and often most long-lasting, involves making sure victims have housing that can keep them separate from their abusers. Homeless women who have been raped need a place to sleep where they can shut the door — immediately. Many need psychological and addiction counseling. Some simply need food.

“You can’t address someone’s emotional needs until their basic needs are met,” Lehman says.

Most of the time Lehman meets victims alongside a detective who has been assigned to investigate a case. But lower-level sexual assault cases that involve offenses such as groping often are not investigated by a detective. The same is true when victims say they don’t want to press charges. In both cases, the women are still referred to Lehman or Jovonavich.

But those cases can be tricky. In one tragic incident last year, a woman told a police officer she had been raped by a nurse at a local hospital. But because the victim did not initially say she wanted to press charges, her case was referred to Lehman rather than a detective. Lehman attempted to call her by phone and, after not hearing back, sent a letter and later closed the case. A month later, the victim called the district attorney, who contacted the police. Lehman called the victim’s pager again, did not hear back and closed the case again. Meanwhile, the nurse assaulted other victims before being arrested.

About three times a week Lehman or Jovonavich starts working with a victim on a case that looks like a good bet for a conviction — but the victim says she won’t press charges or testify. That’s where Lehman’s resolve can get tested, but not as severely as some people think.

“We only do what victims want us to do,” Lehman says. “They don’t want their case investigated, whether they are a minor or an adult, we don’t investigate them. Because that would be re-traumatizing the victim.”

In fact, Lehman says her role can put her at odds with the investigating officer with whom she works.

“My job is to make sure the detectives do what the victims want,” she says. Possibly in reaction, at this point not all the sex crimes unit detectives invite Lehman or Jovonavich to accompany them when they interview victms, as has been recommended by auditors.

Lehman is working with a detective on a case involving a rapist who police think has assaulted a number of women in Portland, and will likely do it again. The rapist has been identified by a victim who reported the rape but says she won’t pursue the case. Lehman says the victim appeared to her “tentative and pensive.” Not only does Lehman feels no desire to push, she thinks the victim might be best served by choosing not to testify.

“We restore the power in their lives to them by giving them the option,” she says.

Also, pushing for testimony could backfire. “Imagine if we pressured a woman to go forward,” Lehman says. “She may not show up for trial. She many not accurately testify. And consider the emotional damage that would inflict on her, to feel somebody else yet again taking away her power.”

Homeless, mentally ill are most vulnerable

Kim was walking in Old Town recently when a man came up and gave her a big bear hug before stepping back and continuing on his way. Later, Kim, a tiny sprite of a woman who has been homeless on and off in Old Town for years, explained how she knew the man. He had raped her just a few blocks away.

Kim (not her real name), says she hardly reacted to the hug. What could she do? After the rape she had felt the same sense of impotence. Convinced nothing would be done to the man, she had not bothered to report the rape to police.

In fact, Kim says, she has been raped a number of times. Pretty much every homeless woman she knows in Old Town has been raped as well. Kim suffers from schizophrenia, and, while clean now, has a history of drug abuse. She knows she wouldn’t make a great witness in a he said/she said courtroom case.

Only once has Kim reported a rape. Two and a half years ago a stranger happened by and saw Kim, arms and legs bound by tape, tape across her mouth to keep her silent, being raped in Southeast Portland. The passer-by stopped the assault and called police.

Kim was taken to a hospital emergency department where she met Portland police Det. Jeff Myers, who called victim advocate Susan Lehman. Myers took Kim’s statement and Lehman arranged to have Kim taken to a women’s shelter after her release from the hospital.

The rapist, one day out of prison after serving time for a similar assault, was easily identified by the bystander. Convinced that this time was different because of her rescuer’s corroboration, Kim agreed to file a report with police.

Lehman’s job during the succeeding 10 months was to “keep her on board.” Lehman found Kim a subsidized apartment, drove her to medical appointments, even found a used computer and set it up so Kim could get email. When Kim said she was afraid to sleep alone, a police officer supplied a cat.

Two to three times a week Lehman visited Kim, taking her grocery shopping and to doctor and dental appointments, aware that if Kim were to become homeless again or her schizophrenia flared up, the case against her rapist would likely be dismissed.

On the day Kim was scheduled to testify in court, Lehman and Myers picked her up and drove her downtown. Lehman had taken a black skirt from her daughter and given it to Kim, along with a burgundy top, so Kim would look “ready for court,” according to the advocate. Lehman noticed Kim fidgeting in the back seat of the car, so they stopped at a Starbucks and talked awhile. Clearly, Lehman says, the prospect of testifying was unnerving Kim, whose mental illness, which can include hearing voices, is exacerbated by stress.

At the courthouse, Lehman stayed with Kim in the victims’ lounge, and later walked her into the courtroom, aware all the time that, “She could have done anything.”

Kim was able to describe the events of her rape well enough that her rapist was sentenced to 25 years in prison.

Behind bars

Her experience is pretty much the standard for homeless women, says Doreen Binder, executive director of nonprofit Transition Projects Inc., which provides day services and shelter to the homeless in Old Town.

Asked what percentage of downtown Portland homeless women have been raped, Binder doesn’t hesitate. “A hundred percent,” she says.

“We’re not just talking about women. Men are sexually abused on the street all the time.”

Binder says whether it occurs while they are living on the street or before, sex abuse in some form is almost always part of the life narrative for the homeless. Many homeless women, she says, are incest and domestic violence survivors. Sexual abuse has shaped their world view and often shaped their later lives.

“You can’t be an incest survivor and abused as a child, end up on the street and say, ‘I won’t allow it.’ It just becomes the norm for you,” Binder says.

As it was to Kim, until Susan Lehman entered her life. Lehman still sees Kim nearly every week. The man who raped Kim in 2011 is behind bars, but others who did the same, including the one who gave her the bear hug, are still walking around Portland.

Kim credits Lehman for much more than helping her put one rapist behind bars. Asked what would have happened if she had not met Lehman, Kim says, “I wouldn’t be living here and I wouldn’t be stable.”

Ed. note: Not only does sexual assault often follow mental illness, it can precede mental illness.  See CNN’s report or download this fact sheet.

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