From the Portland Tribune, May 29 2009

One-night count could be skewed by weather and agency improvements

Oregon’s sagging economy could be behind a large increase in the number of homeless people across the state.

Information released Friday by the Oregon Housing and Community Services found a 37 percent jump from a year ago in the number of homeless people counted during a January one-night statewide census.

The count found 17,122 people who were homeless, up from 12,529 people in January 2008.

Skyrocketing unemployment numbers and some wage reductions during the recession could have contributed to the number of people who live on the streets.

“The numbers confirm what we already knew, families and individuals can’t afford to pay for one of their most basic needs – a place to live,” said Rick Crager, Oregon Housing and Community Services deputy director.

“It’s a new face of homelessness that we’ve not seen before,” said Corky Senecal, director of Housing and Emergency Services at Neighbor Impact in Central Oregon, an area hard hit by unemployment and resulting homelessness. “Last year these people would have read the stories in the paper, watched them on the evening news – and very possibly would have written a check to an organization that helps the homeless. Today, they are homeless.”

Among the state’s most dramatic differences discovered from last year:

• A doubling in the number of homeless veterans.
• A 100 percent increase in the number of childless couples who are homeless.
• A 150 percent increase in the number of people tallied in the street count.
• More than four times the number of households living in doubled-up situations with friends or family.
• An additional 1,150 people who said they were camping.
• A 32 percent increase in the number of unaccompanied youth who were living on the streets.

In the most recent count, 9,890 individuals – nearly 60 percent of the people identified as homeless – did not receive services or shelter, according to the state information. People in more than 2,000 households are on the streets or living with friends or family. And close to half of households counted had a member with an emotional, mental or substance abuse issue.

Crager said the one-night census numbers, while dramatic, could have seen big increases because local agencies have improved the way they find and track homeless folks. “There are more homeless on the streets, and we’re better at finding them,” he said, citing homeless numbers rising from 3,294 on the street in 2008 to 8,561 in 2009.

Weather can be another factor, Crager said. In snow in 2008 hindered efforts in some rural Oregon towns to count homeless people. “In urban areas, cold weather can attract people to warming centers and other services, making them easier to find,” he said.

From the Salem Statesman Journal, May 29 2009

Contract management likely will ‘protect state’s investment,’ report says

A new state audit gives high marks to the Oregon State Hospital replacement team for its handling of the early stages of the $458 million project.

READ – Oregon State Hospital Replacement: Good Construction Management Practices Help Protect State Investment (PDF)

The state is moving forward with a seven-year plan to build two new psychiatric facilities to replace the obsolete and unsafe 126-year hospital in Salem.

Multilayered checks and balances are keeping project costs in line with objectives, according to the audit, released today by the Secretary of State’s Audits Division.

The audit links effective management of the project to three key factors: assembling an experienced project team; establishing clear expectations with project contractors; and managing contracts to control costs.

The project team assembled by the state Department of Human Services “has implemented good contract management practices that should help protect the state’s investment,” the report says.

Linda Hammond, state hospital replacement administrator, said she was pleased with the audit.

“I think it reflects the direction from leadership and the ability of the team that is working on this project,” she said. “This is a monumental project, and we take those responsibilities seriously, as it shows in the audit.”

Plans call for building a 620-bed facility on the existing hospital campus in central Salem, scheduled to partially open late next year and fully open in 2011, and a 360-bed hospital in Junction City, scheduled to open in 2013.

Brown said management of the initial stages of the hospital project has far exceeded prior state construction projects, including a prison-construction project that drew fire from state auditors in 1999.

“Previous audits showed real problems with how state agencies managed construction contracts,” Brown said. “This is an example of good practices that will help control the project’s costs and risks.”

The 1999 audit of prison construction turned up numerous management flaws and resulted in several recommended improvements.

A consultant on the prison project, now working on the state hospital project, used the earlier audit report to help guide construction management practices for the hospital project, according to the Secretary of State’s office.

The new audit partly links the smooth start of the hospital replacement project to the experience of the DHS team formed to work on it.

Human Services officials “recognized the project’s large size and significance, and assembled a team of department employees and consultants with a wide range of experience in construction contracting, project management, and psychiatric treatment,” the report says.

The audit also commends the agency for clearly defining each team member’s role and responsibilities.

Financial controls on the project include sharp scrutiny of contractor invoices, amendments and change orders, reports the audit.

“Specifically, we noted that project staff had reviewed contractor invoices and timesheets in detail, recalculated changes and corresponded with contractors regarding questioned costs,” it says.

Auditors spotlighted one area for change. They recommended that the hospital project team negotiate the prices for equipment rented from the general contractor in advance, as well as carefully track total rental charges to ensure prices are not exceeded.

The hospital replacement team signaled its intent to heed the recommendation, the report says.

Oregon Secretary of State Kate Brown issued this audit report, Oregon State Hospital Replacement: Good Construction Management Practices Help Protect State Investment, in May of 2009.

EXECUTIVE SUMMARY

The Oregon Department of Human Services is in the early stages of constructing two new state psychiatric facilities to replace the outdated Oregon State Hospital. The Oregon State Hospital Replacement Project (OSHRP) is expected to cost approximately $458 million.

Given the large size of this state investment, we performed this audit to provide early feedback on how well the department is controlling project costs and risks. Specifically, we reviewed whether the department has processes to ensure contract payments, amendments and change orders are in line with applicable rules, contract terms and best practices. We also reviewed whether contractor selections were in accordance with public improvement contract laws.

We found the department has implemented good contract management practices that should help protect the state’s investment by controlling costs and risks. The department performed three main actions that led to its success to date:

1. Assembled an experienced project team
2. Established clear expectations with project contractors
3. Managed contracts to control project costs and risks. We also found that the department selected its contractors in accordance with public improvement contract laws.

AGENCY’S RESPONSE

The Department of Human Services generally agrees with the audit conclusions included in the report.

READ – Oregon State Hospital Replacement – Good Construction Management Practices Help Protect State Investment

Substance abuse and addiction cost federal, state and local governments at least $467.7 billion in 2005, according to Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets, a new 287-page report released May 28 by The National Center on Addiction and Substance Abuse (CASA).

The CASA report found that of $373.9 billion in federal and state spending, 95.6 percent ($357.4 billion) went to shovel up the consequences and human wreckage of substance abuse and addiction; only 1.9 percent went to prevention and treatment, 0.4 percent to research, 1.4 percent to taxation and regulation, and 0.7 percent to interdiction.

The report, based on three years of research and analysis, is the first ever to assess the costs of tobacco, alcohol and illegal and prescription drug abuse to all levels of government.  Using the most conservative assumptions, the study concluded that the federal government spent $238.2 billion; states, $135.8 billion; and local governments, $93.8 billion, in 2005 (the most recent year for which data were available over the course of the study).

Multnomah County was one of the handful of municipalities which participated in this survey.

OREGON STATISTICS FOR 2005

The burden of addiction was 9.5% of the total Oregon state budget in 2005 – $1.4 billion dollars
Oregon spent $96 million on addiction prevention, treatment and research- $26 per person
Liquor store revenue total $309,649,000; $83.67 per capita
Tobacco and alcohol tax revenue total $257,301,000; $69.53 per capita

MULTNOMAH COUNTY STATISTICS FOR 2005

The burden of addiction was 15.5% of the total Multnomah County budget in 2005 – $116 million dollars
Multnomah County spent $6.4 million on addiction prevention, treatment and research- $9 per person, 0.9% of the county budget

EXTRA – download the CASA report Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets

Dorothea Carroll holds a picture of her son, Andrew Hanlon, who was fatally shot by a police officer in Silverton, Oregon in 2008. Hanlon was showing signs of paranoia and possible schizophrenia when he was shot.

Run on Morning Edition, May 21 2009
LISTEN – Training Police To Handle Mental Illness Cases

In 1987, a Memphis, Tenn., police officer shot and killed a mentally ill man who was cutting himself and threatening others. The incident inspired training programs to help police handle these tricky situations. Those programs are catching on.

Confronting The Mentally Ill

It’s a situation no one wants to see: An armed police officer is called because someone is in the throes of a psychotic episode. “How the officer handles that situation can have a significant impact,” says Russell Laine, head of the International Association of Chiefs of Police.

The IACP held a two-day meeting recently to discuss how officers should respond. On the first morning of the meeting, there was a silent period for attendees to write the names of officers or people with mental illness who had lost their lives in an encounter. There were about 75 people in the room, and about four dozen names went up on the board. National statistics, though, are hard to come by.

Feeling Threatened

Police officer Darek Ardoin of the Calcasieu Parish Sheriff’s Office in Lake Charles, La., was at the conference. About three or four of the calls he’s sent out on each week involve people with mental illnesses. Ardoin says they’re disturbing the peace, scaring their families or threatening to hurt themselves.

He says he’s rarely felt directly threatened. But last year, a man called and asked for the police to come to his home. The man’s wife was in the bedroom, talking back to the television, and was quite agitated. The man himself wouldn’t get near the bedroom.

“I talked to her from the front door at first, and then I made it to the bedroom door,” Ardoin says. “I could see the knife was there, lying next to her on the bed.”

He followed his training, talked to her quietly and reassured her that he didn’t want to take her to jail. After about 20 minutes, the woman agreed to go to the hospital. “At that point, we had established a relationship,” he says.

The Use Of Deadly Force

Old-style policing calls for subduing the person, usually by force. That approach is upsetting to the person in the throes of a psychotic episode. It’s upsetting to the family, who are often the ones who called the police in the first place. And it’s upsetting to police officers, says Laine.

“Any time an officer has to use deadly force, it takes a significant toll,” he says.

Ardoin has trained three officers who came to training because they had shot and killed a mentally ill man. It was their way of dealing with their post-traumatic stress disorder.

“This is not a magical program, where 100 percent of the incidents will end up well,” Ardoin says. But he says it’s dramatically decreased officer injuries as well as injuries to people with psychoses, and the number of call outs to SWAT teams in Calcasieu Parish.

It’s not just an issue for police. It’s tough from the point of view of the person with psychosis and his or her family members. Sandra Spencer, executive director of the National Federation of Families for Children’s Mental Health, felt that firsthand when her son, who has bipolar disorder, was stopped by police officers when he was walking home from a friend’s house.

“He was manic, shaking,” she says. “He wasn’t coherent.” The police officers told him to be quiet and stay absolutely still. Instead, he reached into his pocket for his cell phone to call her.

“Guns were drawn,” says Spencer.

No shots were fired, but when the officers got her son home, says Spencer, she could see he was a wreck. “He had completely come apart,” she says.

Understanding Mental Illness

She began to talk to other families around the country, and heard a lot of stories about problems with police encounters. She talked to police officers, too, and realized there were lots of misunderstandings. So her organization put out a booklet for families, with advice like always telling the police dispatcher that mental illness is an issue, and not rushing out to greet the police, who might think they were being attacked.

The city of Memphis created a model program for training police officers after that shooting incident in 1987. It was started by Samuel Cochran, who now says officers tend to reflect the views of society.

“When I, in my career in law enforcement, came across a person with mental illness, the reaction I had was, this is just another crazy person that I’ve got to deal with. I was learning that from the community.” Cochran says.

But when the Memphis police chief told him to deal with the public reaction to the shooting, Cochran started talking to mental health experts and families. And he realized that most situations could be defused if police officers were trained to approach mentally ill people differently from common criminals — slowly, calmly and recognizing that the person may not be seeing the situation clearly.

According to the Bazelon Center for Mental Health Law, an advocacy group for people with mental illness, there are now about 200 or 300 police departments around the country with active training programs. The center’s position is that what’s really needed are community services where people with mental illness can get treatment and support, so that crises can be avoided in the first place.

That’s in line with Russell Laine, the head of the police chiefs’ organization. He says one of the challenges facing trained police officers is that there’s often nowhere to take people in need of immediate help other than the county jail.

Oregon State Hospital is in need of volunteers from the community to serve on its Seclusion and Restraint Committee. Oregon law mandates that the committee must have at least three community members.

Committee members support the hospital’s goal to reduce and eliminate the use of seclusion or restraints. Community volunteers should have some knowledge of the state’s mental health system. For example, mental health care providers, mental health professionals or former consumers of mental health services would be considered.

Volunteers will be asked to sign a confidentiality statement because committee members review data that includes patient names and other identifying information. Members must also be comfortable with reviewing and discussing data reports, including tables and graphs, to analyze the hospital’s use of seclusion or restraints.

Interested individuals will be interviewed by the OSH director of quality improvement and appointed by the OSH superintendent. The committee meets on a monthly basis, usually the third Friday of the month, from 10 a.m. to noon.

If interested in volunteering, please contact Ted Ficken, director of quality improvement, at 503-945-0916.

EXTRA – Download Seclusion & Restraint Committee flyer (PDF)

Guest opinion by Mecelle Stone, published in the Eugene Register Guard, May 21 2009

“George W. Bush is the second anti-Christ,” I thought to myself as I entered the Oakway Spa, where only men were allowed on this hot sunny day in 2005.

I had just gone shopping and had bought a new outfit. They let me use the women’s facility to get dressed. I put on a rainbow-colored bathing suit under my new skintight flagger-girl Capri pants and white tank top.

As I was about to leave the spa, I spotted the cards lined up belonging to all the men who were there to work out. I thought it was a secret society. I lunged toward the undercover cop dressed in the neatly pressed suit. I shoved him and said angrily, “I know what you’re up to and you’re not going to get away with this!”

I stripped down to my bikini. I was barefoot, running around the parking lot and threatening to douse myself with gasoline and burn myself to death if anyone touched me.

I now thought I was in a video game. I ran across the street and jumped into a koi pond. The cops were called, and they made their arrest. In the back of the patrol car I was sticking out my tongue and saying “neener, neener, neener,” as if I were 6 years old.

Bipolar disorder was revealing its nasty self once again.

It would be the second of eight hospitalizations in a year and a half. By the end, tranquilizers and restraints often were too well-known. They just reinforced my delusion that George W. Bush was the new Adolf Hitler, and that I was one of his experiments.

Delusions and paranoia controlled my very existence. I had stopped taking my medication because I became suicidal and I was gaining weight.

What a big mistake on my part: I should have worked with my psychiatrist to make adjustments. Instead, I was led to homelessness, unprotected sex and a new love for crack cocaine.

I was hospitalized three times in Eugene. Unfortunately they turned me away the fourth time, which was the night I became homeless. I went missing for two months, hitchhiking to Utah and Colorado. That was right after I told one of my best friends that she was the devil, and that I needed to kill the devil. To this very day, I’ll never know why they didn’t commit me.

During most of my hospitalizations, I would have benefited from a lengthier stay. Instead of a day to a week-and-a-half of treatment, a monthlong stay, minimum, would have been sufficient.

That would have allowed me to get adjusted to my medication and stabilized. Instead, it was as if they bandaged a compound fracture and sent me home as soon as possible.

I believe that I had too many rights as a mentally ill person. In most cases, I threatened to sue the hospital if they didn’t release me. Even though I was out of my mind, legally they couldn’t contain me because I was not “a danger to myself or others.” I actually was quite a danger to myself.

I believe doctors need more power to place individuals on holds, especially if there is a psychologist involved. Due to the system, my therapist did not have the “right” to be part of my treatment. This is someone who had known me for 13 years. She of all people would have been the mastermind of my wellness. Instead, in most cases I was released within a week or so and sent back to society to cope on my own.

I now know that one can appoint a medical power of attorney to overcome the obstacles with one’s medical treatment. The advanced directive form can be found at http://www.nrc-pad.org/content/view/349/5/, or ask your psychiatrist. It will allow people who are incapable of making decisions to have a representative make medical decisions on their behalf.

Although a medical power of attorney is a great measure to have, during the peak of my illness I was in deep denial that anything was wrong. The last thing I would have done was sign an advanced directive form. I believed I had control of the entire universe. The worse my symptoms became, the more in control I thought I was.

Mental illness is a serious biological disease. Funding is low for programs, and they are cutting 30 percent of mental health care services in Oregon. It will take all of us as a community to come together and fight for what’s right, bringing relief to these vulnerable people.

There are many ways one can get involved. Donate clothing, blankets, backpacks and toiletries, and fund the National Alliance of the Mentally Ill/Lane County.

NAMI offers support groups, information and an abundance of resources. Its offices are located at Lane County Mental Health, on the second floor.

Get involved in legislation that supports mental health programs. Also, St. Vincent de Paul has a program called “Lift” and “Vet Lift” that assists people with dual diagnosis. They offer permanent housing for these individuals. You may provide supplies directly to them.

Mechelle Stone of Eugene (www.mechellestone.com) is a student who is writing a book about her experiences with bipolar disorder.

EXTRA – Possible changes in Oregon’s Psychiatric Advance Directive Laws, Mental Health Association of Oregon, May 19 2009
EXTRA – Declaration for Mental Health Treatment (Oregon). Comment – this is not a legally binding document.

Please Help Save Our Multnomah County Human Services!

A hearing for Multnomah County Commissioners will be held Tuesday, May 26th, 6 – 8 PM
501 SE Hawthorne, Multnomah County Building, 1st Floor. The public will be allowed to comment.

It will be a major catastrophe for Oregon’s most vulnerable citizens if critical human services are cut. State and county budget shortfalls are placing essential mental health and addiction services programs on the chopping block.

Come share your story and make a difference:

• Educate the commission and the public about how critical these services are to the health of our communities.

• Thank the commission for protecting human services in their proposed budget.

• Urge the commission to continue to fund human services as the economic crisis continues.

To RSVP contact Joe Cartino at 503-408-4090 ext 405

SEIU Local 503 will be partnering with NAMI Multnomah to turn out advocates for quality mental health and addiction services to this hearing.

Together we can find a long term solution that achieves adequate funding for human services throughout Oregon.

Accessible by Tri-Met bus lines # 4, 6, 10, 14, 33.
Street parking available. Parking garage across street locked up at 6pm

This location is accessible for people with disabilities.

From the Salem Statesman Journal, May 23 2009

New psychiatric facility alone can’t fix Oregon’s mental health system, advocates say

Construction will get under way next month on the first phase of a $280 million psychiatric hospital to replace the obsolete and unsafe Oregon State Hospital.

But mental health advocates warn that it won’t cure Oregon’s ailing mental health system.

As they tell it, the new hospital envisioned by state leaders as a “world class” psychiatric facility won’t succeed unless the state finds more money to bolster community-based mental health services.

“My fear is, we have a monument to futility right now in the state hospital and we’re just going to build a nicer monument to futility,” said Chris Bouneff, executive director of the Oregon chapter of the National Alliance on Mental Illness.

“If they don’t come to some terms soon, we’re going to be stuck with our same old problems that we’ve battled now for decades. The only thing that will change is that we’ll have a nicer building.”

Community-based mental health services include housing, medication, case management, counseling and assistance with employment. Such services are essential to help people with mental illness maintain stable, productive lives, advocates said.

In some cases, proper assistance can prevent people from requiring hospitalization. In others, it can help former hospital patients stay on the path of recovery.

All too often, though, the critical services are lacking in communities across the state.

That’s why Jason Renaud of the Mental Health Association of Portland objects to massive state spending on the new hospital in Salem.

“We believe the state’s attention and funds should be going towards the outpatient system, which is so crippled and porous that people end up in the hospital when earlier and less expensive intervention would have been more successful,” he said.

Like the antiquated state hospital, Oregon’s community-based mental health system has been “broken for generations,” Renaud said.

County jails and state prisons now harbor thousands of mentally ill Oregonians, partly owing to inadequate community-based programs and services, he said.

“The community system has been starved to the point where people migrate from their first episode into jails, into prisons, into parole and probation departments and into the state hospital,” he said.

Also troubling, he said, has been the evolution of the state hospital into a forensics facility, largely housing patients who were judged guilty of crimes except for insanity.

“Looking at the history of the hospital over time, it really has become an annex of the corrections system more than an annex of the mental health system,” Renaud said, “and it is the most feared place for people with a mental illness in the state. It should be the safest and most beneficial place but it hasn’t played that role for several decades. That’s entirely, I think, due to the neglect by the state legislature.”

Hospital projects on track

Gov. Ted Kulongoski, Senate President Peter Courtney and other legislative leaders have stated their intent to go forward with two new psychiatric hospitals to replace the 126-year-old state hospital.

The 620-bed Salem facility is scheduled to fully open by 2011. A 360-bed facility in Junction City is scheduled to open in 2013.

Legislators approved spending $458 million for building the two hospitals. The pivotal decisions came before the state was sent reeling by a deep economic recession and slumping tax revenue triggered by one of the nation’s highest unemployment rates.

Now, legislators face a $3.8 billion shortfall in the 2009-11 budget cycle. Legislative budget writers working to plug that hole recently unveiled a two-year budget that calls for an 11 percent cut for the state Department of Human Services, which oversees mental health programs.

Mental health advocates fear that the underfunded community-based mental health system will remain “broken.” They said that doesn’t bode well for mentally ill people struggling without adequate help in the community or patients deemed ready to leave the state hospital.

“One of the largest problems we face is the lack of step-down services,” Bouneff said. “We have a shortage of residential beds and community-based programs. There’s really nowhere for someone to go once they are well enough and it’s no longer clinically necessary for them to be in a hospital.”

The state has made concerted efforts in recent years to expand the supply of group homes and residential facilities for patients leaving the state hospital. But progress has been slow, partly because of community opposition to such facilities.

“And we’re certainly not making any big new investments in that in the current budget climate,” Bouneff said. “So that’s still a big problem.”

Meanwhile, the state hospital will continue to devour money, he said.

“We’re spending a significant amount of money to house people in the Oregon State Hospital,” Bouneff said. “In the most extreme cases, it costs upwards of $200,000 a year.”

First phase of new hospital

ABC, short for admissions, behavior and corrections, is the term state planners use for the first phase of the new hospital.

It will have 124 beds and house patients in three separate programs:

-Admissions will be the 44-bed entry point for new patients. They will undergo clinical evaluations and get stabilizing treatment, then move to other areas of the hospital for additional treatment.

-Behavior will have 60 beds for patients who violate hospital rules or instigate violence. Such patients now are housed on maximum-security wards in the J Building.

-Corrections will consist of a 20-bed unit reserved for mentally ill patients transferred to the hospital from the state prison system. After short-term care, these patients will go back to the prison system.

Construction of ABC will begin next month with site prep work, followed by laying of a concrete foundation.

Development of the first component of the new hospital marks the beginning of a multi-phased building program. The new hospital is being built south of Center Street NE, within the southern part of the existing hospital campus.

The sour economy could produce early cost savings on the project because firms are hungry to work and tamping down their bids for contract work, said Linda Hammond, hospital replacement administrator for the state Department of Human Services.

“We’re getting some good bids back,” Hammond said. “I’m optimistic about the savings we can make with the condition of the economy.”

The state recently accepted bids on $40 million worth of contractor work on the project, including setting the concrete foundation for the first section of the new hospital and reinforcing parts of the existing hospital’s creaking J Building.

The state plans to seek bids soon for $120 million worth of contract work on the project.

Hammond envisions a short-lived opportunity for cost savings.

“You’re going to lose that advantage pretty quickly when the stimulus projects start hitting the street,” she said. “Right now, companies are looking to keep their doors open until these other projects come along.”

OUR COMMENT – Oregonians have the opportunity to entirely repair our state’s public mental health system – both at the state hospitals and in the county-based outpatient mental health programs through their vote and through their advocacy with our state legislators. It is not a question of malfeasance, or stigma, or corruption, or old-fashioned ideas. It’s really only a question of money.

Multnomah County’s Mental Health and Addiction Services Division has posted several new documents worth reviewing recently on their web site. These include,

Verity Annual Quality Report, dated February 2009.  This presents a set of statistics about mental health treatment providers and results from surveys of clients about the quality of care provided through county contracts.  “Verity Mental Health Organization” is the name of the county department which presents itself as an insurance company for persons with mental illness and addiction.

The 2008 Adult Satisfaction Survey, dated May 2008.  One in four respondents replied to a mailed survey for a total of 808. 

The Draft: Verity Mental Health Organization Quality Management Work Plan, January 2009 – December 2009. Here is a list of goals and expected outcomes of the county’s contracts with independent providers of care for persons with mental illness and addiction.

Last year we asked the Division to post the budget online where we could read it. Yes, it was already online, but buried at the bottom of a deep information pit. For fiscal year 2009, the Division has done more and better than we asked or expected. They’ve put the budget online, and they’ve made it both readable and understandable. Kudos.

READ – Mental Health Safety Net – FY 09 Adopted Budget
READ – Mental Health System of Care – FY 09 Adopted Budget
READ – Addiction Services – FY 09 Adopted Budget

Wait! There’s more!

READ – The 2009 Mental Health Organization Provider Capacity Assurance Report
READ – The 2009 High Inpatient Utilization Performance Improvement Project
READ – The 2009 Initiation And Engagement Performance Improvement Project. (This is where the rubber meets the road, so to speak.)
READ – Collaborative Care For Seriously Mental Ill Consumers – draft

One of the continuing shortcomings of our county and our state’s mental health and addictions services is the capacity of an independent and impartial analysis of these sort of documents and the programs they represent. It’s quite impossible at this point for our little cadre of volunteers to present any informed comment about the county’s plans or achievements – outside of the anecdotal comments we collect from people who are compelled to speak up.

We’d appreciate reading any analysis of these surveys, their methods and outcomes, from persons not employed (or prospects to be employed) by Multnomah County. But until that help shows up, we’re happy to have the data.

Thanks Karl!

From the Eugene Register Guard, May 11, 2009

County, agency try to reach agreement Valia Health Resources is putting its lawsuit against the county on hold for now

A Springfield mental health agency and Lane County are in talks over the county’s intent to close the facility, an attorney for the agency said late last week.

Valia Health Resources, which serves about 150 people with schizophrenia and other disorders, sued the county for breach of contract April 27 after the county said it will discontinue the agency’s Medicaid coverage after two years of alleged mismanagement.

“Valia is holding off on proceeding forward with its civil lawsuit while the parties attempt to come to an agreement,” Valia attorney Margaret Wilson said. “I’m not dismissing (the lawsuit).”

The county sought to end the federal reimbursements April 30, saying it found repeated instances of client assessments lacking documentation, inadequate clinical supervision, treatment goals that did not address issues reimbursable by Medicaid and other problems.

The agency acknowledged billing errors but said Medicaid reimbursements were appropriate and that the county’s review of Valia had numerous errors.

The county postponed termination of Medicaid coverage while the parties try to resolve the dispute. Valia clients do not need to change providers at this time, the county said.

In its lawsuit, Valia said the county breached the parties’ contract by refusing to provide a pre-termination hearing.

Termination of the contract would cost the agency $96,000 in damages for services that would not receive Medicaid reimbursements, Valia said.

Valia is one of the first full-service, peer-run mental health providers in Oregon backed by Medicaid. More than half of its dozen or so counselors, therapists and other employees have recovered from disorders.

Valia said in its lawsuit that Lane County employees “have exhibited a pejorative and insulting attitude toward (Valia) because many of (Valia’s) employees and directors have received mental health treatment themselves.”

Wilson said she hopes for resolution of the dispute in the coming months. If the suit goes to trial it could take almost a year, she said.

Liane Richardson, county counsel, did not return a call seeking comment.

EXTRA – Valia Health Resources is a subset of SAFE / Wonderland, a Springfield-based mental health peer/self-help organization.

“Drug courts are a wonderful first step for many people in recovery” - Richard Harris, Director of Addictions and Mental Health for Oregon DHS.

The East Oregonian, May 16 2009

Though drug court has only been in Umatilla County for going on three years, the national drug court program celebrated its 20th birthday Friday. To mark it, drug courts across the country held graduations. In Umatilla County the next graduation isn’t until August, but the program celebrated with a presentation and reception at the Red Lion Friday morning.

Though officials like Drug Court Coordinator Roxann Fisk marked the statistical success of drug court – she said nationally 75 percent of graduates stay arrest-free in the first two years after drug court – what really tells of the program’s success are the participants and the graduates.

Five of those people spoke at the event Friday.

They told stories of where they were before drug court, where the program has taken them, at what they’ve done to succeed.

Drug court is a minimum year-long program that incorporates treatment, life skills and therapy as a diversion from prison or jail time. Drug court participants go through a four-phase process, each requiring more and more responsibility. They’re given weekly drug tests and are expected to get a job, get a permanent residence and are encouraged to join community organizations or work to get families back together.

Umatilla County has had 28 graduates since it started in July 2006. That number is expected to rise to 40 by the end of the year.

Participants and graduates say it’s been a tough process, but worth it.

Teri Brag said she started with drugs when she was 11 years old after being raised by a drug-addicted mother. When she got away from her mother, she lived with her father, who was an alcoholic. By the time she was 18 she had her first felony drug charge, Brag said. She spent time in and out of jail and treatment centers.

“None of this seemed to work,” she said. “I was running out of options.”

Greg Wheelhouse described himself as homeless and with no phone.

Zach Rodes said he felt angry all the time and like he was just chasing instant gratification.

“I was a miserable person,” he said.

Twyla Johnson said she was sitting in a jail cell, looking at a six-month sentence.

“I figured I could quit doing meth for a year if that’s all it took to get out of jail,” she said, “Then I would be free to go back to my way of life: Getting high, lying, stealing and doing whatever it took. That was my life.”

Terry Baird said he started doing drugs in 1970.

“They were the kind of drugs, a lot of them you’ve never heard,” he said. “The biggest problem I had was it took them 17 years to catch me.”

He served time in prison, but he started drug court when he faced going back to jail and possibly losing his family.

All these people said their lives have been changed through drug court. Baird and Wheelhouse graduated from the program, Rodes will finish on Monday, and Johnson and Brag are in the last part of the program and aim to graduate in August.

But they all said it took work, treatment and, for some, religion.

As Wheelhouse put it, “It’s not about just changing, it’s about changing everything.”

“I had no idea what I was in for,” Johnson said. She said it hasn’t been easy, and sometimes it’s been hard, like when she’s had relapses. But she learned from those mistakes.

“I never thought I would I would say, ‘I never want to get high again,’” Johnson said. “But now I say it daily.”

Rodes said drug court has taught him how to succeed in sobriety, take joy in life and see similarities between himself and others, instead of differences.

“I can say, ‘Hey, I’m good’ and mean it,” he said. “I’m happy in my life.”

Several people credited religion with helping them on their path to success.

“It came down to me praying, ‘God help me. I can’t do this alone,’” Wheelhouse said. “Today I really want to say there’s only one thing that has made me successful in this program, and that is God. …That’s what has made me a success.”

Brag, too, credited religion with helping her work through the program.

Though drug court can be tough, and getting through every day life can be tough, Baird said it’s a far better life than he led for 30 years of drug use.

“They day-to-day living, all that stuff we found so hard when we were getting high is really pretty easy compared to all the energy that’s expended in chasing a bag of dope, or making dope, or stealing the stuff to make it with, or dodging the cops, or finding a couch to sleep on, or breaking in to some house or a storage unit just so you had a place to try to sleep off long enough to wake up the next morning and go find some dope,” he said. “It’s a hell of a lot easier than living that lifestyle.”

EXTRA – 2009 Marks the 20th Anniversary of the First Drug Court in the Nation – Salem, Oregon
EXTRA – Drug Court grads praise program – Terra Haute, Indiana
EXTRA – Drug court graduates get new start – Hattiesburg, MS
EXTRA – Editorial: Kudos for Drug Court – Genesee County, Wyoming
EXTRA – Clark County Drug Court a catalyst to change lives – Las Vegas, Nevada
EXTRA – Drug Court Graduates Embark On A New Beginning – Mansfield, Ohio
EXTRA – Drug Court Welcomes More Than 400 Graduates – Vigo County, Indiana

From Oregon Disability Rights, May 16 2009

If you support disability rights, please take a moment to email members of the House Judiciary Committee and say that you support Senate Bill 874.

Senate Bill 874 will make Oregon law consistent with recent changes to the federal ADA Amendments Act.

Some members of the legislature are on record as saying they do not like the ADA and think that it hurts small business. They may try to defeat or weaken the bill.

The Committee will conduct a public hearing on SB 874 on Tuesday, May 19 at 1:00 pm in Room 357 at the Capitol Committee members need to hear from people with disabilities, their families and their advocates. WE MUST NOT BE SILENT!

HOUSE JUDICIARY COMMITTEE MEMBERS:

Jeff Barker, Chair: rep.jeffbarker@state.or.us
Judy Stiegler, Vice-Chair: rep.judystiegler@state.or.us
Gene Whisnant, Vice-Chair: rep.genewhisnant@state.or.us
Brent Barton: rep.brentbarton@state.or.us
Kevin Cameron: rep.kevincameron@state.or.us
Chris Garrett: rep.chrisgarrett@state.or.us
Wayne Krieger: rep.waynekrieger@state.or.us
Andy Olson: rep.andyolson@state.or.us
Chip Shields: rep.chipshields@state.or.us
Jefferson Smith: rep.jeffersonsmith@state.or.us

SENATE BILL 874-A FACT SHEET

Senate Bill 874–A keeps Oregon law in line with federal law to protect people with disabilities;
Senate Bill 874–A keeps Oregon’s protection of employees of small businesses.

Before the Americans with Disabilities Act (ADA) became law in 1990, Oregon had its own disability discrimination laws. Oregon changed its laws during the 1990s to be as consistent as possible with the ADA with one exception: Oregon continued to protect employees of small businesses. The ADA only covers businesses with 15 or more employees. Oregon covers businesses with 6 or more employees.

In 2008, the U.S. Congress passed and President Bush signed the Americans with Disabilities Amendments Act (ADAAA). It took effect on January 1, 2009.

SB 874 will align state law with the ADAAA so that the laws that Oregonians need to follow will be as consistent as possible.

The key changes in the ADAAA that are tracked in SB 874 are:

* Present law prohibits discrimination against those “regarded as” disabled. The statutes clarify that such discrimination is prohibited whether or not the person’s impairment limits or is perceived to limit a major life activity.
* The statutes direct that the determination of whether an individual has a disability is to be construed in favor of broad coverage.
* An impairment that substantially limits one major life activity need not limit other major life activities in order to be considered a disability.
* An impairment that is episodic or in remission shall now be considered a disability if it would substantially limit a major life activity when active.
* The determination of whether an impairment substantially limits a major life activity is to be made without regard to the ameliorative effects of mitigating measures excepting ordinary eyeglasses.

Many states such as California and Washington have greater protection against disability discrimination than Oregon or the ADAAA. Oregon should, at least, maintain its tradition of tracking federal law while continuing to cover small businesses.

And try not to take this world too seriously.

Seattle author & “Mental Health Chaplain” Craig Rennebohm to speak at First Unitarian Church of Portland, June 5th & 6th

For more information visit the First Unitarian Church Mental Health Action Group website.

Reverend Craig Rennebohm, author, advocate and organizer from Seattle who works with people who have mental illness and are homeless, will be visiting First Unitarian Church of Portland June 5th & 6th.

Rennebohm has worked for the last twenty years on the streets of Seattle with individuals who are homeless and mentally ill. He serves as a resource to families and their loved ones facing mental illness; provides assistance to local congregations seeking to develop mental illness ministries and offers trainings for faith leaders, laity and mental health providers; and as a grassroots community health organizer. Rennebohm is a United Church of Christ minister and his book, Souls in the Hands of a Tender God, was published in 2008 by Beacon Press.

Event Details

All events at the First Unitarian Church of Portland, 1011 SW 12th Avenue, Portland, OR

Book Discussion (in anticipation of his visit)
Sunday, May 31, 1:00 to 2:30 pm, Channing Room
Join us for a friendly and open discussion of Souls in the Hands of a Tender God the Sunday before Craig Rennebohm arrives. No fee. Donations welcome.

Reading & Book Signing: Souls in the Hands of a Tender God
Friday, June 5, 7:00 to 9:00 pm, Eliot Chapel. Book signing to follow in the Channing Room.
No fee. Donations welcome.

Companionship Training
Saturday, June 6, 9:00 am to 12:00 pm, Buchan Bldg.
Suggested donation: $5 – $20. No one will be turned away.

Companionship is a way of being present with another person in the midst of struggle or suffering. We will explore the way of companionship – our natural capacity for sensitivity, compassion and concern and how to introduce ourselves with care. We will share in the basic practices of companionship – hospitality, sharing the journey side by side, listening and accompaniment. We will learn how to honor our limits and support a person in building a circle of care. We will explore ways to practice the way of companionship in our lives – at home, in the church and in our community.