FROM: Kathy Tinkle, Multnomah County Department of Community and Family Services Director, Karl Brimner, Mental Health and Addiction Services Division Director

Re: Response to committee report from City Club of Portland

[Released via email to County staff persons on March 31, 2011]

READ – Mental Health and Addiction Services Division: Response to committee report from City Club of Portland, in original formatting (PDF)
READ – Mental Health and Addiction Services Division: Performance Dashboard for Verity (PDF)

Earlier this week, we received a draft report from the City Club of Portland’s committee entitled, “Improving the Delivery of Mental Health Services in Multnomah County.” The report is the culmination of more than a year of extensive interviews and the exchange of numerous programmatic and budget documents.

We appreciate the City Club committee’s attempt at analyzing the mental health care system, despite some inaccuracies in the report, and we welcome any opportunity to look at how we can improve things.

Budgets

Our Mental Health and Addictions Services Division (MHASD) staff and others in human services spent more than a year providing detailed information – including budgets, program offer details, fiscal information and other data – to the City Club committee. As a public agency, information about our services is always readily available and transparency about our systems is a priority. Having provided this information to the committee, we are perplexed by the tone of the report in this and the other sections.

Contracts

Currently, copies of all county contracts and procurements are available to the public through the county’s Purchasing Office. Oversight of purchasing functions is centralized for the county and separate from the departments. We work closely with central purchasing staff and are within all county procurement guidelines. Contract fiscal compliance is reviewed and monitored by the county’s Finance Department. Programmatic contract compliance is monitored and enforced by MHASD staff.

The City Club committee report appears to confuse “Partnership Purchasing Agreements” with standard county contracting. These agreements are very specialized contracts where partners contribute substantial funding to a system of care in addition to the public money provided by the county. The mental health system utilizes standard county contracts and is completely compliant with county rules for setting expectations in contracts.

Outcomes

Of the nine mental health outcomes measures listed on page 11 of the City Club committee report, we have prioritized our limited resources to measure those that give us the most meaningful and easily obtainable information, including monthly treatment access and referral data, treatment utilization data, cost by mental health level of care, authorizations for care specific outcomes. We support the recommendation that resources should be allocated to collect and analyze data. However, direct services are our priority given our limited resources.

The report mentions the A Collaborative Outcomes Resource Network (ACORN) assessment tool and its appropriateness when considering a tool to pilot that measures patient satisfaction.

The MHASD staff balanced the administrative burden to providers against the need for an appropriate system-wide outcomes tool. ACORN is a nationally recognized tool for outcome data collection that has been applied in many mental health systems.

ACORN offered the system the lowest administrative burden to the provider system while providing the best outcome data. In addition, we found that researchers from two prominent universities had studied this outcome tool for use with the Medicaid population and deemed it reliable for tracking outcomes. We have completed the pilot and we are currently in a Request for Proposals process to choose a tool to be used system wide. The county plans to continue using our Level of Care Utilization System (LOCUS) tool to assign levels of care.

Systems

We support the work of the Oregon Health Authority to redesign the provision of mental health services and are currently working across jurisdictions to streamline care and achieve what is known as the Triple Aim: improved quality, improved access and reduced costs. We are hopeful that Health Care Reform will achieve many of the goals as outlined in the City Club committee report recommendations. The county is working closely with the state, other counties and the fully capitated health plans to develop the new system.

Finally, we value and encourage public involvement in systems planning. Multiple opportunities for public participation and advising MHASD’s work include the following: Adult Mental Health and Substance Abuse Advisory Council (AMHSAAC), Children’s Mental Health Services Advisory Council (CMHSAC), Wraparound Advisory Council, Quality Management Committee, Citizens Budget Advisory Committee (CBAC), DCHS- specific CBAC.

As you know from our briefing with you earlier this year, we are constantly working to improve our services to people with mental health and addictions issues. These vulnerable residents are our priority. If you have any questions about the City Club committee’s report or anything regarding MHASD, please contact: Karl Brimner, 503-988-3371 or David Hidalgo, Senior Operations Manager, MHASD, 503-988-3076. Thank you for your time.

From the Portland Tribune, March 31, 2011

After more than a year of studying Multnomah County’s system for delivering mental health services, a City Club of Portland committee has reinforced what previous studies have concluded: the system needs drastic overhaul.

The committee’s report[] details a fractured health care delivery system saddled by poor communication between agencies and jurisdictions, opaque accounting practices which make it impossible for outsiders to determine if public money is well spent, and contracts paid by the county to mental health providers which identify goals of treatment but not the means to measure whether treatment is actually meeting those goals.

READ – City Club of Portland report, “Improving the delivery of mental health services in Multnomah County.”
READ – City Club Report Rips Into County’s Mental Health System, Portland Mercury
READ – City Club Report Critical of County’s Mental Health System, The Lund Report

John Swetnam, the study’s lead author, says the committee discovered that Oregon is the smallest state in the country using counties to administer mental health programs, and that in itself leads to problems in care and waste.

Most mental health funding comes from federal Medicaid dollars which go to the state and then are funneled down to the counties.

“You have all these layers of administration that are stacked one on top of another and there’s overhead at each of those levels,” Swetnam says.

In addition, Swetnam says, the setup does a disservice to people in the Portland area who need mental health services, but who may get care in different counties. Different caregivers often don’t communicate with each other.

“The system is fractured,” Swetnam says. “People tend to fall through the cracks.”

A handle on the budget

Tamsen Wassell, committee chairwoman, says the system’s waste of public money due to redundant administration and a lack of transparent accounting is a major cause for concern.

“It’s important for taxpayers to know we have no idea how much money is spent on direct services for this vulnerable population, and we don’t know what we get for what money is spent,” Wassell says.

Wassell says the state should move to either one regional authority for mental health services, rather than three metro area counties, or overall statewide administration of mental health services.

County officials say that may be in the works. According to Karl Brimner, director of mental health and addiction services for Multnomah County, the county is already pursuing what may lead to a regional plan.

Multnomah County along with Washington and Clackamas counties is working on a plan to better implement all health care in the metro region, Brimner says.

Wassell, the City Club chairwoman, says that money issues were also a concern.

“The part that was probably most disturbing to me was the fact that we couldn’t get a handle on the budget,” she says. “We were continually told it was complex.”

Wassell, a management consultant, says she often consults with multimillion dollar companies, and never accepts from them the idea that their budget is too complex. In addition, according to the report, other states have made their line item budgets available online.

“This is not nickels and dimes,“ Wassell says. “This is millions.”

Quality of services

David Austin, communications director for Multnomah County, says that county officials held dozens of meetings with members of the City Club committee working on the report and shared with them the mental health budget.

“We are always happy when new sets of eyes look at the things we do, transparency is our hallmark,” Austin says. “We’re somewhat perplexed at the City Club saying we didn’t provide them with information.”

Swetnam says he was particularly concerned about the lack of a system for measuring whether or not mental health services are being effective. Multnomah County serves about 30,000 people with mental illness, according to the report, and about 21 percent of those people have persistent and severe mental illness. But according to Swetnam, the tools the county uses to measure outcomes wasn’t even designed to measure effectiveness in those with severe mental illness.

“We know we’re buying stuff but we don’t know a whole lot about the quality of the stuff we’re buying,” Swetnam says.

Brimner says the county initiated a pilot program last year that does work for measuring outcomes for patients with persistent and severe mental illness.

Jason Renaud, a longtime activist with the nonprofit Mental Health Association of Portland, agrees with the report’s call for a restructuring of the local mental health administration. But Renaud says the fundamental problem is that there is little political will to make the necessary changes.

“The current county commission has shown no interest in mental health or addiction health issues,” Renaud says. “We’ve been down this track before and the political and management leadership — many of those persons interviewed for this report — betrayed that effort and failed to make the changes people wanted.”

From the Salem Statesman Journal, March 29. 2011

Two managers in Oregon State Hospital’s transitional housing program have been reassigned to other duties, and an independent investigation will look into patient complaints against the employees.

Superintendent Greg Roberts reassigned the two nurses, Larry Belcher and Elaine Roper, on Tuesday, one day after patients outlined a litany of complaints against them in a letter to the hospital chief.

Patients told Roberts that “gross mismanagement” of the six-cottage, 36-patient transitional program had created a climate of “continual fear” for patients.

They alleged, in part, that the two nurses have:

• Belittled and intimidated patients.
• Discouraged patients from filing grievances.
• Retaliated against patients who pursue complaints.
• Failed to issue “a transition level appropriate number of passes” for patients seeking community outings.
• Forced “very physically ill patients to (attend) Treatment Mall instead of attending to symptoms.”
• Used “false or selective charting in an effort to discredit patient complaints; falsely applying mental illness ‘symptoms’ to patients who do complain about treatment.”
• Displayed “open hostility” by yelling at other staff members in the presence of patients.

“In short, we feel the actions of both Mr. Belcher and Ms. Roper place us in danger, are counter to our treatment needs, and fail to live up to the hospital’s own Code of Ethics,” states the patients’ letter. “We are asking for their immediate removal from cottage staffing and an assurance that they will not simply be moved to where they may harm other residents.”

Hospital officials have touted the transitional program as a reform-minded measure, designed as the final stop for forensic patients preparing to leave the Salem psychiatric facility and begin new lives in Oregon communities.

As patients tell it, the progressive program has gone awry. Abusive management has “furthered the hospital-wide perception that the cottages are no longer the desired living location, in turn destroying any incentive for non-cottage residents to achieve treatment goals and progress through OSH,” states the complaint letter.

Patient Matthew Kirby described the fear factor this way: “When a key transitioning part of the hospital is run via fear, no one wants to speak up and face more time. It is a vicious circle if we cannot freely address problems due to intimidation.”

In addition to notifying Roberts, patients circulated the letter to mental-health advocacy groups, legislators, state officials and news reporters.

“Because all other attempts to correct these problems have been fruitless, we are forced to make our demands as publicly as possible,” states the letter.

Roberts said Tuesday in a message to the Oregon State Hospital Advisory Board that “because of the gravity” of the allegations, he had referred the case to the state Office of Investigations and Training for independent review.

“In order to ensure the process is fair and objective for everyone involved, including the accused staff, the staff members named in the letter will be assigned to another area while the OIT investigation goes forward,” he wrote. “Depending on the outcome of the investigation, we will take the appropriate action.”

Roberts added: “Please be assured that hospital leadership will explore all of the concerns raised in the letter. I also want to emphasize that patients have the right to file a grievance at any time.”

Cottage resident Neal Forbes told the Statesman Journal that patients in the transitional program had encountered management “stonewalling on issues that are important to our treatment.”

For instance, supervised patient outings into the community have repeatedly been stymied by Belcher, Forbes said.

“To keep down overtime, he basically schedules nurses and mental-health techs out here to the bare minimum, and when he does this he essentially takes away our passes because the staff is not available to take us out,” he said.

Stingy issuance of passes has become one of many recurring sore points for patients in the transitional program, Forbes said.

“On the one hand, we’re told we’re expected and encouraged to apply for passes,” he said. “But when it comes to the passes materializing, there’s trouble finding the staff to actually get things done. We’ve had pass after pass after pass fall right through the cracks.”

Written by Lynnette Miller, an office specialist 2 at Oregon State Hospital, for the Salem Statesman Journal – March 25, 2011

I work at the new Oregon State Hospital Harbors Treatment Mall in Lighthouse 1. This unit cares for the most violent male patients who come from around the state for treatment because they have committed a crime.

This is one of the most difficult units to work on.

With so much negative press about Oregon State Hospital in recent years, I wanted to share some of the positive things. With the new hospital facility now open and due for completion in 2012, I have had the pleasure of working with the staff of RNs, LPNs, MHTs, staff and psychiatrists who put their lives on the line every day. The genuine care and professionalism I witness is extraordinary.

With recent stories of patients being mistreated and uncared for, people on the outside need to know the good things that happen every day. I am honored to be working with so many people — including departmental directors, peer support specialists, hospital administrative staff, art therapists and volunteers — whose mission is to care for and provide support for our patients. These individuals work extremely hard to make sure each and every patient is cared for, given some dignity and respect, while administering difficult treatments to a very difficult patient population.

The new hospital is absolutely beautiful. I would imagine patient morale is better just being in a new place with new carpet, paint, updated fixtures, new gyms, nice outdoor areas to walk in and new places to eat. The recently remodeled Kirkbride Building on Center Street is fantastic; you would never know there had been an old ward inside dating back to 1883. No signs of the past anymore, just brand new offices.

From what I’ve been told, the last building to have been built on state hospital grounds was back in 1950. A new mental hospital has been long overdue.

More than 600 contractors have done an amazing job in restructuring existing buildings and building new ones. But the most important aspects of the hospital are the people who work every day to ensure staff and patients are safe and getting the appropriate treatment they need.

Everyone is caring and highly professional. I have admirable respect for the staff at Oregon State Hospital and couldn’t imagine what the hospital and patients would be like without them.

Patients who come into our hospital usually do so one reason: They have committed a crime. They are sentenced to undergo treatment for a specific number of days before their trial. These individuals come in angry, hurt, beaten, and destroyed by past and current situations. We all have to remember those who suffer from mental illnesses and commit crimes also have to serve the time given to them. Unfortunately, most of these patients don’t agree with that.

Oregon State Hospital’s goal is to get these individuals healthy and hopefully some day they will be back out into our communities in better shape than when they came in. Oregon State Hospital workers should be commended for their dedication and service to these people. They are phenomenal.

http://www.registerguard.com/web/livinglifestyles/26008907-57/homeless-street-code-theatre-voss.html.csp

Hard as it is to put on a performance of any kind, imagine the difficulty of pulling one off when all the actors are homeless. But if anyone can keep it — and the cast — together long enough to take to the stage, it’s undoubtedly Judith Voss.

Lanie Baley of Street Code Theatre performs a scene during a rehearsal of a multimedia piece on homelessness.

“I started this group on a leap of faith, unaffiliated with any agency or organization,” Voss said. “None of these people are professional actors, most have never had any sort of theater experience, but they’re all wonderful — and they’re all worth caring about.”

Some of the pieces that make up the program involve all the actors on stage at once, while others are solo performances that range from poetry to dance to video. One actor plays guitar riffs between elements of the show. But everything on the agenda portrays a particular truth about the uncertain and fluid lives of the homeless.

Nailing down the cast was a major accomplishment, and keeping it together an ongoing struggle. On a Thursday during the early stage of rehearsals, 18-year-old Braydin Aurena — one of the most forceful personalities in the troupe — announced that she and boyfriend Conner Horner-Linch would be leaving for Central Oregon to give her a chance to reconcile with her mother, potentially throwing the 10-person cast into a major reconfiguration.

But by the following Tuesday, that plan had been abandoned. The young couple were back at the rehearsal space donated by the First Evangelical Church of Eugene — wearing the black-and-white Street Code Theatre sweatshirts Voss purchased for all of them — and ready to go on with the show. Mere days after that, Aurena, who describes herself as a “proud 18-year-old trans man” and has been on the streets off and on since age 14, ended up in the hospital with double pneumonia but got out in time to show up for rehearsal.

Each get-together begins with a meal of pizza or sandwiches, followed by a “check-in” time during which each person in the circle takes the floor in turn to share the challenges they’ve faced since the last meeting and how they’re coping.

Given the season and the privations of living without a home — several of the younger members of the troupe regularly sleep in doorways or even less-protected spots — rehearsals are often punctuated with hacking coughs or feverish cast members dozing in their chairs between pieces.

One stormy afternoon, married couple Lanie Baley and Allen Miller, who live in their car with their dogs, arrived nearly at the end of the three-hour session because of problems jockeying their vehicle from one overnight parking space to the next.

“I’m really tired today — I have a sore throat and I feel like being in bed,” Baley said. “But we forced ourselves to come.”

Somehow Voss, who never bosses but nonetheless manages quietly to keep order from descending into chaos, carries on, assisted by Ryan Zimmer, who has his own production company, Hi-Fi Video, but volunteers to provide technical direction and videography for Street Code Theatre.

For her part, Voss has decades of experience as a “life enrichment specialist,” both privately and for care centers, schools and public recreation departments. Three years ago, she orchestrated a performance that featured patients at a Eugene nursing home as actors portraying their own lives. But each time she undertakes to help a group share its particular creative expression, it’s a whole new challenge.

“These shows take a lot out of me,” Voss admits. “But it’s something I seem to have to do. Last fall, I thought I was done with this kind of thing — I moved and gave away 20 years’ worth of trunks full of props and costumes. But then I had a vision that I needed to do a show on behalf of people who are homeless. For me, sharing the talent and showing the value of people who are often marginalized in our society is a profound experience.”

As a 51-year-old woman with a doctorate in special education, a master’s in counseling psychology and a bachelor’s in English, Voss sums up her dedication to helping disadvantaged people portray their lives through performance by quoting religious scholar, teacher and author Andrew Harvey. “He said, ‘Don’t follow your bliss, follow your heartache,’ ” she said. “And that’s what I have often felt called to do,” to the point that she foots the bill for her theatrical productions from her own personal funds.

Her goal in directing this particular show “is to increase public understanding about some of the issues underlying homelessness by dispelling myths and stereotypes,” she said, “and in the process to provide each performer with a greater sense of self worth.”

Homeless people often are made to feel less than others, even almost invisible, “and for each to follow through on performing, not only does it give an outlet for personal stories to be heard, but it also seems to be providing a sense of worth, of doing something tangible to feel proud of,” she said.

That’s part of what drew Patricia Hampton to the group, even though her only experience with homelessness was being stranded in Eugene for 10 days once with her dog, waiting for a check to arrive so she could continue her journey. She later returned to Eugene, where she lives in an independent retirement facility.

“I spent those days until my money arrived living in my car in a parking lot,” Hampton said. “I showered at St. Vincent de Paul’s Service Station and ate where the other homeless people ate. I had nothing to keep warm, so St. Vinnie’s gave me a $15 voucher to buy a blanket and a pillow — to this day, I still have the same car, the same blanket and the same dog. And when I heard about what Judith was doing through a friend, I had to become involved.”

She has two pieces in the show. One is a slow dance trailing colored scarves in front of projected photographs while she reads an essay she wrote about “inner homelessness” and “Dance of the Blessed Spirits” by Christoph Gluck plays in the background.

Others portray their feelings about homelessness differently. Dylan Mocabee, a young man whose street name is Fox, recites a rap poem he wrote called, “The Hustler’s Prayer” and also demonstrates his prowess at break dancing.

Sometimes the artistic aspects of Street Code Theatre become hijacked by the realistic.

One night, “I happened to check my e-mail before I went to bed — it was a really cold night — and there was a desperate plea from Braydin and Conner, who were using a computer somewhere there was Wifi available, and they had nowhere to sleep,” Voss said. “I got up and got dressed, and I was able to get them space in a hostel for one night, and I met them there just before the final check-in deadline.”

When she arrived, two other members of the troupe also were there without a place to stay “and with no warm clothes, with just a sleeping bag wrapped around their shoulders, and they asked me if I could pay for them to sleep there, too,” she said. “I was not able to do that, and they thanked me anyway and walked away in the dark. That was heartbreaking.”

The next day, Aurena came to rehearsal with a poem she had written about the experience, “It Was Cold Last Night,” and it was immediately incorporated into the program.

Despite the energy it takes for homeless people simply to take care of their daily needs, Voss isn’t surprised that they have enough spirit left over to turn their lives into a performance.

“My experience is that people have a need to be seen, known and honored on a deep level that is as important as breathing, eating and sleeping,” Voss said. “If I can help give them that experience through this performance, then that is what I am meant to do.”

From the Eugene Register Guard, March 20, 2011

Junction City mayor David Brunscheon stands next to the site of the proposed state prison and mental hospital.

The state budget shortfall, human rights concerns and scrutiny by the U.S. Department of Justice are among the reasons opponents want the state to cancel the project.

The hospital still has many powerful backers in the Capitol, including Senate President Peter Courtney, D-Salem, and House Co-Speaker Bruce Hanna, R-Roseburg.

Gov. John Kitzhaber continues to support it, his press secretary Christine Miles said, but he also is involved in discussions about the future of the state’s mental health care system as a whole.

“We’re evaluating all options statewide to find what is the best solution,” Miles said.

In 2007, after controversies surrounding Oregon’s treatment of the mentally ill, lawmakers approved a $458 million plan to build two new hospitals — a 620-bed facility in Salem and a 360-bed facility in Junction City — to replace the dilapidated Oregon State Hospital in Salem.

The new Salem psychiatric hospital will be completed this year. Work to prepare the state-owned site in Junction City for both the hospital and its proposed sister facility, a state prison, began in 2008.

By July, the state will have spent $24.8 million on infrastructure in Junction City, and by October, the state’s tab for design and other preliminary work for the hospital will hit $24.1 million, project administrator Linda Hammond said.

Last month, the governor’s proposed 2011-2013 budget cut the Junction City facility to 174 beds, based on a revised forecast of bed need by the Department of Human Services.

Kitzhaber’s 2011-2013 budget originally covered all of the remaining construction for the smaller Junction City facility — $83 million — which would have allowed the hospital to be built and open by the fall of 2013.

But in the past few weeks, the governor has proposed shifting $50 million of those construction costs to the 2013-15 biennium, the legislative fiscal office says. That translates into a construction delay.

But it doesn’t mean the governor is wavering, Miles insisted. “We are simply adjusting the timing,” she said.

A debate over cost, care

Opponents this session want to halt construction completely and protect future state budgets against the estimated $101 million per biennium costs of staffing and operating the 174-bed Junction City facility.

Rep. Carolyn Tomei, D-Milwaukie, said that given state government’s gloomy revenue forecasts, Oregon won’t be able to afford a second big psychiatric hospital. “My concern is that we would have a new hospital but never have the money to staff it,” she said.

Even legislators who still favor constructing the Junction City hospital admit they are concerned about fitting the operational costs into future state budgets. Each patient treated in an institutional psychiatric setting costs the state more than $200,000 a year, the Oregon Health Authority says.

“We don’t want to pass off funding of an empty institution to the next Legislature,” Hanna said.

“We don’t have endless amounts of money to throw at this,” said Rep. Tina Kotek, D-Portland.

But Rep. Val Hoyle, a Eugene Democrat who represents Junction City, argues that the operating costs of the 174-bed Junction City hospital would only represent a relatively slight increase in net state spending if the state carries through on its plans to close its two satellite psychiatric hospitals, OSH Portland and Blue Mountain in Pendleton.

Both need upgrades and increased staffing to meet federal standards, the DHS says. Factoring in the savings of not making the upgrades to both facilities and closing them, the forecast estimated that the additional costs incurred by the Junction City facility for the state would be $11 million per biennium.

But some legislators argue that Oregon needs to move away from the institutional model of care for mentally ill patients regardless.

“If we build a second state hospital in Junction City, we will be indentured to the institutional style of care for mental illness in our state for as long as we can foresee,” said Rep. Sara Gelser, D-Corvallis. “We will have taken a clear position. There will be no reverse course.”

The National Alliance on Mental Illness and Mental Health America are lobbying for a shift toward community-based care, where they say patients are treated more humanely in smaller facilities and given more independence.

“It’s not good policy to build ‘big box’ hospitals,” said Chris Bonueff, executive director of NAMI Oregon.

A few small, typically 16-bed, state-funded psychiatric facilities exist in Oregon cities for patients who do not pose a threat to the safety of others or themselves. But those facilities face possible severe budget cuts this session.

Tomei favors shifting funding away from the Junction City project and into small facilities and preventative care, particularly as dollars spent by the state on community-based care receive a federal match.

The small facilities represent “a different mindset from what we’ve had before, and now is the time to do it,” she said.

But Courtney warns that institutionalized and community-based care serve two very different populations.

“The Junction City facility has nothing to do with community mental health care,” he said. “People have no business comparing the two. … It’s reckless and unconscionable. … Everyone is forgetting the statements of law enforcement officials and mental health experts that say we need more institutional beds.”

Under federal scrutiny

DHS’s 2010 report estimates that Oregon will need 960 psychiatric hospital beds by 2030: 620 in Salem, 166 beds in community-based settings, and 174 beds in Junction City.

“There continues to be a need for hospital-level care and transitional care at the proposed Junction City campus,” it states.

Hoyle said the report confirms her belief that the population needing institutional care is too large for the state hospital in Salem alone.

“I’m not in favor of building (the Junction City hospital) just to build it,” Hoyle said. “But after looking at all the facts, I have no doubt that we absolutely need it.”

But Gelser and Tomei said that if the state used its Salem beds more efficiently — through reforms to the state’s Psychiatric Security Review Board, for example — it could handle all the patients who need 24-hour supervision.

“We must avoid the danger of institutionalizing those who would thrive in a different setting,” Tomei said.

Last November, the U.S. Department of Justice — which has had Oregon on its radar since the controversies at the old OSH Salem — notified the state that it was expanding its investigation into the state’s treatment of the mentally ill.

The federal agency is particularly worried that Oregon may be spending money to increase institutional capacity while cutting community mental health, its letter reads.

Opponents of the Junction City hospital believe that letter shows that the federal government is serious about implementing community-based mental health care as the national norm and would not look kindly on completion of the Junction City project.

Gelser said that, in a worst-case scenario, the federal government could try to take control of Oregon’s psychiatric hospitals.

Others are less certain that federal officials are specifically critical of the Junction City project.

“I don’t think we’d be sending the wrong message (by building the Junction City hospital). But at the same time, we can’t take money away from community-based care to build it,” Kotek said.

Hanna agreed: “The federal pressure is more about whether we have the capacity, employment and training to treat the people we need to help.”

A Justice Department representative declined to elaborate on the letter.

Location a concern

Some opponents also fault the Junction City location.

“The site choice was problematic from the start,” said Bonueff, the NAMI executive. “Institutions need to be close to people being served. Shipping patients to a location hours from where they live, without public transportation access, is counterproductive.”

Nearly 70 percent of Oregonians who need institutional care live in Northwest Oregon, mostly in Portland, Bonueff said.

If the state mental hospital in Portland is closed as part of the plan to build the one in Junction City, Portland would be left with zero state psychiatric hospital beds, he said.

“People say Salem is close enough,” Bonueff said. “Well it’s not.”

Legislators found no optimal Portland locations for a new hospital when they began the planning, Courtney said. So they decided “Salem would serve the northern part of the state, and Junction City would serve the southern part,” he said.

Despite the taxpayer dollars already spent, the Legislature could still shelve the Junction City project this session.

Bonds to finish the construction have not yet been approved by the Legislature or sold, said Jack Kenny of the Department of Administrative Services.

Prison still up in air

Construction on the Junction City state mental hospital’s sister building, a state prison, has been put on hold for two years by the governor’s proposed 2011-2013 budget.

Gov. Kitzhaber has said he would like to see that project permanently canceled.

Unless there’s unexpected interest by lawmakers in pushing ahead with the project, the state won’t revisit the matter until 2012 at the earliest.

By Maxine Bernstein, The Oregonian – March 19, 2011

Jeri Olson arrived at Multnomah County Circuit Court anxious and tired from a restless night.

“This is the worst day of my life,” she said as she walked to a second-floor courtroom for a civil commitment hearing for her 32-year-old son who suffers from mental illness.

Around a table sat two mental health examiners and a judge, all waiting for the state’s attorney and public defender. At least five witnesses, including Portland police, a psychiatrist and a county mental health investigator gathered in the hall. Olson stepped out to find her son’s attorney.

“Officer (Mike) Stradley said he thinks this is a good thing” Olson said, “but you know what, it’s not his child.”

Olson’s son was a typical kid until age 22, when he was diagnosed with paranoid schizophrenia. He worked as a Benson Hotel valet, took classes at Portland Community College, liked to shoot hoops with friends and swim in the river.

“He was a fun, good-looking guy,” his mom said.

Now he’s reclusive and housebound. Has trouble reading because he can’t concentrate. Talks of hearing 30 voices.

Jeri Olson has worked full-time as an advocate for her 32-year-old son, who has paranoid schizophrenia. Her struggle to find long-term care for him while making sure he stays safe is the experience of many families who have children suffering from a mental illness. At times, her persistence has irritated county or state officials who have been besieged with her calls and e-mails.

“He deserves more of a life than this,” said his mother, who has been his full-time caregiver for more than five years, ensuring he takes his medication and eats.

Jeri Olson knows her son needs long-term medical attention. His psychotic outbursts have led to multiple calls to the crisis line, 9-1-1 calls, short stays at local hospitals. She’s tried to keep him hospitalized when he’s delusional and violent, only to be frustrated when he is released days later, no longer deemed a danger.

So the cycle repeats, with mom calling the crisis line and often directed to 9-1-1 for help, putting the burden on police to serve as front-line mental health crisis workers.

Olson’s struggles are like those of so many families who have children with mental illness. They are forced to go to great lengths — in this case even with the help and partnership of police — to get a loved one long-term care. Then they face the ultimate Catch-22: To get help, a person with mental illness must do something criminal or harmful, the very kinds of dangerous acts families are trying to avoid in the first place.

Typically the only option is involuntary commitment, which forces families to relinquish control — a difficult prospect for parents who have been full-time caregivers and advocates for their children, a difficult prospect for parents who have been full time caregivers and advocates for their children.

The numbers of those in crisis, resulting in hospital mental health holds, are staggering.

In Multnomah County alone, there were 3,938 in 2009-10. For those people, the county has 14 full-time investigators who are expected to review within three days of a patient’s arrival whether the person is a danger to himself or others and should be presented for involuntary commitment or released. In an average week, investigators handle 70 to 85 holds.

With that volume, it’s easy to see how police increasingly find themselves confronting dangerous or suicidal suspects, a phenomenon Portland Police Chief Mike Reese has described as “overwhelming.”

Jeri Olson, too, has relied on police but takes an active role in how they interact with her son. When she’s called 9-1-1, she waits at a corner several blocks away to screen the arriving officers.

“I’m not going to let them in my house if they don’t have any compassion and understanding,” Olson said. “When they send out a police officer, then it’s really hit and miss. They’re all supposedly trained in CIT (Crisis Intervention Training), but they’re individual people with their own personalities. Some of them have a lot of compassion, while others don’t really care.”

Olson has even asked for certain officers.

“You have to be really persistent, and take the lead. If you do it enough, you start knowing the cops and you can actually request them. Some of them are so kind, they’ll give you their own personal cell phone.”

Two days after Christmas, Jeri Olson called 9-1-1.

Her son was hearing voices, trashing the house and throwing things out the front door. He smashed an antique family clock, which lay shattered on the front stoop.

Olson ran out of the house, and her son followed, throwing a beer bottle at her. He was now walking down the street.

Olson waited at Northeast 59th and Alameda Street until Officer Stradley arrived and returned with her to her house. There, he patiently sat as she explained her son’s behavior, his side effects from changing medication and mental health history. Stradley, in turn, shared that with officers out looking for him.

Stradley also called Project Respond, which was familiar with Olson and agreed that a hospital hold was appropriate.

Stradley located Olson’s son about four blocks away. He stood bewildered as Stradley tried to talk to him. On the ride to the hospital, he told Stradley that he wanted to go to “another galaxy.” Stradley asked how he planned to do that.

“He told me he would make the police shoot him,” Stradley wrote in his report.

Stradley took Olson’s son to Legacy Emanuel Medical Center.

He called his mother the next day, yelling that he wanted out to buy a gun to kill himself. Two days later, he was released from the psychiatric unit.

“I feel like I’m beating a dead horse. What more do they need?” Olson said. “It makes you irate. It’s like this bad dream that doesn’t stop.”

State mental hospitals
The Oregon State Hospitals in Salem and Portland, have a combined capacity to serve 641 individuals. Approximately 20 percent of the beds are available for individuals who have been civilly committed. The remainder are for individuals who have been forensically committed – found guilty except for insanity or judged unable to aid in their defense
Blue Mountain Recovery Center in Pendleton has the capacity to serve 60 individuals, most who have been civilly committed.

Olson had hoped the county would allow her son to remain hospitalized for up to two weeks to stabilize his medications. However that 14-day diversion for intensive treatment is granted only if a county investigator considers the patient a candidate for involuntary commitment, and the patient and an attorney agree.

Furious, Olson called Stradley, who called the hospital, reiterating concerns that Olson’s son was intent on killing himself.

But because he was no longer expressing a desire to hurt himself that moment, a Multnomah County investigator released the hold.

“If someone says, ‘I want a suicide by cop,’ and then goes with police voluntarily, that’s not imminently dangerous. That’s someone saying, ‘Come help me,’” said Jean Dentinger who oversees involuntary commitments for the county mental health division. “People can say they’re suicidal; it doesn’t mean they’re going to act on it.”

Stradley alerted dispatchers to provide an immediate two-car police response to any future 9-1-1 calls from Olson, and Olson’s son took a bus home.

Less than two weeks later, police were back.

He was scheduled to meet with his case manager at Cascadia Behavioral Healthcare. Jeri Olson had arranged for a volunteer to pick up her son because she was too afraid to drive him. The morning of the appointment, he cursed at his mother, yelling that she needed to “get the (expletive) out of here.”

So she did.

About an hour later, a neighbor called her cell phone. Olson had given her neighbors cards with her son’s name, diagnosis and symptoms and her cell phone number, should they ever need to call police.

Her son had thrown a clock, dishes, a mug and a vase out the front door. Olson called police at 12:11 p.m. and urged them to hurry, fearful her son might hurt the volunteer scheduled to drive him to his 1 p.m. appointment.

Officer Randy Brandt walked up to the house as Olson’s son walked out for his ride. Brandt decided to follow in case of problems, then went back to the Olson home to learn more about mother and son.

Brandt has since checked in on Olson’s son and established a relationship with him.

Turns out, Brandt, 60, once worked as a psychiatric aide supervisor at the former Dammasch State Hospital.

“It’s something I enjoy, taking more time with mental health issues than most officers probably because of my background,” Brandt said. “Not everybody has the same capacity to strike a rapport with mentally ill people, or to understand what you’re walking into.”

“I just kind of talk to him. See where he’s at. What’s going on in his head. What he’s thinking. Let him know there’s someone interested in him.”

Brandt thinks that attention might stave off police crises down the road.

Olson is grateful.

“Brandt really took a special liking to him, and kept coming back. The sincerity with Officer Brandt is different,” she said. “My son always answers the door, like it’s his friend.”

Still, her son’s voices became constant, and the calls to 9-1-1 more frequent.

A social worker gave her advice she decided to follow, though it hurt to do so: “If you want to help, leave him alone. You’re just holding him up enough so he’s never going to get the help he needs.”

She knew he couldn’t take care of himself, and her mother’s instincts wouldn’t let her kick him out.

So she left the house. And she didn’t answer his calls.

About 48 hours later, she returned to a house littered with beer cans and food cartons, but her son was gone. She called police. “I’m thinking, ‘Is he going to be dead from an OD if I look in his room?”

Brandt arrived.

“It was like he was my guardian angel,” Olson said.

He helped her search the house. They spotted her son’s cell phone. The last number called: 9-1-1.

He’d been taken to Providence Portland Medical Center.

Her son would later tell a county investigator: “I called the crisis line, they weren’t able to help me, so I called 9-1-1 and told them I was suicidal.”

“It truly goes on and on like that,” Olson said.

“You just want your son back. You just want them to have a real life. When he says he’s suicidal, I would be, too.”

And so it’s come to this day, when county mental health officials seek to lock her son in a psychiatric hospital. The catalyst: He struck two staff at Cedar Hills Hospital, where he was transferred from Providence Portland Medical Center.

His mother worries about putting him through a hearing in which he’ll hear doctors and police describe in excruciating detail his problems. An application is pending for Telecare in Gresham, a locked-down 16-bed residential treatment facility for those with severe and persistent mental illness. It’s the only place that provides long-term, secure residential care for the seriously mentally ill that’s a step down from the state mental hospital. All referrals are made through the state’s mental health division; generally half the costs covered by the state, half by Medicaid.

There are few, if any, avenues for voluntary admissions to Telecare, which disturbs Olson.

“I can understand their frustration,” said Jane-Ellen Weidanz, adult mental health services unit manager in the state Addictions and Mental Health Division of Oregon Health Authority. “But the state has limited resources and has to prioritize those resources to those individuals who are at most risk to themselves or others.”

As Olson awaits her son’s commitment hearing, she thinks out loud: “They’re going to win, anyway. They have all the facts, and witnesses that he’s a danger to himself… Why’s it have to come to this extreme?”

She tracks down the state’s attorney hoping for a last-minute alternative. “What can I do instead of putting my son through this torment?” she pleaded. “… I’d rather see him say, ‘OK, I’ll do this.’”

Her insistence appeared to pay off. The deputy district attorney and public defender worked out a deal that her son accepted. He agreed to stipulate to an involuntary commitment for up to 120 days – less than the typical 180-day commitment. His public defender said in court that Olson’s son expected to remain at Cedar Hills Hospital until he could be transferred to Telecare. The judge accepted the 120-day commitment.

“That would be a happy ending if there’s a happy ending to a commitment,” Olson said. “But why do you have to give up your civil rights to get help?”

Yet 11 days later, Olson got notice that her son was considered too aggressive for Telecare, and on March 2 the state sent him to Blue Mountain Recovery Center, a state hospital in Pendleton — 3 1/2 hours from Portland.

Once someone is committed, the state assesses where that patient should go, despite options discussed at the county commitment hearing. “The civil commitment doesn’t give the judge the authority to make that interpretation,” Weidanz said.

So Olson scrambled to get her son to appeal, which he did, but the county denied it, citing no clinical reason to change the state’s referral.

“I am horrified,” Olson said. “That’s not what the agreement was. I would never have done any of this if I knew this was going to happen.”

The Community Acupuncture Network has hired award-winning Portland filmmaker Brian Lindstrom to capture the culture and power of community acupuncture on film, and it’s just about ready!

Brian will be showing the first part of our doc-in-progress, with segments filmed at Working Class Acupuncture and at Philadelphia Community Acupuncture on Friday, April 8 at 6:30 and 8:00 PM. Join in the fun by watching help us raise the funds to complete the film.

Brian Lindstrom: “Its been a privilege to film at Working Class Acupuncture and Philadelphia Community Acupuncture, and to see the difference community acupuncture makes in people’s lives. Please join us on April 8th to see our documentary in progress!”

When & where: Friday, April 8th – St. Charles Church 5310 NE 42nd Ave Portland, OR 97218

Call Working Class Acupuncture (503) 335-9440 to reserve your seat at either our 6:30 or 8:00 PM screening of the film.

Space is limited so snap up your seats fast!

Community Acupuncture Network (CAN) is a non-profit organization of practitioners, patients, and supporters whose goal is to make acupuncture more affordable and accessible by promoting the practice of offering acupuncture in community settings for a sliding scale ranging within $15-40 a treatment.