1 in 6 people has a common mental illness at some point in their life (Psychiatric Morbidity Survey, 2000).
About 1% of the population experience schizophrenia at some point in their lives (Mental Health Foundation, 1999).
About 1% of the population experience manic depression at some point in their lives (Mental Health Foundation, 1999).
1 in 200 people have experienced a psychotic illness in the last year (Singleton, Psychiatric Morbidity, 2000).
The average age of onset of psychotic symptoms is 22 (Department of Health, 2001)
Deprived areas and rural districts have the highest levels of mental health problems and suicides (ONS, 2001).
People from Afro-Caribbean backgrounds are 3-5 times more likely than others to be diagnosed and admitted to hospital for schizophrenia. (Mental Health Foundation, 1999)
About 25% of people diagnosed with schizophrenia will make a full recovery; about 60% of people will have fluctuating symptoms; about 10-15% of people experience long term incapacity (Mental Health Foundation, 1999).
35% of people with mental illness are unemployed but want to work (ONS, 2003), the highest want to work rate of any disability.
Only 1 in 4 employers said that they would knowingly employ someone with a history of mental illness (Manning et al, 1995).
Three quarters of employers say that it would be difficult or impossible to employ someone diagnosed with schizophrenia (DWP, 2003).
Less than 5% of people who kill a stranger have symptoms of mental illness (Department of Health, 2001).
People with mental illness are more likely to be the victims than the perpetrators of violence (Walsh, 2003).
More than 1 in 4 people with severe mental illness report being shunned when seeking help (Rethink, 2003).
30% of GPs’ time is spent with people with mental health problems (Sainsbury Centre for Mental Health (Maudsley Monograph, 2002).
44% of people with mental health problems report discrimination from general practioners, such as physical health problems not being taken seriously (Mental Health Foundation, 2002).
Almost 80% of carers for someone with a severe mental illness say that caring has had an impact on own their mental health (Rethink, 2003).
Almost 80% of carers for someone with a severe mental illness say that caring has had an impact on their own physical health (Rethink, 2003).
Only 48% of mental health professionals know about local policies on sharing information with carers (Rethink/IoP, 2006).
Mental health problems cost the economy untold billions per year through care costs, economic losses and premature death. (Sainsbury Centre for Mental Health, 2003).
21% of people with schizophrenia have a dual diagnosis (Cantwell, 2003).
Up to half of people dependent on alcohol have a mental health problem (Turning Point, 2003).
People with schizophrenia and bipolar disorder die 10 years younger due to physical health problems (British Journal of Psychiatry, 2000) and have double the average rate of heart disease (British Journal of Psychiatry, 2006) and five times the average rate of diabetes (Department of Health, 2004).
People with severe mental illness smoke twice as much as average, do half as much exercise and eat less fruit and vegetables than average (Running on empty report, 2005).
Alien Boy Showtimes
Private Screening
Multnomah County
April 23 - 5:30 PM
“Infuriating, tragic, heartbreaking and incendiary in equal measures... plays out like a horror film and leaves you absolutely breathless.”
~ AP Kryza, Willamette Week
The Non-Traditional Health Workers Subcommittee, which has been designing standards for community health workers in Oregon, believes it’s important to continue its work to oversee the development of that work force. It intends to ask the Oregon Health Policy Board for permission to become a formal advisory body.
“There’s a lot more work to do,” said Carol Cheney, the subcommittee’s facilitator and equity manager in the Oregon Health Authority’s Office of Equity and Inclusion.
Meghan Caughey works on a sumi-e piece (Japanese for black ink painting) in her studio apartment, with her dog, Ananda.
Last year, the subcommittee began developing training and education standards for community health workers, and make recommendations to the Policy Board about how the work force should be incorporated into Coordinated Care Organizations (CCOs). The CCOs are part of a major overhaul to the Oregon Health Plan’s delivery system, and are expected to integrate physical and mental healthcare for 650,000 Oregon Health Plan patients in August.
The subcommittee is also proposing that its name be changed, and has recommended that it be called the “Community Health Worker-Peer Workforce Advisory Committee.” The subcommittee feels that its current name — which uses the phrase “non-traditional” — runs counter to its mission to help community health workers become part of the mainstream healthcare system.
“We recognize the irony of this name,” Cheney said.
It’s unclear which office within the Oregon Health Authority will oversee the subcommittee’s work. There was tentative consensus that the Office of Equity and Inclusion was the appropriate office, but the authority’s Addictions and Mental Health Division and the Public Health Division were also suggested when the subcommittee met on Wednesday.
A draft charter that was circulated during Wednesday’s meeting describes the advisory committee’s responsibility as advising CCOs “on the role and utilization of community health workers, personal wellness specialists, and personal health navigators” in the healthcare delivery system.
One of the main priorities identified during the meeting was educating CCOs about the role of community health workers so they are not overlooked by physicians and other traditional providers.
“I fear that out of ignorance, potentialities will be overlooked,” said Meghan Caughey, Senior Director of Peer and Wellness Services for Cascadia Behavioral Healthcare.
The subcommittee also wants to make certain that the current community health workers be grandfathered in, exempting them from the training and certification requirements the subcommittee has recommended for future community health workers (which include 80 hours of training).
Community health workers who now have at least five years of work experience or completed training within the last two years would be grandfathered in, according to the subcommittee. That action “assures availability of recently trained or experienced [non-traditional healthcare workers] for CCOs,” the subcommittee recommended.
Cheney said the advisory board would also continue developing the curriculum and training requirements. “This is a work in progress,” she said, adding that the requirements may change as CCOs and the role of community health workers evolve in the next few years.
Kris Anderson, director of the Oregon Family Support Network’s training and curriculum development, hopes that one topic would continue being discussed — more clearly defining the roles of community health workers, peer support specialists and personal navigators in a CCO.
“We’ve never really clearly defined what those roles are,” Anderson said, recognizing that the timeline to have CCOs operational means that “things are moving so fast.”
If those roles aren’t defined early in the process, they may never be delineated, she said.
Although some of those roles were outlined when the subcommittee made its presentation to the Policy Board in January, said Anderson, “they were very ambiguous.”
“They’re very broad,” agreed Cheney.
Among the roles of community health workers are being an advocate for patients, providing case management support, doing outreach to patients’ homes, and helping patients adopt a healthier lifestyle.
Jennifer Valentine, executive director of the Area Health Education Center in Bend, worries that a more detailed description could hamper CCO’s in determining the best way to use community health workers.
“If we defined [the roles] too tightly, we don’t give that experimentation enough opportunity,” she said.
In order for the advisory board to become a formal body, it needs approval from the Policy Board. Approaching the board is expected to be one topic discussed when Cheney and other members of the subcommittee make a presentation before the Oregon Health Care Workforce Committee on April 4.
On Friday, March 30th, State Arbitrator Jane R. Wilkinson ruled that Officer Ron Frashour should be reinstated, with back pay, after he was fired for shooting Aaron Campbell in the back, despite the fact that Mr. Campbell was unarmed.
The Links below will take you to the appropriate sections of this posting, including local media coverage of this sad event.
Portland Police BureauPolice investigators photographed the casing fired from former Officer Ronald Frashour's AR-15 rifle on January 29, 2010 as evidence. The .223 caliber bullet struck Aaron Campbell, 25, in the back, killing him. Frashour was fired from the Police Bureau in November 2010 for his use of deadly force.
A state arbitrator has ruled in Portland police union’s favor, saying fired Portland Officer Ronald Frashour should get his job back.
The union’s challenge of Frashour’s November 2010 termination largely rested on the testimony of bureau training instructors who say Frashour followed his training when he used deadly force against Aaron Campbell on Jan. 29, 2010. The trainers were set to testify in federal court as well that they were never consulted before Chief Mike Reese and Mayor Sam Adams let Frashour go.
Frashour was fired for fatally shooting Campbell, an unarmed 25-year-old African American man, in the back with an AR-15 rifle.
Campbell, distraught and suicidal over his brother’s death that day, emerged from a Northeast Portland apartment, with his back toward officers and his hands behind his head. Officer Ryan Lewton, who said he was trying to get Campbell to put his hands in the air, fired six bean bag rounds at him. Campbell turned and ran toward a parked car. Frashour fired a single shot at Campbell from the rifle, killing him.
Reese found it unreasonable for Frashour to believe that Campbell posed an “immediate threat” of death or serious injury. He found Frashour seemed to only focus on his AR-15 rifle without noticing what was going on around him, and refused to acknowledge that the six beanbag rounds that struck Campbell before the fatal shot could have caused a pain reaction, such as running away.
But the arbitrator found the city didn’t prove “just cause” to terminate Frashour, and that a reasonable officer could have concluded that Campbell was armed, and that when he ran, “there was sufficient evidence for a finding that Mr. Campbell made motions that appeared to look like he was reaching for a gun.”
“This was a very tragic case, one where the Monday-morning quarterback has the clear advantage when divining what went wrong,” wrote arbitrator Jane Wilkinson, a Lake Oswego attorney, in her 78-page ruling.
But she said she rested her decision on constitutional law and Portland police directives.
“Although it turned out that Mr. Campbell did not have a gun with him in the parking lot, Graham (case law) and its progeny consistently emphasize that ’20-20 hindsight’ must be avoided,” she wrote.
“In the instant case, although Mr. Campbell had not committed a crime and displayed some behavior showing surrender and compliance (although this behavior was inconsistent), the Arbitrator concludes that it was reasonable to believe that he could be armed, and that when he ran, there was sufficient evidence for a finding that Mr. Campbell made motions that appeared to look like he was reaching for a gun.”
The arbitrator ordered the city to reinstate Frashour to his former job as a police officer and to make him whole for lost wages.
The city of Portland had paid outside lawyers to assist deputy city attorney Stephanie Harper in defending the firing. As of Feb. 4, the city had spent $434,514 for outside counsel in this arbitration case.
The arbitrator held 16 days of hearings between Sept. 14 and Nov. 29.
“I spoke with Aaron Campbell’s mother today and expressed my disappointment in today’s ruling,” Adams said. “Chief Reese and I have been vocal about our stance on this case and we asked for this officer to be removed from service, based on the facts of the investigation and our policies. The City is reviewing all of its options, including whether we can appeal, and whether this is an award that is enforceable under state law.”
“The decision regarding this discipline was incredibly difficult and complex,” Reese said, in his prepared statement. “While I believe that each Bureau member was attempting to do their best, it was important to recognize the significant issues in regard to policy violations and performance issues that were brought forward. I concurred with recommendations made by the Performance Review Board and delivered what I believed to be appropriate discipline.”
Officer Daryl Turner, president of the Portland Police Association, called the firing politically motivated and applauded the arbitrator’s ruling. He said 25 Portland police officers testified before the arbitrator that Frashour’s use of deadly force was reasonable and in full compliance with bureau rules.
“The events of January 29, 2010 were a tragedy for the Campbell family and the City. It was wrong, though, to compound that tragedy with political decision-making that disregarded the facts of what occurred that night,” Turner wrote in a released statement.
“The reinstatement of Frashour is another in a long line of arbitration overturning firings of officers who use deadly force or otherwise take actions often targeted at communities of color,” the coalition said, in a prepared statement.
From: Portland Copwatch
Date: Friday, March 30, 2012
Subject: MEDIA ADVISORY: AMA Coalition to Protest Officer Frashour’s Reinstatement: Monday, April 2, 12:00 Noon, City Hall
To: News Media
Albina Ministerial Alliance Coalition for Justice and Police Reform
c/o Dr. LeRoy Haynes, Allen Temple, 503-287-0261
PICKET LINE/NEWS CONFERENCE TO PROTEST OFFICER FRASHOUR’S REINSTATEMENT
Justice For Aaron Campbell Monday, April 2, 2012, 12:00 Noon, Portland City Hall, SW 4th and Madison
On Monday, April 2, the Albina Ministerial Alliance (AMA) Coalition for Justice and Police Reform will hold a picket line and news conference to protest the State Arbitrator’s decision to reinstate Officer Ron Frashour to the Portland Police Bureau (PPB). Frashour shot the unarmed Aaron Campbell in the back in January, 2010 and was fired later that year. The action will take place at 12:00 Noon on the 4th Avenue side of City Hall, between Madison and Jefferson Streets.
The reinstatement of Frashour is another in a long line of arbitration overturning firings of officers who wrongfully use deadly force, or otherwise take actions often targeted at communities of color.
–Officer Scott McCollister, who was suspended for six months after shooting and killing African American Kendra James in 2003, was reinstated with back pay;
–Officer Douglas Erickson, who shot and wounded African American Gerald Gratton in the back in 1993, was reinstated;
–Officers Richard Montee and Paul Wickersham, fired for selling T-Shirts reading “Don’t Choke ‘Em, Smoke ‘Em” after an officer choked African American security guard Lloyd “Tony” Stevenson in 1985, were reinstated;
–Officers Craig Ward and Jim Galloway, fired for tossing dead opossums on the porch of a black-owned business in 1981, were reinstated;
and
–In one case where the victim, Dennis Young, was white, Lt. Jeffrey Kaer was reinstated after being fired for shooting and killing Young in 2006.
The apparent racial bias of the arbitration system comes in the midst of a national debate on racial profiling, sparked by the shooting of teenager Trayvon Martin in Florida. Like Keaton Otis, an African American man shot and killed by Portland Police less than four months after Campbell, Martin was deemed suspicious for wearing a hoodie.
The AMA Coalition for Justice and Police Reform is working toward these five goals:
1. A federal investigation by the Justice Department to include criminal and civil rights violations, as well as a federal audit of patterns and practices of the Portland Police Bureau.
2. Strengthening the Independent Police Review Division and the Citizen Review Committee with the goal of adding power to compel testimony.
3. A full review of the Bureau’s excessive force and deadly force policies and training with diverse citizen participation for the purpose of making recommendations to change policies and training.
4. The Oregon State Legislature narrowing the language of the State statute for deadly force used by police officers.
5. Establishing a special prosecutor for police excessive force and deadly force cases.
The AMA Coalition for Justice and Police Reform follows these three principles:
–Embrace the five goals.
–Accept the principles of non-violent direct action as enunciated by Dr. Martin Luther King, Jr.
–Work as a team in concert to achieve the goals.
“The City is reviewing all of its options, including whether we can appeal, and whether this is an award that is enforceable under state law.” — Mayor Sam Adams
The City of Portland and the Portland Police Bureau have been informed by Arbitrator Jane Wilkinson that she has ruled in favor of the grievant, Ron Frashour, who was terminated from the Portland Police Bureau on November 16, 2010, following the January 29, 2010 shooting of Aaron Campbell.
The arbitrator has ruled Ron Frashour should be reinstated as a police officer. This award is the result of the grievance process. See the attached decision.
Ron Frashour’s employment was terminated by the Police Chief, an action approved by the Mayor, for violating Directive 1010.10 Deadly Physical Force, Directive 1010.20 Physical Force, and Directive 315.30 Unsatisfactory Performance.
“I spoke with Aaron Campbell’s mother today and expressed my disappointment in today’s ruling,” Mayor Sam Adams said. “Chief Reese and I have been vocal about our stance on this case and we asked for this officer to be removed from service, based on the facts of the investigation and our policies. The City is reviewing all of its options, including whether we can appeal, and whether this is an award that is enforceable under state law.”
“The decision regarding this discipline was incredibly difficult and complex” said Chief Michael Reese. “While I believe that each Bureau member was attempting to do their best, it was important to recognize the significant issues in regard to policy violations and performance issues that were brought forward. I concurred with recommendations made by the Performance Review Board and delivered what I believed to be appropriate discipline.”
The Mayor and Police Chief are disappointed in this ruling. However, out of this tragedy came several changes in police tactics and training, including:
* re-evaluating the Bureau’s less lethal directives to ensure uniformity;
* ensuring members who are selected to train and carry an AR15 rifle receive a comprehensive performance evaluation that includes the reinforcement of the Bureau’s Use of Force Directive;
* establishing an annual Less Lethal operator in-service;
* conducting command officer training on leadership in tactical incidents; and
* continued emphasis in training on de-escalation of people in mental health crisis as well as reviewing training scenarios to ensure they construct a need for situational awareness so members are trained in identifying the totality of circumstances in deadly force incidents.
The Community and Police Relations Committee also conducted a thoughtful review of our force policy and practice and made numerous recommendations — several of which Chief Reese is implementing.
The Mayor and Chief Reese remain committed to working with this and other community groups to police in a way reflective of community desires.
“As Chief, I remain committed to continuing to looking at national best practices, improving partnerships with mental health service providers, and refining tactics and training that involve people in mental health crisis,” Chief Reese said.
Media Contact:
Caryn Brooks, Communications Director, Office of Mayor Sam Adams
503-823-4799
1221 SW Fourth Ave, Suite 340, Portland, OR 97204
Email: caryn.brooks@portlandoregon.gov
Twitter: @carynbrooks Web: mayorsamadams.com
For the fifth time, an independent review of the actions of Officer Ron Frashour has found that Officer Frashour fully complied with the law and with national and local standards for the use of force. After an 18-day trial, Arbitrator Jane Wilkinson has ruled that Officer Frashour’s actions and decision making were those of a reasonable police officer, and that his conduct was fully in compliance with his training.
The hearing before Arbitrator Wilkinson could hardly have been more thorough. More than 30 witnesses testified, and thousands of pages of exhibits were considered. Expert witnesses on police procedures and deadly force incidents testified at great length. The City was represented by one of the best labor law firms in the country. Arbitrator Wilkinson, who once served as the chairperson of Washington’s Public Employment Relations Commission, has more than 20 years experience as an arbitrator, and is a member of the prestigious National Academy of Arbitrators.
In the end, facts are important. Arbitrator Wilkinson conclusively ruled that Officer Frashour reasonably believed that Mr. Campbell, who had threatened “suicide by police’ was armed and was reaching for his weapon at the time he was shot. 25 Portland police officers, who collectively have hundreds of years of service for the City, testified that Officer Frashour’s decision to use deadly force was reasonable and in full compliance with the Bureau’s rules.
The Portland Police Association cannot allow Portland Police Officers to face termination and substantial discipline for doing their jobs correctly. If that occurs, public safety would be deeply compromised. The events of January 29, 2010, were a tragedy for the Campbell family and the City. It was wrong, though, to compound that tragedy with political decision making that disregarded the facts of what occurred that night. The neutral arbitrator agreed to by the City to hear the case has found the same thing as the grand jury that considered the case more than two years ago- that Officer Frashour was credible, and that he was not at fault in the incident.
The Portland Police Bureau is exploring a dramatic shift in the way it handles what’s become a flood of calls involving the mentally ill — with plans in the works for a new, specialized unit that would pair cops with clinicians 24 hours a day.
According to city budget documents released this month (pages 9 to 10 have ‘Mental Health/Police Intersection’), police officials are sketching out how much it would cost to assign officers to a standalone mental health unit that would work hand-in-hand with Multnomah County’s Project Respond. The unit would come on top of the crisis training already required of every officer and replace current plans to have Multnomah County’s crisis hotline handle low-level 911 suicide calls.
And, unlike the bureau’s current partnership with Project Respond — which pairs one day-shift cop and one clinician on patrol in just one precinct — the new unit would operate around the clock. There’s just one catch so far: At a time of budget cuts citywide, the new program is expected to cost as much as $2.5 million.
“There is still a lot of vetting being done with the budget,” cautioned Sergeant Pete Simpson, a bureau spokesman, “so nothing is set in stone.”
The unit is based on a nearly 10-year-old project created by the Los Angeles Police Department that closely links officers with county mental health workers. Unlike Portland’s proposal, the Los Angeles program also includes follow-up care for people deemed most likely to be suicidal or become violent with police. The project is well regarded enough that it was plucked as a national example of how cops ought to deal with people enduring a mental health crisis.
More info about the Los Angeles model that inspired this:
That’s been a sore subject in Portland. In the 13 officer-involved shootings since January 2010, at least 10 victims had battled addiction issues or were in a mental health crisis.
Portland’s outline is fairly detailed. It calls for a 24-hour “triage” officer who, when a call comes in about someone in crisis, would be tasked with checking if that person has a mental health history and deciding whether to send over county workers, Project Respond, or patrol officers. Two clinicians from Project Respond would work all day, taking calls currently handled by 911.
Also, expanding on the bureau’s current Project Respond “mobile crisis unit,” all three precincts would see a cop and a clinician paired for day-shift patrols.
The proposal has cautious interest from mental health advocates who applaud the police bureau for trying to devise new solutions in the wake of high-profile shootings and an ongoing federal probe of how the bureau uses force against the mentally ill.
Beyond working to send some 911 calls out to Multnomah County (a still-ongoing process), the bureau in recent months has instituted a “walk-away” policy in some cases involving people in crisis and launched a pilot program requiring better documentation of when officers use force.
But advocates also question why police have to step in and do a job — treating the mentally ill — that’s supposed to be done by the county.
“The Portland Police Bureau has become our community’s most active advocates for additional services for persons with acute mental illness—especially when it comes to launching new efforts,” says Jason Renaud of the Mental Health Association of Portland, adding that there are “reasonable concerns about police bureaus providing any routine health care service. When police officers are our front-line mental health service, we criminalize mental illness.”
David Austin, a spokesman for Multnomah County Chairman Jeff Cogen, welcomed the effort by Portland police. But he bristled at the notion that it meant the county’s mental health system is broken. He pointed to the county’s mental health line — 503-988-4888 — and said a new crisis treatment center that opened last summer, the Multnomah County Crisis Assessment and Treatment Center, had already served nearly 330 people through January 31. After patients are stabilized, they’re released to nonprofits.
“That’s something that works,” he says. “People say the system is broken, but we don’t see it that way. It’s people not knowing there are resources out there.”
Austin did acknowledge that budget cuts have made it hard to build more facilities like the crisis treatment center — and said that at some point, voters will have to step in and decide they want to better fund mental health.
The police bureau wouldn’t say much more about the program than what was mentioned in budget documents. Talk of creating a mental health unit in the police bureau surfaced recently at a mayoral candidates forum on police issues that also touched on the federal probe of the bureau, announced last spring. Asked if the bureau was responding to the federal probe, Simpson said it’s been discussed longer than that.
“What I can say at this point,” he says, “is that [the] proposal captures a number of things that the police bureau has been working toward for a long time.”
The U.S. Department of Justice says it has reached agreement with Oregon officials on a yearslong strategy for reforming the state’s community mental-health system, correspondence obtained by the Statesman Journal shows.
Federal officials said in a recent letter to the state Department of Justice that the agreement paves the way for changes that will “improve the lives of thousands of Oregonians living with mental illness.”
S. Amanda Marshall
If envisioned reforms materialize, that will resolve an ongoing federal investigation of Oregon’s mental-health system, without legal action against the state, wrote Jonathan Smith, chief of the Special Litigation Section of the federal Justice Department, and S. Amanda Marshall, the U.S. Attorney for Oregon.
The newspaper obtained the March 13 federal letter, and a March 23 state response letter, through Oregon’s public records law. The documents were released by the state Department of Justice.
As outlined in the federal letter, the Civil Rights Division of the U.S. Department of Justice, along with mental-health experts hired by the agency, will work cooperatively with the state to identify and plug gaps in the community-based system. Federal involvement in Oregon mental-health reforms could last for several years, the letter says.
“We are hopeful that our work together will address the gaps in, and improve the quality of, the community system for persons with mental illness during the coming years,” it says. “It is contemplated that this process will successfully resolve our investigation once an array of essential community services are in place and positive outcomes are being achieved on agreed-upon metrics.”
The community mental-health system provides services and support for tens of thousands of Oregonians, including housing, case management, crisis services, drop-in centers, job training, living skills training, peer support and more.
Mental-health advocates long have complained about inadequate state funding for community-based services. They have argued that the state spends too much money on mental hospitals, at the expense of the community system. Such concerns have fueled intense opposition to a state plan to build a new psychiatric hospital in Junction City.
The state spends more money in total on community mental-health programs than at the state hospital. The current two-year budget for community care is $434 million; for the state hospital it’s $339 million, although the hospital cares for about 600 patients compared to the thousands of patients in community programs.
Federal officials mentioned the funding controversy in their recent letter to the state.
“Throughout our investigation, we have met with a range of stakeholders, including consumers, advocates, providers and elected and public safety officials,” it says. “We have heard a consistent message that the state must invest more in critical community based services and that investments in institutions – including the proposed hospital at Junction City – are draining resources that should be used to keep people in their homes and in the communities.”
The feds vowed to “continue to meet with these stakeholders as the state implements its reform process to ensure that this agreed-upon process translates to real improvements in the lives of people with mental illness.”
The behind-the-scenes agreement between the federal Justice Department and the state comes nearly six years after federal investigators, in June 2006, launched an investigation into patient care and conditions at the Oregon State Hospital in Salem.
A scathing report issued by the federal agency in January 2008 detailed a multitude of flaws at Oregon’s main mental hospital. The report came as the state was gearing up to replace the outdated and unsafe institution with a new $280 million hospital. The new state hospital complex became fully operational this month.
Amid reform-minded changes at the Salem psychiatric hospital, the federal Justice Department notified Oregon officials in 2010 that it was widening the civil rights investigation to examine state-funded community mental-health programs and services.
Key to the expanded federal inquiry is whether the state is violating provisions of the Americans with Disabilities Act by failing to provide mentally ill Oregonians with adequate community-based services.
Oregon’s push to overhaul health care, led by Gov. John Kitzhaber and Oregon Health Authority Director Bruce Goldberg, “provides a unique opportunity for the state and the Civil Rights Division to work together to address our concerns by embedding reform in the design of the health care system,” the federal letter says.
Under the agreement, specific reforms in the community mental health system will occur in stages during coming years, with desired outcomes spelled out in provider contracts, regulations and other documents, the letter says.
“Initially, the state has agreed to collect statewide system data on the services currently being provided and the people being served,” it says. “Working with the United States and our experts, this data will be transformed into outcome measures that will be included in plan documents, contracts and regulatory materials. We contemplate working cooperatively with the state for the next several years. In this unique context, we are optimistic that the iterative process to which we have agreed will improve the lives of thousands of Oregonians living with mental illness.”
In a March 23 response to the federal officials, Oregon lawyer John Dunbar, head of the Special Litigation Unit of the state Justice Department, expressed optimism about moving forward, along with some concerns.
“We agree that we have made tremendous progress,” he wrote. “We are appreciative of USDOJ’s outcome-driven approach, and we are glad to see you share our desire to avoid costly, wasteful litigation if possible.”
However, the state attorney also noted that he had “some substantive concerns” about the federal letter. For example, he said the document “appears to overstate the state’s commitments,” and he took issue with some of the reform metrics, or measurements, outlined by the feds.
“We should be able to straighten these issues out, but I wanted to make sure we were all on the same page so that misunderstandings don’t develop,” Dunbar wrote.
On Monday, two leaders of Oregon mental-health advocacy groups said they were encouraged by the accord on mental-health reforms.
“I think the overall message is that this is very encouraging and the timing is very good,” said Bob Joondeph, executive director of Disability Rights Oregon. “As in the spirit of health care reform, we’re hoping as advocates to have some input into this before it’s memorialized.
“It’s very much a breakthrough,” he added. “Interestingly enough, it’s a breakthrough that is very consistent with what Oregon is doing to reform its health care delivery system in the Medicaid world. So it may just be that the timing was right.”
Chris Bouneff, executive director of NAMI Oregon, a chapter of the National Alliance on Mental Illness, said: “It will take some time to digest the spreadsheets of measurements to draw a conclusion. At a rough first glance, the progress seems positive.”
Bouneff said he was put off, though, by Oregon’s objections to some of the reform measurements sought by the feds.
“One glaring omission on Oregon’s side is the state’s unwillingness to accept certain process measures that are widely credited with improving outcomes,” he said.
But more work needs to be done to develop the training and education programs
Community health workers who will work with coordinated care organizations (CCOs) will be expected to need 80 hours of training and education, but not be licensed, according to recommendations that a subcommittee of the Oregon Healthcare Workforce Committee expects to approve Wednesday.
The committee, called the Non-Traditional HealthCare Workforce Subcommittee, was created by the Oregon Health Policy Board to create standards and guidelines for a state-wide workforce of community health workers.
Once CCOs get under way in August, community health workers will engage with patients outside of a doctor’s office, visiting them at home, connecting them to health and social services, and working closely with people who have chronic health conditions so they can remain out of the hospital and lead healthier lives.
“They are a very essential piece of the healthcare system,” said Teresa Rios Campos, coordinator of Multnomah County’s Capitation Center and co-chair of the subcommittee.
Kelly Volkmann, manager of Benton County Health Department’s Health Navigation Program, who sits on the subcommittee, agrees.
What makes community health workers unique within the health care system, she said, is their ability to relate to the patient and motivate and encourage them to improve their health.
“Community health workers do a better a job than anyone else,” Volkman said. “They have the linguistic, cultural, community and shared life experience [of the patient]. They understand in ways that [healthcare providers] never could.”
Not only do they work with patients over a long span of time, community health workers can empower patients, teaching them to take a more assertive role in their healthcare.
“It’s make the leap from getting someone education to helping them make lifestyle changes,” Volkman said. “Knowledge does not equal behavior change. You have to work with people in a different way and breakdown those barriers.”
“We provide cultural, accessible information and teach the concepts in a way that people will understand. We don’t lecture people. We really empower people,” Campos said. “The heart of the model is based on social justice and overcoming health inequalities.”
House Bill 3650, which passed by the Legislature last year, created coordinated care organizations and set in motion the overhaul of the Oregon Health Plan’s delivery system. These CCOs are expected to employ the following workers: community health workers, personal navigators and peer wellness specialists.
Community health workers will work with a small population of patients who have multiple illnesses and barriers to accessing care, and make sure they don’t fall through the cracks by reminding them to take their medications and not miss physician appointments.
Personal navigators will help patients find social and healthcare services not available through the CCO.
Peer wellness specialists have a very specific task: finding appropriate mental health services for patients and working with mental health providers.
In creating these recommendations, the subcommittee tried to draw a fine line between developing standardized criteria and not creating barriers.
One of the biggest challenges was simply learning what these workers are expected to do. Currently, their training and job descriptions can vary from organization to organization, said Judith Woodruff, the Northwest Health Foundation’s healthcare workforce program director and a subcommittee member.
Determining how many hours of training and education were needed presented another challenge. “Some felt 40 hours wasn’t enough, and maybe 120 hours was too much. Everybody was coming from a different paradigm,” Volkman said.
As far as regulation is concerned, the subcommittee didn’t find it necessary for community health workers to be licensed.
“Part of what makes a community health worker so valuable is that they’re not part of the mainstream medical profession,” Woodruff said. “There are some community health workers who haven’t had a day of education and they are the more effective, amazing community health workers I know.”
Another challenge is making certain there’s a sufficient infrastructure to provide adequate training and education throughout the state.
Central Oregon Community College offers a 36-hour community health worker course, and other community colleges offer similar programs. But Noelle Wiggins, director of Multnomah County’s Capitation Center, worries that programs at community college programs may not be appropriate.
“We need a coherent, well-planned system of training programs,” she said. “We have to think about how we’re going to involve community health workers as trainers, and we have to think about how to use an appropriate methodology.”
Having the appropriate infrastructure for training will continue to be discussed by the subcommittee, Woodruff said. “This is an evolving process. The committee is still very active.”
For community health workers to be successful, said Wiggins and Volkman, a culture change is needed so providers – who are often well-trained and educated in a specialized field of healthcare—are willing to accept community health workers as a vital part of the work force.
“If I don’t understand what it means to be a community health worker, and I don’t listen to them, I’m going to underutilize them or marginalize them,” Volkman said. “Community health workers would be set up to fail.”
“They are not well understood at this point, and that can impair their effectiveness,” Wiggins said. “In order to maintain the heart of the community health worker profession, it is absolutely necessary for us to look at things in a different way, and not try to fit them into existing categories.”
Graduate students in the computer lab inside the new Lewis and Clark College Counseling Center on Southwest Barbur Boulevard study under mental health professionals and gain first-hand experience to help them become counselors in the future.
Portlanders and their families experiencing mental health, addiction and relationship issues now have an affordable place to turn to at the new Lewis and Clark Community Counseling Center, which is dedicated to serve those in need with affordable and culturally sensitive low-cost counseling.
According to Antonia Mueller, the director of the center located at 4445 S.W. Barbur Blvd., counseling services are often too expensive for individuals and their families who are looking for a safe and nurturing environment to be heard.
“With the economic times, people are unable to afford higher levels of therapies and support,” she said. “So the graduate school at Lewis and Clark is responding to the economic needs of the Portland community.”
The goal of the new mental health facility, which provides counseling services on a sliding scale from $10 to $50, is to serve the underserved, with a special focus on outreach to African-American, Spanish speaking and LGBTQ communities.
Since opening its doors in January, the clinic has already seen dozens of clients, including families, couples and individuals from multiple age groups and walks of life.
Antonia Mueller directs mental health services for people in need by overseeing the new Lewis and Clark College Counseling Center, which is geared to providing affordable services.
“Our goal is to serve the community in any way we can and take as many clients as we can because we know the services are needed,” said Mueller. “We believe in providing ease of access to the unemployed, working poor, immigrant and refugee populations in our neighboring communities.”
Antonia Mueller directs mental health services for people in need by overseeing the new Lewis and Clark College Counseling Center, which is geared to providing affordable services.
The new center, which provides services to all social classes, races, sexual orientations, nations of origin, ethnic groups and genders, also provides students within the Graduate School of Education and Counseling the chance to learn from experienced professionals through intensive training and supervised counseling sessions.
“Students learn from the expertise of faculty members who have been in the field for a long time and are sensitive to cultural backgrounds who are onsite providing supervision to students and future generation of counselors,” said Mueller.
”We do live supervision with students before they graduate, so they can be ready in the field right when they graduate so they can provide services to clients from a diverse background.”
According to graduate student Rico Garcia, 25, the center has a strong social justice perspective.
“It allows us to address social economic status, racial inequality, sexism, homophobia, ablism, ageism, and understand how this interacts with our community and our clients,” he said.
“You can’t just treat the client’s symptoms. You have to address the epidemiology of the problem or situation that brought them in.”
Currently, Mueller said there are over 30 students involved with the center, where they receive supervision and education from eight faculty members.
Although the center is not a crisis intervention facility, and does not offer medication management, the clinic has three programs offered, including a marriage coupling and counseling program, mental health counseling, and co-occurring and addiction counseling. “Encompassing all that in one center is a unique service to the community,” she said.
She added, the center strives for a diverse faculty and array of counselors.
“One thing we are working on right now is increasing our services for Spanish speaking clients,” she said. “Not only are these individuals dealing with economic pressure and downfall, but they are also dealing with power struggles, being a minority and oppression.”
So we try to work within this community because we can help empower relationships by providing a safe and nurturing environment, said Mueller.
“We have faculty members who are themselves Hispanic, and they feel like they can provide the expertise and knowledge to students to help them go out into the community and provide a high level of care.”
She added that the location of the center, which shares a building with the Confederate Tribes of Grand Ronde, was chosen to ensure individuals from throughout the metro area could easily access their resources. “We are right on a bus line and bike route with free parking,” she said. “It was really important to us to make sure we are accessible easily by public transportation.”
Although she said there are many aspects of the center that she is proud of, Mueller said the most exciting aspect is that the college is deepening their already existing connection with others.
“This is Lewis and Clark’s opportunity to really give service to the community,” she said. “The center offers a safe and nurturing environment at low cost, so we can serve people who normally don’t have access to these services.”
The Lewis & Clark Community Counseling Center is open Monday through Friday, 8 a.m. to 9 p.m. It is not an inpatient or emergency care facility. For more information about the center call 503-768-6320 or visit http://graduate.lclark.edu/clinics/community_counseling/.
The effort, initially funded by a 2006 grant, is now being extended to Coordinated Care Organizations in southern Oregon
A quick, 15-minute appointment with a mental health counselor to talk about the effects of stress and anxiety when a person has an ulcer is radically different than a traditional hour long appointment with a counselor. But providers in southern Oregon are discovering that such appointments, which integrate mental healthcare in the same primary care setting, go a long way toward improving a patient’s health.
For the last three years, a licensed clinical social worker has been seeing patients at the Harvard Medical Park primary care office under a joint arrangement between Douglas County Independent Practice Association, the managed care plan providing care to Oregon Health Plan patients in Douglas County, and ADAPT, a Roseburg-based nonprofit offering substance abuse and mental health services.
Both managed care plans, which are intent on becoming Coordinated Care Organizations (CCOs) in southern Oregon, are working with ADAPT to bolster the integration between mental and physical health.
In August, CCOs are expected to replace the state’s managed care organizations, and integrate the physical, mental and dental healthcare for the 650,000 people on the Oregon Health Plan and emphasize preventive care, decrease hospital utilization and reduce costs.
In the clinics run by these two managed care plans, social workers work directly with primary care physicians to integrate physical and mental healthcare. When a physician believes a patient might have a mental health or chemical dependency problem, they’re referred directly to a social worker, who sees them for brief fifteen minute appointments.
“Typically, embedding mental health and substance abuse counselors in primary care has occurred in umbrella systems like Kaiser, HMOs, and federally qualified health centers,” Gardin said. “It’s very rare to have this kind of service in a private practice.”
Although rare, such a concept is becoming increasingly common elsewhere in Oregon. Central Oregon embeds mental health workers in primary care clinics, as well as the Old Town Clinic run by Central City Concern and other Portland-area nonprofits that serve vulnerable patients.
In 2006, after receiving a three-year $375,000 grant from the Health Resources and Health Management Administration, ADAPT began embedding licensed clinical social workers in a primary care clinic.
Within three years, that social worker saw 2,000 patients, half of which were Oregon Health Plan patients. Of that group, 15 percent saw the social worker more than five times, and their utilization including hospital visits decreased by 30 percent.
The short appointments patients had with the social worker were designed to target specific mental health problems that had exacerbated their physical health issues. “It’s just effective to give some basic tools, skills, training and development about what you can do,” Gardin said. “It’s way more practical.”
That way, there’s a higher probability of a patient seeing a mental health provider at the same clinic rather than being referred elsewhere. “Referrals just don’t work,” Gardin said. “They just won’t go.”
Physicians have responded positively to the program. “They can hand off problems for which they’re not well-equipped or well-trained to do,” Gardin said. “They can do what they went to medical school to do.”
However, integrating mental and physical healthcare does require a certain amount of flexibility by providers, Gardin said. “The medical environment is a very different environment from the counseling environment. The model is dependent on the physicians understanding that the social worker is there to help.”
A former Portland police officer who gained notoriety for his involvement in the city’s most expensive settlement in recent history is running for sheriff in rural central Oregon.
Christopher Humphreys, the Portland officer who faced public scrutiny for two separate on-the-job incidents in 2006 and 2009, was first to file paperwork for the position of Wheeler County sheriff in the May election, according to the Wheeler County News.
Wheeler County Deputy Sheriff Mike Garibay will run against Humphreys as a write-in candidate, according the newspaper.
Humphreys was at the center of the city’s most expensive settlement in recent history after a mentally ill man, James Chasse Jr., died in police custody in 2006, after he suffered numerous injuries after being tackled by officers. The case ended in 2010, when the city agreed to pay Chasse’s estate $1.6 million.
Humphreys again faced scrutiny in 2009, when he shot a 12-year-old girl in the leg at close range with a beanbag gun after she punched another officer in the face. He was suspended during the department’s investigation but was cleared of wrongdoing.
According to the Wheeler County News, Humphreys “has since been living in Wheeler County, where he was raised and where he has extended family.”
Humphreys retired for medical reasons from the Portland police last year, according to a police department spokesman.
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