Mental Health Association of Portland

From the Portland Business Journal, June 2010 – not available online

Under Derald Walker’s leadership, Cascadia Behavioral Healthcare quietly turned itself around.

Two years after a financial meltdown nearly destroyed Multnomah County’s safety net for the mentally ill, the nonprofit at the center of the crisis has rebounded.

Cascadia Behavioral Healthcare Inc. is a shadow of its former self, and will bear the burden of its April 2008 near collapse for many years. Even at half its former size, however, the Portland nonprofit remains a key component of the county’s safety net.

It returned to profitability in March. CEO Derald Walker, appointed in the midst of the crisis to turn Cascadia around, hopes to build a $500,000 cash reserve by early 2011.

Two years ago, these results seemed inconceivable.

Cascadia Behavioral Healthcare runs clinics for people struggling with addiction, offered counseling to people with severe mental illness and housed poor people with mental illnesses.

But in spring 2008, poor bookkeeping put all that at risk.

State Medicaid officials had ordered Cascadia to repay $2.7 million when the nonprofit could not provide documents backing previous years’ claims. Capital Pacific Bank had demanded repayment of a $2 million loan.

Leslie Ford, who had been CEO since Cascadia Behavioral Healthcare was founded through the 2002 merger of several smaller nonprofits, had been forced out. Two consecutive chief financial officers hired to turn Cascadia around had quit, after declaring the company’s books a mess and uncovering still more liabilities.

By summer 2008, it appeared as though Cascadia Behavioral Healthcare’s programs would be dismantled and farmed out to other nonprofits. Instead, the nonprofit is paying down its debt.

“They still have to watch their pennies,” said Kathy Tinkle, business services director for Multnomah County Human Services. “But they’ve made significant progress.”

Under Walker’s leadership, Cascadia obtained a $2.2 million loan from Multnomah County and the state. It negotiated its Medicaid assessment down to $1.2 million, payable over five years.

It also relinquished its role as Multnomah County’s pre-eminent mental health care provider by transferring several of its programs to other area nonprofits in order to cut expenses.

In August 2008, Lifeworks Northwest took over Cascadia’s Gresham clinic and Central City Concern took control of a downtown clinic at Southwest 12th and Stark streets. Luke-Dorf took control of Bridgeview, a residential treatment center.

Surrendering these programs cut Cascadia’s expenses, and the nonprofit cut costs still further by consolidating office space and leaving administrative jobs unfilled.

By drawing down the county-state loan, Cascadia invested in a $250,000 medical billing system aimed at further improving the nonprofit’s finances. The system prohibits Cascadia from submitting incomplete Medicaid claims, so that it can never again be reimbursed without adequate documentation, Walker said.

These cuts are paying off for the organization, but they have also left Cascadia much smaller.

It lost $2.1 million on revenues of $55.9 million in the year ending June 30, 2008, and lost $514,000 on revenues of $42.5 million the following year. Walker expects to end this fiscal year with a surplus of at least $200,000 from a budget of $38 million.

In 2008, Cascadia provided about 80 percent of Multnomah County’s mental health services. Now it provides only 32 percent of these services.

Meanwhile, county mental health officials have undergone their own transformation aimed at avoiding more surprises like the April 2008 Cascadia meltdown.

“We have realized that we can not be in a situation where we are so dependent on a single agency,” Tinkle said.

County mental health leaders now meet quarterly with their largest nonprofit contractors, and monthly with Cascadia, to track the performance health of the nonprofits that they fund.

Jason Renaud, volunteer and secretary of the board of the Mental Health Association of Portland, applauded Cascadia Behavioral Healthcare’s turnaround, and the county’s renewed oversight.

But he also lamented a mental health system that faces stagnant funding and growing demand.

Cascadia’s front-line workers, in particular, have borne a difficult burden through this transformation.

They have not received pay hikes since 2008. With a recent increase in the portion that many pay for health insurance, a number are now taking home less than they did two years ago. Walker also cut vacation days.

A new program that manages counselor productivity can allow some employees to boost take-home pay if they increase billings as a share of total hours worked. Though many workers have embraced the program, others grumble on the growing emphasis on money in a caring profession.

Since the nonprofit’s fiscal crisis, employees have had to accept paper checks because Cascadia does not have enough of a cash buffer to implement a direct deposit system.

But unlike the crisis of two years ago, these are challenges that observers expect Cascadia Behavioral Healthcare to survive.

“Unfortunately, any nonprofit with the county is in this boat,” Tinkle said. “Our dollars aren’t growing as fast as our personnel and expenses.”

LEARN – Cascadia Behavioral Healthcare
READ – Cascadia Behavioral Healthcare, Independent Auditor’s Report, June 30, 2009 AND 2008

From the Portland Tribune, April 21, 2010

For years, community activists have pressured the Portland City Council to reduce violent confrontations between the police and the mentally ill.

But while police have been placed under the public spotlight as a result of these confrontations, the mental health system doesn’t get the same level of scrutiny. And some activists say that state and federal privacy laws make it impossible to know whether the mental health system should be held accountable along with law enforcement officers.

“It’s a huge issue,” admits Jason Renaud of the Mental Health Association of Portland, who has been one of the most vocal police critics. “Right now, we have no way of knowing whether the mentally ill are receiving the best possible treatment.”

Pressure on the council began to mount more than three years ago when James Chasse, a diagnosed schizophrenic, died after fighting with several Portland police officers and Multnomah County sheriff’s deputies. It increased this year when Portland police killed Aaron Campbell, who was suicidal, and Jack Collins, a transient who had cut his throat with a utility knife.

Multnomah County grand juries cleared the police of criminal wrongdoing in all three cases, helping to fuel anger among the activists. But all police records have been released in the three cases. Grand jury transcripts from the Campbell and Collins cases also have been released, allowing the public to judge the actions of the police leading up to the deaths.

But the mental health files in the three cases remain secret – even though police records indicate Chasse and Campbell were treated by mental health professional before their deaths. Collins may also have been in contact with such professionals, too. Because these records are not made public, however, citizens have no way to determine what efforts were made to help the three men lead normal lives, why those efforts failed and what lessons have been learned from their deaths.

The files are restricted because state and federal laws guarantee the privacy of medical records, including those related to mental health and addiction treatment. The privacy laws even apply to internal reviews conducted by public agencies who fund such services.

Renaud says such privacy laws are essential to encourage mentally ill and addicted people to seek treatment without fear of exposure. At the same time, he acknowledges that the restrictions prevent the public from learning whether everything possible is being done to prevent such tragedies.

“There’s no way to measure the effectiveness of the mental health system,” says Renaud, a candidate for City Council who is not running an active campaign.

And the transparency gap between the local law enforcement and mental health systems is growing even larger. In the wake of the three deaths, the council increased public oversight of the Portland Police Bureau. On March 31, it unanimously voted to strengthen the role of the Independent Police Review Division of the City Auditor’s Office in alleged police misconduct cases.

Yet none of these reforms apply to the mental health system.

Laws keep records sealed

Mental health services are provided by a range of licensed professionals, including psychiatrists, psychologists and addiction counselors. In Multnomah County, the publicly funded mental health system is overseen by the Mental Health and Addiction Services Division of the Department of County Human Services. It contracts with numerous nonprofit organizations to provide a range of services to those who cannot afford private care. The organizations include Cascadia Behavioral Healthcare, Central City Concern and Outside In. The current budget is around $78 million. County-funded programs assessed and served around 45,000 people last year.

The privacy of everyone who receives such services is protected through federal and state laws. The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 includes privacy provisions covering all medical records. Oregon laws also guarantee that alcohol and drug treatment records are private.

“People have the right to expect that their medical records are confidential, and that includes mental health and addiction-treatment records,” says Christina Gardner, the division’s HIPAA compliance officer.

Even law enforcement officials are prevented from accessing a person’s medical records. This means that when police encounter people who appear to be mentally ill, they cannot easily learn whether they are under someone’s care.

In most cases, Gardner says, this is not a serious problem. If police are worried enough, they can contact the Mental Health Call Center operated by the county or Project Respond, a mobile mental health crisis response team operated by Cascadia on behalf of the county.

In both cases, mental health workers will be dispatched to the scene with access to a database of everyone in the county mental health system. If the person is in crisis, the mental health workers are allowed to provide the police general information about the individual’s condition to help resolve the situation.

But this did not happen with Chasse, Campbell or Collins – primarily because the confrontations that led to the deaths escalated too rapidly or unfolded differently than expected.
Numerous contacts with system

Because of the privacy laws, county officials cannot disclose or discuss whether Chasse, Campbell or Collins ever received mental heath or addiction treatment. However, police records released after their deaths indicate that they did.

Chasse died after being chased and fighting with police on Sept, 17, 2006. One month before his death, according to police documents, caseworkers were concerned Chasse had stopped taking his medication and needed to be hospitalized. Two days before his death, a mental health worker and police officer went to see Chasse at his apartment, but he ran away.

Campbell was shot and killed by Portland police after an hourlong standoff on Jan. 29. When police were called to the apartment complex where Campbell was staying, they were told that he was suicidal and had a gun. After his death, Campbell’s girlfriend told police that he had spent time in a “mental hospital” after trying to kill himself a year early. She said Campbell received psychiatric medicine from the hospital but had stopped taking it “because of his ulcers.”

Collins was shot and killed on March 22 after charging an officer with a utility knife. He was a longtime alcoholic who had lived on the streets for years. During that time, Collins was repeatedly cited for drinking in public, suggesting he may have also visited or been taken to the Hooper Detoxification Center, which is operated by Central City Concern.

Eleven days before his death, Collins walked into Central Precinct and asked for mental health treatment. He was directed to Cascadia, but there is no way to know whether he showed up because any record of his visit would be confidential.

“The mental health system is supposed to be accountable internally, but there’s no way for the public to learn the results,” Renaud says.

First call shouldn’t always be to police

In the wake of the controversial police shooting of Aaron Campbell, the Skanner newspaper published an editorial urging its readers not to call 911 if they were in an emergency situation.

“The fact is, we at The Skanner News simply have to warn our readers away from calling the police when they are in a crisis situation,” wrote the paper, which is primarily aimed at African-Americans in North and Northeast Portland.

The Feb. 15 editorial has repeatedly been cited as proof that Portlanders no longer trust the police. But some points in the editorial happen to be directly in line with what authorities recommend. When someone is facing a mental health crisis, there may be a better option – 503-988-4888, the number of the Mental Health Call Center operated by Multnomah County. It also can be reached at 1-800-716-9769.

According to county spokes-person David Austin, the call center is “the hub” of the mental health system. It is operated by professionals who are trained to quickly understand whether the crisis is so serious that the police must respond. If not, the operators can instead dispatch mental health workers to the scene.

“The call center is not as well known as 911, but in many cases involving the mentally ill, it is a better option,” Austin says.

The privacy of all crisis calls to the center are guaranteed by state and federal laws. It received over 45,000 calls in 2009, the most recent full year for which figures are available.

Despite a recent warning in The Skanner, Derald Walker, CEO of Cascadia Behavioral Healthcare, thinks Portlanders can, and should, call 911 in crisis, if needed. It’s appropriate, Walker said, and can connect people with resources.

The Skanner’s warning came after the shooting death of Aaron Campbell on Jan. 29. Campbell was, according to The Oregonian, “an unarmed African American guilty of nothing except being suicidal and distraught.” Rev. Jesse Jackson called the death an “execution.”

Walker said he realizes that people have concerns and fears, which he called unfortunate, but, to some extent, understandable.

He added, “I think the Portland city police are trying to handle a lot of things on the streets that, quite frankly, if mental health services were more available, they probably wouldn’t be confronted with.”

Resources Needed

Walker believes that Portland police are trying to reduce the number of bad outcomes. The bureau has adopted crisis intervention training, which is now required for all officers.

But additional resources are needed, said Walker.

“We need more housing for people with mental illness, more after-hours service for people with mental illness – for everybody. And people aren’t always eligible for treatment. If you’re not on the Oregon Health Plan, you may not have access to mental health treatment; we need universal funding for mental health services. Funding is just not adequate at this point.”

Build Networks

Dan Handelman, of Portland Copwatch, said that police shootings are actually down in recent years.

Still, in the past five years, at least five people with mental illness, or in crisis, have been killed by Portland police:

Aaron Campbell, 2010
James Chasse, Jr., 2006
Jerry Goins, 2006
Tim Grant, 2006
Raymond Gwerder, 2005

Handelman points out that it’s difficult to pinpoint the exact number of cases, since mental illness is not always reported, and “crisis” is open to interpretation.

Asked whether people should call 911 in crisis, Handelman said ideally, people wouldn’t have to.

“In my opinion, people should build networks with family, friends, coworkers and neighbors so that, to the extent possible and reasonable, there is no need to call police. I also believe that a person should be able to call 911 and explain they have a mental health crisis situation and that should be able to be resolved without an armed police presence.

“People need to make up their own minds about what to do, but certainly given the possible outcomes I hope that more community building and less reliance on armed intervention is in this city’s future.”

From the Portland Outlook, November 2, 2009

Over the last two decades, northeast Portland has seen its neighborhoods and social landscape dramatically altered by rapid renewed economic interest in the area.

But a brick building, on the corner of Northeast 17th Avenue and Alberta Street, has housed a social institution that has steadily limped along through the area’s metamorphosis – and might now be enjoying some stability.

Since 1991, House of Umoja has strived to combat gang violence in Portland while strengthening social ties in the city’s African American population. But at times it has flirted with collapse.

Recently it began a new chapter after coming under the control of Lifeworks NW, a culturally-responsive social service provider, which aims to bolster the long-standing community institution, both fiscally and administratively.

When the House of Umoja opened its doors Portland was riddled by gang violence to the point where people made appeals for Mayor Bud Clark to call in the National Guard to quell the discord.

Umoja was seen as an innovative step to addressing the problem. It was based on a Philadelphia program that offered gang-affiliated youth a way to chart a new course for their lives.

It housed a 15-bed facility where former gangsters would live under traditional Swahili social principle that stressed purpose, cooperation, self-determination, and unity- or “umoja” in Swahili.

The House of Umoja was widely praised. Donations poured in, and its waiting list groaned with people wanting to leave gang life.

But a few years after opening its doors, the House of Umoja had some hiccups that knocked it off course.

In 1997 the county government, which provided much of its budget, released a scathing report that asserted that the House of Umoja was failing to meet its own goals, with about a third of the youth it served returning to gang life.

The changing realities of street life also prompted it to pivot its mission. The number of delinquent youth in Multnomah County dropped off in the late 1990s, spurring the House of Umoja to close its residential rehabilitation program for gangsters, and shifted its focus to job training and outreach.

This was a point of contention for people who had been involved with Umoja early on.

Lolenzo Poe, a founding member of Umoja, said that he was dismayed when the residential program was removed, and hopes it will return.

“I think that part of the problem in the past has been not having a good administrative structure,” added Poe, who said that Lifeworks NW’s merger with Umoja is a positive step.

In the early 2000s, Umoja started and restarted programs. It lost funding sources, including a grant from the Portland Children’s Levy, causing it to shuffle staff and close its doors temporarily to take stock of its situation.

As revenue steadily dropped off, the administrative functions of Umoja were taken over by Cascadia Behavioral Healthcare.

But when Cascadia nearly collapsed last year, Umoja approached Lifeworks NW with the proposal to merge.

Mary Monnat, the CEO of Lifeworks NW, said that because her non-profit runs so many similar programs it was a natural fit, and took over management of its gang outreach program this summer in addition to general administrative duties.

She explained that much will stay the same. The staff will remain, as will its programs. It also appointed Michele Harper, who was on the Umoja board, to its own.

“The only part we’re doing differently is adding more services,” she said.

Now rechristened as the “Umoja Center,” Monnat explained that the name was chosen to signify that there are some changes. It’s added an addictions treatment service, a program to link youth with jobs opportunities, and offers “Third Thursday,” which connects locals to needed services.

“The House of Umoja is alive and well,” said Ebony Clarke, an addictions service director with Lifeworks NW.

Clarke said that Umoja is now more of a drop in center, where people can use computers, find out about area support services, and network.

The Umoja Center held its “Kuji” celebration earlier this month where past employees and community members gathered at the facility. A poster that once covered up the windows facing
Alberta Street was taken down to make the building more welcoming, and local youth gather there after school snacking on fruit, granola, cookies and playing air hockey.

However, Umoja still strives to instill a strong cultural identity in young African Americans, and maintains a gang outreach program.

“We’re not here to change; we’re here to expand,” said Clarke.

It still maintains its gang outreach program that focuses on youth who haven’t entered the legal system, and seeks to connect them with a supportive adult figure. Gentrification has caused Umoja to expand its focus to east Portland and east Multnomah County, said Clarke.

“I hope we just stay with the same focus: getting the kids the tools they need to be successful in today’s society,” said Walter “Tiny” Butler, a gang outreach worker. “Because sometimes it changes really, really fast.”

From The Lund Report, October 12, 2009

A building boom may be good for capacity but it threatens to supplant community mental health options

As private mental health hospitals spring up across the state to compete with a new Oregon State Hospital building under construction, community mental health providers are crying out for their own funding.

Leaders at the highest levels in the state’s mental health system acknowledge the strange universe that funds hospitals for the mentally ill while allowing out-patient preventative care to whither.

Given the recent crisis and patchwork reformulation of the state’s largest mental health provider, the current situation is even more surreal. In the wake of Cascadia Behavioral Healthcare’s collapse last year, providers hoped that a better community-treatment system would emerge from the ashes, but so far, they lament no framework has proven viable to replace it.

Most insiders aren’t especially surprised that community mental healthcare got the short shrift once again.

“Community mental health has never been adequately resourced in Oregon,” says Mary Claire Buckley, executive director of the state’s Psychiatric Security Review Board.

Convicted criminals who successfully assert the insanity defense are placed under the review board’s jurisdiction, yet Buckley worries more and more about what prevents patients from entering the criminal justice system in the first place. “The more resources you have in the community, the better the whole system, and that’s what I’m concerned about,” she says.

Concern is especially high throughout Oregon’s mental health field due to a January 2010 ballot referendum that would renege $733 million in state taxes designated for upkeep of social services post-recession. Gina Nikkel, the Association of Community Mental Health Programs executive director, argues that the mental health care situation had reached dire proportions long before the economic downturn.

“If that ballot measure at the end of January goes south for us, we’ll be looking at cutting 30 percent of services, and we already don’t have funding that’s even close to adequate,” Nikkel says.

That said, critics of insufficient allocation to community mental health wouldn’t want community funding to come at the expense of acute care centers such as the state hospital.

Buckley, whose board manages forensic patients’ entry into and exit from the state hospital, has always tried to keep lengths of stay to a minimum. The facility was originally built in the 19th century and is best known as the filming location for the Academy Award-winning version of Ken Kesey’s One Flew Over the Cuckoo’s Nest. “A replacement of the current hospital is long overdue,” she says.

However, Buckley and other administrators lack many alternatives to the state hospital, which has operated at more than 100 percent of capacity in recent years. The last biennium budgeted $373 a day per patient, which quickly adds up over $100 million when the hospital keeps more than 800 patients year-round.

“It’s not the chicken or the egg, we need all levels of care,” Nikkel says. “You have to fund it all.”

She sees a dangerous proposition in such an uneven funding environment. “You can’t shift all the money to the front end and let the back end fail or vice-versa,” she says.

Yet now the main hope of community mental health care advocates lies in the unlikeliest of places, the hospital system itself. Once a new Salem building is completed in 2011, Roy Orr, superintendent of the Oregon State Hospital, sees an opportunity for his staff to administer non-ward-based services that have traditionally been solely in the community realm.

“Historically the state hospital hasn’t been strong enough on treatment in general, but more specifically, we’ve lacked the staff to provide the intensity of treatment that our residents deserve,” Orr says.

The shortage of services has not been unique to the state hospital. Richard Harris, Addictions and Mental Health Division director of the Oregon Department of Human Services, figures that only half of the vulnerable population has any access to care.

“Sub-acute capacity needs to be increased in communities,” Harris says. “The goal for all mental health services should be to get people self-sufficient.”

Orr has agreed to this goal in principle and claims it’s already playing out in practice at the state hospital. He points to “treatment malls,” designed toward socialization, in which his staff has already begun participating off-site.

“We can’t just take the old contents of the state hospital and dump it in the new one,” he says.

As to why the funding for building wasn’t spread out among more community facilities, Orr says, “That decision was frankly made before my arrival, and I didn’t second-guess that.

“Our critical point of articulation with community providers, whether out-patient or acute, is that we provide a safety net,” he adds. “What we really try to do is work as closely as we can with AMH and through them work with all the community providers.”

Advocates aren’t so sure the system can support itself effectively. Buckley emphasizes the importance of preventative care to support the acute-care facilities.

“DHS has been doing a good job creatively getting people back in the community, but there is only so much they can do with the current funding situation,” she says. “Hopefully what that building’s going to bring is a whole new treatment model, but we’re spending all these millions on the state hospital, and that’s only a small piece of the process.”

OUR COMMENT – As for the question of who approved the development of two new “hospitals” when the preponderance of evidence shows the greatest need for funding is in the community was entirely in the hands of politicians – and not clinicians or medical administrators. The Mental Health Association of Portland is on record in opposition to these new facilities from the moment they were proposed.

This misappropriation of funds toward hospital-which-are-prisons and away from community mental health clinics – and those who know better and are not speaking up – is a grave betrayal of persons with severe and persistent mental illness for future generations. These buildings, and the staffs who occupy them, have a determined life of their own, which is proven dangerous to their inmates.

Don’t be fooled by the public relations machine in Salem – the new Oregon State Hospitals are a $600 million dollar boondoggle our children and grandchildren will loath us for permitting.

From the Portland Tribune, September 17 2009

Interesting, how one building can mean so many different things to so many people.

Cascadia Behavioral Healthcare reopened its Garlington Center on North Martin Luther King Boulevard Friday amid a great deal of rejoicing. A ribbon was cut, speeches were made by notables, including an ex-mayor and a variety of leaders in the Portland black community. But not everyone present was celebrating the same thing.

Derald Walker was celebrating financial progress and also the way a disaster opened room for new community connections. Cascadia’s chief executive officer, Walker came to the nonprofit in 2008, shortly after the financial meltdown that very nearly closed Multnomah County’s largest provider of mental health services. It took a $2.5 million state and county line of credit to save Cascadia.


But the Garlington’s Center’s particular disaster was near total destruction from a fire in October 2008. The fire’s cause has not yet been determined, but many members of the Garlington community are convinced an arsonist was involved.


Walker said it cost $2.2 million to rebuild Garlington, nearly all of it covered by the building’s insurance policy. Of more concern is the ongoing operating cost for the center, an estimated $1.3 million.


Walker didn’t say keeping Garlington open on a sustainable basis will be easy, not with Cascadia still paying off $2.3 million worth of loans.


“Running publicly funded health care is not for the faint of heart,” he said. But on Friday, at least, Walker said the future for Cascadia looked brighter.

“We survived last year and we’ve come out a lot stronger,” he said. “I think we’ll be fine.”

New clinic space

The new Garlington Center represents substance for Jill Ginsburg, and relief. A family physician who started the North by Northeast Community Health Center three year ago in a tiny building on North Williams Avenue, Ginsburg has watched her free clinic patients line up outside on Thursday evenings, and sometimes wait in their cars.

Some of those people who had come to North by Northeast for the only health care available to them had to be turned away, sent to other safety net clinics. Ginsburg simply had no room.

Ginsburg has room now, at the Garlington Center. Her new clinic space is four times the size of the old, with four treatment rooms instead of two, a waiting area that can seat 20, and even a break room for volunteers.

Was there some sort of break room in the old North by Northeast clinic?

“Are you kidding?” Ginsburg asks. “We had a treatment area in a hallway behind the curtain. We’re growing up and (Garlington Center) is a beautiful place for our patients.”

Youth resource center

Proud as she has been of the Sexual and Gender Minority Youth Resource Center for which she serves as program director, Favor Ellis has recognized the center has not been as diverse as its name implies.

The Cascadia-financed center, based in Southeast Portland for 11 years, has been the only organization in Portland with the aim of providing a supportive environment for lesbian, gay, bisexual and transgender youths.

But nearly all those youths were white.

And that is the primary reason the center has moved its offices and hangout space into the new Garlington Center.

“Queer identified African American youth in Northeast Portland may have felt like SMYRC was a resource for white youth,” Ellis said, adding that non-heterosexual black youths may not have felt welcome in Southeast Portland. “It may have been scary for them,” she said.

In the new Garlington Center building, the minority youth resource center may truly be able to bring in minority youths, Ellis said. Outreach has begun to predominately black organizations and churches in North and Northeast Portland. The message, Ellis said, is that gays, lesbian and transgender youths of all races are at increased risk for suicide, drugs, alcoholism, teen pregnancy and as victims of violence.
Reopening is a tribute

Maggielean President also attended Friday’s opening ceremony at the Garlington Center. President, a Northeast Portland resident who has been a Cascadia client since 1999, attends group therapy twice a week, so she’s happy to have Garlington back. But the real significance of the reopening for President was what she calls “paying tribute.”

Garlington Center is named after John Garlington, a black minister and social activist who died in a car accident 13 years ago. Reopening the center keeps Garlington’s memory alive, according to President.

“Whoever did this did us a favor by setting this place on fire,” President said. “The favor is that this place is looking better that it was at first.”

More triumphs

Nobody understands the daily struggle to overcome life’s obstacles better than those who suffer prolonged mental illness. Ryan Hamit took the fire personally.

“I’ve seen programs come, stay a while and go. I’ve seen staff leave. I’ve seen a lot,” said Ryan Hamit, who lives in the Pearl District but for years has received a variety of mental health services at Garlington, nearly an hour away by public transit. Hamit serves on the Garlington consumer council, which lobbied county officials to save Garlington during Cascadia’s financial crisis.

“It’s like an extended family to me,” Hamit said, explaining why he travels cross-town.

The fire, to Hamit, was another obstacle in a series of obstacles faced by Garlington and the people who need its services.

“It’s hard when there’s always somebody out there trying to cut us down,” he said.

For Hamit, last Friday’s reopening was just one more in a long line of triumphs.

From the Oregonian, July 6 2009

More than a year after its financial crash threatened to upend mental health care services in Multnomah County, Cascadia Behavioral Healthcare made its first payment on the $2.3 million government bailout that allowed the agency to stay afloat.

Cascadia, the county’s largest provider of mental health care services, came near to collapse in April 2008 under the weight of poor business practices.

The nonprofit company last week paid $90,000 toward the loan, said Althea Milechman, a Multnomah County spokeswoman.

Forty percent of that amount will go to the state Department of Human Services and the rest to the county. Payments are scheduled in increasing increments through February 2021.

At the time of the crash, Cascadia provided about 80 percent of the county’s adult mental health services, including housing, treatment and crisis services for mental illness and drug and alcohol addiction.

In the aftermath, Cascadia has transferred several clinics in Multnomah and Washington counties to other providers.

“We don’t want to put all of our eggs in one basket,” said Mindy Harris, Multnomah County chief financial officer .

Four documents pertaining to housing rights and due process within supportive housing communities, also called Residential Treatment Facilities and Residential Treatment Homes, have appeared on the Multnomah County Department of Human Services, Mental Health and Addictions Services Division web site, but as usual, they’re buried.


We don’t know when these documents might disappear, so we’ll post them permanently on our secure server.

In light of what happened to Sean Liam Kelly, who after making multiple complaints about his threatening neighbor was murdered in the front yard of his home, EVERYONE who lives in Cascadia housing should ACT QUICKLY and COMPLAIN to authorities coutside of Cascadia Behavioral Healthcare if they feel their rights are being violated by staff members or by neighbors.

These documents, linked and listed below, could save your life.

Residential Treatment Facility – residential rights
Grievances and Appeals – Residential Treatment Facility Rule (OAR 309-035-0157)
Grievances and Appeals – Residential Treatment Home Rule (OAR 309-035-0390)
Multnomah Mental Health Crisis Poster (updated for accuracy by MHAP)
Residential Treatment Facility ‘Bill of Rights’ from OAR 309-035-0155

Listen, words pinned to the community room cork board are fine. But if you’ve been measurably hurt while living in a residential treatment facility or residential treatment home, write to the Mental Health Association of Portland by mail at POB 3641, Portland, Oregon 97208 or by email at info@mentalhealthportland.org, and we’ll help you get a lawyer.

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Residential Treatment Facility – residential rights (OAR 309-035-0155)

(1) Statutory and Constitutional Rights. Each resident will be assured the same civil and human rights accorded to other citizens. These rights will be assured unless expressly limited by a court in the case of a resident who has been adjudicated incompetent and not restored to legal capacity. The rights described in paragraphs (2) and (3) of this section are in addition to, and do not limit, all other statutory and constitutional rights which are afforded to all citizens including, but not limited to, the right to vote, marry, have or not have children, own and dispose property, enter into contracts and execute documents.

(2) Rights of service recipients. In accordance with ORS 430.210, residents will have the right to:

(a) Choose from available services those which are appropriate, consistent with the plan developed in accordance with paragraphs (b) and (c) of this subsection, and provided in a setting and under conditions that are least restrictive to the person’s liberty, that are least intrusive to the person and that provide for the greatest degree of independence;
(b) An individualized written service plan, services based upon that plan and periodic review and reassessment of service needs;
(c) Ongoing participation in planning services in a manner appropriate to the person’s capabilities, including the right to participate in the development and periodic revision of the plan described in paragraph (b) of this subsection, and the right to be provided with reasonable explanation of all service considerations;
(d) Not receive services without informed consent except in a medical emergency or as otherwise permitted by law;
(e) Not participate in experimentation without informed voluntary written consent;
(f) Receive medication only for the person’s individual clinical needs;
(g) Not be involuntarily terminated or transferred from services without prior notice, notification of available sources of necessary continued services and exercise of a grievance procedure;
(h) A humane service environment that affords reasonable protection from harm and affords reasonable privacy;
(i) Be free from abuse or neglect and to report any incident of abuse without being subject to retaliation;
(j) Religious freedom;
(k) Not be required to perform labor, except personal housekeeping duties, without reasonable and lawful compensation;
(l) Visit with family members, friends, advocates and legal and medical professionals;
(m) Exercise all rights set forth in ORS 426.385 and 427.031 if the individual is committed to the Department;
(n) Be informed at the start of services and periodically thereafter of the rights guaranteed by this section and the procedure for reporting abuse, and to have these rights and procedures prominently posted in a location readily accessible to the person and made available to the person’s guardian and any representative designated by the person;
(o) Assert grievances with respect to infringement of the rights described in this section, including the right to have such grievances considered in a fair, timely and impartial grievance procedure;
(p) Have access to and communicate privately with any public or private rights protection program or rights advocate; and
(q) Exercise all rights described in this section without any form of reprisal or punishment.

(3) Additional Rights in Residential RTFs. Residents will also have a right to:

(a) Adequate food, shelter, clothing, consistent with OAR-309-035-0159 [0165?];
(b) A reasonable accommodation if, due to their disability, the housing and services are not sufficiently accessible;
(c) Confidential communication, including receiving and opening personal mail, private visits with family members and other guests, and access to a telephone with privacy for making and receiving telephone calls;
(d) Express sexuality in a socially appropriate and consensual manner;
(e) Access to community resources including recreation, religious services, agency services, employment and day programs, unless such access is legally restricted;
(f) Be free from seclusion and restraint,
(g) To review the Residential Treatment Facility’s policies and procedures; and
(h) Not participate in research without informed voluntary written consent.

(4) Program Requirements. The program will have and implement written policies and procedures that protect residents’ rights, and encourage and assist residents to understand and exercise their rights. The program will post a listing of residents’ rights under these rules in a place readily accessible to all residents and visitors.

resident name:____________________ signature:__________________________

review date: ______________ staff name __________________________

Original to Resident+1 copy to chart and check off on intake information recap

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Grievances and Appeals – Residential Treatment Facility Rule (OAR 309-035-0157)

The Residential Treatment Facility will have a written policy and procedures concerning the resident grievance and appeal process. A copy of the grievance and appeal process will be posted in a place readily accessible to residents. A copy of the grievance and appeal process will be provided to each resident and guardian (as applicable) at the time of admission to the facility.

All complaints will be investigated

To ask questions call to your local Community Mental Health Program at (503) 998-5464 (open Monday through Friday, roughly 9 to 5 PM)
Or the statewide office of Disability Rights Oregon at 1-800-452-1694 (open Monday through Friday, roughly 9 to 5 PM)

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Grievances and Appeals – Residential Treatment Home Rule (OAR 309-035-0390)

The Residential Treatment Homewill have a written policy and procedures concerning the resident grievance and appeal process. A copy of the grievance and appeal process will be posted in a place readily accessible to residents. A copy of the grievance and appeal process will be provided to each resident and guardian (as applicable) at the time of admission to the Residential Treatment Home.

All complaints will be investigated

To ask questions call to your local Community Mental Health Program at (503) 998-5464 (open Monday through Friday, roughly 9 to 5 PM)
Or the statewide office of Disability Rights Oregon at 1-800-452-1694 (open Monday through Friday, roughly 9 to 5 PM)

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

The Residential Bill of Rights

As a resident of a licensed residential treatment facility, you have certain rights outlined in Oregon State law. These laws are known as Oregon Administrative Rules (OAR) and Oregon Revised Statute (ORS). Your rights as a resident are listed below.

OAR 309-035-0155

(1) Statutory and Constitutional Rights. Each resident will be assured the same civil and human rights accorded to other citizens. These rights will be assured unless expressly limited by a court in the case of a resident who has been adjudicated incompetent and not restored to legal capacity. The rights described in paragraphs (2) and (3) of this section are in addition to, and do not limit, all other statutory and constitutional rights which are afforded to all citizens including, but not limited to, the right to vote, marry, have or not have children, own and dispose property, enter into contracts and execute documents.

(2) Rights of service recipients. In accordance with ORS 430.210, residents will have the right to:

(a)Choose from available services those which are appropriate, consistent with the plan developed in accordance with paragraphs (b) and (c) of this subsection, and provided in a setting and under conditions that are least restrictive to the person’s liberty, that are least intrusive to the person and that provided for the greatest degree of independence;
(b)An individualized written service plan, services based upon that plan and periodic review and reassessment of service needs;
(c)Ongoing participation in planning services in a manner appropriate to the person’s capabilities, including the right to participate in the development and periodic revision of the plan described in paragraph (b) of this subsection, and the right to be provided with a reasonable explanation of all service considerations;
(d)Not receive services without informed consent except in a medical emergency or as otherwise permitted by law;
(e)Not participate in experimentation without informed voluntary written consent;
(f)Receive medication only for the person’s individual clinical needs;
(g)Not be involuntarily terminated or transferred from services without prior notice, notification of available sources of necessary continued services and exercise of a grievance procedure;
(h)A humane service environment that affords reasonable protection from harm and affords reasonable privacy;
(i)Be free from abuse or neglect and to report any incident of abuse without being subject to retaliation;
(j)Religious freedom;
(k)Not be required to perform labor, except personal housekeeping duties, without reasonable and lawful compensation;
(l)Visit with family members, friends, advocates and legal and medical professionals;
(m)Exercise all rights set forth in ORS 426.385 and 427.031 if the individual is committed to the Department;
(n)Be informed at the start of services and periodically thereafter of the rights guaranteed by this section of the procedure for reporting abuse, and to have these rights and procedures prominently posted in a location readily accessible to the person and made available to the person’s guardian and any representative designated by the person;
(o)Assert grievances with respect to infringement of the rights described in this section, including the right to have such grievances considered in a fair, timely and impartial grievance procedure;
(p)Have access to and communicate privately with any public or private rights protection program or rights advocate; and
(q)Exercise all rights described in this section without any form of reprisal or punishment.

(3)Additional Rights in Residential Treatment Facilities. Residents will also have a right to:

(a)Adequate food, shelter, clothing, consistent with OAR 309-035-0159;
(b)A reasonable accommodation if, due to their disability, the housing and services are not sufficiently accessible;
(c)Confidential communication, including receiving and opening personal mail, private visits with family members and other guests, and access to a phone with privacy for making and receiving telephone calls;
(d)Express sexuality in a socially appropriate and consensual manner;
(e)Access to community resources including recreation, religious services, agency services, employment, and day programs, unless such access is legally restricted;
(f)Be free from seclusion and restraint, accept as outlined in OAR 309-035-0167.
(g)To review the Residential Treatment Facility’s policies and procedures; and
(h)Not participate in research without informed voluntary written consent.

(4) Program Requirements. The program will have and implement written policies and procedures, which protect residents’ rights and encourage and assist residents to understand and exercise their rights. The program will post a listing of residents’ rights under these rules in a place readily accessible to all residents and visitors.

Stat. Auth: ORS 409.010 & ORS 44.3450
Stat. Implemented: ORS 443.400 to ORS 443.455 & ORS 443.991(2)

Signature of Resident: _____________________________________
Signature of Staff Person: __________________________________
Date Resident Rights were explained: ____________
Original to resident – photocopy in resident chart

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

EXTRA – What happened to Sean Liam Kelly
EXTRA – Obituary site created by Kelly’s family

From the Oregonian, April 15 2009

Ralph A. Williams is still on the docket to appear in Multnomah County Circuit Court today to respond to his neighbor’s request for a permanent stalking order against him.

Instead, Williams, 54, faces murder charges, and his neighbor, Sean Liam Kelly, 40, lies in the morgue, dead of stab wounds and crushing blows to the head.

Kelly had been begging for help for at least the past month from Cascadia Behavioral Healthcare housing officials, police and the courts, citing his neighbor’s increasing threats of violence against him, court records show.

He had hoped a judge would sign a permanent order today against Williams, who lived next door to him in an independent housing building for the mentally ill on North Chase Avenue.

Stalking orders between residents living side by side in public housing complexes aren’t uncommon. Judges can’t order people to move, making such orders a challenge. Judges say they must be creative to give the person seeking an order some sense of security and make sure they have a safety plan in place.

“It’s one of the most difficult things that we face,” Multnomah County Circuit Judge Cheryl Albrecht said. “In stalking orders, there’s just no ability to force someone to move from their residence. It’s not an effective remedy. It’s just not. You just hold your breath and try to be as direct and clear with the respondent about the scope of your order. It’s perilous at best.”

Kelly obtained a temporary stalking protective order against Williams last month, detailing ongoing harassment, intimidation, racial slurs and vandalism he endured from Williams.

Kelly, who was on unemployment and attending classes at Portland Community College’s Rock Creek campus, called police twice last month and documented the abuse, threats, property damage and growing tensions between him and Williams in back-and-forth e-mails to Cascadia Housing property manager Deborah Hicks.

In early March, Kelly said Williams poured six gallons of water into the gas tank of his car and then became aggressive and called Kelly a “snitch” after he reported the vandalism to police. He said Williams stuck his hand in his face, threatened to harm him, and banged on his apartment door while spewing profanity and racial slurs, according to the stalking order application.

“I was clearly not safe in my own house, and I began to be afraid of leaving my room,” Kelly wrote, noting Williams, at 6-foot-5 and more than 200 pounds, was much larger. Kelly was 5-foot-11 and weighed 160 pounds.

Cascadia had recommended mediation between the two men and urged Kelly “to stay clear” of Williams, although that was next to impossible because Williams lived in the neighboring unit and they shared a kitchen. Cascadia also recommended Kelly contact the courts or police and mailed Williams an eviction notice March 13, listing Kelly’s well-documented run-ins with Williams.

“I understand that you are fearful, and I would be too,” Hicks e-mailed Kelly on March 16. “I hope he doesn’t do anything to harm you, but you are totally within your rights to do whatever legally you can. … You want to do whatever you can to protect yourself while we wait this out.”

Cascadia does not staff the housing complex with a case manager, and the property manager is not on site.

Jim Hlava, Cascadia’s vice president for housing, said he could not talk about specifics but said the case would be reviewed internally.

Applicants must be assessed as “ready and capable” to live on their own, Hlava said. Cascadia also does a criminal background check and reviews the person’s documentation of income and disability.

Kelly moved to the North Chase Avenue unit early this year. It’s not clear how long Williams lived at the site. Williams also faced an unrelated domestic violence restraining order filed against him in March 2008, after he knocked a woman unconscious and stomped on her head, court records show.

Christy Brewfaugh, a close friend of Kelly’s mother, questioned why Williams was allowed to live in the building, considering his violent past.

Hlava said that when tenants don’t get along, Cascadia gives them options, whether it’s mediation or calls to police if there’s vandalism or violence.

“We take appropriate landlord action with the information that is given to us,” Hlava said. “We work within the landlord-tenant law.”

The court granted Kelly a temporary stalking protective order March 18. The next day, a Multnomah County sheriff’s deputy served the notice in person to Williams. It ordered Williams not to come into “visual or physical presence” of Kelly, speak with him or damage his property.

Just before 7 a.m. Tuesday, a 9-1-1 call came to Portland police, reporting an assault at the North Chase Avenue address. When police arrived, Williams was outside the building, and said, “Arrest me. … I stabbed him with a butcher knife.”

According to Williams, Kelly had come into the common kitchen area of the building, told Williams to get out of his way, and went back to his apartment. Williams told police he had “had enough” of Kelly, grabbed a butcher knife and waited for Kelly to return.

Once he returned, Williams told police, he “let the knife do the talking.”

He said he stabbed Kelly five to seven times in the upper chest and head. As Kelly tried to run across the street, Williams tried to stab him in the back, a probable cause affidavit says.

When the knife blade broke, Williams picked up a cinder block and struck Kelly in the face as he lay dying on the front yard of a neighbor’s home.

READ – Suspect identified in deadly stabbing outside N. Portland halfway house, KGW.com
READ – Man Stabbed To Death In North Portland – Body Found Outside Group Home, KPTV.com
READ – Sean Kelly’s stalking order petition and correspondence with Cascadia staff staff about threats from Ralph Williams
READ – N. Portland deadly stabbing suspect confesses in court, KGW.com

A little more than a year has passed since State and County officials began to worry about the state of affairs with Oregon’s largest private provider of mental health services – Cascadia Behavioral Healthcare.

After a series of newspaper articles which questioned the financial state of the nonprofit after a Medicaid audit were met with reassurances of stability, Leslie Ford, then CEO, President and founder of Cascadia abruptly resigned in April. She was followed by all of her longtime senior staff members. Finding a substantial and unpredicted shortfall in revenue left behind, the Cascadia appealed for assistance from Multnomah County. Their appeal resulted in several infusions of cash, and county officials insisting Cascadia do it’s business differently.

Clients of Cascadia were in real jeopardy for a short duration of time. Without intervention from the county and state, vital and irreplaceable services could have vanished. Big changes have occurred, administrative, financial, clinical.

The Mental Health Association of Portland has asked Cascadia Behavioral Healthcare to answer some basic questions about changes at Cascadia, general and specific. They’ve agreed, and over the next few weeks we’ll post this virtual dialogue on this web site.

You’re welcome to join in and both ask your own questions and comment on the answers given by leaving a comment below. Send your questions to info@mentalhealthportland.org.

Question for Derald Walker, Ph.d, CEO and President of Cascadia Behavioral Healthcare.

Can you tell us what Cascadia is today, and give us a basic understanding of how Cascadia transformed over the past year?

Cascadia Behavioral Healthcare is much more financially stable. The changes that have led to a more stable organization are due to a variety of cost cutting moves that included painful but necessary staff reductions. The large majority of the staff reductions were administrative in nature. Cascadia continues to focus on eliminating costs where possible without impacting consumer services. We’ve completed the implementation of our new automated billing system as well as a fully integrated accounting software program. The combination of cost reductions and improved revenue and accounting systems have helped significantly.

Cascadia no longer operates clinics in Gresham and Downtown Portland. The contracts in these two locations and in Washington County were transferred to other community providers. In addition to these changes, Cascadia’s Bridgeview program was also transferred.

While these changes have reduced Cascadia’s scope, we continue to provide an impressive continuum of services that comprises a valuable system of care for our community. Some of these services are residential, community clinic services, mobile crisis outreach, integrated services between addiction and mental health as well as specialty affordable housing services.

Given the uncertainly with publicly funded healthcare, Cascadia’s financial future will continue to provide challenges. However, with the improved internal information systems that include claims, clinical productivity, and financial accounting, our ability to anticipate and adjust in ways that will protect consumer care is greatly enhanced.

EXTRA – Cascadia Behavioral Healthcare

From the Portland Observer, December 2008


In the early 90s, Ryan Hamit had a “bad spell” and ended up in a hospital struggling with a personality disorder. He bounced from various social service agencies and hospitals, encountering counselors that talked down to him and seemed to make problems worse.

Things got better when he started using the Garlington Center, a longtime local mental health provider with multicultural roots, currently operated by Cascadia Behavioral Healthcare.

At Garlington, he found himself better respected by the staff and not talked to as if he was a confused child, like he had at other places. Hamit started to improve.

“I wouldn’t be near as well off if it wasn’t for the Garlington Center,” said Hamit.

But over the past year, Garlington has had its own bad spell. It almost collapsed financially when Cascadia fell into financial turmoil. Then the center had a devastating fire.

Named after the late Rev. John Garlington, an African-American minister who worked closely with the poor, the Garlington Center is one of the most culturally sensitive providers of mental health and substance abuse services in the area. It also connects people with stable housing and jobs.

“These are the folks, where if they don’t have these services, they’re going to be downtown costing the community a lot more money,” said Jim Hlava, Cascadia’s vice president of housing.

Essie Mae Morphis, an African-American client of the center for about 10 years, explained how Garlington has provided her with care that has no parallel in its cultural tactfulness.

“If I couldn’t get my meds I’d be somewhere in a state hospital,” said Morphis of the value she places on Garlington services.

Cascadia’s chief executive officer Derald Walker explained that the center helps people through group therapy, helping them develop a sense of stability, and assisting them in managing their own medication regimen.

Statewide, Cascadia has an operating budget of about $42 million, which comes from a patchwork of state, county, and federal funds, according to Walker. It services about 525 people, he added.

Last summer, the non-profit nearly collapsed financially due to mismanagement. According to reports on Multnomah County’s website, Cascadia was hemorrhaging money due to a faulty billing system (among other problems) that essentially didn’t charge the appropriate sources for services.

In April of this year, Cascadia informed the county that it was on the verge of defaulting on a $2 million line of credit from Capitol Pacific Bank, and was about to go under. The Garlington Center would have expired had it not been for a loud chorus of voices that rose in protest.

Gascadia was saved by a $2.5 million loan comprised of state and county funds. A nationally recognized consulting fire was called in to correct the problems with billing, among others.

According to Walker, Cascadia has implemented many of the firm’s suggestions and is steadily recovering.

“We’re cautiously optimistic,” said David Austin, spokesman for the county’s department of human services, which has worked closely with the Cascadia on its financials. He added that the mental health provider continues to provide an essential service to Portland.

Austin said that Cascadia is taking recommendations from the county and the consulting firm seriously, and appears to be stabilizing. He also pointed out that Cascadia has passed along two of its other clinics to other non-profits, which has been a huge financial relief.

The fire sparked last October in the Garlington Center’s Martin Luther King Jr. Boulevard location extensively damaged the building, a former NIKE factory outlet.

Currently, the center looks as if it’s the aftermath of a war. Its windows are boarded up. Yellow tape lines scorched walls and corridors. The sharp, sour smell of the smoke has marinated the air, and still lingers heavily. The floor of some rooms is pitch black and sprinkled with broken glass.

Since the fire, clients have had to go out of her way to an alternate Cascadia center on Southeast Division Street and 43rd Avenue.

“It’s a hassle,” said Morphis of having to make the trek to the alternate center.

The clinic’s director Tasha Wheatt-Delancy expects to have the MLK facility back up in about six months. Currently there are several trailers outside the building where clients will be served. They are not quite ready, said Wheatt-Delancy. But she’s hoping they’ll be ready soon.

Hlava isn’t sure how much the building repairs will cost.

The fire is considered “suspicious,” and is under investigation by local and federal investigators.

Walker said that Cascadia is taking great care not to allow the tumult facing the organization to interrupt services facing clients.

However, Cascadia’s problems aren’t entirely in the past. Walker said that the state budget cuts could affect the non-profit’s addiction treatment program, but isn’t entirely sure what could happen.

“Making sure we have stable funding is our biggest challenge,” said Walker.

From the Oregonian, November 12 2008

Imagine your brother had a severe chronic illness. Imagine it messed with his ability to realize how sick he was and made him act a little crazy.

Imagine he resisted getting treatment and insisted he was fine. Imagine he threatened you when you tried to help. Imagine his caregiver nearly went bankrupt. Imagine you found out he was off his meds again and about to be evicted. Imagine you were scared, desperate and clueless what to do — but decided to visit him one more time.

Imagine, in other words, you were Theresa Rockwood last month.

Her dilemma played out with horrific consequences: She was found stabbed to death in her brother’s apartment. Her brother, Joseph F. Rockwood, 54, who has schizophrenia, is charged with murder.

“One of the things our system is not well prepared to do is engage families,” said Chris Bouneff, director of marketing and development for DePaul Treatment Centers and president of the National Alliance on Mental Illness of Oregon.

With a physical illness, Bouneff said, caregivers are more insistent on bringing family members into discussions about treatment. “Typically, in mental health, that doesn’t happen.”

There are many reasons: fear, stigma, denial, ethical concerns about privacy protection.

“It’s not uncommon for family members to struggle with trying to get care for their loved ones,” Bouneff said. The problem gets especially dicey when the loved one has schizophrenia, which plays havoc with self-awareness and logic.

“It doesn’t work to say to them, ‘Why don’t you just get help?’ Their frame of reference will never be that they need help,” Bouneff said.

Like Theresa Rockwood, clinical psychologist Xavier Amador had a brother diagnosed with schizophrenia. Amador’s book, “I Am Not Sick, I Don’t Need Help: How to Help Someone with Mental Illness Accept Treatment,” is based on his own frustration, starting when he confronted his brother Henry and accosted him for tossing his medicine into the trash can.

“With every dose of ‘reality’ I tried to give him, Henry countered with more denials,” Amador writes. “And with every go-round we both became angrier and angrier.

“My natural instinct to confront his denial was completely ineffective and made things worse.”

So where does a worried relative turn? “There’s no easy answer,” Bouneff said.

Even if the law made it easier to confine mentally ill people against their will — a controversial move — there’s little capacity to take care of them.

“You can’t get into the state hospital, and you can’t get out of the state hospital,” Bouneff said. “There’s nowhere to go. Cascadia is overwhelmed.”

Cascadia Behavioral Healthcare, the state’s largest nonprofit provider of mental health services, nearly collapsed financially in May. It has scaled back staff and services to get into the black.

Friends of Theresa Rockwood said she told them her brother had a caseworker and a doctor at Cascadia. Cascadia officials declined to discuss the case, citing federal privacy laws.

“We have a system that’s chronically underfunded,” Bouneff said. “Situations like this put providers in a bind. The problem is much more complex than pointing a finger at the provider.”

Mental illness is not voluntary, said Beckie Child, president of Mental Health America of Oregon, an advocacy group. “Nobody asked to be mentally ill.”

Her group hears from families that are at a loss about how to handle the needs of relatives with mental health problems. “We certainly can listen,” Child said, “and sometimes that’s the most helpful thing we can do.”

Mental illness carries stigma that physical illnesses such as cancer or heart disease do not.

“It affects the whole family,” Child said. “It’s really tricky not to wind up blaming the person who has the illness. And it’s hard to be patient and watch someone go through the healing process — or not.”

EXTRA – Stabbing death: Another victim of Oregon’s broken mental health system

Opinion editorial by Jason Renaud, published in The Oregonian, November 12 2008

The judge will say Joseph Rockwood is guilty but insane. That verdict will try to shut the door on the pathetic and predictable death of his sister. But Theresa Rockwood’s death will haunt those dependent on Oregon’s broken mental health service delivery system.

For people dependent on services from agencies such as Cascadia Behavioral Healthcare that door remains wide open.

Is Joe Rockwood guilty? Yes and no. Is he accountable? He will assuredly spend the rest of his life locked up, and ironically receiving the medical treatment he sorely missed.

But will judging Joseph make amends for his crime? No.

So who bears responsibility for the death of Theresa Rockwood?

The Oregon Legislature.

That our ’system’ is broken is undeniable. It’s been broken for decades. That our ’system’ attempts to provide direct and essential services for thousands is a fact. That tens of thousands of family members, friends, neighbors and colleagues, depend on capable and competent services being available. Our courts, our hospitals, our primary care clinics, our police, and our city and county managers also depend on these services.

The financial cost of not providing capable and competent services far outweigh the cost of providing services.

But the political cost of doing little and less is negligible.

For decades the Oregon State Legislature has evaded responsibility to fund these services. They’ve cut budgets in good times and bad. They’ve ignored fair warnings from impartial observers. They’ve plead and proven ignorance and disdained education.

Local governments share in the responsibility here, but our state legislators need to be held directly accountable for pathetic and predictable tragedies like the death of Theresa Rockwood.

Renaud represents the Mental Health Association of Portland, www.mentalhealthportland.org

From the Oregonian, November 11 2008

Days before Theresa A. Rockwood was stabbed to death in her brother’s apartment, she wrote a long e-mail to her aunt in Illinois, describing Joseph Rockwood’s declining mental health.

He was getting more delusional and carried a bat. He wasn’t taking his medication or paying his rent and faced eviction. She said she was trying to get him help and had talked to his caseworkers but was frustrated that he hadn’t been placed in a secure group home.

In the Oct. 27 e-mail, she described her plea to her brother’s mental health team: “I put a call into them, and begged them to do something because of his state of mind and all that he is doing. … He’s out of control, needs to be in a nursing home with other people like him so staff can oversee his care. … I do not know what to do.”

On Monday, Rockwood’s brother, Joseph F. Rockwood, 54, was wheeled into a Multnomah County courthouse to face a single count of murder in the fatal stabbing of his sister Theresa, 52. She was found on the bathroom floor of his Southeast Portland apartment Friday with multiple wounds to her stomach. Police suspect her body had been there for more than one week.

Pleas for help and understanding

10/27/2008 11:51:09 A.M. Central Standard Time

“Joe is spending all his money on fast foods And pizza. And crazy things like books he will never read and thousand of vitimins, etc.. i tried to talk to him about his finances and offered to help him get help, he has refused.

“His mental health team was there to see him on thurs of last week.I put a call into them and begged them to do something because of his state of mind and all that he is doing. he put on a great show that all was well with him and that he was not in need of there help and he asked them to leave. they called me back we talked for over an hour on his case, said they cannot do anything with Joe because of the fact he can put on a good face when they bring the mental health department in to evaluate, Joe can snap out of it when they show up.

“They had to close his case after all this time, Joe has refused all treatments and will not allow them to work with him this past year. They do know he is not well, but said they have the law they have to go by. Joe has refused any and all treatments medications, assistance and including consuling by the mental health.

“When i was at his place he told me to go and get pizza and other food stuff, he said he bounces checks all the time and the bank just keeps paying them and sending him a bill, so that is another way he owes so much bounces multi checks per week.

“He is out of control, needs to be in a nursing home with other people like him so staff can over see his care. ILL has tighter rules for the mentally ill, if he was in IL he would be in a facility, Oregon has more activist that put laws in place that they can do whatever and live whereever as long as they do not harm themselves or another. They can be totally crazy and live on their own here. I do not know what to do.

“I do think he has gotten himself into this mess to end up in IL near the family. But i have tried to tell him, It is very different now, that everyone is busy with their lives and it is not all fun and parties. He is very mad at me for telling him that. he said i am dead to him, and that i am trying to break the family apart.

“I will talk to the mental health social worker again today. as far as needing a truck… i would say if he goes to IL it would have to be by train and all his stuff can go by train, he has used furniture, junk, he would just need his clothing and a few of his other things. One can take the train with 3 boxes at 50 pounds each and then 2 carry ons of the same weight. Tom came to Oregon that way and come to think of it that is how Joe came out here, and if he goes to IL where is he going? none of the sisters will take him, that is why he is calling on you and aunt Marylou. I would say maybe our couisn Cathy rockwood, but then again he is unsatabe and i do not feel comfortable one on one with him. he carries a bat with him. he is mentally unsatble to live with someone or even alone.

“call me tonight after 9 pm if you can, my mins are free then.”

love
therese

Date: Sun, 26 Oct 2008 14:57:34 -0400

“Hi Theresa, Would like to talk to you later today re: Joe……………did he get kicked out of his apt? He mentions (in a voice mail), that he needs me to get a truck and come there to help him move back to Illinois……….Said his check bounced and he was tossed out of his apt………….

“Is the Dept of Mental Health still involved with him? He’s really in need of them.

“Will call you today (or call me)”

xxooxx
Aunt Barb

“She was the best advocate for him,” said Theresa’s close friend, Kari Hillebrecht. “She had such a love in her heart for him. She just wanted to help him. Nobody else would; the state wouldn’t.”

Friends of Joseph Rockwood, who suffers from schizophrenia, also said they were increasingly concerned about his behavior. They feared he wasn’t taking his medication in recent months, so they sought help from his caseworkers, doctor and pastor.

They say his downward spiral could have been prevented, and some blamed Cascadia Behavioral Healthcare, where he had a caseworker and a physician.

“I really feel if they were doing their job, then none of this would have happened,” said Kim Reinecker, a friend of Rockwood’s who worked as his housekeeper. She said she’s also a client of Cascadia. “How far does a mentally ill person have to go before the mental health system will listen?”

Amy Baker, director of outpatient services for Cascadia Behavioral Healthcare Inc., said she couldn’t talk about Rockwood’s case, citing federal privacy laws. But Baker said her organization must balance the needs of its clients with their civil rights and has to show that clients are a danger to themselves or others in order to put an involuntary hold on them.

“For the thousands of people we serve, there are people we work with who really want these services, and some people who really don’t want these services,” Baker said. “We have to honor people’s civil rights when we work with them. ”

Hillebrecht said Theresa Rockwood spoke at length about her brother’s troubles during their last lunch together, on Oct. 28, just hours before Theresa went to visit him. Hillebrecht and Rockwood met 15 years ago when Rockwood, who was a nurse, cared for Hillebrecht’s seriously ill infant daughter.

Hillebrecht said Theresa Rockwood told her she wanted to visit Joseph before returning home to Hood River, where she recently bought a home. Hillebrecht urged her not to go. The siblings’ last contact, during the summer, took a dangerous turn. Theresa had locked herself in a room at her brother’s apartment and called 9-1-1 because he was acting in a threatening manner.

“She knew he was getting worse and worse. She said she’d keep her space, never would get close enough to him,” Hillebrecht said. “She knew to be careful. I think she went back for one last try because she knew he was being evicted, and he would be on the street.”

When Hillebrecht hadn’t heard from her friend in the days that followed, and learned Friday that she had left her beloved collie, Lacey, alone at home, she panicked and drove straight to Joseph Rockwood’s Southeast Portland apartment. She found Theresa’s car in the parking lot.

“When I found her car, I knew something was wrong,” Hillebrecht said.

Police were called to the apartment complex at 11614 S.E. Division St. at 11:39 a.m. After repeated knocks went unanswered, police entered the third-floor unit and found Joseph Rockwood. He denied anyone else was in the one-bedroom apartment. Officer Robert Slyter discovered Theresa’s body on the bathroom floor.

At the discovery, according to an affidavit filed in court, Joseph Rockwood blurted out to officers, “Just my dead sister, with the Holy Moses picture on the wall beside her.”

He added, “I didn’t mean to hide anything.”

The officer found a blood-stained knife with a broken blade on the kitchen counter.

Reinecker said she used to clean his house about two days a week, but in recent months her husband was afraid to let her visit Joseph alone.

“I know he was off his meds. I’d go over to his house, and there would be cockroaches, and mice and stuff. It smelled like feces and urine,” she said. On Oct. 12, she and her husband wrote a letter to his Cascadia caseworker and doctor, telling them of the unsanitary conditions in his home, his three blaring TVs kept on to reportedly block out the voices in his head, and his increased weight. Rockwood weighed 450 pounds when booked at the jail.

In her last e-mail to her Illinois aunt, Theresa Rockwood wrote of her frustrations. Her brother refused all treatment and would not allow his caseworkers to work with him in the past year. When they’d visit, he’d “snap out of it” and convince them that he was OK. She said she was no longer comfortable one-on-one with him.

Hillebrecht says she’s more upset with the state mental health system than she is with Joseph Rockwood.

“I think if the state would have heard Theresa’s cry for help and would have done something,” she said, overcome with tears. “His sister was the one who truly, literally laid her life down for him.”

The judge will say Joseph Rockwood is guilty but insane. That verdict will try to shut the door on the pathetic and predictable death of his sister. But Theresa Rockwood’s death will haunt those dependent on Oregon’s broken mental health service delivery system.

For people dependent on services from agencies such as Cascadia Behavioral Healthcare that door remains wide open.

OUR COMMENT

Is Joe Rockwood guilty? Yes and no. Is he accountable? He will assuredly spend the rest of his life locked up, and ironically receiving the medical treatment he sorely missed.

But will judging Joseph make amends for his crime? No.

So who bears responsibility for the death of Theresa Rockwood?

The Oregon State Legislature.

That our ’system’ is broken is undeniable. It’s been broken for decades. That our ’system’ attempts to provide direct and essential services for thousands is a fact. That tens of thousands of family members, friends, neighbors and colleagues, depend on capable and competent services being available. Our courts, our hospitals, our primary care clinics, our police, and our city and county managers also depend on these services.

The financial cost of not providing capable and competent services FAR OUTWEIGH the cost of providing services.

But the political cost of doing little and less is negligible.

For decades the Oregon State Legislature has evaded responsibility to fund these services. They’ve cut budgets in good times and bad. They’ve ignored fair warnings from impartial observers. They’ve plead and proven ignorance and disdained education.

Local governments share in the responsibility here, but our state legislators need to be held directly accountable for pathetic and predictable tragedies like the death of Theresa Rockwood.

From the Oregonian, November 1 2008

County may spend $1.5 million more on mental health system – Multnomah officials want to ease Cascadia’s burden

Multnomah County leaders may spend another $1.5 million to stabilize the mental health system after the near-collapse of the state’s largest provider of mental health services.

The money would help with the transfer of two county-funded mental health clinics and a residential housing program for people with mental illness to smaller providers to reduce the scope of the struggling nonprofit, Cascadia Behavioral Health Care.

Cascadia was on the brink of collapse in May, when the county provided an emergency loan of $1.5 million — with the state chipping in another $1 million — to keep services running for the thousands of residents who depend on its services. Mismanagement and inadequate government oversight had allowed risky financial practices to continue for years.

County leaders immediately pushed to reduce the dependency on Cascadia — then responsible for providing 80 percent of the county’s mental health services.

Cascadia agreed to transfer control of two of its five clinics as well as some smaller programs to other nonprofits: The downtown clinic to Central City Concern, the Gresham clinic to Lifeworks Northwest and Bridgeview, transitional housing in Portland that helps seriously mentally ill transition to independent living, to Luke-Dorf Inc.

“It allows us to strengthen our relationships with multiple providers in the mental health system rather than just relying on Cascadia,” said Joanne Fuller, director of the county’s Department of Human Services. Fuller said she doesn’t expect the county to put any more extra money into shoring up the mental health system.

The county Board of Commissioners will vote on whether to approve the money at its meeting Thursday, although some of the money has already been spent. Under the proposal by Human Services, the county would provide $914,000 to help pay the startup costs associated with the transfers, such as computer upgrades, photocopying medical records and hiring former Cascadia employees.

The other $554,000 would be loaned to Central City Concern to make up for any lag in cash flow as it takes over the downtown clinic, which has been losing over $500,000 a year, Fuller said. The county may loan another $441,000 next year, according to the plan. The loans will be repaid, Fuller said.

Cascadia has stabilized in its smaller form, though county leaders continue to closely monitor its fiscal health. Cascadia has not repaid any of the $2.5 million it was lent.