Mental Health Association of Portland

From the Portland Tribune, June 17, 2010

Portland police and other emergency service providers will have a new place to bring mentally ill people in crisis besides the county jail or local hospitals.

Multnomah County, the city of Portland and the nonprofit Central City Concern reached a final deal Thursday, June 17, to build and operate a mental health intake center above the Hooper “sobering center” east of the Burnside Bridge, 20 N.E. Martin Luther King Jr. Blvd.

Groundbreaking for the new Crisis Assessment and Treatment Center is planned in August, with completion expected about six months later.

The $5.3 million facility will feature professional and peer counselors who can work with mentally ill people experiencing breakdowns or other crises, and 16 beds where they can be lodged in a safe, dormitory-style setting.

Officials have talked about the need for such a center for years. But the need became more urgent in the aftermath of the September 2006 death of James Chasse Jr., a schizophrenic, who died in police custody from serious injuries suffered when he was tackled during his arrest. Two others – the Jan. 29 shooting of Aaron Campbell at a Sandy Boulevard apartment complex, and the May 12 shooting of Keaton Dupree Otis in the Lloyd District – also involved people who were said to suffer from various mental illnesses.

Emergency services providers often lack the skills to identify and handle mentally ill people undergoing episodes or outbreaks, and the results can sometimes be tragic.

“This helps fill a very important gap in our mental health system,” said County Chair Jeff Cogen, after the cooperative agreement was finalized with the city and Central City Concern, which operates the Hooper center. The complex agreement, in the works more than two years, called for Central City Concern to relocate its Hooper Detox Center to a renovated facility at a former Ramada Inn, at North Williams Avenue and Weidler Street near the Rose Quarter.

Drunks picked up by police or other authorities are brought to the sobering center for medical treatment until they sober up, and then moved to the detox center, a residential program that allows them to continue to receive substance abuse treatment.

The new mental health intake center was seen as a good fit for the sobering center on the ground floor.

The new facility isn’t going to solve all the problems with the mental health system in the city and the county, said Central City Concern Executive Director Ed Blackburn. But “not a week goes by” when there isn’t a need for such a facility, he said.

Portland Mayor Sam Adams helped expedite the allocation of $2 million in promised city urban renewal funds to speed up development of the intake center. The state provided $1 million, the county put up $842,000 and $1.4 million came from New Market tax credits.

Operating the center will require more than $3 million a year, most of it from federal and state Medicaid funds. The city and county agreed to split the remaining costs, which are estimated at $550,000 a year for each entity, said Dave Austin, a county spokesman for human services programs.

Multnomah County will seek bids from an outside entity to operate the new Crisis Assessment and Treatment Center, Austin said.

Central City Concern could be one of the nonprofit or other groups bidding to run the program.

From The Oregonian, January 09, 2010

This alley in Northwest Portland became a place of great significance for the filmmakers of the documentary, "Old Town Diary." Many of the actors, recovering addicts, are real characters from the neighborhood.

What they took to calling The Alley — a place that would come to carry great significance for them — is an unremarkable patch of concrete set against a crumbling brick building, not far from the Greyhound bus station and Blanchet House, surrounded by a chest-high wall. They had searched for days for a suitable place to stage an epiphany. But in the typical workings of the universe, the minute they set out looking for one, they couldn’t find it.

If anything, though, this was a group that knew something about persistence, and one day, they happened to peer over the wall. They took in the needles, sodden blankets, discarded socks and empty bottles littering the ground. In the background, the Steel Bridge — where a young couple, unable to see a way out of their heroin addiction, killed themselves a little more than 10 years ago — loomed. And they knew they had found the place.

* * *

They are clients of the Community Engagement Program, at Portland nonprofit Central City Concern, who since June have participated in a filmmaking project designed to give voice to their experiences on the streets and their attempts to change their lives. But there’s a tension in all this, because it’s Central City’s policy to maintain clients’ anonymity because of federal medical privacy laws, but also because as it sorts through years of addiction, mental illness and homelessness, recovering addicts are still in a very precarious place. And on the one hand, especially to reporters, this policy can feel maddening — shouldn’t people be able to tell their own stories? On the other hand, if you stop to think about it, the stakes here are higher than most of us can fathom from the comfort of our lives, those of us who have never had to start over from nothing — let alone multiple times.

Many of the actors, recovering addicts, are real characters from the neighborhood. But a few others volunteered to be part of the film, including Everclear singer Art Alexakis. After the filming, Alexakis did studio voice recordings.

Those in the filmmaking group, for their part, when faced with the anonymity policy, came up with a compromise: They would write a fictional screenplay — though drawn from actual experiences — and they would film it in on location in Old Town, in places familiar to them. They’d use an actor or two, but mostly, they would cast real characters from the neighborhood — people outside the program, who could be filmed.

I, too, compromised. I could follow the participants through the process, see the Old Town they would show me, so long as I didn’t identify the participants. Otherwise I was free to report events as they unfolded, interview anyone I wanted.

The leader of this filmmaking group is a man named Brian Lindstrom. Among his own projects, he has made two documentaries about people overcoming addiction — “Kicking,” which follows three drug users through detox, and “Finding Normal,” which tracks recovering addicts as they take the first steps toward rebuilding their lives (and which I wrote about in 2007).

Lindstrom also has worked with Central City clients since 1994, teaching them the fundamentals of moviemaking as a way to help them gain greater clarity over their lives. As he puts it, it is a way to give back by helping those who are often subjects of his personal films tell their own stories. (Ed Blackburn, Central City’s executive director, said of Lindstrom’s approach: “He has the ability to encapsulate people’s stories in a way that preserves their dignity and is also responsible in terms of not exploiting their vulnerabilities … but it’s real, it’s not a propaganda piece … .”)

Lindstrom believes the collaborative nature of filmmaking is a good way to draw people out of their isolation and help them recognize that they have something valuable to contribute. At the same time, he says, it can give people a way to try out possibilities for their own futures: “Taking a character through the challenges that are inherent in a dramatic story, it allows someone to say, ‘That person overcame obstacles. I’m in the process of overcoming obstacles. I think I can do that, too.’”

The group began meeting weekly in June.

How they came to it? Two answers:

“My P.O. and the judge told me I had to go to a program and once I’m done with a program I’ll be off paper,” one man said. “My counselor came and got me from Hooper” — a detox center — “and I’ve been here ever since. It’s going to take some time — I’ve been using all my life. I’m slowly getting my people back in my life … I like coming here because it gives me something to do, makes me think there’s hope out there.”

“I’ve been clean a little while,” another man said. “There’s nothing unique about my story. I’m a heroin addict who has trouble staying clean … .”

Why come to the filmmaking class?

“This is something fun. And I like learning things.”

Together, they studied films — “Finding Normal” and “On the Bowery,” a 1957 film that blended documentary and scripted moments to tell the story of life on the margins in the New York neighborhood and which inspired the group’s own hybrid approach. And then together, they wrote a script they called “Old Town Diary.”

* * *

Which brings us back to The Alley.

In the script, The Alley becomes the scene of the film’s turning point, the place where the main character realizes he can’t go on, that he’s ready to check into detox.

Lindstrom takes the collaborative aspect very seriously — as one member of the group told me, “I feel like I’m working with him; it’s like he’s grateful for our insight” — and he charged the group with scouting for the perfect locations. They, in turn, spent hours of their own time and offered all sorts of ideas: The interior of The Joyce Hotel. A meal at the Blanchet House. The Burnside Bridge.

But it was The Alley that participants mentioned most often.

“I did not want to miss The Alley scene,” said one young man in his 20s, one of the group’s most recent additions, who had pulled himself out of bed that morning with this particular motivation. It was December now, and filming of “Old Town Diary” finally had begun. Over time, the group had dwindled from eight to about three stalwarts, as members battled the very same challenges they sought to capture in the film. There were relapses, medical emergencies. Jail time to be served. “All kinds of things that made it difficult,” Lindstrom said. “And that’s frustrating, but what’s also true is there’s been such a momentum to the project and such follow-through. People have taken it so seriously. Despite all these things, they still come back.”

Working with a $5,000 grant from the Regional Arts & Culture Council, donations from the Lindlay Family Fund and a crew of volunteers, including director of photography John Campbell (who shot “Mala Noche” and “My Own Private Idaho”), camera operator Justin Alpern (who donated the camera package), and Everclear singer Art Alexakis (who offered to play the main character and who also let hair and makeup artist volunteer Madeline Roosevelt make him look so sickly and tired that a stranger walked up to him and said, “Are you Art Alexakis? Man, you look HORRIBLE”). They filmed “Old Town Diary” over three frigid days in mid-December.

Every day, group members are there for the filming, as are their caseworkers — Carly Laney and Lexi Olson — watching the script they worked so hard on come to life. Some are missing, including one of the most dedicated members, who the caseworkers leave messages for that go unreturned for days. But then, here it is again, the surprising return: He shows up for the last day of filming. Another man, 59, also among the most dedicated participants, had stayed for all nine hours of the first day of filming, enduring the cold — so cold that when they film outside Hooper, they leave their prop sleeping bags with two men who are trying to sleep there that night — only to wake up sick the next morning, desperately disappointed.

* * *
He could not be there again the next day, when they reported at 7:30 a.m. to the Joyce Hotel and rented Room 212, where they would film the main character discovering a notebook someone has left behind in his $30-a-night room — the diary of the film’s title.

This diary belongs to me, Steve. If you’ve found it, I’m probably dead. Or maybe in jail. Or in a mental institution. … What I’m going for is I’m just going to try and write the truth.

I’m so sick of repeating the same misery. Every damn day wakin up dope sick, the humiliation of begging, stealing, scoring, plunging the … needle. There has to be more than this. I have to be more than this. I have to find a way out.
While they film, a man bangs on the door of Room 208, repeatedly calling for a friend who never answers. From down the hall comes the sound of someone being sick. A woman emerges from her room and recognizes one of the participants — the one who spoke of his hope to get “off paper.” “Hey Shorty. What’re you doing here?”

“Making a movie,” he says and laughs.

And then, it’s a scene downstairs between the main character and the man at the front desk, in this case, played by Greg Blank, who actually works the front desk at 8 N.W. Eighth Avenue, which offers drug- and alcohol-free affordable housing, and who is a familiar face to many people in Old Town trying to get their lives straight. There are also appearances by people in “Finding Normal”; in fact, the group specifically requested that one of the documentary’s subjects — Paul Kochs, a man who speaks with deep eloquence about his path to recovery — star as the film’s other major character opposite Alexakis.

And then it’s time for The Alley scene. The crew members arrive to discover a bedroll, recently used, and new needles scattered about, and they settle in to film the moment that marks the main character’s revelation, where, as the script says, “something gathers within himself.”

Michael Jo's real life story about alcohol addiction and recovery is part of the film. Participating was a way, he says, to use his real life experience to help people who see the film to accept and understand people living on the street.

Just a week before, Lindstrom, Campbell and the man who had endured the first marathon day of filming only to wind up sick, much to his regret, had been here to take photos for the film’s storyboard. The man’s name is Michael Jo. He asked that I use it so that maybe the people who helped him when he was at his worst would know he’s still alive. And while we stood there, staring at the dirty ground, Michael Jo started telling me his story, and it seems only right that I leave you with his voice and with his name — your own Old Town Diary — because he says it far more beautifully than I ever could, why they are drawn to this place, why they do not want it to remain overlooked and unnoticed, why they want the rest of us to see it, too:

I should tell you, I hit the bottom with alcohol. I’d been living in Arizona, and it was time for me to go before I killed myself there. I stepped off the bus in Portland on Sept. 9th 2002, and from the moment my foot hit the ground, I didn’t have a drink for three years. I knew that for what I was going to do I needed a clear head. Just being sober for three years was a big leap. I reconnected with my family, reconnected with my mother. I had an apartment. I made it beautiful, comfortable. And then one night I went to Fred Meyer’s to get a bike hook. I had money in the bank, a Visa. I went to the Fred Meyer in Gateway, and I bought a pint. At the time I thought, what’s wrong with this picture, but I told myself I’ve been sober 3 years — I’m cool. I never stopped. I was evicted, lost all my stuff. I spent 10 months in residential rehab.

As we stand here today, I have two months, two weeks clean. It’s the most quality clean time I’ve had since I got off the bus. It’s been sort of like I’m learning to walk all over. I can honestly say the Community Engagement Program saved my life. I’d been down so long I thought what’s the point, I’ll just drink until I’m dead. Two months ago, I was just hanging around CEP and someone said why don’t you come to the film-making group and I just got drawn in.

I feel like I can see the world now. I’m not all fogged in. And this time I have a real sense of well being — it’s not euphoria, it’s just somehow everything’s led up to a point where I feel good.

I want to do something that will let me sustain that feeling. What we’re doing with this film, this feels good. … I’ll never be a great director or an actor, but I can be real. … I’ve fallen on my face on the sidewalk. I know what that feels like. Part of the thing with this film is I’m using my experience … for something good, that maybe it can help people accept and understand people on the streets.

As for me, I’m hoping I can feel alive the way I have these last two months.

A guy died in my building the other night. It was complications from diabetes. It was a natural death. I’m not going to say that’s a good death.

But it was just his body that gave out.

Coming up
Old Town Diary
When: 6 p.m. Feb. 28
Where: Cinema 21, 616 N.W. 21st Ave.
Screens along with Brian Lindstrom’s other film, “To Pay My Way With Stories.”

From the Portland Mercury, November 4, 2009

City Finally Reveals “Secret List” of Probable Drug Abusers—But Is the Program Worth Saving?

“I went because I was tired, and I was hurting. I guess that’s the difference. I was done,” says Vance.

Vance is just one of many names on Portland’s “secret list.” In short, it’s a list of frequent arrestees kept by downtown police, targeted for priority drug treatment. If anyone on this list is busted for regular drug possession in certain areas of Portland—say, if they’re carrying a crack pipe in Old Town—it’s no longer a misdemeanor. Instead, they are prosecuted with a felony, and given a choice: Either enter drug treatment, or go to jail.

It’s been 18 months since the Mercury first learned about Portland’s secret list, but as this story goes to press, it’s been only two weeks since I first met someone who’s actually been through the controversial rehabilitation program.

It’s been a long road. First, the city denied the existence of the list altogether—City Commissioner Randy Leonard, who takes credit for spearheading the program, went so far as to write extensively about it on this paper’s website last September:

“I have never been told of a list,” he wrote. “I have never seen a list, I have never been told by the police bureau there is such a list, and I have never emailed an officer or anyone else about a list.”

Leonard insists he was telling the truth at the time.

“When I said I didn’t know about a secret list, it’s because I didn’t know,” Leonard says. “I knew they tracked people, but I didn’t know it was on a list, and the moment I learned that the list was secret, I asked why. Because it’s public information.”

It then took a legal fight by the American Civil Liberties Union (ACLU) of Oregon in February to get the city to formally articulate how someone could end up on the list—ACLU partner attorney Elden Rosenthal even compared those running it to the Gestapo.

“The principle at stake is not wanting to collect secret police lists,” he said. “Secret police lists have never come to any good, whenever they are used. There’s just too much opportunity for abuse.”

Bizarrely it was Leonard, not the ACLU, who eventually forced Police Commissioner Dan Saltzman to make the list public at a council hearing on October 21. Saltzman has argued that the people on the list are vulnerable individuals who should be protected from the glare of the media. But ironically, some of these “vulnerable individuals” have been more than happy to talk about the program, while Saltzman declined to be interviewed for this story.

All participants in this article were willing to have their full names printed—but the Mercury has chosen to omit last names to protect their privacy, as well as to avoid any future problems that could be caused for them by the long memory of the internet.

VANCE AND FLOYD

“I’ve been out here with no shoes on, no shirt, my pants full of shit, down to 120 pounds,” says Floyd. “You become what the street turns you into. Aggressive, careless, you take, take, take, and you run, run, run.”

Floyd and I are enjoying coffee with Vance at Backspace on NW 5th and Couch on Monday afternoon, October 26. On the short walk over from the Estate Hotel where both men are now in “dry housing,” they cast their eyes around for drug dealers.

“If anybody sees us coming over here with you, they’ll think you’re a mark,” Floyd smiles. “And they’ll come get your money.”

“You best be careful,” Vance laughs.

They may be cracking wise now, but until earlier this year, Floyd and Vance were among Old Town’s most desperate crack addicts. Floyd has a string of felony convictions going back to 1988—mostly for dealing, but a few for theft and two fairly recently for unlawful possession of a firearm.

“I’ve been arrested eight times in a day,” he shrugs. “For 20 years, I stayed numb.”

Floyd does most of the talking. Meanwhile, Vance has a string of misdemeanor theft and cocaine possession convictions on his record, and a couple of felonies for theft and burglary in the ’80s and ’90s. He also has several convictions for alcohol on public property.

“Me, in a sober frame of mind, I’m not going to walk out and smoke crack,” he explains. “You’ve got to get me drinking first.”

I like both men. I first met them five days earlier, at the day treatment center run by Volunteers of America (VOA) in Southeast Portland.

Vance went into rehab on May 12. “I was told nine months before I went that I could go,” he says.

“He gave me some burritos and some bread as he was going,” says Floyd, as he breaks into another smile. “I sold half of that shit.”

Floyd followed Vance into treatment on June 18. They stayed for about three months—actually, Floyd stayed four—in the VOA’s new 12-bed residential treatment center on SW 2nd. Both men have been through treatment programs in the past, but this time, it was different, they say.

“A lot of it, to me, was seeing people I’d been out on the street with,” says Vance. “I’d say, ‘Well shit, I knew how Darryll was when he was out there—he ain’t no worse off than I was. This could work for me, too.’”

The 24-hour support offered by the program was vital for Floyd. In previous treatment programs, he says, he would have an “issue” in the middle of the night and have nowhere to turn for help. Both men are about three months from looking for housing for themselves and acknowledge that the road ahead isn’t easy.

“But we’re both gonna make it,” says Floyd. “We are. I networked to get my drugs. I did everything I could to get my dope, and I’m gonna get this too. The same way I went after my dope.”

DARRYLL

Darryll is further along than Floyd and Vance. He graduated from the program in December last year, and is now living in Gresham, having once been homeless in Old Town.

“We called ourselves the 12 generals,” Darryll says, describing his three months in the residential treatment center with 11 other men. “On the streets we couldn’t interact too much because we had to share the money. Now we were all sleeping next to each other—we had to be kind, turn the music down. And we couldn’t BS each other because we knew the game.”

Now Darryll is facilitating his own rehabilitation groups at the Grove Hotel on W Burnside, and organizing a blanket drive for the homeless at VOA this winter. If he stays arrest free for three years, Darryll’s name will fall off the list. At 6 am on Friday, October 23, I followed Darryll around Portland as he opened and cleaned a series of restrooms—the first of which at NW 5th and Glisan is known as “Randy’s Loo,” Commissioner Leonard’s brainchild which was built last year.

Darryll has a job with the downtown Clean & Safe program—a collaborative effort between the Portland Business Alliance (PBA) and social service agency Central City Concern. As he arrives at Randy’s Loo, there’s a strung-out old homeless couple inside, and Darryll asks them if they “got done with their business.” They say “yes,” and scurry off. Darryll cleans things up and puts in fresh toilet paper, before getting into his Chevy Astro and heading up to Couch Park in Northwest Portland.

“I used to get high in those bathrooms,” he told me, two days earlier, when we met at VOA’s day treatment center. “I’ve been booked more than 100 times, I’ve got 14 felony drug convictions, just a whole life. They gave me a second chance and I’m grateful for it.”

The PBA did not allow me to talk to Darryll while on the job, because they too identified him as “vulnerable,” and it’s against their policy to allow Clean & Safe employees to be interviewed. But regardless, I decided to observe him on his rounds from a distance, because he works in the public right of way. He appeared to be enjoying himself.

We had scheduled a follow-up meeting on Tuesday, October 27, but Darryll cancelled, sending this text message: “I have been told 2 break all contact with u. I don’t want 2 b in the middle of what is going on. Sorry.”

The PBA did not confirm or deny by press time whether they gave Darryll these instructions.

Earlier at the VOA, Darryll had told me he can’t go back to using.

“I have to ask myself, is it realistic for me to go back?” he said. “When I go down to do the bathrooms, I’ve been really surprised by the level of respect I’ve gotten. People say, ‘Darryll got a job.’”

THREE OUT OF 77

Floyd, Vance, and Darryll: Their stories are all inspirational. For example, two weeks ago, Floyd went to visit his mother’s grave for the first time, having avoided it for three years after her death while he was in the penitentiary.

“I was too embarrassed, too hurt,” he says. “I had a lot of shame.” Now, he says, he can begin grieving.

This is heady stuff—and as we’re talking, I find myself wanting to praise the program from the rooftops. However, overcoming even a run-of-the-mill booze addiction is an emotional experience, fraught with pitfalls. Darryll, Floyd, and Vance say they know of a handful of people who dropped out of the program—and VOA didn’t have time to arrange more meetings with others on the list, making it difficult for me to fairly judge the program’s success. So I attempted to get some more objective information.

Since February 2008, 77 people have gone through the rehab program associated with the list, says Pam Kelly, division director for rehabilitation service at VOA. Fifty-five have been discharged, 22 are in treatment now, 14 have been re-arrested, and 18 have been re-enrolled. There are currently 359 people on the list, in total.

There wasn’t much more statistical information available during the course of researching this article to ascertain the success of the program. And Kelly didn’t have any additional information on why those clients had been re-arrested or re-enrolled, or whether the others had left town, or stayed here, and so on.

Indeed, Kelly admits, the city’s contract with VOA doesn’t require that the success of this program be measured in the same way as its contracts with Multnomah County. For example, the success of another VOA contract with the county’s Department of Community Justice is measured by tracking how many clients get arrested before they go through the program and how many afterward. Kelly says partners in this program are due to go on a “facilitated retreat” later in November to begin working out what the “criteria for success” might look like.

“This is a very difficult population,” Kelly admits. “So success for these folks might not look the same as it does for other people.”

Last year, Leonard and others were touting a “71 percent reduction in recidivism” associated with the program. He says he thinks it’s higher now, but the Mercury has seen no clear evidence to back that up−and without it, how are we to know if that figure wasn’t essentially meaningless to begin with?

“If Leonard is trusting the police bureau with this 71 percent figure the same way he trusted them that there was no secret list,” says Chris O’Connor, a defense attorney who has represented a handful of clients on the list, “then that’s a cause for concern.”

NO MEASURE OF SUCCESS

The Mercury asked the city to put a dollar amount on the program over the last year. In the fiscal year 2008-2009, the city spent $2.43 million on the program. In 2009-2010, the city has spent $2.55 million—a total of $4.98 million over two years. In addition to housing and treatment, that figure includes $412,000 in police bureau overtime over the same period.

Copwatch activist Dan Handelman has been trying to track the expenditure of tax dollars at council meetings, but has found it difficult because the city has kept changing the name of the program over the last year and a half.

“It’s been called the Service Coordination Team, the Neighborhood Livability Crime Enforcement Program, Project 57—the secret list, of course—and the Treatment Priority List,” says Handelman. “There are so many names for this program, it makes your head spin. And I think that’s been the idea—that you can’t nail it down.”

City Commissioner Nick Fish has described the program as a “substantial investment of public resources.” Indeed, for just $1.2 million, said Fish, voting for the allocation of money to housing for the program on October 21, “we can tackle about 40 percent of the homeless problem on the streets of Portland.”

Central City Concern boss Ed Blackburn feels Fish is comparing apples and oranges. “This has a different objective from housing homeless people,” he says. “There’s a huge cost benefit in terms of the crimes these people are not committing.”

Nevertheless, Blackburn says he suggested “two or three times” during the establishment of the program that an independent contractor be brought in to do a cost-benefit analysis, and that he was ignored.

“I’m not necessarily the most influential person with those folks, and I think they were more focused on their own ideas for measuring success,” he says. “Now, of course, the question is being raised, and they don’t have those statistics.”

Dividing the number of people (77) who have gone through rehabilitation on the list into the cost ($4.98 million) equals a total cost of $64,675 per person going through rehabilitation.

“You could have hired a ton of social workers for that money,” says O’Connor. “You could have paid for a social worker to stand on every corner of the city for a year. It’s one thing if the police want to be social workers—but should we really be paying them police overtime wages to do that?”

Leonard, like Blackburn, says the program is worthwhile because of the damage the worst offenders can cause to the community.

City Auditor LaVonne Griffin-Valade says the city has no immediate plans to audit the program—at least until its next reassessment of auditing priorities next spring. She doesn’t feel qualified to comment directly on the program without knowing more about it, but says, “We would hope that when any bureau is trying to establish a new program, they will determine how to track outcomes, and then how to measure those outcomes for success.

“That’s just basic good management practice,” Griffin-Valade continues.

The program has also been ramped up after the demise of the city’s controversial Drug-Free Zones (DFZ) in late 2007, after the DFZs were caught overwhelmingly targeting African Americans, says Copwatch’s Handelman.

“I think the people behind the new program are hoping it won’t attract the same level of scrutiny as the DFZs,” he says.

However, when the Mercury first saw a leaked copy of the secret list in April 2008 ["Blacklisted," News, April 24, 2008], 52 percent of the people listed were African American, while comprising just 6 percent of the population. Today, that number has only dropped to 50 percent.

“I do support treatment,” says Reverend Doctor LeRoy Haynes from the Albina Ministerial Alliance. “But at the same time we want to make sure that African Americans who are homeless or addicted are not being abused by law enforcement.”

Haynes adds that city council has always expressed a wish for transparency around the police bureau, in the past. Commissioner Leonard says he would now support more statistical information being made publicly available about the program, “as long as it’s not redundant.”

“They don’t always connect the dots on the politics,” says Leonard, referring to Officer Jeff Myers and Bill Sinnott, the managers of the program at the police bureau. “They can sometimes be their own worst enemy by looking like they don’t want to share information—but I don’t think they’re intentionally hiding anything.”

Both Myers and Sinnott declined to be interviewed for this story and did not return repeated emails seeking comment.

CLUMSY OR CALCULATED?

It’s difficult to tell whether the city’s elusive answers to questions about this program over the past 18 months have been the result of calculation, defensiveness, clumsiness, or a combination of the three. Either way, Handelman says he now wants a thorough public debate about the merits of the program, its expense, and whether it might be cheaper to pursue alternatives.

“Ten years ago if you were a desperate addict, you could get 90 days of inpatient treatment just by asking for it,” says Jason Renaud with the Mental Health Association of Portland—who ran the Estate Hotel for Central City Concern for three years in the early ’90s. “The people on this list would have gotten access to treatment without having to go through the criminal justice system first.”

Since then, says Renaud, state and federal funds to provide rehabilitation services at a local level have been lost and the police are left to fill in the gap.

“They’re just trying to make this work in their own clumsy way,” he says.

Being included on the list, Vance does express concern about being given a felony before he could enter treatment. But Vance, Floyd, and Darryll are largely unconcerned by many of the problems associated with the program in the eyes of its critics.

“Maybe the white guy in the bar selling cocaine is just using his brain a little bit more than I am,” says Vance. “At the end of the day what I see from the guys that are in charge of this is a ‘give and take.’ You can’t imagine the amount of crime that’s not happening right now because of this program.”

Floyd is more succinct.

“When I look at all the money the government wastes on bullshit,” he says, “it’s still worth it, even if you only save two people.”

You can donate to Darryll’s blanket drive at Volunteers of America (537 SE Alder). If you would like to see the city auditor take a closer look at the program next year, email your concerns to her office representative at andrew.bryans@ci.portland.or.us.

From the Portland Tribune, October 22, 2009, & see OUR COMMENT below.

Frustration builds as county crisis center proposal falls short

The closet-sized room near the emergency department entrance at Oregon Health & Science University isn’t much — a few chairs, a footstool and a counter. It’s not a place police officers want to spend time, but frequently it is a place where they spend half their day, or more, finishing paperwork or just hanging around.

That’s because nearly every day Portland police officers pick up people from the streets who are suffering psychotic episodes and might be dangerous to themselves or to others. The officer has the option of taking that person to jail, which police say usually doesn’t make sense. The other option is a trip to a hospital emergency room, where staff can assess the newly arrived patient and eventually find placement, most likely in a hospital psychiatric room.

That’s where the little waiting room comes in. Police officers are required to stay with people they have brought in until a physician tells them they can leave. But with inpatient psychiatric rooms often filled, and hospital psychiatrists often unavailable, assessment and placement can take hours. So the police officers wait.

Police had hoped that a solution to this longstanding issue was at hand, now that Multnomah County is proceeding with a new crisis assessment and treatment center for mental health patients. But ironically, as plans for this project become clearer, it appears that police officers still will be left frustrated — and still waiting.

In July, county commissioners voted to build the new crisis center, also known as a sub-acute facility, to fill what police, mental health providers and hospitals have long seen as a serious gap in mental health services. The new center would share space in a building that houses nonprofit Central City Concern’s David P. Hooper Detoxification Center, east of the Burnside Bridge. Remodeling for the new center is expected to begin next spring.

In most American cities, police can take people displaying psychosis to a psychiatric emergency room — similar to a regular hospital emergency room but set up to quickly triage psychiatric patients and get them off the hands of the police. Portland hasn’t had such a facility since the county’s Northeast Portland crisis triage center closed in 2001, but some sort of triage center is what Portland Assistant Police Chief Brian Martinek would like from the new sub-acute facility.

He’s not going to get it, however, largely because a number of conflicting interests have prevailed.

Administrators at local hospitals would like the center to relieve them of the hundreds of psychiatric patients — many uninsured — who clog their emergency departments even though they don’t need traditional emergency services.

Mental health advocates want a place where people in need of immediate psychiatric care and assessment are not mixed in with others who may be experiencing severe psychosis and needing physical restraint.

So the county’s plan calls for a 16-bed facility that would use the sanctuary model of care favored by many hospital psychiatric facilities, and that emphasizes minimal use of restraint and seclusion on patients who appear to be out of control.

Not enough money

Joanne Fuller, director of the Multnomah County Department of Human Services, which runs the public mental health system that will include the new center, says the renovation project is expected to cost between $3 million and $4 million. The county has spent $1 million to move the detox center, freeing up space at the Hooper building, which freed up $2 million of Portland Development Commission funds for the remodeling. Fuller says the county is still working on finding the last $1 million to $2 million.

The county estimates that operating the new center could cost around $3 million per year, about half of which could come from Oregon Health Plan coverage of patients. Fuller says the county doesn’t yet know where the rest of the money is going to come from — though some money currently spent on hospitalization of mental health patients might be reallocated to the center.

The shortage of available cash will require the new center to perform a limited role, with most patients there no more than 10 days. The hope is that short stays will help patients stabilize to the point that they can access community outpatient mental health services.

What nobody wants, according to Ed Blackburn, Central City Concern’s executive director, is a repeat of the last version of a crisis triage center. Blackburn says that plans for that facility were too grand, including 10 units of housing, case managers to help residents, a sub-acute facility with four holding rooms for triage, and a pharmacy.

In the end, Blackburn says, there wasn’t enough funding to support the old facility.

“What you had was a lot of people coming in to get their prescriptions refilled and it was a drop off place for police. Once the services started being taken away it collapsed,” Blackburn says.

No place for restraint

The less ambitious sub-acute center, which the county hopes to open by late 2011 or early 2012, has a chance of succeeding, according to Blackburn.

“This is going to be much more focused on people who are actually in crisis,” he says. “We’re not going to try to do too much.”

That is why the police won’t have their dropoff station.

Fuller says the new center will not be the place for people who need restraint, but it might be appropriate for some patients in psychosis who don’t appear violent.

Under current plans, if police officers think they have someone appropriate for the new center, they first would need to have the county’s mental health call center or Cascadia Behavioral Healthcare’s mobile Project Respond unit authorize placement at the new center.

But assistant chief Martinek says Project Respond too often is not available to police, who need an immediate response. And calls to the crisis line will put police officers in the position of having to assess the status of the person they’ve just picked up — a role Martinek says police would rather not have.

But that extra assessment step, Fuller says, will help keep the new center from becoming overloaded with patients who need detox from drugs or drinking more than they need mental health services — a problem at the previous crisis triage center.

The police often pick up people who need emergency medical treatment before they need mental health triage. County officials want to keep those pickups from overcrowding the center as well.

“If you become a triage center, you become an emergency center and you fill up too soon,” says David Hidalgo, senior operations manger for Multnomah County’s mental health division.

All of which leaves the police still looking for a way to disengage from assessing and spending time with psychotic citizens.

“This doesn’t solve the police problem,” Martinek says. “The mental health field and the law enforcement field are in way different places philosophically.”

OUR COMMENT – The Portland Police Bureau are not the users of this facility, or the deciders about what services are provided by this facility. The PPB, and the City of Portland, are not financial contributors to the project. The County has a long-standing agreement that it’s mental health services are PATIENT CENTERED. That means the needs and interests of the PATIENT are the foremost consideration in the planning and delivery of services.

The police are impatient for a solution to what they now are recognizing as a long-term shortcoming in their orientation to the issue of mental illness. For thousands of years they’ve been the cruel cudgel, the push out the door, the clang of a cell door. Now, with limited insight into their role as punishers of persons with mental illness, they’re seeking quick solutions.

Secondly, this facility is far from defined. The county plans many public meetings to develop a complete service plan. The police are going to be part of that planning – but it won’t be a drag-and-drop.

Central City Concern unveils Golden West Building African-American History Exhibit
October 22, 2009, 5:00 – 6:30 PM @ Carleton Hart Architects
322 NW 8th Avenue, Portland, Oregon
The celebration is free and open to the public

The Golden West Building houses the Bridgeview Community, a program managed by Luke Dorf, which provides housing and some case management for persons with severe and persistent mental illness who would otherwise be homeless.

In an earlier incarnation, the Golden West Hotel was at the center of Portland’s first African-American neighborhood early in the twentieth century. Due to its proximity to Union Station it served African American railroad workers denied lodging in other Portland hotels. It is one of the oldest remaining landmarks of African American history in Portland.

Central City Concern purchased and renovated the building in 1989, and recently took full ownership. For the past 19 years, the Golden West has served countless homeless and mentally ill people. In 2007 Central City Concern undertook a number of renovations to the building. We earmarked $4000 to restore the historic display that faces Everett Street sidewalks.

When the City of Portland Visions in Action grant program became known, Central City Concern contacted Old Town History Project Director Dr. Jackie Peterson who helped us put together an application. Central City Concern was awarded $9250 from the City and $1000 from the Oregon Council on the Humanities. The combined funds, plus in-kind labor contributions primarily by Central City Concern, will allow us to restore and improve the exhibit panels and to also add two new display windows on the Broadway side of the building and a sound component. The major goal is to convey the vibrancy of the African American neighborhood around the Golden West in the early part of the 20th century.

For more information, see Golden West Project

OUR COMMENT – This moment in history would have been forgotten without the persistent pestering and problem-solving of Will Bennett, a mental health advocate transforming into a scholar of African-American and Oregon history. Thank you Will.

We are pleased to invite you to a series of meetings designed to provide information on Multnomah County’s creation of a Crisis Assessment and Treatment Center.

The facility will serve as a place where people can receive mental health treatment instead of being sent to a hospital or a jail.

The center is a top priority for Multnomah County and its Board of Commissioners, and it’s slated to open roughly in 2012.

It will be an integral piece of the mental health care system. In order to make sure the center opens on time and meets the needs of the community, we need your help.

We would like you to attend two community engagement meetings this fall. The first will be held on Sept. 21 from 2 p.m. to 5 p.m. in the Lincoln Building, 421 S.W. Oak St.

The meetings will:

* Give community members a chance to look at architectural drawings and learn about the redesigned building; and

* Allow stakeholders to gain an understanding of the program’s overall goals and provide input.

After these community engagement meetings, our Mental Health and Addictions Services Division will create an advisory committee to continue looking over the project.

The advisory committee and the community will receive regular updates from the Mental Health and Addictions Services Division staff until the center is completed.

There’s a lot of work to be done before we can open the Crisis Assessment and Treatment Center. But we’d love to have your participation in creating this critical piece of our county’s mental health care system.

Please RSVP to Lisa Rand-Thibeau by e-mail at lisa.rand-thibeau@co.multnomah.or.us or by phone at 503-988-4055 no later than September 15th.

We look forward to hearing from you.

Sincerely,

Joanne Fuller, Director Multnomah County Human Services

OUR COMMENT – Ed Blackburn, executive director of Central City Concern told Multnomah County Commissioners on July 2 2009 this facility would be open in April 2010.

Remember – mental health treatment delayed is mental health treatment denied.

From the Oregonian, July 2 2009

Multnomah County commissioners today voted 4-0 to approve a record $925,000 settlement to end its part in the federal civil rights lawsuit brought 2 1/2 years ago by the family of James P. Chasse Jr.

“We believe this is a good business decision for the county and for the taxpayers of Multnomah County,” county attorney Agnes Sowle told the commissioners. She added that the settlement does not suggest wrongdoing by the county.

Chairman Ted Wheeler said he felt grateful that Chasse’s family agreed with the county, allowing officials to focus on improving mental health services.

“I think it allows us to get beyond the legal issues to improve our delivery of mental health care,” Wheeler said. ” In order to do that, we need to work together.”

Portland attorney Tom Steenson, representing Chasse’s family, said the settlement does not effect the pending lawsuit against the remaining defendants, including the city of Portland and American Medical Response, Inc.

The family is preparing for a March 16 2010 trial, accusing two Portland police officers of excessive force, denial of proper medical attention, and discriminating against Chasse because of his mental illness, Steenson said.

Chasse, 42, who suffered from schizophrenia, was chased by officers who said he appeared to be urinating in the Pearl District on Sept. 17, 2006. The officers knocked him to the ground and struggled to handcuff him. He suffered multiple broken ribs, some of which punctured his left lung, early in his encounter with the Portland officers and a sheriff’s deputy.

Ambulance paramedics who responded said Chasse’s vital signs were normal, and police drove him to the Multnomah County Detention Center.

He appeared to suffer a seizure in a holding cell. A jail nurse looked through the cell door window and told police the jail would not book Chasse. Portland police placed him in a patrol car, where he died on the way to a hospital. The cause of death: broad-based blunt force trauma to his chest.

The settlement would remove from the lawsuit the county and its employees, including then-sheriff’s Deputy Bret Burton, who was involved in the initial struggle with Chasse, and jail nurses, who are accused of failing to examine or treat Chasse or call an ambulance.

Before accepting the settlement, the Chasse family made sure the county made changes to ensure that ambulances – not law enforcement vehicles – are used to transport injured people to provide appropriate medical care.

Wheeler scheduled the vote as the county pressed forward with a 16-bed mental health crisis treatment center in Portland. The Portland Development Commission has set aside $2 million to redevelop the David P. Hooper Center as the county’s new mental health triage center. The city and county have pledged to split the $3 million operating costs. The state has also pledged support.

“We have an opportunity to begin a process of filling a big gap in the services to people who are experiencing mental health crises in Multnomah County,” said Joanne Fuller, director of the county’s Department of Human Services.

Wheeler said the new crisis center would be a “humane and cost-effective alternative” to taking someone with a mental health crisis to jail, or to the hospital.

Ed Blackburn, executive director of Central City Concern, said the new site for Hooper detox center should be available by April 2010. He said he’ll work to have the renovated Hooper facility available for the mental health crisis center by either late 2011 or early 2012.

Richard Harris, who heads the state Division of Addictions and Mental Health Services, said he supports the county’s move to steer mentally ill people to more appropriate care, which will likely reduce state hospitalization costs. He said similar crisis centers are needed across Oregon, not just in Multnomah County.

EXTRA – County settles in death suit, KOIN.com
EXTRA – Multco board approves $925,000 payment for Chasse’s family, KATU.com

From Joanne Fuller, director of the Multnomah County Department of County Human Services, distributed June 26 2009

Multnomah County has been working to site, develop and fund a Crisis Treatment & Assessment Center (formally referred to as the sub acute mental health facility) for several years. This 16-bed secure facility would offer short-term mental health crisis stabilization for persons in acute mental health crisis who would benefit from an alternative to a costly hospitalization. Approximately six hundred individuals could be served each year. Each individual would stay in the center for up to ten days with an average length of stay of fewer than seven days. This facility has the potential to divert individuals not only from psychiatric hospitalization but also from inappropriate placement in jail. It would offer a less restrictive, more supportive and more welcoming environment for individuals who did not need the intensive medical services of a hospital. Individuals experiencing a mental health crisis would be referred by the police, other emergency responders and county mental health crisis services.

Developments within the Past Year : Recently Multnomah County entered into an agreement with Central City Concern (CCC) to utilize space in the Hooper Center at 20 NE Martin Luther King Boulevard as a Mental Health Crisis Assessment & Treatment Center (CATC) facility starting in fiscal 2011. CCC will be renovating the building for this purpose. The current plan calls for CCC to renovate the former Ramada Inn in the Rose Quarter as a housing and drug/alcohol detoxification facility. Once the Ramada is renovated, the detoxification program will be moved from the Hooper building to the Ramada. That will allow CCC to remodel Hooper so that sobering services remain on the first floor and the second floor becomes available for use as a CATC.

Multnomah County has provided CCC with $1 million for the part of the renovation of the Ramada. CCC plans to use $2 million provided by the Portland Development Commission for the Hooper remodel.. The Ramada renovation is underway and the planning for the Hooper remodel will begin in the summer of 2009. The county and CCC will complete a feasibility study of the Hooper site this summer and fall. That study will result in a detailed plan for the remodel of the Hooper facility including costs. The county, the city and other partners will seek additional funds if needed to fully cover the cost to remodel the Hooper building.

The county continues to work on identifying the operating funds for the CATC. The estimated total annual cost for operating the center would be $3.4 million. The county, in its role as an Oregon Health Plan Mental Health Organization (Verity) pays for hospitalization of its members when a member receives treatment at the Center. Verity will provide reimbursement. An estimated $1.6 million in Oregon Health Plan funding may be used for this service through Verity. Because the county is the payer of last resort for involuntary mental health hospitalization, the county may be able to utilize local funds currently used to pay for hospitalization for individuals that could be better served in the CATC than in the hospital. The county continues to meet with the State Department of Human Services regarding additional funding for the remodel of the Hooper Center and operations of the CATC services.

Because of its potential to divert individuals from jail and hospitalizations, the Mental Health Crisis Assessment & Treatment Center continues to be a high priority for the mental health system and other community stakeholders. The Local Public Safety Coordinating Council engaged in a thorough public safety planning process last year and the CATC was identified as a top priority in the final Public Safety Report.

From The Oregonian, June 1 2009

Instead of turning away addicted mothers and their young children, Nancy Anderson is once again gearing up to accept them into one of the state’s few residential drug and alcohol treatment programs for such women.

The normally tough director of the Letty Owings Center had been awash with worry since the governor released a budget to cut state money for residential treatment by 80 percent. That would have meant shutting down most of the places that house Oregon’s 476 state-funded treatment beds, including 43 at Letty Owings.

But in an unexpected turn, the Legislature’s Joint Ways and Means Committee didn’t make a single cut to residential treatment in the new two-year state budget. The state provides three-fourths of the money — $15 million annually — for Oregon’s residential treatment.

“It’s kind of astounding,” said Anderson, who had started taking fewer clients to prepare for the worst. “Maybe they heard us. Maybe the Legislature heard us.”

In the hours after the budget’s release, some social services officials were so sure of big cuts that they weren’t sure they were reading the numbers right.

“It doesn’t look like they reduced funding at all — we’re still waiting for confirmation from the state,” said Joanne Fuller, director of the Multnomah County Department of Human Services. “If it’s true, then it’s incredibly exciting for us and important for our community.”

In March, Sen. Margaret Carter, Ways and Means co-chair, had vowed to protect residential treatment, but warned with the state facing a multibillion-dollar shortfall, nothing would go untouched.

Yet Carter, D-Portland, said the high cost to the state if treatment dried up for addicts — particularly addicts who are parents — outweighed any immediate benefit of cuts. She also emphasized the role of public testimony for treatment.

“It influenced my decision greatly,” Carter said. “The message was strong all across this state to make sure we preserve drug and alcohol programs because so many Oregonians are crippled” by addiction.

But lawmakers still must pass the budget and cuts could still come.

In the meantime, the potential crisis highlighted the vulnerability of treatment funding and the need to find permanent dollars and create a stable and accountable system, said Attorney General John Kroger.

“The system as a whole is not a successful one,” Kroger said. “We need to produce a coherent long-term plan for drug treatment.”

Kroger has drafted a bill calling for the creation of a state commission that would find permanent funding, allow more people to get treatment and force providers to track the success of their programs once people have gone through them.

“The current budget crisis is in a lot of ways an opportunity for us,” he said. “Right now providers can’t add treatment beds because they’re never certain if they’re going to have the money to pay for them. We have a very weak treatment and prevention program. Ten years from now I want us to have a very good one.”

Anderson has no arguments with that. The waiting lists for people to get into drug treatment across the state can be four months long. And like other providers, Anderson would love to track families once they leave her doors, but doesn’t have the money to do it.

For now, she’s relieved that she isn’t going to have to turn away the women who want to turn their lives around.

“We told them about the budget and they are just so happy,” Anderson said. “We’re gearing back up again.”

EXTRA – Letty Owings Center – Central City Concern
READ – Oregon drug treatment cuts: a lot to lose, The Oregonian – March 30 2009

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.

Richard Harris takes on Oregon’s Mental Health and Addictions Division

Interview by Amanda Waldroupe, published by Street Roots, October 24 2008

The Oregon office of Addictions and Mental Health Division is moving and shaking.

On September 12, it was announced that Richard Harris, 68, the retiring executive director of Central City Concern, would replace Bob Nikkel and serve as interim director of the division.

Tapping Harris to head the Addictions and Mental Health office, which is a division within the state’s Department of Human Services, is nothing short of bold: His admirers say Harris is perhaps the only person in the state who has the integrity and experience to tackle the challenges facing Oregon’s mental health and drug treatment systems.

Some of those challenges include a dilapidated state hospital that was taken through the wringer by an investigation conducted by the Department of Justice released in January of this year, determining the future of Cascadia after its April financial implosion, bolstering the state’s community health systems, and all in times of scarce financial resources.

Harris has a solution, one that he has found working for Central City Concern for 29 years. The social service agency’s nationally recognized way of providing alcohol, addiction and mental health services—combining supportive services with housing in a supportive community—is a model he hopes to begin replicating at the state level.

Harris started the job on Monday, September 29. In an interview with Street Roots, Harris talked about his plans for being interim director and some of the challenges he faces.

Amanda Waldroupe: Why are you coming out of retirement to be the interim director of Addictions and Mental Health Division?

Richard Harris: I was on the track to retire. I had a series of meetings with Bruce Goldberg (Director of the Oregon Department of Human Services). After one of those meetings, he asked me if I would consider coming to AMH on an interim basis while the department did a national search. I wrestled with that about a month, trying to understand what it really meant. Bruce and I had several conversations. I think we came to the understanding that we had a mutual interest. My interest was in preparing the AMH in adopting an integrated model or approach to the problems of addiction and mental health. That means combining health, housing, employment services, and drug services in a more coordinated and integrated fashion. I think that’s Bruce’s dream, and I think that’s my dream.

A.W. What is important about an integrated approach? Why is it needed?

R.H. My experience on the ground here, operating programs over the last 25 to 29 years, has been a gradual understanding of how powerful housing combined with services becomes if you’re trying to intervene with problems like homelessness, addiction, and mental health.

The synergy that comes from housing combined with services is pretty amazing. When we started, we thought were just trying to get people into addiction and drug treatment services. Only later when we started combining the services did we understand why services were more effective when people are in more stable housing. And housing worked better for people if they had adequate services. This integrated service model is not easy to do. It’s very challenging. We see the outcomes. Since the state of Oregon is not organized, it requires working with all levels to find common ground here. That is the dialog I want to see get started.

We’ve learned a lot about how we make alcohol and drug services effective. I think we have (Central City Concern) about the most effective alcohol and drug treatment program certainly amongst any alcohol and drug programs I know of. A lot of it has to do with providing housing, and providing recovery mentors, on top of what we might call normal outpatient services. If you’re dealing with a late stage alcoholic population, getting people to live in sober environments is huge. If you put the right pieces in place, you get much better results. What we’ve learned is that we get very good outcomes with serious heroin addicts when we provide mentors, acupuncture, health care, alcohol and drug treatment and housing. If you took any of those elements out, you get less outcomes.

A.W. What works and what doesn’t work?

R.H. Housing is critical to the issue. Not only does it meet a basic need that people have, but we’ve come to see housing as a place and environment where not only healing takes place but positive relationship building. 8 NW 8th is more about a supportive based community. You build self-esteem and it comes from other people. Personal relationships are what matters. People will stay clean and sober because they’ve incorporated it into their lives. People who want to stay clean and sober will do it better when they have support from their peers. Housing creates a sense of community for someone. Their thinking is not all jumbled up with drugs. Housing does two things: creates a supportive community, and it does put a sense of security in your life. All of those are elemental.

I have learned so much from people in recovery. We need to make sure part of who we’re listening to is people effected by services. It’s inspirational, motivational, but because of experience, they have a unique view of how to deliver services. I intend to listen to and rely on a lot of people who have been through these issues.

A.W. You believe the Oregon Health Plan (OHP) should be playing a larger role in helping individuals dealing with a mental health problem. What would you like to see change with OHP?

R.H. I think the Oregon Health Plan was a bold move to advance this type of health insurance program, and we’ve just backed off of it by chopping it down. It’s cost us more money to leave uninsured people on the streets.

One of the things I want to look at is adding people back into the plan, particularly people who have alcohol, drug, and mental health issues. What are the cost drivers in our criminal justice system, in our mental health system? Ultimately, what you come down to is if you don’t treat addictions, you do it in the jails. Over 70% of people in prison are there as a result of addiction or a drug related crime.

A.W. How does spending money on policies like mandatory minimums affect Oregon’s ability to provide adequate mental health care?

R.H. We’re in a situation where if you spend money on jails and prisons you’re not going to spend it on health care and mental health. The two ballot measures (Measures 57 and 61) are likely to have a huge financial impact. It’s a problem.

I’m very much interested in how our next Attorney General (John Kroger) is going to take this on, because he clearly understands if you don’t do something about addiction issues, you can’t get a hold of criminality issues. The most effective way to reduce crime is to get addicts off the street. But where is he going to get the money? If you’re spending resources on more prisons, it’s less money in the zero sum game we have in the state budget.

A.W. What do you think is the single biggest challenge for Oregon’s mental health system?

R. H. I’m not sure. I’m an outsider. I don’t spend my everyday thinking about what the biggest challenges are to the mental health system. I think there are a lot of challenges. I do believe that people will probably agree that there are a lack of resources to deliver the quality of services that people deserve. It goes without saying that it’s under funded. The question is how you focus and prioritize resources, and how you make services more effective.

A.W. Since Cascadia defaulted on a 2.5 million dollar credit line, the county, state and service agencies have stepped up to continue funding Cascadia or taking over some of its services. What if Cascadia, Oregon’s largest mental health provider, fails or gets so small that it cannot offer the same services to its clients?

R. H. We’ve downsized it so far and that seems to be working. That means there’s far less pressure on Cascadia. It’s down to a manageable size. They’ll be more focused. That probably will work. If it doesn’t, it means another agency may need to consider taking on some of the services Cascadia provides. Cascadia needs to be successful. This is a complicated population of people to serve. I’m fairly optimistic that (the actions taken) will help them stay solvent.

A.W. The Department of Justice investigation on the conditions and practices of the Oregon State Hospital (OSH), released in January of 2008, concluded that “numerous conditions and practices at OSH violate the constitutional and statutory rights of its residents.” What do you think are appropriate responses to improving the conditions at the Oregon State Hospital?

R. H. It’s not an area I’m particularly knowledgeable about, but ultimately, someone else is responsible for that. The thing I would say about the State Hospital…is that they are necessary services for some, and that they should be seen as they typically are, as services of last resort. You enhance state hospital programs by providing effective community health services. Funding adequately that kind of community mental health structure has never really happened in Oregon. We have been struggling with this issue for a long time.

A.W. The big missing lynchpin of Multnomah County’s mental health system is a sub acute center. There have been movements lately to get one started. What can the state do to help the county achieve this?

R.H. That’s a really good question. I’m not sure if I know enough about the way state resources can be directed to counties for certain things. That’s something I need to learn more about. It’s going to take some assistance from the state to create the services.

A.W. The anniversary of James Chasse’s death recently passed (on September 17). What do you think of the strides Multnomah County and Portland have made since his death?

R.H. My understanding is that there’s been some additional training for the police and added resources. Is that enough? I think you have to look at what kind of services you’re going to provide and whether they’re going to be adequate. Because he (Chasse) was involved in services. He had housing. I’m not sure that this won’t repeat.

Ed Blackburn, executive director of Central City Concern, the largest provider of social housing in Portland.

Prince George Citizen, October 13 2008

It’s shortly before 10 p.m. on a brisk fall night and Lio Alaatatoa and Quinn Colling, two outreach workers who specialize in establishing contact with the homeless are underneath one of the many bridges crossing the Willamette River into Portland’s downtown.

About a half-dozen “campers” scattered among the pillars of what’s a parking lot in the daytime emerge from underneath sleeping bags and blankets and make their way over to the back of a van where the two are passing out cups of soup and blankets.

The mood is upbeat and the two are repaid with appreciative smiles and heartfelt thanks. It’s the same sort of response all the way along as they drive from spot to spot looking for those who are still awake and in need of a little help.

Making sure everyone is comfortable as they nestle into doorways and alcoves for a night’s sleep is not their only job. In fact, it’s a rare occasion when they’re able to bear such gifts.

Alaatatoa and Colling work for JOIN, a social agency whose motto is “connecting the street to a home” and on most nights they carry nothing more than business cards and search for homeless who may make good candidates for an alphabet soup of programs designed to make them productive members of society.

Throughout the tour, Alaatatoa and Colling stress the importance of establishing a relationship and developing a level of trust. Shortly after we stop at the foot of some towering pillars where the same bridge begins to soar over the river, Alaatatoa, an avuncular, soft-spoken Samoan may have found a prospect.

A woman in her 20s who’s been sleeping out the street for about a week but still carrying a cheery demeanour expresses her joy at getting an extra blanket to survive the looming cold. Like Alaatoa, she possesses a Polynesian complexion and asks if he’s from Hawaii – a rapport has begun.

While roots may be important to the woman, what matters to Alaatoa is that she says she’s been going to a temp agency during the day in search of a job. He gives her a business card and urges her to show up at the JOIN office the next day.

Within a couple hours Alaatoa and Colling have completed their drive and although they could go home now, they’re kind enough to take me over to an all-night diner where we talk about the “housing first” approach to dealing with the homeless, where people on the streets are put into stable accommodation before work on their other issues begins.

So far, the approach has been reasonably successful – about 80 per cent of the 1,500 or so homeless who’ve been put into housing over the program’s first two years remain indoors and working on the shortcomings that got them into trouble in the first place.

In general terms, Alaatatoa and Colling like the idea, but also stress there are those who don’t make it and contend it’s not for everyone. The conversation turns to a perplexing character we encountered earlier, an elderly gentleman who on paper would make a perfect candidate for the program.

An alcoholic who’s had his share of visits to the hospital, he had recently recovered from a broken ankle suffered when he fell after drinking too much. It’s estimated that the 10 per cent of homeless who are considered chronic — defined as someone with a disabling condition who’s been out on the street for more than a year — consume 50 per cent of the total resources spent on the homeless they cycle through the social services system, hospitals, corrections, and emergency services.

Under the housing first model, housing is not contingent on compliance with services – instead, participants only have to live up to a standard lease agreement and are provided with the services and supports that are necessary to help them do so successfully.

But he simply does not want to go inside for for a grocery list of reasons, a fear of failure and a reluctance to enter “low barrier” housing where he’d be placed with other alcoholics and drug addicts prime among them.

“You need to listen to the homeless themselves because they know best what they need,” Alaatoa emphasized.

The next morning at the offices of Central City Concern, the largest provider of non-profit housing in Portland, executive director Ed Blackburn agrees.

“There is not one thing that works for everyone,” he said, and went on to note that CCC provides a eight different types of housing, ranging from so-called “wet” or “low barrier” housing where addicts are not required to quit their habits, to alcohol and drug-free housing for families.

Even so, there’s a handful who are simply too troublesome.

“They tend to be very difficult, they tend to drive other residents crazy, they give staff a constant bad time and they cross the line and can be evicted,” Blackburn said. “You work with them and work with them and staff are exhausted and say o.k., that’s it, bye.

“There’s no perfect approach to this but you can significantly reduce the number of people on the street by providing housing,” he said, noting about 400 people who’ve averaged 8.5 years of homelessness have been housed by CCC in the last three years.

He also urges social service providers to “throw out the parameters” and include both harm reduction and recovery approaches in their programs.

“Look at the person’s needs, what they want and what they are motivated to do,” Blackburn said and added that mixing those who want to quit their habits with those who don’t is a recipe for trouble.
“It’s more cost effective to customize your housing alternatives,” he said.

Under a plan to end homeless in a decade, the City of Portland and Multnomah County intends to establish 2,200 units of permanent supportive housing by 2015 — 1,600 for chronically homeless single adults and 600 for homeless families with special needs.

About half of these units, 1,200, are expected to be found through new construction or acquisition and rehabilitation of existing buildings and the other 1,000 from existing units — both affordable and private market — through rent subsidies and services.

CCC owns 19 properties, totaling 1,300 units of housing. Pride of place goes to the 11-storey Richard L. Harris building, named after Blackburn’s predecessor at CCC, that towers over a nearby park that used to be frequented by drug dealers but is now reasonably trouble free.

It not only holds 180 units of dorm-like single-room occupancy housing but a one-stop medical centre is housed on the building’s first two floors. Similar to the Central Interior Native Health Centre in Prince George, it offers a wide range of health services including acupuncture, which Blackburn said is helpful in easing the cravings addicts are trying to overcome.

Blackburn’s emphasis on providing a wide range of options was a message not lost on Mayor Colin Kinsley who toured CCC projects during last week’s trip to the city of 570,000.

“The continuum of care is so very important,” Kinsley said. “I’ve heard about it, and I’ve now actually seen it in action. Get them into a bed and get the process started.”

Coun. Murry Krause had similar comments.

“It really is about the individual and the issues they have,” he said.

The last public meeting co-hosted by Metro and the Mental Health Association of Portland about the creation of a memorial for the patients of the Hawthorne Asylum and a remembrance of the good works of Dr. James C Hawthorne is TODAY.

Public Meeting Today October 10
2:30 PM
Central City Concern
Richard Harris Community – 8 NW Eight Avenue, Portland
8 NW 8th Avenue, downtown. See a MAP.
Public transportation: Bus 20 Burnside / Stark

For over one hundred years Lone Fir Cemetery has been the resting place for hundreds of patients of the Hawthorne Asylum. These graves are mostly unmarked, relatively unknown, and until recently were rudely covered with an access road, a county building and a parking lot. Metro intends to do something about this – and wants the input of people interested in the welfare of those with mental illness before proceeding.

EXTRA – The Lone Fir Cemetery and the Asylum Patients of Dr. James C. Hawthorne – PDF
EXTRA – Lone Fir Cemetery and the Asylum Patients of Dr. James Hawthorne
EXTRA – Oregon State Hospital Patient Remains

Can’t make it? You can still participate and help by taking the ONLINE SURVEY. The survey will remain open until October 15.

From the Portland Mercury, October 8 2008

In a room two stories above the North Park Blocks, Jeremy’s ears are full of carefully placed needles. His body seems a bit tense as he recounts the last time he used heroin, 49 days ago. “I just realized that [getting high] didn’t feel as good as the experiences I’ve had being clean and sober,” he says. “Synthetic happiness is just not as good as spiritual happiness.”

Around Jeremy, a half-dozen other addicts recline in deeply cushioned chairs, the air filled with tinkling Asian music. In all of their ears are five thin pins. All of them are using acupuncture in an attempt to keep clean.

For 20 years, acupuncture has been an integral part of Portland’s approach to treating drug and alcohol addiction. But recently, the need for heroin treatment has jumped, while funding has been slashed.

In June and July alone, 117 people overdosed on heroin in downtown Portland—double the number of overdoses for the same time period last year, says Central Precinct Commander Mike Reese. Behind the alarming increase is a change in the kind of heroin available in Portland. The cops’ drug and vice unit says Portland’s heroin is the purest bought and sold on any city’s streets in the US, funneled to Oregon by Mexican drug cartels. The purer the heroin, the stronger its effects and the stronger its grip on addicts.

According to a Multnomah County study, one proven way to keep addicts in therapy and get them through the harrowing first few days of withdrawal without relapsing is using acupuncture in therapy. But right now, the need for treatment in Portland is overwhelming programs.

For Central City Concern Executive Director Ed Blackburn, the increase in demand for treatment is obvious. Ten years ago, when he worked at Hooper Detoxification Center on NE MLK—the first place addicts land when trying to get clean—the clinic occasionally had to turn away 10 people a day. Now, they often turn away up to 50 people. There are 54 beds at Hooper and Blackburn estimates funding only covers 38. As for the rest, “We fill ‘em, we just lose money sometimes,” he says. “We have the same capacity we had in 1984.”

In the room where Jeremy receives acupuncture five times a week as part of a months-long rehab program run by Central City Concern, three acupuncturists treat 50 to 60 recovering addicts a day. The staff was twice that size until 2004, when the Oregon Health Plan made major budget cuts. And “all bets are off” as to the program’s future funding, says Blackburn, citing the current economic picture.

Yet acupuncture is a proven treatment method. The 1999 Multnomah County study found that addicts receiving acupuncture in therapy were 20 percent more likely to get through the first few days of withdrawal, and twice as likely to continue long-term rehab.

“It’s subtle. It takes the edge off,” says Jeremy, with a thin needle stuck right between his eyes. “It makes me feel more at peace in my own skin, and I’ve had tremendous problems with that.”

Other options for quitting heroin involve taking methadone, a chemical anesthetic. “If someone’s doing methadone daily, it’s different than what we’re doing. We’re trying to get them off all drugs,” says Chuck Sve, one of Jeremy’s acupuncturists. “They come in and they’re feeling nauseous, they’re irritable, they’re not well. We put the needles in and they’re chill. It calms them down without any use of force or anything.” Once patients are calm and their bodies no longer pained and twitching, they’re much more able to participate in counseling sessions.

Acupuncturist David Eisen, who directs addiction treatment center Quest Center for Integrative Health, points out that the acupuncture helps with long-term withdrawal symptoms that lead to relapse, like depression and insomnia. “When I can’t sleep, there’s certain sleep points that really help,” says one of his clients, Stephen, referring to acupuncture pressure points. “It still takes me three hours to fall asleep, but I don’t need to run out and get shots of whiskey to help.”

This week, Stephen celebrated his ninth month of sobriety. “It was definitely either this or jumping off a bridge,” he says.

Hooper Detox

From OPB.org, September 4 2008

Several local health care providers are helping keep a regional detox center open — at least for the next two years.

LISTEN to this report.

A handful of local health care providers contributed six-hundred-thousand dollars to keep the sobering station at Hooper Detox in Portland operating.

The center is operated by the non-profit Central City Concern. It’s a place for police to take people found in public who are inebriated to the point of incapacitation.

This condition can be deadly if not properly treated.

Dave Underriner is an executive with Providence Health and Services, one of the health care providers that contributed funds to the detox center.

He says it’s a lot cheaper to treat people at a specialty detox center than the emergency room.

Dave Underriner “I mean you look at the sobering station, you look at what Central City Concern is doing, it’s a great program and to lose that, and then to end up having the emergency department be the place where people end up going, it doesn’t make any sense at all.”

EXTRA – Hospitals, insurers fill detox center budget gap, Oregonian September 4 2008
EXTRA – Hooper Detoxification Center gives people a safe place to sober up, Oregonian, September 10 2008

Multnomah County officials say they’re working on a sustainable way to fund the detox center.