Mental Health Association of Portland

By Maxine Bernstein, The Oregonian, May 4, 2013

After her son died, Carol Slaney found help at the CATC.

Carol Slaney woke up Jan. 31 to find her 26-year-old son dead beside her bed from an accidental drug overdose. She grabbed a .45-caliber revolver and disappeared, hiding in an abandoned house behind her Southeast Portland apartment.

“I just sat in that house, spinning the gun, planning my death,” Slaney said. “He was my world.”

Worried family members called police to check on her. As officers shined flashlights into the windows of her apartment, Slaney watched through the window of the derelict home nearby.

Slaney, who suffers from depression and post-traumatic stress disorder, had been placed on mental health holds before, a self-described frequent flyer at hospital emergency rooms. She didn’t want to return there, so she remained hidden from police.

On her fourth day alone, Slaney desperately called her case manager and pleaded, “I need to go to CATC.”

Peer support counselor Ashleigh Brenton

“In my darkest time, they just took my hand and walked with me,” Slaney, 49, said this week, as she sat inside the Multnomah County’s Crisis and Assessment and Treatment Center. “This place is personal and genuine. CATC is probably my savior.”

The 16-bed secure center opened in June 2011 off Northeast Grand Avenue to considerable fanfare by city, county and state officials. They touted it as a much-needed alternative to jail and hospital emergency rooms for people suffering a mental health crisis. Portland’s City Council resolution called the investment “a very high priority.”

But nearly two years later, Mayor Charlie Hales has recommended cutting the city’s annual $634,000 share of funding for the center, based on reports from Portland police that they haven’t found it useful.

CATC Administrator Dan Clune

Some veteran patrol officers dedicated to crisis intervention work say they didn’t know the center existed. The Police Bureau hasn’t encouraged officers to bring people they encounter there, largely because it doesn’t allow for drop-offs.

“It’s a valuable service,” said Lt. Cliff Bacigalupi, who is supervising the creation of a new police crisis intervention team. “It just wasn’t a good fit for us.”

Center managers, though, point to statistics that show while Portland police aren’t taking people directly to the center, many of the people they encounter are ending up there for treatment anyway.

To date, the center has treated 1,300 people. Of those, 942 patients came from emergency departments, where police likely took them initially, county officials said. Another 358 came from community referrals through social service agencies and the county jail. Of those referrals, 82 came from Project Respond staffers, who police regularly call out to mental health emergencies.

Peer support counselor Akil Stigler

“We discovered the police have been using it indirectly,” said Jeff Cogen, Multnomah County chairman. “But it doesn’t have to happen that way.”

The center, on the second floor of the David P. Hooper Sobering Center, serves adults 18 or older who live in Multnomah County and have serious mental illness. They must be indigent or have insurance coverage through Oregon Health Plan-Health Share.

The locked floor with 16 rooms resembles a wing of a hospital, yet with a lounge area decorated with patients’ artwork, an outdoor patio with picnic tables and a kitchen. It’s the only short-term crisis center of its kind in the county.

Patients stay from four to 14 days, until their symptoms stabilize. They must have a diagnosed mental illness, be referred from either a community care provider, an emergency room or acute hospital unit. They also must have stable medical vital signs on arrival. Upon discharge, they leave with a plan for follow-up treatment.

A patient room at the CATC.

Mental health clinicians, psychiatrists, nurses and peer support specialists are on staff 24 hours, seven days a week.

If the Portland City Council approves the mayor’s proposed cut, the county-run center expects to reduce its beds to 11 and serve about 200 fewer people a year. The city and county had agreed in 2010 to each pay 20 percent, or $634,000, of the center’s $3.5 million operating costs. The state picks up the rest.

Police say the center simply isn’t practical for patrol officers. In a March 2012 report, they said they can’t take people straight there and that the center doesn’t accept patients who are a danger to themselves or others, combative or assaultive, high on drugs or drunk. Instead, the report said, police end up arresting people in crisis and taking them to jail or driving them to local emergency rooms.

READ – Police Bureau report on CATC, March 2012

Outside patio at the CATC.

The Police Bureau’s position baffles center administrators, particularly when federal investigators have demanded Portland police improve their encounters with people suffering from mental illness.

The county also has a dedicated line for police to call when dealing with mental health emergencies and the staff can refer them to the crisis center. But police have rarely used it.

Center managers said police can request workers from the nonprofit Project Respond to assess people in the field and refer them to the center for treatment when appropriate.

Project Respond tries to use the center as much as possible, said the agency’s director, Jay Auslander. “It allows some folks to avoid going to the ER, or helps shorten their hospital visits,” he said.

Staff meeting at shift change.

Center managers estimate that it takes an average of 15 to 30 minutes to admit a person, often a far cry from the lengthy wait police find at hospital ERs.

They also dispute that the police claim that the center doesn’t treat people who are a danger to themselves or others.

“We take those folks all the time,” said Kevin McChesney, the regional director for Telecare, which contracts with the county to operate the center. In fact, he said, most patients are considered a danger to themselves or others.

Center workers just want to make sure police have disarmed the people so they’re not an immediate threat, he said.

Artwork on the wall was done by a former patient.

“We can certainly take people police pluck off a bridge who are suicidal,” McChesney added. But he acknowledged: “We’re not so certain about the person swinging an ax.”

It appears from his discussions with police, McChesney said, that they want a drop-off treatment center that accepts people without a referral, similar to the county-sponsored Crisis Triage Center that operated at Providence Medical Center until its closure in 2003.

“It seems to me they want an all or nothing solution. There needs to be a cooperative effort with police and so far that hasn’t occurred,” he said. “I think there are additional avenues where police can use this. There really hasn’t been a great dialogue about that, and I would welcome that.”

Police Capt. Sara Westbrook said most of the people officers place on mental health holds require a higher level of security and care than the patients accepted at the center. It just isn’t a good option for police, she said.

The mayor said the city is working to seal an agreement with the U.S. Department of Justice for police reforms on how to help people with mental illness.

“If it’s the county center or another resource, the bottom line is helping people who the police encounter,” Hales said by email. “… We’re actively engaged with a wide array of parties to determine the type of resources that would be of greatest practical assistance to our officers on the street.”

Slaney has been admitted to the crisis center at least five different times. She’s gotten to know the staff, many of whom had met her son, Jonathan, during his visits with her. He died from methadone and methamphetamine toxicity.

“Sometimes I get weak and fall astray and return here,” she said. “I didn’t think anyone could ever understand. I didn’t see no hope. But the staff here reminded me that I needed to honor my son’s memory. Regardless of my mental illness, you’re made to feel special here.”

Slaney recently packed up her son’s clothes and donated them to the crisis center.

“They don’t get enough credit for who they are and what they’re about,” she said. “I just knew where I was, and what they’ve done for me.”

County Chair Jeff Cogen

Mayor Charlie Hales stunned Multnomah County officials Tuesday when he announced that the city would no longer pay its share of a 16-bed secure mental health treatment center that opened two years ago after the death of James P. Chasse Jr.

Portland Police Chief Mike Reese presented a report to the Downtown Public Safety Action Committee on Feb. 14th, defending his bureau’s record in dealing with suicidal people. So far, there are seven stories in the local media, included in full in this post – use the following Links to go to each section.

The Oregonian: Portland Chief Mike Reese Defends Use of Force, Says Officers Responding to Twice as Many Suicide Calls

KGW TV Video: MHAP’s own Jason Renaud in the KGW TV Hot Box

KGW TV: Review: Police Force Down in Oregon, Suicides Up

KPTV Video: Portland Police Bureau Sees Drastic Increase in Suicide Calls

OPB News: Portland Police See Increase In Suicide Calls

Portland Mercury: A Chief’s Consistent Plea

Oregonian Editorial: Widening the Lens on ‘Suicide by Cop’

Some Background Information:

What happened to Aaron Campbell

What happened to Brad Morgan

Portland Chief Mike Reese Defends Use of Force, Says Officers Responding to Twice as Many Suicide Calls

By Maxine Bernstein, The Oregonian, Tuesday, February 14, 2012

Portland Police Chief Mike Reese defends his bureau's record in coping with increasing number of suicidal subjects.

Portland Police Chief Mike Reese this morning went on the offensive, defending his officers use of force as he presented a report to a downtown public safety group about the increasing number of suicidal calls to police in the city.

“We’re trying to do good in a very broken system,” Reese said, speaking in the Rose Room of City Hall.

The chief and Sgt. Greg Stewart pointed out the city police are responding to nearly double the number of calls involving either someone who is attempting suicide, threatening suicide or has completed suicide since 2001.

In 2011, police took 1200 such calls, compared to 630 in 2001, the bureau’s report said. In 2011, police took 1100 people into protective custody. The actual number of suicides in Multnomah County between 2001 and 2009 did not rise as dramatically – 111 in 2009, compared to 83 in 2001.

“When officers get there quickly, we save a lot of lives,” Reese said.

The chief also presented bar graphs that showed a decline in police use of force between 2008 and 2011. In 2011, the bureau data shows police used force in less than .3 percent of all contacts and less than 4 percent of all arrests.

“One of the things we’ve done very well over the last few years is manage force,” Reese said.

Reese’s and the bureau’s presentation comes as a Multnomah County grand jury is reviewing the latest officer-involved fatal shooting of Brad Lee Morgan, a 21-year-old man who was located atop a downtown parking garage after he had called 9-1-1 and threatened to jump. Police said a sergeant and officer fired multiple shots after Morgan pulled out what turned out to be a fake black handgun. Morgan died from a single gunshot to the head.

It also follows the city’s $1.2 million settlement of a federal wrongful death lawsuit filed by the family of Aaron Campbell, an unarmed African American man who was fatally shot in the back by police in Jan. 29, 2010. Campbell was described as suicidal and distraught over his brother’s death that day. The family’s attorney pointed out a “disconnect” between the chief’s findings that the shooting violated policy, and 11 training officers who were ready to testify that Officer Ronald Frashour acted as trained.

Two assistant Oregon U.S. attorneys who are working with federal justice department officials attended the meeting. Since June, the federal authorities have been examining if the police bureau engages in a pattern of excessive force, particularly when dealing with people in a mental health crisis.

The presentation echoed a similar address Reese gave to the same group – the Downtown Public Safety Action Committee – in March, following an unusual spate of police officer-involved shootings between Jan. 1, 2010 and Jan. 2, 2011. During that time, police shot 8 men.

This morning, Reese, crime analyst Stewart, and Leisbeth Gerritsen, the bureau’s civilian mental health professional who coordinates the bureau’s crisis intervention training, highlighted the faltering safety net for people suffering from mental illness — from the closure of the 24-hour Crisis Triage Center to the lack of care for the uninsured and an inadequate voluntary commitment process.

If there isn’t a system of care in place to catch people suffering a mental health crisis, it’s no surprise that they’re going to have multiple contacts with police, Gerritsen said.

Derald Walker, Chief Executive Officer of Cascadia Behavioral Healthcare, said the Bazelon Center for Mental Health Law is continuing to examine how to provide better care for people with mental illness to reduce their contacts with law enforcement.

“The problem is with the system that fails to provide the supportive preventive services,” Walker said.

When asked what the best national model is on how law enforcement should approach someone who is suicidal and armed, there were few answers.

The chief reiterated his support for crisis intervention training for all officers, calling it a “core competency every officer needs to have.” Reese also said he continued to support the bureau’s use of its single mobile crisis unit that focuses on people with frequent police contacts and officers’ ongoing relationships with social service providers.

Walker said the best way to approach someone who is suicidal is to take your time, be empathetic and supportive, and help the person solve their problems and recognize there are other options than taking their life. But he said that when someone is suicidal and under the influence of alcohol or drugs, it’s a “highly unpredictable situation.”

Reese also told the group that the bureau is in the process of putting in a place a new policy that requires sergeants to immediately respond to scenes where officers use force and begin investigations. This was a policy that the federal Department of Justice had recommended, Reese has said.

What the chief did not share is that the new policy is on hold as the Portland Police Association, the union that represents sergeants, has filed a grievance, arguing that such new duties for sergeants need to be negotiated.

The chief said the bureau has placed a “new inspector” in its Professional Services Division to primarily analyze all officer use of force data within the bureau after federal justice officials identified that gap in the bureau.

“They pointed out to us we don’t have one single person tracking all use of force,” Reese said.

MHAP’s own Jason Renaud in the KGW TV Hot Box

Review: Police Force Down in Oregon, Suicides Up

By KGW Staff, February 14, 2012

The fatal shooting of a man threatening “suicide by cop” last month has prompted another review of how Portland police handle suicide calls.

Mayor Sam Adams, police Chief Michael Reese and other city officials presented a draft report Tuesday to the public safety action committee.

The number of suicide calls has nearly doubled since 2001. The review also showed that the use of force by police has declined over the last four years.

On January 25th police responded to a call of a suicidal man in downtown Portland. The call ended in the death of Brad Lee Morgan who was armed with a replica handgun.

Reese said every officer on the street goes through crisis intervention training and the bureau has a mobile crisis unit that can respond to suicide calls. He said the review also found that the use of force by police has declined over the last four years.

Jason Renaud, with the Mental Health Association of Portland, issued a statement to the media following the police press conference Tuesday. He said the state’s mental health crisis has developed as a result of “decades of financial cuts” and lack of state, city and county support.

“Mental illness is a public health issue – not a public safety issue. The police want to be part of the solution, but they are not suited to be an entire response to the problem,” Renaud said. “What’s missing are robust, welcoming and engaging community mental health and addiction services.”

Renaud also encouraged friends and family members of people with mental illnesses to prepare for crisis and develop their own plans for recovery that don’t involve police unless a person is dangerous to others.

“Our comment for the general public is if you want this to change, demand it from your political leadership,” he said.

Portland Police Bureau Sees Drastic Increase in Suicide Calls

By FOX 12 Staff, Tuesday, Feb. 14, 2012

The Portland Police Bureau is dealing with a drastic increase in the number of suicide calls.

Between 2001 and 2011, suicide calls to officials in the city of Portland grew from 630 calls to 1,200.

In a meeting with the Downtown Public Safety Action Committee on Tuesday, Chief Mike Reese and several mental health professionals made a presentation on suicide, the mental health system and police contact with people in crisis.

The most recent officer-involved shooting in Portland happened on Jan. 25, when police say a man was threatening to jump from a downtown parking garage.

Before mental health officials arrived, police say the man pulled out what they now know is a fake gun, and an officer fired and killed the man.

In Tuesday’s meeting, Reese said that the rise in the number of suicide calls may be due to fewer mental health and addiction services.

He also said that all officers have been through Crisis Intervention Training and the bureau has done a good job managing force in all situations.

“We use force in less than 4 percent of all arrests, and only in a quarter of a percent of all contacts,” said Reese.

“We’re trying to get people out of the criminal justice system and into appropriate care,” Reese explained.

Reese said the bureau will continue to work with other safety partners and mental health providers to explore additional options in how they help people in dealing with a mental health crisis.

Portland Police See Increase In Suicide Calls

Kristian Foden-Vencil, OPB News, Feb. 14, 2012

[ Listen to this story ]

Portland Police say the number of calls they receive regarding suicides and mentally ill people have increased 90 percent since 2001.

Mayor Sam Adams called for a review of suicide calls after Brad Morgan was shot by officers last month. He was suicidal and carrying a replica handgun.

The review found police deal with an average of three suicide calls each day.

Police chief Mike Reese says officers usually arrive in time and save lives. But he stressed, five crisis centers and hospital clinics for mentally ill people have closed since 2001 and the police are increasingly coming into contact with disturbed people.

Derald Walker, CEO of Cascadia Behavioral Healthcare, thanked police for drawing attention to the issue.

“In an ideal world where there are adequate resources in a community, police officers should not be the first responders to someone who is in a psychiatric crisis,” Walker said.

The Mental Health Association of Portland said what the community is missing is robust and welcoming mental health and addiction services.

A Chief’s Consistent Plea

by Denis C. Theriault, ‘Hall Monitor’, The Portland Mercury, February 16, 2012

Denis C. Theriault

HERE’S THE THING about Police Chief Mike Reese — he’s consistent. Very consistent. Every time his police officers shoot and/or kill someone in the throes of a mental health crisis, he reliably does several things:

First, he defends his troops. Then he talks about some kind of policy change the bureau is making or exploring, either directly in response to the latest tragedy or just generally. And finally, he firmly and persuasively lays serious blame at the feet of a starved mental health system that’s forced his officers to add the unwelcome role of counselor to their usual gig as peacekeeper.

But this month, after cops shot Bradley Morgan — a suicidal man who waved a realistic replica handgun—Reese tweaked the usual pitch. And maybe it’s because federal investigators are looking at whether his bureau has a pattern of inappropriately using force against the mentally ill.

He gathered some damning statistics on suicides (calls to police have doubled since 2001, even though the actual suicide rate has held relatively steady), mental illness (commitment “holds” have nearly doubled since 1998), and treatment (beds and funding have dropped) and bundled them in a report.

Then he gathered a coterie of service providers and mental health experts to help make his point:

We’re adapting as much as we can, as fast as we can, but the problem is way bigger than the police bureau.

The unveiling came at the Tuesday, February 14, meeting of the Downtown Public Safety Action Committee, a group of business leaders, social services advocates, and government officials.

Sounding a lot like the mayoral candidate he almost was, Reese implored the room to help with problems like unemployment, homelessness, a lack of treatment facilities, and inadequate access to health insurance.

“Those are things all of us in this community have to own,” he said.

Reese is right, of course. It’s good the police bureau is doing things like appointing a full-time inspector to review cops who use force. It’s good crisis training is now a “core” training element for officers.

But what good is any of it if there isn’t a triage center where officers can hand off someone in crisis, or if there isn’t money for preventative care that can keep someone from going off the deep end.

The response was heartening. “What could we lobby for?” asked Steve Trujillo, the committee’s co-chair.

But Jason Renaud of the Mental Health Association of Portland says even that help won’t be enough.

Cops will never be fully out of the equation, he says, but minimizing their role — making sure preventive care looms larger than public safety — requires a higher power.

“This will take the Legislature,” he says, “the voters. Voters who can vote in people who won’t cut the safety net.”

Or, maybe, voters who might finally approve a ballot measure dedicated to mental health treatment. Because eventually, the sheer number of crisis calls works against cops. They’ll eventually end up shooting someone.

Widening the Lens on ‘Suicide by Cop’

By The Oregonian Editorial Board, Tuesday, February 14, 2012

On Tuesday, Police Chief Mike Reese effectively implored the community to widen its lens. Suicide calls are on the upswing, and police are taking the brunt of these calls. A narrow focus on what police can and should do differently at a scene to avert a “suicide by cop” is extremely important, of course.

But zooming in on that moment, and that moment alone, misses the chances for prevention that arise long before a fatal confrontation.

Right now, a Multnomah County grand jury is examining the death of Brad Lee Morgan, 21. Police fatally shot Morgan Jan. 25 after he called 9-1-1, threatened to commit suicide by cop and then pointed a fake gun at officers at the scene.

The grand jury, no doubt, will help to clear up some of the fairly narrow questions about what happened that night. Yet what needs to take place, as well, is a much broader and deeper conversation about what people who are concerned about a family member in crisis can do to intervene.

It may sound simple, but one of the keys is to mention “suicide.” Suicide expert Leslie Storm, with Oregon Partnership, says people are frightened to ask, “Are you thinking about killing yourself?” for fear of triggering it or making the possibility sound more real. But, “by bringing it up,” she says, “you’re breaking the ice.”

Last year, nearly 20,000 calls came in to Oregon Partnership’s suicide prevention hotline (most from Oregon, but some from Idaho and eastern Washington). Remarkably, a crisis worker was able to defuse the situation on the phone 99 percent of the time, Storm said. Only 1 percent of the calls required the follow-up of calling 9-1-1.

Suicide calls to Portland police have roughly doubled since 2001, though, going from 630 to 1,200. (These are calls concerning people who have committed it, are attempting it or are threatening to do so.) Suicides in Multnomah County have increased, too, going from 83 in 2001 to 111 in 2009.

In Oregon, suicide rates have increased over the past decade, as well, according to state health officer Mel Kohn, who is involved in national efforts to boost suicide prevention. Oregon had 678 suicides in 2010, Kohn said, which is more than double the number of deaths from car crashes.

Keeping a gun and alcohol away from a suicidal person can be crucial, too, if it’s possible to do so, because the combination is often lethal. “Suicide is a major national public health problem,” said Portland State professor Mark Kaplan, who just landed a $953,459 grant to study the link between suicide and alcohol. “It results in more than 30,000 deaths each year and is the 10th leading overall cause of death in this country.”

It’s right to focus on how the front-line responders, the police, could or should have behaved when they confront a distraught person, like Morgan. It’s right, too, to do as the chief was implicitly suggesting Tuesday — to figure out how the city, county and state can do a better job of bolstering services for the distraught and others in crisis.

No matter what kind of services we provide, though, ultimately, the timely intervention of a family member or friend will be vital. So, yes, by all means, revisit final minutes. Just don’t forget to examine hours, days and weeks, too — what could have been done differently by everyone involved to avert such a death.

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Portland Mercury, November 21, 2007 – County Chair Ted Wheeler has accepted an invitation by mental health activists to attend a public meeting to discuss his apparent failure, so far, to prioritize a sub-acute facility for the mentally ill in Portland.

Wheeler told the Mercury at the end of last month he might not secure funding for such a facility—where police officers could take people in mental health crisis instead of jail—until 2010. November 2008 is the very earliest he could secure funding, Wheeler said.

Nevertheless, on October 4, Wheeler voted against a proposal by County Commissioner Lisa Naito to fund such a center by diverting $4 million of county subsidies from Gresham ["Less Than a Crisis?" News, Nov 1].

Reopening a sub-acute facility—Portland has been missing its crisis triage center since 2003—was a key priority of Mayor Tom Potter’s Mental Health/Public Safety Initiative formed last fall, following the death in police custody last September of the 42-year-old schizophrenic, James Chasse Jr.

Portland Mental Health Association President Roy Silberstein wrote to Wheeler last Friday, November 16, inviting him to hold a public meeting to explain his “plans to make the opening of a sub-acute facility a high priority.”

“Since the closure of the Crisis Triage Center in 2003,” Silberstein wrote, “people with mental illness, their friends and family members, mental health clinicians, first responders, and a variety of others have experienced or witnessed a high number of bad outcomes which could have been avoided had a psychiatric sub-acute facility been an option.”

Wheeler’s office agreed to the meeting this Tuesday, November 20—to take place on January 18, 2008, at 6 pm.

“I think it’s very encouraging that they want to meet their constituents to talk about their decisions,” says Jason Renaud of the Mental Health Association. Wheeler himself did not return the Mercury‘s call by press time, but a spokesman confirmed the meeting will take place.

From The Portland Business Journal, June 6, 2004

Four years ago, Multnomah County’s mental health care system, like so many of its patients, was in crisis.

People struggling with severe but manageable mental illnesses were unnecessarily hospitalized at great expense.

Lack of adequate emergency services and poor coordination among Portland-area mental health agencies led to expensive, inefficient and sometimes tragic outcomes, such as the 2001 shooting death of a Mexican immigrant at Pacific Gateway, the now-closed psychiatric hospital.

That same year, the county’s Crisis Triage Center closed due to escalating costs, cutting off a crucial emergency service for patients suffering from acute mental illnesses.

To deal with these and other mounting problems, county and mental health leaders began three years ago to revamp the way adult mental health services were delivered.

They created a system that now includes a 24-hour mobile response unit, 24-hour walk-in clinics, and teams of mental health and social workers who design out-of-hospital treatment plans for mentally ill clients.

The redesign still is in progress, but it has brought some dramatic results particularly in reducing hospitalizations of adult mentally ill patients, say officials of Portland-based Cascadia Behavioral Healthcare, the largest of about a dozen mental health organizations that contract with the county to provide mental health services.

“We have cut unnecessary hospitalizations in half, thanks to increased hours, outreach and more intensive services,” says Mark Schorr, director of communications and staff development for the agency, which performs services worth $38 million a year.

“This has been vital, not only because of the state financial crunch, but also because two hospitals with psychiatric beds [Pacific Gateway and Woodland Park] were closed in the past few years.”

Peter Davidson, medical director of the county’s mental health and addiction system and its clinical services coordinator, says the redesigned system has reduced the amount the county spends to hospitalize patients covered by the Oregon Health Plan — the state-sponsored safety net for low-income residents lacking health insurance — from $9 million three years ago to “well under $4 million” this year.

Some of the reduction is due to cuts in the health plan itself and the number of patients it covers.

“But [the cuts] weren’t nearly enough to account for the size of the reduction — they played only a small part,” says Davidson, who led the county’s redesign efforts when he was hired three years ago as medical director of its mental health division.

Under the redesign, Cascadia has managed to cut the number of days its Oregon Health Plan clients spend in the hospital from 678 in September 2002 to 291 last month, according to agency data.

Considering that hospitalization costs about $800 a day per patient, fewer hospital stays mean more money for out-of-hospital care, says Leslie Ford, Cascadia’s chief executive officer.

“For every month that we lowered inpatient utilization another piece, we were able to share in some of the savings and build up our outpatient system,” she says. “The more we build that up, the less we need to default into acute care [hospitalization].”

Adding to increased efficiency, Davidson says, is a mental health call center operated by the county that includes a crisis line where people can call during emergencies.

The center also has $9,000 that can be used to fix short-term problems, such as paying for transportation or medications for someone in crisis.

“We are building the details of the system project by project,” Davidson says.

Cascadia serves 80 percent of adults on the Oregon Health Plan who need mental health services. It responds to the bulk of the county’s emergency calls through Project Respond, a 24-hour mobile outreach program based at Cascadia’s largest facility at Southeast 43rd Avenue and Division Street.

Cascadia’s staff numbers around 1,000 and it operates about 60 sites in Multnomah, Washington and Marion counties

Besides mobile response teams, Cascadia’s programs include treatment, counseling, housing and job-seeking programs for people with severe and persistent mental illness.

Cascadia formed in January 2002, just as the county was embarking on its redesign program, with the merger of three independent mental health agencies — Unity Inc., Mount Hood Mental Health and Network Behavioral HealthCare. The merger was independent of the county’s redesign efforts, but Cascadia soon became the county’s major contractor for mental health services.

Cascadia primarily serves adults. Other agencies, such as Morrison Center and Trillium Family Services, work with children struggling with mental illnesses.

Trillium — formed in 1998 with the merger of Parry Center for Children and Waverly Children’s Home in Portland and the Children’s Farm Home in Corvallis — has redesigned its programs in ways that are similar to the county’s revamped system.

Trillium changed its funding model from traditional fee-for-service contracts to a more flexible system that allows children to receive an array of services, said Trillium President Kim Scott.

“We treat about 18 percent more children through flexible funding,” Scott said. “Outcomes are better, families are better supported and the services are more lower-cost.”

Trillium’s services include providing case managers and therapists to work in teams with parents, teachers and others who are acquainted with the children.

“Our goal is to help guide the child from high-end care back to the community,” Scott said.

Mental health services provided by the county and its contracted agencies get most of their funding from government sources — federal, state and the county’s own general fund. Not surprisingly, state and county budget shortfalls have presented hurdles in the county’s mental health redesign efforts.

The mental health division has had to absorb Oregon Health Plan cutbacks during the last two years, reducing the number of adults who receive services.

The income tax surcharge approved last year by Multnomah County voters gave the Mental Health Division $11 million to restore critical-care services that were on the chopping block, according to Davidson.

But adults with persistent, though not acute, mental illnesses have been dropped from the plan, leaving more adults without insurance for mental health care.

For instance, health plan cuts forced Cascadia to drop 2,500 cases since February 2003, from 8,500 to 6,000.

The agency saw a corresponding, 88 percent increase in the number of people seeking crisis services after the cuts, says Cascadia CEO Ford.

“That’s why so many cases are out in the street,” says Ford. “A lot of [mentally ill people] do not have insurance.

“As a state, we will have to deal with the issue of the uninsured because if you treat them in high-end services, like emergency rooms and hospital stays, it is less effective and far more expensive.”

Despite the cutbacks, county officials will continue to work for more cost efficiencies in the mental health care system, Davidson says.

Among the goals: continue to improve services for mentally ill adults, including finding solutions for homeless and other mentally ill people who are walking the city’s streets; combine programs that treat mental illness with those that treat alcohol and drug addiction; beef up systems for children and families.

“We’re in the earliest stages of finding out what works,” Davidson says.

From The Portland Business Journal, September 16, 2001

The area’s mental health care system is in a state of disrepair, but county officials have created a stop-gap plan

Anyone involved in the local mental health system as a client, provider, administrator or family member has been familiar with the litany of faults and failures of the system for years.

But it took a one-two punch–closure of Sellwood’s Pacific Gateway Hospital, where a Mexican national died this spring, and the subsequent collapse of Multnomah County’s Crisis Triage Center–to point out the grave structural defects in the system to the rest of us.

Critics say problems in the health care system can be traced to 1998, when the county switched from fee-for-service contracts to managed care. Additional system stresses include the expansion of mental health services covered under the Oregon Health Plan and cost controls placed on nonprofits that deliver mental health care services in the community.

Residents of Multnomah County access mental health care at a rate twice the state’s per capita average. The average cost of an acute care bed in area hospitals was $422.50 through June of 2001. But new per-diem rates negotiated with local hospitals bring that cost up to almost $700 a day.

“It’s keeping me awake at night,” admitted Diane Linn, Multnomah county commissioner chair. “We’ve really been struggling with this.”

The problems attending the grim statistics are large and complicated, involving various agencies, each with its own bureaucracy; a difficult and expensive client base with which to work; and a virtually nonexistent data collection system.

Add in the larger social issues, such as the lack of affordable housing, the stigma still attached to mental illness and ambivalence toward the poor and homeless, and it’s clear there are no easy answers.

The county spends almost 20 percent of its mental health care budget on hospitalizing mentally ill patients because cheaper and more effective care alternatives have been cut.

Linn believes the system is failing in its responsibility to its most vulnerable citizens.

“If you look at it from the perspective of the person who needs to use this system, it’s awful,” she said.

The closure of Crisis Triage Center–the centralized care center for Multnomah County–has further complicated the situation. The CTC opened in 1997 as a state-of-the-art psychiatric triage facility, located at Providence Portland Medical Center. It served everyone from private clients to Oregon Health Plan enrollees in psychological crisis.

The CTC contract with Multnomah County expired June 30, and talks to renew it broke down over escalating costs. The closure of the CTC on Aug. 1 left emergency personnel with no designated place to take area residents in psychiatric crisis.

The closure of Pacific Gateway Hospital, following the death of Jose Victor Santos Mejia Poot this spring, further added to the gap.

The county has redesigned a system that would redirect dollars from acute care facilities like emergency rooms and hospital beds to neighborhood clinical services and outreach professional services.

The county’s “gap” plan establishes four walk-in, no-appointment clinics and mobile crisis teams to replace the failed Crisis Triage Center.

It also calls for adding a secure evaluation facility to replace the 66-bed psychiatric ward at Pacific Gateway in the near future. The gap plan addresses the first 90 days of the newly redesigned county system. Phase two, which should be adopted this month, covers days 91 through 365.

The improvements can’t come too quickly for emergency services that end up with seriously mentally ill clients in their care while an overcrowded system tries to find a place for them for longer-term care.

“Now officers must go to the nearest emergency room and wait,” said Ed Riddell, head of the Portland Police Bureaus’ Crisis Intervention Team. “And the wait is often four hours or more.”

Riddell points out that officers waiting in emergency rooms with mental health patients is awkward and keeps them from doing police work.

Three of four walk-in clinics opened Aug. 1, and another one in downtown Portland is expected to open in September. Clinics offer services in a more welcoming, less anxiety-producing environment, said Jim Hlava, program director of rehabilitation services at Network Behavioral HealthCare Inc., which operates the walk-in clinics.

“There are other existing programs here,” he explained. “We have peer counseling. We have a meals program. Some of the clients who walk in here are homeless and they haven’t had a bath or a shower in awhile. We’ve got a shower and that helps bring down someone’s anxiety or agitation. If you’re feeling a little bit better about yourself you’re not as angry and agitated.”

That’s the approach favored by Barry Kast, an administrator with the State of Oregon Health Services, which includes mental health.

“The key to a successful mental health program is that you’re combining a health program with other services, such as income support, housing, employment,” he said.

Adding to the county’s troubles with the redesign is the discovery of a $4.7 million revenue shortfall.

Estimates of county reimbursement through the Oregon Health Plan were both too high in the number of clients served and the reimbursement per client the state would provide.

To get clinics and mobile teams up and running, the county plan calls for dipping into the existing mental health care reserves for a one-time bailout of $1.72 million.

“We’re pretty much shoulder to shoulder with chair Diane Linn, and her staff,” Kast said. “She has quite courageously taken on what has been a decade or two of struggling to find the right system for the county. It’s a very difficult problem.”

Though the contribution per patient has dropped, according to Kast, the state has allocated an additional $1.5 million to help meet the extra costs, on top of the money already earmarked for Multnomah County health services.

“I have to tell you that I think the general community still struggles with the whole issue as a great big terrible, frustrating, tragic mystery,” said Linn. “There is a terrible stigma attached to mental illness, and that complicates the problem.”

In addition to walk-in clinics, the plan calls for a county-run crisis phone service, to attach mobile outreach crisis teams to each clinic, as well as a contract for a new secure evaluation facility to replace Pacific Gateway.

The plan calls for a centralized mental health care administration, the installation of a data system, provider contracts increasing the accountability for outcomes and incentives to avoid acute hospital care.

“We as a community have the responsibility to manage this,” Linn said. “For me that is very close to home.”

From The Portland Business Journal, September 16, 2001

The Crisis Triage Center was the centralized care center for Multnomah County mentally ill needing urgent care. The center served more than 8,700 people in the last fiscal year and still it turned away another 400 patients in emergency vehicles because it was full.

The closure of the Crisis Triage Center on Aug. 1, left emergency personnel with no designated place to take area residents in psychiatric crisis.

“They are going to ERs of the hospitals in the area,” said Kent Ballantyne, a senior vice president with the Oregon Hospital Association. “We are triaging those patients through the acute care setting, which is an expensive and inappropriate place to do this kind of care.”

Ed Riddell, the head of the Portland Police Crisis Intervention Bureau, called the closure “devastating” to police officers because of the extended period of time officers have to wait in emergency rooms with patients in custody before patients can be seen or transferred to a more appropriate setting.

Dr. Christopher Richard, head of OHSU emergency room operations, said the closure of both the CTC and Pacific Gateway has resulted in significantly longer emergency room waits for all patients.

“The ER is not a destination,” he said. “If we can keep our length of stay down to the traditional three or four hours, we’re much better off. Unfortunately, our length of stay has gone way up and it’s a problem.”

In an attempt to treat mental illness less expensively, walk-in clinics were established in three different areas of Multnomah County the same day the CTC closed; another is due to open this month.

Eventually, each of the clinics will also have a mobile team of mental health care professionals attached to it and they, rather than the police, will respond to requests for urgent and emergent mental health crises.

Mobile mental health teams are vital to community-based mental health services, according to Jason Renaud, executive director for the National Alliance of the Mentally Ill of Multnomah County.

“They depend on building a friendship, a relationship with people,” he said. “And these are very sick people who don’t want to be in treatment and routinely hang up the phone, slam the door, walk away, don’t take their medication, don’t want to be involved. These teams are very effective at getting these folks involved.”

The Crisis Triage Center opened on Jan. 13, 1997 as a state-of-the-art psychiatric triage facility which was located on the Providence Portland Medical Center campus in Northeast Portland. It served everyone from private clients to Oregon Health Plan enrollees in psychological crisis. The CTC contract with Multnomah County expired June 30th and talks to renew it broke down over escalating costs.

The CTC was too expensive, according to county officials, and provided less crisis response services than originally agreed to. In addition to the cost overruns, the county redesign task force found that the usefulness of the CTC was compromised because more appropriate, less costly alternatives were not available to provide adjunct services.

Jim Hlava, program director of rehabilitation services for Network Behavioral HealthCare Inc., said business has been brisk at his clinic at 43rd and Division in Southeast Portland, and that is true for the clinics in North Portland and Gresham as well.

The building, which will house another clinic in the downtown area, is still undergoing renovations and should open this month.

However, the clinics are already helping to keep patients out of hospitals.

“We’re part of the solution,” he said. “We’re seeing between 10 and 20 patients here a day, and we originally thought there would be between five and 10 patients a day across all of the clinics. So we’re busy, but we’re not overwhelmed.”

Hospitalization is less likely to happen if clients can request services in a clinic setting when they need it but the clinics send their emergency cases to local ERs if they can’t be stabilized there.

“If clients are a danger to themselves or others, we send for the police,” he said. “That’s the system that’s in place right now because we don’t have our crisis services completely up and running.”

The county is also in negotiations with Woodland Park hospital to contract for psychiatric beds, but the talks have been clouded by recent allegations of safety and patient care by former employees.

A preliminary investigation found some procedural and record keeping problems but a final report will not be available until later this month.

Pacific Gateway, meanwhile, may reopen under different management.

“The potential buyer intends to operate the hospital as a behavioral health facility,” said Beth Page, a spokesperson for Ardent Health Services, who owns and operated the facility.

“And we are hopeful these negotiations will be concluded in the near future.”

From the Portland Business Journal, September 14, 2001. Not available elsewhere online.

The Crisis Triage Center was the centralized care center for Multnomah County mentally ill needing urgent care. The center served more than 8,700 people in the last fiscal year and still it turned away another 400 patients in emergency vehicles because it was full.

The closure of the Crisis Triage Center on Aug. 1, left emergency personnel with no designated place to take area residents in psychiatric crisis.

“They are going to ERs of the hospitals in the area,” said Kent Ballantyne, a senior vice president with the Oregon Hospital Association. “We are triaging those patients through the acute care setting, which is an expensive and inappropriate place to do this kind of care.”

Ed Riddell, the head of the Portland Police Crisis Intervention Bureau, called the closure “devastating” to police officers because of the extended period of time officers have to wait in emergency rooms with patients in custody before patients can be seen or transferred to a more appropriate setting.

Dr. Christopher Richard, head of OHSU emergency room operations, said the closure of both the CTC and Pacific Gateway has resulted in significantly longer emergency room waits for all patients.

“The ER is not a destination,” he said. “If we can keep our length of stay down to the traditional three or four hours, we’re much better off. Unfortunately, our length of stay has gone way up and it’s a problem.”

In an attempt to treat mental illness less expensively, walk-in clinics were established in three different areas of Multnomah County the same day the CTC closed; another is due to open this month.

Eventually, each of the clinics will also have a mobile team of mental health care professionals attached to it and they, rather than the police, will respond to requests for urgent and emergent mental health crises.

Mobile mental health teams are vital to community-based mental health services, according to Jason Renaud, Executive Director for the National Alliance of the Mentally III of Multnomah County.

“They depend on building a friendship, a relationship with people,” he said. “And these are very sick people who don’t want to be in treatment and routinely hang up the phone, slam the door, walk away, don’t take their medication, don’t want to be involved. These teams are very effective at getting these folks involved.”

The Crisis Triage Center opened on Jan. 13, 1997 as a state-of-the-art psychiatric triage facility which was located on the Providence Portland Medical Center campus in Northeast Portland. It served everyone from private clients to Oregon Health Plan enrollees in psychological crisis. The CTC contract with Multnomah County expired June 30th and talks to renew it broke down over escalating costs.

The CTC was too expensive, according to county officials, and provided less crisis response services than originally agreed to. In addition to the cost over-runs, the county redesign task force found that the usefulness of the CTC was compromised because more appropriate, less costly alternatives were not available to provide adjunct services.

Jim Hlava, program director of rehabilitation services for Network Behavioral HealthCare Inc., said business has been brisk at his clinic at 43rd and Division in Southeast Portland, and that is true for the clinics in North Portland and Gresham as well.

The building, which will house another clinic in the downtown area, is still undergoing renovations and should open this month.

However, the clinics are already helping to keep patients out of hospitals.

“We’re part of the solution,” he said. “We’re seeing between 10 and 20 patients here a day, and we originally thought there would be between five and 10 patients a day across all of the clinics. So we’re busy, but we’re not over-whelmed.”

Hospitalization is less likely to happen if clients can request services in a clinic setting when they need it but the clinics send their emergency cases to local ERs if they can’t be stabilized there.

“If clients are a danger to themselves or others, we send for the police,” he said. “That’s the system that’s in place right now because we don’t have our crisis services completely up and running.”

The county is also in negotiations with Woodland Park hospital to contract for psychiatric beds, but the talks have been clouded by recent allegations of safety and patient care by former employees.

A preliminary investigation found some procedural and record keeping problems but a final report will not be available until later this month.

Pacific Gateway, meanwhile, may reopen under different management.

“The potential buyer intends to operate the hospital as a behavioral health facility,” said Beth Page, a spokesperson for Ardent Health Services, who owns and operated the facility.

“And we are hopeful these negotiations will be concluded in the near future.”