Mental Health Association of Portland

There’s a very high preponderance of people on the Oregon Health Plan who have a mental health or substance abuse problem, according to Mary Monnat, president and CEO of LifeWorks NW. In the Portland metropolitan area, such problems affect 70 percent of that population.

Now that coordinated care organizations are under way, it’s not only important for people to receive better coverage, but mental health professionals also need to connect their patients with primary care physicians, said Monnat, who serves on the board of Health Share of Oregon (formerly known as the Tri-County Medicaid Collaborative).

“We were very concerned about the people we were seeing,” said Monnat, who initiated a partnership with Virginia Garcia Memorial Health Clinic to provide such services.

Working with that clinic and Providence Health & Services, her agency began analyzing claims data to identify the highest users of emergency services, and help people find a medical home.

Once they realized that people were visiting emergency rooms because they were unable to get time off work during the day, Virginia Garcia extended its clinic hours to accommodate evening visits.

The clinic has also assembled healthcare teams that respond to patients’ needs so that a mental health provider can screen for depression or substance abuse as part of a primary care visit.

“We really need to provide culturally diverse care,” said Monnat, since racial and ethnic minorities tend to be overrepresented in the Oregon Health Plan.

When the coordinated care organizations were formed, “there was a big concern that mental health would be left behind” said Ed Blackburn, executive director of the Central City Concern who’s also on the board of Health Share. “So far I have not found that to be true.”

Blackburn has firsthand experience bridging the gap between mental health and physical health services at Central City Concern, which started out as a substance abuse treatment facility, but gradually expanded into those other areas.

“We find that people with lower level mental health diagnoses, we can treat effectively through integrated primary care,” Blackburn said. “A coordinated care model for people with mental illness that includes primary care and social services intervention helps across diagnoses on the mental health side.”

Monnat is optimistic about how coordinate care organizations can make a difference in peoples’ lives. “If you keep the patient, the consumer, at the center of all this, that’s what grounds me,” she said. “I’m working hard to keep that front and center.”

By Amanda Waldroupe, for Street Roots, March 6, 2012

A patient’s housing and sociological condition can have a direct affect on his or her health care, but a bill in Salem to incorporate those providers into the new health care reform failed to make the books.

As a result, the legislature has left unanswered a critical question in the state’s new health care structure: Will health providers serving Oregon Health Plan patients work with social-service providers to address a patient’s sociological and psychological barriers to health care.

Senate Bill 1522 would have required Coordinated Care Organizations, which are currently developing to provide care to Oregon Health Plan patients by July, to incorporate and pay for addressing a patient’s sociological and psychological barriers to getting quality health care and becoming healthy.

Coordinated Care Organizations (CCOs) are the backbone of the reforms the Legislature has made to the Oregon Health Plan’s delivery system (see, “Just What the Legislature Ordered,” Street Roots, Oct. 14). CCOs are foreseen as locally driven organizations made up of patient teams — including doctors, nurses, behavioral health providers, community health workers, etc.

Those providers will coordinate and integrate the physical, mental and dental health care of Oregon Health Plan patients, who receive health care through Medicaid. The hope is that better coordinated care will keep people out of the emergency room, lower costs, and provide better healthcare.

Jennifer Pratt

But the Oregon Primary Care Association (OPCA), which represents the state’s safety net clinics, sponsored Senate Bill 1522 out of the concern that addressing those barriers would get lost in the shuffle of making sure that CCOs are able to adequately provide care by July.

“A great majority of patients that our clinics serve have behavioral and socio-economic barriers to health,” says Jennifer Pratt, the OPCA’s deputy director of policy. “It’s a critical issue.”

Behavioral, socio-economic and sociological barriers to health include homelessness, issues related to substance abuse, access to transportation, socio-economic status, rural isolation, race, ethnicity, and other factors that are often called the “social determinants” of health.

“They are part of a person’s health situation,” Pratt says. “They are intrinsic, not an add on.”

“This is where the rubber meets the road,” Doug Riggs, the OPCA’s lobbyist told the committee. “These are the most vulnerable patients.”

Pratt uses the example of people who are homeless and diabetic. People with diabetes have to manage their weight, diet, and also take daily medications that have to be refrigerated. All of those things become extremely difficult, if not impossible, if someone does not have a home.

In general, caring for those patients is more time intensive and costly because of the variety and complexity of the issues they face. They also tend to be unhealthier, Pratt and others say, which leads to a disparity in health among populations simply because they have more barriers to accessing healthcare than other populations.

The OPCA was joined by almost 30 organizations calling for Senate Bill 1522’s passage. But it died in the Senate’s Healthcare, Human Services and Rural Policy committee after two hearings. Legislators worried that the bill was unnecessary.

Alan Bates

“The goal of CCOs is to take care of these people,” said Sen. Alan Bates (D-Medford). “I don’t think we need to call it out any more than we are.”

Without the bill, some worry that a segment of Oregon Health Plan patients will continue to be unhealthier than other populations. And without a legislative mandate, it will be up to each individual CCO whether it chooses to address barriers to health, or works with social service providers to better address those concerns.

The OPCA is planning to convene a workgroup to talk about the organization’s next steps and influence the development of CCOs when the Oregon Health Authority begins drafting and writing the administrative rules and regulations for CCOs this summer.

Bob Joondeph

Bob Joondeph, the executive director of Disability Rights Oregon, says it’s going to be absolutely necessary to address a patient’s social and psychological needs, in addition to their medical ones.

“It’s going to be a really primary piece of what these CCOs are going to do,” he says. “Frankly, that’s where the state sees the opportunity to improve health and save money.”

Although Senate Bill 1522 did not pass, he thinks there is ample opportunity for people to influence the development of CCOs. Each CCO will have a “community advisory committee” made up of stakeholders from the community who are not involved in a CCO as providers. That, he says, provides an opportunity to pressure CCOs to take a certain course of action when it comes to determinants of health.

“Many, many more details are going to be worked out at the local level,” Joondeph says. “There’s a lot of opportunity for people to be engaged and to steer the course of how any particular CCO goes.”

He thinks it is highly likely that CCOs will begin forming strong partnerships with social service agencies to the effect of “social service-izing the medical world.”

“It goes beyond patching a person up,” he says.

Ed Blackburn

Ed Blackburn, the executive director of Central City Concern, agrees. “The social interventions are going to be critical,” he says.

Central City Concern’s programs are built on the assumption that providing all the social services one might need — whether it’s housing, medical care, substance abuse treatment, detox services, drug free housing, etc. — can make providing health care to those people more effective.

“We know we can reduce incidents of hospitalization … and reduce conditions that are exacerbated by those (psychological and social) conditions,” Blackburn says. “Someday, we’ll not see (health care and social services) as separate.”

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By Crane-Station of Fire Dog Lake, November 20, 2011

Note: Letty Owings is my mother. She is not only larger in life to me. She has been a mother and teacher to many. Letty grew up in poverty, on a farm in Missouri. At age 12, she left home to pursue her education. She is the most amazing teacher I have ever had in my life. She taught at Lakeridge High School in Lake Oswego for many years, the best years of my life. To this day we reminisce. The world was different back then.

If you drive past the Letty Owings Center in Northeast Portland, Oregon, you may mistake the house for any other vintage neighborhood home. However, for the women and their babies residing there, the home is the beginning of a new life.

Co-founded in 1989 by retired English teacher Letty Owings and tireless advocate Nancy Anderson, the Letty Owings Center is a treatment center that is unique, in providing both long-term addiction treatment and living skills to pregnant women and women with children.

Mothers in the community mentor mothers at the center. Mothers in the center learn to cook, plan meals, clean house, and engage the children in age-appropriate play. Here is the website.

As of this writing, the Letty Owings Center has changed so many lives for the better that the second generation, the children, are themselves becoming advocates. Take a look at this:

Central City Concern employees work

“collaboratively with inter and intra agency partners on the provision of services needed in all life domains to promote recovery and self sufficiency, and ensuring services are delivered in accordance to organizational policies and procedures, ASAM criteria, ISSRS, county, state and federal contract requirements, and other pertinent standards.”

We need more programs such as this. Co-founder Nancy Anderson, who has dedicated her life to changing lives, has made a substantial difference directly in the lives of more than 1000 women who would otherwise be locked up or dead, and also in the lives of the children, who would likely become motherless, or themselves addicted, incarcerated or dead.

Letty Owings, who is now elderly, voices concern about the center. Funding cuts may mean that the center will someday be closed. If that happens, many of the clients, totally without resources, may likely be re-incarcerated, separated from their children or worse. Letty states, “How would this save any money?”

Put simply, the Central City Concern Letty Owings Center is a home of hope and documented multi-generational success. It is a wonderful alternative to incarceration and cyclic multi-generational incarceration that is so known to be fraught with recidivism and tragedy.

If you live in the Portland area, please take a moment to learn more about the Central City Concern Letty Owings Center and join six-year-old Zoe in supporting it.

From The Oregonian, June 16, 2011

As Carly Laney takes a seat in the basement meeting room, the regular morning review at the Community Engagement Program sounds like a Thanksgiving dinner when everyone present is talking about everyone who is absent, and the news is not encouraging.

Carly Laney, an outreach worker with Community Engagement Program, visits with homeless folks she knows on the streets of downtown Portland. She has worked for CEP for more than four years and says she feels a deep connection with her clients.

Laney, 31, knits as she listens, and at her turn, she mentions a client with schizophrenia she’s been counseling and, “I’ve got to say that the police were friendly and low key and not make it a high stress situation.

The meeting breaks up, and the social workers scatter from the CEP office at 232 N.W. 6th Ave. Laney puts away her yarn and needles and heads to the tiny space she shares with two colleagues. She slings her bag over her shoulder, smiles at the photo on her computer of her young daughter and heads out to spend the day in downtown and Old Town visiting people who live with the triple whammy of mental illness, addiction and homelessness.

Her goal? “Sometimes, I just buy someone a milkshake. Sometimes, I visit someone in his room to make sure he’s OK. Sometimes I’m telling someone that I know he’s not going to kill me. It varies.”

CEP is an agency of the nonprofit Central City Concern with a particular mandate: “We are dealing with the most vulnerable among us,” says Dann Mooty, the CEP supervisor. “We’re kind of the end of the line. And what makes us different is that we don’t wait for you to come and see us. We will go out and find you. If you’re under a bridge, in a doorway, in the hospital, we’ll find you.”

The program’s 15 social workers have a caseload of about 200 clients. CEP’s budget of about $3.2 million comes from the city of Portland, Multnomah County and federal sources – a grant, Medicare/Medicaid payments and subsidies from the Housing and Urban Development Department.

Central City Concerns says a 2006 study found that the psychological support and housing assistance that CEP provides to just one person eases the burden to society — in emergency-room visits, shelter space, police response — by an average of $16,000.

CEP social workers often work with Portland police in managing their clients. Ed Blackburn, Central City’s executive director, said he would not comment on the U.S. Justice Department’s decision this month to review how Portland police use force, particularly with the mentally ill. But Blackburn said his agency’s data for the past two years shows “there’s nothing in those reports about client mistreatment by the police.”

“Police know they have CEP has a resource,” he said. “I see relations with the police at this point as being mutually supportive.”

Laney brings to CEP a ground-level understanding of the problems facing the clientele. Her mother is mentally ill and has been homeless in Portland for years. Laney lived on the streets with her, for a while addicted to heroin. But she went to the Janus Youth Program, got clean, and became an outreach worker to other drug-addicted youth. She moved to CEP 4 1/2 years ago.

“I’ve had a long interest in this subject,” Laney says. “I’ve had a lot of experience on both sides. I know these people. I want to do what I can.”

One day this spring, Laney stopped at the Hotel Alder downtown to check on a client, an immigrant from Mozambique. He greeted her outside: “So nice to see you!”

He led Laney to his room to show off his music posters and his television. He chattered on, his accented English musical but dense.

“You’ve done a lot of work,” she told him. “You’re doing really well.” “Yes!” he replied. “Yes! Thank you!”

Laney said goodbye. Then she hit the street in search of another client.

Ed Blackburn

City’s ‘housing first’ policy demonstrates its value as a big step toward a new life for homeless

Peter Korn raises important policy issues regarding public investments in housing for homeless people suffering from addictions and mental illness in “Homeless and addicted: On the street or off?” (May 12).

The article initially poses the issue as a simple dichotomy of “dry vs. wet” housing with adherents advocating for one or the other. The reality is that no one type of housing works well for all or perhaps even most homeless people.

For homeless people who are addicted and motivated to enter recovery, living in a community with others who are experiencing the same journey makes sense and recovery housing is the most effective option. For many, transitional assistance with housing is appropriate because they are completely capable of then working and paying their own way.

Approximately 60 percent of those placed into Central City Concern’s transitional recovery housing finish treatment, are sober and are successfully placed into permanent housing in the community. Another 85 percent remain clean and sober and permanently housed; 70 percent remain employed 12 months after program graduation.

A case in point is Jody, homeless, unemployed and addicted for 20-plus years with multiple arrests and unavailable to his young son and family members. Jody connected to our transition housing and recovery services (Recovery Mentor Program), graduated from our Community Volunteer Corps program, then sought employment assistance with us. Less than a year later, Jody has landed a full-time job, has moved into his own apartment and has reconnected with his son.

There are other beneficial impacts for the community – the Regional Research Institute at Portland State University found that a cohort of 87 graduates reduced their criminal involvement by 93 percent. Criminal involvement during the 12 months prior to entering recovery cost the community $2 million, not including the cost of arrests, court and incarceration.

But not all addicted and mentally ill homeless people are motivated or presently capable of maintaining a sober lifestyle. Many who are chronically homeless have attempted to end their addictions many times without much long term success. Continuous homelessness often results in increased physical and mental deterioration. These people are often the victims of violence, chronic illness and at times volatile encounters with law enforcement.

Several years ago Central City Concern implemented the Community Engagement Program, which is designed as a “housing first” program where housing and services are provided to the chronic homeless who have both serious addictions and mental health issues. These people have been very high users of hospitals and public safety resources. There is no sobriety requirement, but housing has significant benefits for their health and reduces costs to the community.

An independent evaluation by Herbert & Louis LLC found a $4.4 million cost savings to the community as a result of enrolling 293 people in the program. Additionally many clients have entered recovery after they have become stabilized in housing.

Take Brad, for example: With a long history of heroin use, Brad was homeless, sick with Hepatitis C and cirrhosis of the liver, frequently arrested and exhibiting major depression symptoms as well. Once into CEP, Brad had housing, medical care, a community and staff who regularly checked in on him. He went on to embrace a recovery lifestyle and his Hep C went into remission. He was no longer on the streets, no longer walking into emergency rooms and no longer burdening our public safety resources.

CCC provides several types of housing (including family housing) that addresses the actual needs of homeless people, their stage of development and capacity to change. Our goal for those experiencing homelessness with addictions and mental illness is to always achieve the highest level of self-sufficiency possible.

Salina is a good example of blossoming self-sufficiency. She started drinking at a very young age and spent about half of her life on parole. She entered our residential alcohol and drug treatment for pregnant/parenting women at Letty Owings Center where she got clean and sober and gave birth to a healthy boy. Eighteen months ago, she completed treatment and moved into supported alcohol and drug-free housing. She seized her opportunities by becoming a full-time student at Portland Community College and attaining full-time employment for a local restaurant.

The city of Portland, Multnomah County and Housing Authority of Portland have made significant contributions to providing housing and services to homeless people. During these challenging times it is even more important that we make future investments in cost-effective housing for people experiencing homelessness, which should include both recovery and housing first options.

These investments ultimately save money for the community in the form of reduced hospitalizations and public safety costs. Furthermore, for previously homeless people – now employed – we turn tax-users into taxpayers.

From The Portland Tribune, May 10, 2011

Housing First policy opens doors to alcoholics and drug users

Jason Renaud was trying to help a longtime street addict who said he was finally willing to do what it takes to stop being homeless.

Formerly homeless David Lyman peeks out from his Biltmore Apartments studio in Old Town at crack dealers on the street below. Lyman says he's an alcoholic, and a regular user of sleeping pills and anti-depressants. These publicly subsidized apartments allow drinking. Some advocates say recovery housing, where drinking is not allowed, would be a better place for many homeless.

The man was told he would have to wait a year.

Renaud’s friend is back on the street and using drugs, and Renaud — for years one of Portland’s most outspoken advocates on behalf of Portlanders suffering mental illness and addiction — says he has given up on Portland’s public housing policy as a way to help the mentally ill and addicted.

Renaud is one of a number of people working with the homeless and the addicted in Portland who are concerned that the city and federal governments’ commitments to “Housing First” — with its philosophy of first getting chronically homeless people off the street — has allowed the pendulum to swing too far in favor of housing unconditionally.

Their frustration has surfaced because of the imminent opening of the Bud Clark Commons, the city’s newest and most expensive homeless housing project, which features 130 apartments in a $47 million LEED-certified building. The tenants for the commons are selected because they are the most vulnerable of Portland’s chronically homeless. Nearly all of them have addictions and mental health problems — and will be allowed to stay in their apartments for as long as they abide by the building’s rules of behavior.

The commons is what often is called a “wet” building, based on the Housing First model adopted by the Portland Housing Bureau, and promoted nationally by the federal Department of Housing and Urban Development.

The commons pushes the idea of wet housing to a degree that is unique to Portland, but exists in other cities. In St. Paul, Minn., a wet housing project houses 60 previously homeless alcoholics at $18,000 a year per person, with the understanding that few will ever recover. Drinking on the building’s back patio — rather than alone in rooms — is tacitly encouraged.

Seattle has eight wet public housing buildings for its most vulnerable homeless.

At the Bud Clark Commons, drinking will be allowed. Illegal drug use will be tolerated to an extent, but not in communal areas of the building. If it weren’t, many of the new tenants, who have addiction problems, would soon wind up back on the street, according to housing advocates.

John Blair sits alone in his $3 a month Butte apartment in Old Town. Blair, homeless for years, says he had to wait four years to get into his publicly-subsidized unit.

Discussions about what type of public housing to build are all set in relief against a disturbing backdrop: There simply isn’t enough to go around. Seven years into Portland’s 10-year plan to end homelessness, the city has more homeless people than before the plan was adopted. That isn’t because of any lack of effort to address the problem.

So if there’s only going to be enough public housing for a fraction of those who need it, the questions become: What type of housing should we support, and who should get priority?

Renaud says he supports what the commons is trying to do. He hopes it succeeds. And yet, he’s frustrated that “persons currently using illegal drugs and abusing alcohol get a preference over persons coming out of an alcohol and drug treatment program, or stepping down from a mental health treatment center.”

For nearly a decade, the concept of Housing First has dominated the conversation when it comes to housing the homeless. Sometimes it is called “low barrier housing,” because it comes without conditions about whether, for example, alcoholic tenants can continue to drink.

Others refer to it as “harm reduction housing” because getting the chronically homeless off the street at least lessens the harm they cause while on the street — both to themselves and to taxpayers. Public expenses related to the chronically homeless can be extraordinary because of the crimes they commit and their unpaid visits to hospital emergency departments and overnight shelters.

Ed Blackburn, executive director of nonprofit Central City Concern, which provides a wide range of social services to the homeless, says that in the past few years almost all of the taxpayer money spent on public housing has gone toward Housing First buildings.

“I’m not against this kind of housing, but what we’re really lacking now is capacity for people who want to enter recovery and significantly change their lives,” Blackburn says.

Both homeless and addiction policy advocates recognize the need for both types of housing, wet and dry. They also know that the terms wet and dry housing are oversimplifications because there are many variations. For instance, transitional wet buildings that lead to permanent dry apartments, or dry buildings that forgive relapse.

Housing advocates tend to favor the Housing First, harm-reduction model. The cost of leaving on the street those 130 tenants soon to be living in Bud Clark Commons would be enormous, in some cases close to $1 million in taxpayer money during just one of those individual’s lives.

“It does no good to evict them and put them back on the street; then it’s a problem for everybody,” says Bobby Weinstock, housing consultant with Northwest Pilot Project, a Portland nonprofit that helps seniors confronting homelessness.

Two men (who asked not to be named) drink beer on the bank of Interstate 5 in Northeast Portland and discuss what they say is a need for wet housing for those unable to give up their addictions. Both men, chronically homeless, say they don't qualify for most affordable housing because of prior criminal convictions.

Mental health and addiction treatment providers say harm reduction looks at the big picture, but fails to look at what’s best for the individual homeless person.

On a daily basis, Eric Bauer sees as many homeless, addicted people as anybody in Portland as executive director of the Portland Rescue Mission in Old Town. Bauer says wet housing is necessary and humane for what he estimates might be 30 percent of the homeless. Those include the homeless with severe mental illness, chronic diseases and people older than 60.

The rest, Bauer says, have a better chance at recovery if they are in buildings where they have to try, and can’t be seduced by buildings where they don’t have to.

“Recovery is hard work,” Bauer says. “There are going to be moments when you say you can’t do this. If free wet housing is available to you immediately, you’re going to take it at some point.”

Bauer says that the idea of Housing First has changed from when it was first proposed locally, when the idea of harm reduction prevailed.

“When this first came out, it was the 10-year plan to end chronic homelessness and every city had a few guys or gals who were million-dollar guys. The argument was a solid argument for the million-dollar wonders but they aren’t the norm,” Bauer says.

Bill Russell, another member of the faith-based recovery community as executive director of the Old Town Union Gospel Mission, says placing addicts in a building where drinking is allowed doesn’t make sense. The Mission’s LifeChange program houses and helps recovering addicts, most who start out homeless, and demands complete abstinence from drugs and alcohol.

“People who have been working to help facilitate sobriety and responsible living, there’s been an almost universal eye-rolling toward the Housing First policy,” Russell says. “Most of us on this side of the fence say it’s not going to happen. (Sobriety) will happen for a week or a month or a quarter, but people abandon their housing because their impulse control problems end up thrusting them out of stable, responsible living.”

Russell says that most homeless addicts have plenty of examples in their pasts of housing and jobs that they’ve left.

“To say, you get stability back by giving them housing and employment, we kind of head scratch on that by saying, well, we’ve given them housing and employment,” Russell says.

Housing First advocates, however, turn that argument around. For those who have tried recovery and failed, they say, wet housing is the more compassionate last hope.

“If you extend the logic of the arguments around enabling (advanced by those who) are opposed to harm-reduction approaches, essentially they say that these people should remain homeless for their own good. And I fundamentally reject that,” says Daniel Malone, director of housing programs for Seattle’s Downtown Emergency Service Center. The Service Center runs eight wet buildings.
‘More about ideology’

Central City Concern’s Blackburn says that for the majority of homeless, dry housing works better. Central City Concern runs a variety of housing types, wet, dry, permanent and transitional housing. One of the advantages of dry, he says, is peer pressure. Central City Concern’s recovery buildings require tenants to sign a covenant in which they promise to abstain and support other tenants in their abstinence.

On the other hand, Blackburn says, if the goal is simply keeping people off the street, studies show that once in wet buildings, previously homeless tenants tend to stay longer. In recovery buildings, he says, more tenants put their lives together and move on.

Blackburn says he wonders what will happen to tenants in the Bud Clark Commons who decide they want to embrace recovery, but can’t do it in a building dominated by those still drinking and using. If they leave the commons, they could be homeless for a year waiting for an opening in a dry building, he says.

What most concerns Blackburn and others is that finding the right mix of wet housing vs. dry housing doesn’t appear to be part of the policy discussions. Nationally and locally, he says, there are two entrenched camps and very little give and take. Housing First has prevailed.

“This isn’t all about evidence and what’s the right thing to do,” Blackburn says. “It’s more about ideology.”

Housing First or strings attached?

Housing First means exactly what it says – provide housing unconditionally as the foundation for stabilizing the lives of the homeless, and then offer services such as drug and alcohol treatment to clients better able to embrace the change.

In addition, Housing First advocates say restrictions on alcohol use in an apartment – even one funded by taxpayers – would be unjust, since alcohol is a legal substance.

The argument against setting conditions comes from John Song, a University of Minnesota physician who studies end of life issues with the homeless. People who say public housing for addicts and alcoholics should come with strings attached don’t truly believe addiction is a disease, Song says.

“Alcoholism should be looked at more like cancer,” Song says, pointing out that few would take away public housing from a cancer sufferer who refused to get chemotherapy.

Yet, Song says, “If an alcoholic says, ‘I’m not ready to be treated,’ we treat them like they’ve done something wrong.”

Still, there are precedents for attaching strings to public money for homeless people and addicts. Oregon’s Temporary Assistance to Needy Families program is guided by rules that can require recipients who are substance abusers to enter recovery programs to keep their benefits.

The U.S. Veterans Administration provides housing vouchers for homeless veterans, but those are also conditional. Substance-abusing vets are required to work with case managers on their problems to receive their vouchers.

Closer to home, the Portland Police Bureau’s Service Coordination Team works to get the city’s most frequently arrested citizens – most of whom are homeless and addicted – off the streets. The bureau’s team has access to recovery programs and immediate housing that make it the envy of most social service agencies.

There are strings attached when the service coordination team offers housing. Clients get about a month grace period in free wet housing, where drinking is allowed, and then they have to cooperate with a treatment plan if they want to keep the housing and graduate to more permanent “dry” apartments, according to Program Manager Austin Raglione.

It makes sense for her clients to require conditions on some housing, Raglione says.

“It’s not going to work for every case,” she says. “It could work more than people realize. We see it happen every day.”

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 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.