Mental Health Association of Portland

By Maxine Bernstein, The Oregonian, May 16, 2013

Crisis Assessment and Treatment Center

Portland Mayor Charlie Hales announced Thursday that the city will not cut its share of funding for the Crisis Assessment and Treatment Center, as he had set out to do in his proposed budget.

“We are gratified that people having serious mental health issues will continue to have this vital resource,” Hales said, in a joint statement with Multnomah County Chair Jeff Cogen. “In the two years since the county and city jointly opened the CATC, the center has helped to stabilize about 1,300 people in a mental health crisis.”

Hales’ proposed cut was harshly criticized by Cogen as a short-sighted mistake.

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, Hales had 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.

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.

Center managers, though, earlier this month pointed to statistics that showed while Portland police haven’t been taking people directly to the center, many of the people they encountered were ending up there for treatment anyway.

Of the 1,300 people treated since the center opened, 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.

Under an agreement signed in 2010, the city and Multnomah County each agreed to 20 percent, or $634,000, of the center’s $3.5 million operating costs. The state picks up the rest.

The mayor’s about-face came after further discussions with Cogen about the crisis center, as well talks about finding ways to fund other services, such as the needle exchange program, a one-stop domestic violence center, local senior centers and SUN schools.

“Because Multnomah County is in a stable budget position this year” Hales and Cogen said in their statement, “we agreed that the county will pick up the city’s share for the needle exchange program and one-stop domestic violence center. And the county will provide one-time-only money to maintain the current level of funding for our community’s senior centers and split the cost of three SUN schools for one year, giving both the city and county time to work on a longer-term solution for both of those vital services.”

At least 56 people experiencing homelessness died in Multnomah County in 2012, an average of at least one every week. That is the troubling finding of Multnomah County’s second annual “Domicile Unknown’’ report released Friday, May 10.

READ – Domicile Unknown, 2012 (PDF, 406KB)

The analysis by Dr. Paul Lewis, Deputy Health Officer for Multnomah, Washington and Clackamas counties, is based on data collected by the Oregon State Medical Examiner and Multnomah County Medical Examiner’s Office. The report is produced by Multnomah County, the City of Portland and Street Roots.

Dr. Lewis said the ages of the people involved, and the causes of the deaths, suggest that virtually all the deaths were avoidable. More than half the deaths were accidental and included death from overdose, drowning, burns and hypothermia. The average age of death was about 46.

“Forty-six is too young to die,’’ Lewis said. “Especially since most of these deaths are preventable.’’

Israel Bayer, executive director of Street Roots, said that, “as a community we should pause and understand that each one of these people was a human being who passed away far too early in life.

“Housing is not only the safest way to provide people adequate health care, it’s also the most cost effective,’’ Bayer said. “We know that by providing people a safe and stable home that we can give people the opportunity to live long and successful lives.’’

Multnomah County Commissioner Deborah Kafoury said the report is key to understanding the impact of homelessness.

“This report makes it clear why we need to end homelessness in Multnomah County,’’ Kafoury said.  ”Each of the people in this report was someone’s brother, sister, mother, father or neighbor.  Their lives matter and so do the lives of every person in our community.”

By Steve Duin, The Oregonian, May 6, 2013

In chopping CATC — the Crisis Assessment Treatment Center — off at the knees, Mayor Charlie Hales is only looking to finish what the Portland police started.

What remains to be seen is whether the cops’ stubbornness about the mental health facility is driving (a) the city’s budget priorities, and (b) a quick wedge between the mayor and Multnomah County Chair Jeff Cogen.

The timing of Hales’ announcement to eliminate $634,000 in CATC funding couldn’t have been worse, breaking even as the city announced a $2.3 million settlement for a deplorable cop shooting that left William Kyle Monroe, who suffers with bipolar disorder, permanently disabled.

But the mayor’s move also added to the perception — shared by the U.S. Department of Justice and many local mental-health advocates — that the police bureau considers its dealing with the mentally ill a colossal inconvenience.

After Cogen and former Mayor Sam Adams opened CATC with great ceremony in 2011, the cops acted as if the triage center didn’t exist.

Capt. Sara Westbrook, head of the behavioral health unit, dismissed the center as unworkable for police last spring, and remained wedded to her objections on its admission guidelines long after CATC revised them.

As The Oregonian’s Maxine Bernstein reported over the weekend, many patrol officers never knew CATC was an option. Never mind that almost 200 of the 1,300 people treated there were first dropped off by police at local emergency rooms.

“This wasn’t designed to make the cops’ lives easier,” Cogen reminds us. “This was designed for people having a mental health crisis. The real focus is that these 1,300 people have a place to go so they don’t run into the cops.”

Small wonder if Cogen feels betrayed. He partnered with Adams on CATC funding when partnering with Adams wasn’t easy. Briefed on potential budget cuts by Hales, he asked for one lone reprieve.

“I said to him very clearly, ‘The one I really hope you don’t cut is CATC,’” Cogen said.

The preliminary proposal was submitted for Hales’ consideration by Commissioners Nick Fish and Steve Novick.

Fish is holding fast to his original diagnosis.

“We were charged with being provocative,” he said Sunday. “This is a healthy debate, and long overdue. And the more I look into this, the more I hear that there have been a lot of misgivings about CATC.”

Novick has a different take. Given the city’s financial stake in the center, he says, “It puzzles me that Sam never followed up to see if the cops were using it.”

Even more striking, he says, were the contradictory narratives that city commissioners heard from the police and county leaders garnered from their people about the facility.  “From the very beginning,” Novick says, “there have been two conflicting messages.”

Westbrook continued to argue CATC wouldn’t accept people who were a threat to themselves or others long after the center was beaming up a different message with the bat signal.

As Kevin McChesney at Telecare, which operates the center for the county, told Bernstein, its doors are open to anyone short of “the person swinging an ax.”

If there’s a lesson here about police bureau mulishness, there’s another one about leadership and attention to detail.

“Normally, the efficient and right thing for a political leader to do is listen to your staff people and trust what they’re telling you,” Novick said.

“But you have two organizations here — mental health and the police — who don’t naturally speak the same language. They got locked into these positions over the last year and a half.”

Which proves? “There are situations where political leaders need to dig into the weeds and say, ‘What’s going on here?’ Read the documents. See if there isn’t a misunderstanding instead of blindly following what their people are telling them.”

Novick met with Cogen on Monday. Off what he heard, he said, “There’s a stronger argument that the city should fund a portion of the CATC than I thought there was based on the information I had last week.”

Is that cause for Portland cops to join the conversation? Time will tell. Historians are skeptical.

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.

Chief Mike Reese (center)

By Maxine Bernstein, The Oregonian, April 9, 2013

Portland police have selected about 50 officers who volunteered to be part of a new specialized unit to respond to mental health crisis calls.

The new unit is one of the initiatives that federal justice investigators last year urged the bureau to adopt to improve police encounters with people suffering from mental illness.

The U.S. Department of Justice found last year that Portland police engaged in a pattern of excessive force against people with mental illness.

The Portland officers assigned to the bureau’s Enhanced Crisis Intervention Team will remain on patrol but become the go-to responders on mental health crisis calls.

While all Portland patrol officers have received 40 hours of crisis intervention training, this group will receive an additional 40 hours over four days next month that’s based on input from mental health agencies and consumers.

The training will include classroom instruction, role-playing, tours of mental health facilities and a panel discussion with people living with mental illness and their family members.

Central Precinct Officer Amy Bruner-Denhart, who joined the bureau 8-1/2 yrs ago, will serve as the team coordinator.

“We have high hopes that when someone is a volunteer, they’ll be perhaps more familiar and more able to react in a highly supportive manner,” said Terri Walker, board president of the Multnomah County chapter of the National Alliance on Mental Illness.

Police have also created the Behavioral Health Coordination Team, with  police meeting twice a month with representatives of mental health care agencies. Together, they identify the city’s most vulnerable citizens who have been the subject of repeated police calls or are considered a heightened danger to refer them to appropriate treatment.

“Our hope is we can plug the right person with the right agency,” Central Precinct Cmdr. Bob Day said Tuesday.

Lt. Cliff Bacigalupi said the Behavioral Health Coordination Team is modeled after the bureau’s existing Service Coordination Team, which works to connect repeat low-level offenders with alcohol treatment and housing.

The Behavioral Health Coordination Team meets every other Friday, drawing representatives from agencies such as Cascadia Behavioral Healthcare, the U.S. Department of Veterans Affairs, Transition Projects and Multnomah County’s Mental Health and Addiction Services, along with a new county prosecutor assigned to mental health cases and county jail medical staff.

Laura Maurer, the county’s deputy district attorney assigned since September to work on mental health matters, said she attends the meetings to help police or mental health care providers navigate legal matters that might arise. She also works to educate officers and others on what’s needed for civil commitment hearings.

Last month, the U.S. Department of Justice urged the bureau to return to a specialized group of officers who have the desire, crisis intervention training and skills to work with people suffering from mental illness. The federal review found Portland’s crisis training sorely lacked key components: “live exposure” to mental health consumers and family members, role-playing scenarios and community collaboration.

Portland police had adopted the Memphis model in 1995, creating a specialized team of volunteer officers to respond to crisis calls after the 1992 Portland police shooting of Nathan Thomas, a 12-year-old held hostage by a mentally ill man with a knife. Portland police started it with 60 officers who volunteered for the 40-hour training and, within 18 months, grew to 185 officers.

But the bureau veered away from the voluntary training and required that all officers be trained in 2007. The switch came after the controversial 2006 death in police custody of James P. Chasse Jr., who suffered from paranoid schizophrenia.

Shannon Pullen, interim executive director of the National Alliance on Mental Illness’ Multnomah chapter, is co-chairing a new advisory committee for the police bureau’s Behavioral Health Unit.  It has met twice this year and includes members of Central City Concern, Volunteers of America, Cascadia, Disability Rights Oregon and mental health consumers.

Pullen said she’s excited that police are engaging a diverse group of people who work in the mental health field. The advisory panel will sit in on next month’s enhanced crisis intervention training and is coordinating a panel to address the officers.

“It’s what the community has wanted,” Pullen said. “My mantra is engagement. We can only work better together and try to see the issue from each other’s point of view. And, hopefully, it’ll result in better outcomes.”

By Peter Korn, Portland Tribune, March 28, 2013

Ten months ago Multnomah County opened the nation’s first court set in a homeless facility. Nobody showed up.

In what court authorities around the country labeled a potential breakthrough experiment, Multnomah County’s Community Court last year moved its Friday afternoon operation to Bud Clark Commons.

The court deals mostly with low-level citation crimes such as drinking in public and small thefts. Many of the accused are homeless. The hope was that defendants might be more willing to show up for their court dates if court were held in a facility where many of the defendants spend their daytime hours.

The second week the court was in session, one defendant showed up, out of 16 who had been issued citations and ordered to appear.

Last Friday, 65 people were ordered to appear at the Bud Clark Commons Community Court and 21 did so.

Doreen Binder, executive director of Bud Clark Commons and the driving force behind the new court, says that’s progress. And, Binder says, the progress is best measured not by how many accused offenders actually make their court date, but by what happens to those who do.

Of the 15 who appeared in court two weeks ago, five agreed to perform community service and one chose to take his case to a full trial. Three opted to work with social workers to get treatment for addictions or attend groups to help them deal with the problems that have played a role in their homelessness. Six had returned to the court after completing work with social service agencies.

Those last nine, according to Binder, are the reason it makes sense to hold court in a facility that serves the homeless.

“We’re trying to turn the court into an entryway into services rather than something people view as a punitive institution,” Binder says.

Still, the fact that only about one in three defendants makes their court appearance shows there is still work to be done. Failure-to-appear rates for Community Court have long been a problem, though nobody can say exactly how large a problem since Multnomah County court officials don’t keep records on appearance rates.

The penalty for failing to appear can be a fine which many never pay, knowing they won’t be sent to jail anyway. At Bud Clark Commons, many of those who fail to appear are simply placed on the next week’s docket. Some are scheduled week after week and never appear. But Larry Turner, engagement director for Transition Projects, which runs the day facility, thinks holding the court at Bud Clark Commons gives him an opportunity to increase the appearance rate. In fact, he knows it does.

At Bud Clark Commons homeless men and women can use computers, do their laundry, take showers and connect with social service agencies. On a typical afternoon, dozens will be seated in the main lobby, waiting their turn or just hanging out. Every Wednesday Turner gets the docket for the Friday Community Court, which gives him two days to spot the familiar faces of those he knows are supposed to appear, or who failed to appear the week before.

When Turner finds them, he tries to persuade them to show up on Friday. He’s armed with a couple of convincing arguments. One section of Bud Clark Commons has overnight beds for the homeless. Four of those beds are reserved for people who have made their court appearances. On a Friday afternoon, a homeless man can go straight from his court appearance to one of those beds.

Turner’s bigger pitch has to do with longer term housing. All of the social services offered at Bud Clark Commons are aimed at getting homeless people off the street and into permanent subsidized apartments throughout the city. For some, the first step is an addiction recovery program, for others it might be mental health treatment.

But people with outstanding warrants and fines cannot legally be placed in those apartments. Which is why Community Court judges are willing to waive fines if an offender agrees to perform substitute community service or begin drug treatment.

Still, getting those defendants to court is an uphill battle. Turner says he can predict fairly well who will appear and who won’t. The most chronic offenders with multiple prior arrests for nuisance crimes rarely show up, he says.

“They know it’s just going to be a fine,” he says. “They’ll get picked up again. They’re always drinking, always loitering, because they know the most that can happen is a fine.”

A fine that likely will never be paid, according to Turner.

But, Turner says, those among the homeless who have been issued their first citations for drinking in public or small thefts are more likely to show up for court dates. Which, he says, makes a strong case for doing everything possible to get them into court before they become chronic offenders who never show up.

What Turner would like to do is begin an outreach program that would allow him to send social workers, possibly Bud Clark mentors, to search the streets for the people on each week’s docket and persuade them to come to court on Friday.

“Everybody knows where they are,” Turner says.

Training those mentors would take a little money that Transitions Projects can’t spare. But Turner remains optimistic about the community court program’s future.

“The court is still in its infancy,” Turner says. “It’s only been nine months. For people to expect this court to make drastic changes in people’s lives in nine months is expecting a miracle. But I believe with continuity, and the more familiar people get, the longer it happens, the more success we’re going to have.”

Multnomah County prosecutor Laurie Abraham says the still-high failure-to-appear rate doesn’t mean the community court isn’t working.

“Maybe it’s not getting a lot of people into housing and drug and alcohol treatment, but it is getting a few,” Abraham says. “Even when you get a few you save the criminal justice system a lot of money.”

Criminal justice officials around the country will be watching, says Julius Lang, director of technical assistance for the nonprofit Center for Court Innovation in New York City.

“It’s turning the paradigm on its head,” Lang says of the Bud Clark Commons approach of bringing the court to the defendants. “What we need is evidence of the impact that Bud Clark is having. Once we have a more complete story to tell I think it will be a very compelling example.”

At the Bud Clark Commons Community Court, about 1 in 3 defendants shows up. At Community Court in Hartford, Conn., better than 9 in 10 do.

The Bud Clark Commons Community Court experiment is intended to lower a historically high failure-to-appear rate. But in Hartford, Conn., tackling time, rather than place, is proving much more effective.

In Multnomah County, a police officer issues a citation for a court date that is usually two to four weeks away. In Hartford, no more than two days lapse between when police issue a citation and the court date.

“The quicker you get them here, the better it is,” says Hartford Community Court Judge Raymond Norko, who suggests Portland should at least attempt to have court dates the same week as citations are issued.

A shorter turnaround time makes sense, says Binder, the Bud Clark Commons executive director. “These are people who, some are sleeping on the streets. It’s almost impossible (for them) to remember dates,” she says.

The Hartford court, which is in session five days a week, does more than shorten the time between citation and court appearance. Every afternoon the court sends the next day’s docket to the homeless shelters in town. Shelter staff members check who in their facility is scheduled to appear in court, and then accompany clients to the courtroom.

Multnomah County prosecutor Abraham says “logistics” have made it impossible to shorten the time between citations and court dates here. Police officers have to get their reports to prosecutors who have to get them to the court, and in Multnomah County that paperwork process is often taking a month.

“We can’t seem to shorten that period up,” Abraham says. “We ought to be able to do that faster and I don’t really know why we can’t.”

The Hartford approach is vastly different from Portland’s, where nuisance offenders often tear up police citations as soon as they are issued, and know they likely will never be taken to jail if they fail to appear in court. Even if they are arrested after an abundance of failures to appear, they are released after a few hours, according to Abraham.

That wouldn’t fly in Hartford, according to Norko. Hartford defendants who don’t show up for their nuisance crime court dates face a $150 cash bond that can be worked off with community service, according to Norko. Social workers who offer addiction services and mental health treatment are part of the process as well.

But if offenders still don’t appear, Norko issues an arrest warrant, police bring them to jail, and their community service time increases. The failure-to-appear rate has dropped below 5 percent.

“You can make the argument you’re criminalizing the homeless, but the community in Hartford demands their quality of life be enforced by the police department and the court,” Norko says.

Johneen Manno, owner of Whole Systems Counseling & Consultation

By Steve Beaven, The Oregonian, March 30, 2013

A clinic that treats Portland-area sex offenders quietly moved into a nondescript office complex on Southeast Stark Street on March 1, two months after angry parents forced the clinic out of the Sellwood-Moreland neighborhood in Southeast Portland.

It wasn’t easy to find new offices for Whole Systems Counseling & Consultation. Owner Johneen Manno said she started with a list of about 20 office properties and checked out more than half before signing a lease at Plaza 125, at Southeast 126th Avenue and Stark Street.

Manno’s options were limited. She didn’t want to rent near a school or a daycare center or in a dense residential neighborhood with a lot of children. But she couldn’t choose an isolated industrial area, in part because many of her clients use public transit.

Throughout the Portland metro area, therapists who treat sex offenders face the same limits. They have to balance their clients’ need for treatment that is confidential and accessible with the public’s fear of their clients.

“When (people) hear ‘sex offender’ in any context, it’s like going to a doctor’s office and hearing ‘cancer,’” said Thomas Brewer, supervising clinical psychologist at Sunset Psychological and Counseling Services, which has a contract with Multnomah County to treat sex offenders. “They react out of fear.”

But there are no state laws, local ordinances or official guidelines to direct these clinics to appropriate locations. Multnomah and Clackamas counties, which pay Whole Systems to treat a portion of the sex offenders under supervision, don’t provide input either.

Patrick Schreiner, district manager in the county’s department of community justice, said in an email that the county doesn’t have the authority to tell Whole Systems where to locate.

“Neither Multnomah County nor any of the other 35 Oregon counties have a say in where sex offender treatment clinics are located because there is not a provision under state law which governs where they provide services,” he wrote.

Jenna Morrison, the community corrections manager in Clackamas County, said clinics avoid areas where clients could violate the conditions of their supervision.

“You wouldn’t put an A.A. meeting in the back of a bar,” she said.

Clackamas County currently supervises about 350 sex offenders, while Multnomah County supervises 750. Not all of the sex offenders under supervision are receiving treatment.

While therapists must deal with limitations on where they can open their offices, it’s not an issue statewide, said Kraig Bohot, a spokesman for the Oregon Sex Offender Treatment Board.

“It’s never really been a not-in-my-backyard issue until the specific incidents in Sellwood,” he said.

Manno, a licensed counselor, started Whole Systems in 2003. Her clinic treats anyone affected by sexual abuse. Manno also trains educators and others on treatment of sex offenders and the rules that govern their conduct.

She has a five-year contract with Multnomah County that pays more than $225,000 and a one-year contract with Clackamas County for $47,500.

Whole Systems moved to 7304 S.E. Milwaukie Ave. in Sellwood-Moreland in December 2011. Manno attracted little attention until the following November, when residents held a community meeting to express anger about the clinic’s proximity to a Montessori school and a family-oriented neighborhood.

Residents also said Manno didn’t do enough to notify the neighborhood about the clinic when it opened.

Manno said she didn’t know there was a Montessori school nearby until after she had moved in. It was “very disappointing” when she found out, she said.

She added that she relied on her landlord to inform surrounding businesses of her arrival. “The public shouldn’t expect us to be the ones to get the word out,” Manno said. “I think Sellwood was expecting me to go out door to door.”

Whole Systems moved out of the Milwaukie Avenue office at the end of December. For the first two months of 2013, Manno rented space at the Mead Building, at 421 S.W. Fifth Ave., where other Multnomah County community justice programs are housed. She also rented an office in Oregon City.

As she was looking for a new office, Manno said, she drove through some neighborhoods to make sure her clinic would fit. But it was difficult because of the density of commercial, residential and office development.

“There’s so much mixed-use in Portland it’s hard to find something that doesn’t include housing,” she said.

Whole Systems is now next to a clinic that provides addiction treatment. Plaza 125 is also home to other mental health providers, attorneys, dentists and other white-collar businesses.

Manno said she thinks her new neighbors will be less upset about the clinic.

“There aren’t as many houses around us,” she said. “I don’t know of any single-family houses around us.”

In fact, single-family homes line the streets behind the office complex. There are also several apartment complexes nearby.

But people in the surrounding homes, as well as in the office complex, offered muted responses to news of the clinic’s arrival.

Of more than a dozen people interviewed, most said they hadn’t been informed that Whole Systems had moved in. But none expressed outright opposition.

Leah Hunter said she brings her 8-year-old son to a dentist in the complex once or twice a month. Any parent would be concerned about a clinic that treats sex offenders, Hunter said.

“But I would be more concerned if they weren’t receiving care,” she said. “Then they wouldn’t be monitored.”

Marcia Harris is the director of client education for Senior Helpers, which provides in-home care for the elderly and has an office in Plaza 125. She supports Whole Systems’ mission.

“Everybody can be helped and everybody deserves to be helped,” she said.

But Harris said she was initially miffed that she hadn’t been informed of the clinic’s arrival. “The more information you have, the better decisions you can make about your environment and your comings and goings,” Harris said.

Manno said she has sent letters to nearby businesses and held an open house. One person showed up.

The primary fear about having sex offenders nearby is that they will target random children. But studies consistently show that the majority of sexual abuse victims know their attackers. And not all sex offenders victimize children.

One of the challenges people have is they assume that people who sexually offend are all the same,” said Maia Christopher, executive director of the Beaverton-based Association for the Treatment of Sexual Abusers. “We know that that’s not true.”

Manno’s current concerns are based on her experience in Sellwood, where she said one news crew came to the building’s back entrance and knocked on the door. She worried that her staff and clients wouldn’t be able to leave without being on television. Manno said she doesn’t want their safety or confidentiality compromised.

She’s eager to explain her work to neighbors.

“The more they can know, the better,” said Manno, adding, “It’s natural to have fear, but a lot of that is based on not having all the information.”