Mental Health Association of Portland

By Ryan Bemis, published in Guidepoints: News from NADA, January 2012 – not available online, reprinted with permission.

Paid licensed acupuncturist positions within addictions and psychiatric programs in Oregon and California have sharply declined in recent years largely due to budget issues, and as a result dozens of acupuncture-based services for the public have ended, according to an informal survey conducted by the National Acupuncture Detoxification Association (NADA). Meanwhile NADA advocates and acupuncturists who have lost such jobs continue to work for NADA policy reform in the face of opposition from the acupuncturist profession.

Aren’t there enough licensed acupuncturists in the US to provide NADA ear acupuncture clinics within addictions and mental health programs? This is a common, and fair, question posed by acupuncturists.

To answer this question, Guidepoints zeroed in on 2 states that are home to some of the largest populations of acupuncturists: California and Oregon. We interviewed both addictions providers who have laid off acupuncturists, and acupuncturists who lost their jobs in treatment programs. According to their reports, very few acupuncture-based addictions programs currently operate in these two ADS restrictive states. Only five known NADA programs exist in Oregon.

The report contrasts with numbers of NADA programs in states that permit allied health workers to perform the NADA protocol, such as New Mexico, where currently there are 19 NADA programs, and Maryland which has 20. The survey supports a hypothesis that it is not sustainable for addictions and mental health programs to exclusively depend on hiring an outside contracted acupuncturist at $30-$70/hour to perform the NADA five point ear protocol.

Oregon: NADA giants cut in half

In Portland, Oregon, which at one time was home to more NADA programs than anywhere in the world, jobs for acupuncturists within addictions programs have almost disappeared. Due to severe budget cuts, the high salary of an acupuncturist (which can range from $30-$70/hour), is often the first item to be cut.

In 2004, 20-25 acupuncturists were employed within the network of NADA programs. Today, there are less than half as many employment opportunities: only 11 mostly part time jobs for acupuncturists. In a state like Oregon, if a program can’t pay a licensed acupuncturist or find a willing volunteer acupuncturist, the program can no longer offer NADA services to their clients.

“Lack of ADS is the killer,” remarks Guidepoints founding editor Jay Renaud about the massive program closures. Renaud worked for years as an addictions program administrator in the Portland area.

ADS refers to an Acu Detox Specialist, an individual who has received the full 70 hour competency based US training offered by the National Acupuncture Detoxification Association (NADA). ADS denotes a health worker qualified to provide NADA ear acupuncture protocol services for broad-spectrum behavioral health symptoms. Integral to a cost effective NADA model, ADSes are not licensed as acupuncturists, but are rather counselors, nurses, social workers, psychologists or other community health workers. According to one comparative study, NADA services provided by licensed acupuncturists was 16 times more
expensive for a treatment program than utilizing existing treatment staff trained as ADSes (Mercier, 1992).

Mercier, D.G. (1992) The Kent-Sussex Program: A Case for Acupuncture Specialists. NADA Literature Item # 1028. Laramie, Wyoming: National Acupuncture Detoxification Association.

The total cuts in the past 8 years are estimated to be 55%-59% (calculated by estimating the number of 3-4 hour shifts of NADA groups and acupuncture sessions accessible to Oregonians within psychiatric and addictions programs).

The rollback began in 2004 at Central City Concern (CCC), a comprehensive recovery and housing program located in the heart of Portland, a year after the National Health Care for the Homeless Council recognized CCC’s use of acupuncture as a model for providing care to the homeless. Eight psychiatric and addictions acupuncture based programs staffed by CCC acupuncturists lost funding. Acupuncture services at CCC’s detox and outpatient program were also scaled back, alongside two inpatient programs through Ecumenical Ministries of Oregon and Volunteers of America.

In 2007, the NADA based drug court program in Multnomah County lost funding; acupuncture is no longer a service for their clients. The NADA protocol was an integral component of their comprehensive drug court services since inception in 1991, and independent evaluators estimated that the NADA program reduced crime and saved taxpayers $79 million in “avoided costs” over a 10 year period.

Most recently in June 2011 the 18-year old NADA style program at the Washington County Community Corrections Center, where licensed acupuncturists served 100-150 clients weekly, free for the public, lost funding for salaried acupuncturists.

California acupuncturists just say no to NADA reform

In California, the picture is not better.

Between 1998 and 2003, eight NADA programs closed due to funding problems, which together had offered acupuncture within mental health and addictions programs for an estimated 30+ clinic sessions a week. Since then, NADA programs within a homeless shelter in Santa Maria and another inpatient program called Cottage Care lost funding. Just since the budget crisis of 2008, at least 10 NADA programs have been cut, according to reports from acupuncturists who worked in these programs.

The California Acupuncture Board was approached by state legislative assembly workers in May 2010 presenting the possibility of a NADA policy that would permit existing treatment staff, with ADS training, to perform NADA services. This effort was backed by the California Association of Alcohol and Drug Program Executives (CAADPE), a policy advocacy and workforce development organization representing addictions and mental health providers across the state.

In addition, acupuncturists who lost their jobs as NADA protocol providers came out in support of the NADA policy. They envisioned creating new opportunities for acupuncturists to work as trainers, similar to states like New York, Texas, and Virginia. Such a policy would have also helped establish new educational opportunities for addictions and psychology graduate students, similar to the Yale Medical School’s NADA training program, which exists today as a result of the Connecticut ADS exemption rule.

However, the Acupuncture Board unanimously voted against NADA reformers, stating in their minutes that they would “not support the practice of acupuncture outside of licensed acupuncturists.”

And with that statement, the crisis has continued to worsen.

More jobs for acupuncturists have since been cut, which has led to fewer NADA ear acupuncture clinics accessible to the public.

“It is so painful to be looking at this sad reality,” laments Project Recovery’s Executive Director, Ruth Ackerman, who witnessed in spring of 2011 the slashing of NADA services in their outpatient program as well as a homeless shelter in Santa Barbara, California. “The programs all loved the acupuncture treatment, they have just been cut to the bone.”

Last summer, a 19-year old hospital based NADA detox program in Oakland staffed by Gregory Ross lost funding. For years Ross wrote a column, Not the Emperor’s Acupuncturist, in which he told his personal and professional experience as an employed acupuncturist in a public health setting, was dropped by Acupuncture Today editorial staff. In his farewell column, “Saying Goodbye to Healing”, he wrote, “I am far from alone in this experience in the acupuncture detox field. Over the last 10 years or so, I have known at least eight acupuncturists that have left the detox field due to the bad economy.”

NADA advocates refuse to give up. The news is not new to most: Acupuncturists are out of work.

Wait lists remain long for addicts seeking recovery, relapsing and returning to the streets.

And while some see the current economic downturn as the beginning of the end of acupuncture based healing for addictions, west coast legislators and licensed acupuncturists, addictions providers and acupuncture students alike continue to support the NADA concept and explore ways to make NADA services accessible to people seeking help.

Carolyn Reuben, a licensed acupuncturist who lost several paid NADA gigs amidst the 2008 California budget crisis, continues to advocate for reform. As the director of the California Addiction Recovery Association (CARA), Reuben has spent years building support for a NADA policy so that addictions programs can save money by training existing treatment staff in the NADA protocol. She expresses optimism about prospective support from California acupuncturists in the future.

In late 2011, after a 2-year funding hiatus, California legislators passed a measure that renewed a contract with CARA to resume NADA services for correctional clients. Burke Adrian, supervising officer at the the Sacramento Drug Court told Guidepoints in 2009 that CARA’s NADA and nutritional program had a “great deal” to do with their program’s reputation in the state for cutting crime (17% 2-year recidivism rate, a figure well below the weighted (27.5%) and unweighted ($25.5%) national averages, according to an independent study).

In Oregon, Central City Concern has for decades and continues to employ the NADA protocol as a front line treatment for the homeless. The cost effectiveness of utilizing the NADA protocol within addictions programs has long been promoted by former Central City Concern director, Richard Harris, who is the current state director for the Addictions and Mental Health Division of the Oregon Health Authority. Harris also served on past federal addictions panels, offering recommendations for expanding access to the NADA protocol for the US Center for Substance Abuse Treatment.

With credit to David Eisen, a former Central City Concern administrator and executive director of the Portland-based integrative health center Project Quest, funding for remaining NADA services has been stabilized through Medicaid and Access to Recovery third party reimbursement. In addition, Eisen is exploring multi-year grant funding to renew the Washington County program.

Eisen, a faculty at the Oregon College of Oriental Medicine (OCOM) in Portland, also has played an important role in educating students and acupuncturists in the NADA concept of ADS provided treatment. For the past two years he has mentored student research projects on the use of the NADA protocol by non-acupuncturist NADA trained women health promoters (promotoras) who currently provide free clinics for people affected by drug war violence in Mexico. Another OCOM student research project in 2009, mentored by former OCOM research director Richard Hammerschlag, recommended training veteran peer workers in the NADA protocol as a best practice for acupuncture care among military veteran populations diagnosed with Post Traumatic Stress Disorder.

Still, acupuncturists in Oregon cannot provide such training in their own state under current regulations. With a NADA policy, schools like OCOM in Oregon could offer ADS training to counselors and psychologists similar to Texas acupuncture schools.

For information on how to assist NADA advocacy in any state, or to receive assistance from NADA in policy reform efforts, email advocacyfornada@gmail.com. To contact Ryan Bemis: ryanbemis@gmail.com.

Data collected and compiled with assistance of acupuncturists and program directors who have worked in programs suffering cuts: David Eisen, Ruth Ackerman, Debra Mulrooney, Lisa Kipplinger, Carrie Klein, John Blank, Christine Knight, Carolyn Reuben, Cally Haber, Gregory Ross, Lianne Audette. Reflects data current as of September 2011.

Here’s the December 2011 edition of Eyes & Ears, a mental health consumer run newsletter for consumers, their friends & family and mental health professionals.

Download and read the December 2011 issue at:

Online Reading Version of Eyes & Ears – with links
Full article version of Eyes & Ears – for printing

Contact the editor at eyes.ears@cascadiabhc.org

Included in this issue:
* 9-1-1 mental health calls to soon go to counselors not cops
* New $20 million Central City Concern building opens in Old Town
* Meeting the mental health needs of our jail population
* Progress Without Pepper Spray
* Testimony wanted on Oregon health transformation
* Oregon health transformation news
* Mindfulness and stress
* Extra on the online version with links: Richard Harris Retires;Find Purpose after living with delusions; Summary of Alternatives 2011; Street Root series on autism; Low-Cost Broadband and Computers for Students and Families; and more
* Coming Events: Rethinking Psychiatry 2012 Winter Film Festival; Spirituality and Mental Health Solstice Ceremony; and more

Besides other news there are a variety of listings of meetings, services, support groups, job opportunities and more.

Guest opinion by Richard Harris, director of the Addictions and Mental Health Division of the Oregon Health Authority

Richard Harris, presenting an award to Amy Anderson, Cascadia Consumer Advisory Council, with Maggie Bennington-Davis, Cascadia Medical Director

Right now, our state is engaged in an important discussion about how to provide treatment for those suffering from mental illness, especially those who may have committed a crime. The goal is to provide the right care at the right time in the right place. Before Oregonians move forward, we must have a clear understanding of the issue.

To help meet their needs and the needs of local communities, the state’s Addictions and Mental Health Division is studying the scope of mental illness in our county jail population. We are looking at the number of people in jail with mental illness as well as the severity and type. We know that people face everything from depression to psychosis, and there are often issues of substance abuse but we need solid data.

Once we have that information, workgroups of mental health consumers, providers and other stakeholders will make recommendations to the legislature on the best way to meet the mental health needs of our jail population. There are many successful interventions already in place in some parts of the state that we can learn from, such as crisis centers and mental health courts, that divert people away from jails and into the appropriate services.

For people who have entered the criminal justice system who need a higher level of mental health treatment and care, the Oregon State Hospital provides an important service. When that’s necessary, the law requires the hospital to admit people within seven days, and there is no waiting list.

Right care, right time, right place. By engaging the community in this discussion, our goal is to reach a place where, instead of being locked up, people with mental illness get the help they need. If you are interested in participating in this process, contact Len Ray, Adult Mental Health Administrator at len.ray@state.or.us.

From the Salem Statesman Journal, November 28, 2011

The administrator of the $458 million Oregon State Hospital replacement project will shift to a new job early next year, becoming interim director of the state office of addictions and mental health treatment programs.

Linda Hammond, who steered construction of the Oregon State Hospital replacement project, will become interim director of the state office of addictions and mental health treatment programs.

Linda Hammond, who has steered construction of a soon-to-be-completed state hospital complex in Salem, will succeed Richard Harris as head of the Addictions and Mental Health Division, or AMH.

Harris is retiring in January.

Bruce Goldberg, director of the Oregon Health Authority, announced the looming leadership change in an email circulated Wednesday.

Goldberg credited Harris for providing “innovative, thoughtful and inspirational” leadership “during a time of great change and challenge for our agency.”

Harris’ accomplishments included hiring Greg Roberts, the current superintendent of the state hospital, and overseeing transformation of the 128-year-old psychiatric facility “into a place of hope, healing and safety,” Goldberg said.

He said Hammond is the right person to step in as interim AMH director, citing her “strong administrative experience and a proven ability to lead people through change.”

Goldberg said a national search for a permanent director will be conducted in the summer.

Hammond has received kudos from state leaders for keeping the hospital replacement project on schedule and within its budget.

Completion of a state-of-the-art 620-bed hospital in Salem is scheduled for early next year. After that, construction will start on a smaller mental hospital on state prison land in Junction City.

In 2007, legislators approved construction of two hospitals to replace the crumbling, long-neglected psychiatric hospital in Salem, which opened in 1883 and was deemed obsolete and unsafe by state-hired consultants in 2005.

For the past several months, Hammond has held a dual role — as administrator of the hospital replacement project and interim chief financial officer for the Oregon Health Authority.

In an email to co-workers Wednesday, Hammond said Jodie Jones, deputy administrator of the hospital replacement project, will take the reins as its administrator.

“What I realized while I was in my dual-roles of interim chief financial officer and project administrator is that the project is too important — this team is too important — not to have a full-time, designated leader,” Hammond wrote.

“During my absence, Jodie has done an outstanding job, with support from all of you, as this project’s on-site administrator. I have asked and she has accepted this as her permanent role. She will continue to report to me but in my position as interim AMH administrator.”

By Amanda Waldroupe, The Lund Report, November 23, 2011

Some counties will receive more, or less, funding for mental health programs than they did in the past

Richard Harris

With some kinks fixed and recalculations made, a new formula defining the amount of funding each county receives for mental health programs is here to stay, said Richard Harris, the director of the Oregon Health Authority’s Addictions and Mental Health Division, when he appeared before the legislative committee responsible for determining the budgets for the state’s human services programs.

The amount of money counties receive for mental health services will now be based upon their population and the prevalence of mental illness. Previously those dollars were based on a wide variety of factors, including whether some services were available in some counties but not others; the existence and number of residential programs, and whether other funding, such as grants, could be leveraged with additional state funding.

The change is due to a bill (HB 3067) passed during the 2007 legislative session sponsored by Rep. Gene Whisnant (R-Redmond) to distribute state dollars more equitably.

“[It] was designed to make our reallocation process sensitive to population changes from county to county,” Harris said. “Some counties were growing in population, and some counties were decreasing in population, but the funding stayed the same.”

The formula went into effect this July, and some counties, such as Deschutes, Lane and Washington received extra money. At the same time, Multnomah County sounded the alarm that it would be losing money — approximately $5.56 million for services to the uninsured and low-income people with severe mental illnesses. That cut, county officials said, would egregiously impact the county’s mental health programs.

The state added back approximately $4.7 million of the cuts, and the county voted in September to use some of its one-time only money, general fund reserves and Verity funds to make up for the rest of the cuts.

“We knew there were going to be losers and winners,” Harris said. Before July, counties were notified of the change, and given an approximation of what the new budget would be. “The shock, when it actually came to the counties, was pretty difficult for some counties.”

That prompted the Addictions and Mental Health Division to review each of its contracts with the counties. Because service level and demand had changed, the contracts were out of date, and some miscalculations had been made.

With the ink on the contracts now dry and an expectation that they will be signed within a month, those calculations have been corrected, and the amount of money will remain fixed.

Harris said that as a result of recalculations, $4.8 million was added back to the state’s budget for mental health services, which will be split and shared among the counties. Given that Multnomah County is receiving $4.7 million, there’s another $100,000 for the rest of the state.

“But still, it means that some counties will have fewer dollars than they had in the last budget period, and some counties will have additional dollars,” Harris said. “But these should reflect the population changes in those counties.”

Legislators didn’t raise concerns about the new formula or its impact on counties. But Sen. Alan Bates (D-Ashland) commented that there are some counties that contribute more general fund dollars to their mental health programs than others, and that some counties may be providing services to shared populations.

“It gets to be really difficult,” he said.

Rep. Jean Cowan (D-Newport) eluded that much of the kerfuffle may not have happened if the division’s contracting process had been simpler.

Karynn Fish, the spokeswoman for the division, said it’s common for contracts to be amended throughout the year, because of changes in service level, demand and other factors. There have already been 2,500 changes to the contracts since July, she said.

“I was truly struck with the complexity of this system and the amount of contract changes,” Cowan said. “This is an extremely cumbersome process.”

Harris responded that the Addictions and Mental Health Division’s contracting process may improve as a result of state-wide reforms to the Oregon Health Plan (known as “health transformation”).

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To: Addictions and Mental Health Services Interested Parties
From: Bruce Goldberg, M.D., OHA Director

Richard Harris

Today I share news of the January retirement of Richard Harris, director of the Addictions and Mental Health Division.

Richard has been a truly outstanding leader at AMH and OHA during more than three years of service.

As many of you know, he left retirement from Central City Concern in Portland to guide AMH during a time of great change and challenge for our agency. His leadership has been innovative, thoughtful and inspirational. Among his many accomplishments are hiring the superintendent at the Oregon State Hospital, Greg Roberts, and overseeing
the rebuilding of the hospital into a place of hope, healing and safety. Richard has also been strongly committed to the work of better integrating addictions and mental health services into Oregon’s health care system. I for one am most appreciative of his contributions, and know everyone joins me in thanking him for his service to our clients, our agency and our state. He is leaving us better than he found us.

I have asked Linda Hammond to serve as interim director of AMH after Richard’s retirement.

As we work to transform the health care delivery system with our partners, over the next several months we will also need to transform ourselves and the way we work. Linda is the right person to lead us through that period of change. We will conduct a national search for a permanent director next summer, when we have a better idea of the needs of our agency, our health care system and our state.

I know many of you are familiar with Linda. She has served in key leadership roles in AMH and in community services in Oregonand elsewhere. She brings strong administrative experience and a proven ability to lead people through change.

Before her current role as administrator of the Oregon State Hospital Replacement Project, Linda was the budget administrator for AMH. Prior to that, she held key leadership positions at Oregon Housing and Community Services and other nonprofit organizations. She also worked in a community facility in England for children living with mental and physical disabilities. Linda holds degrees in psychology, specializing in child development, and business management.

Over the next few months Richard and Linda will work together closely to ensure a smooth transition. Please join me in expressing appreciation to Richard for his service and in welcoming Linda to her new role.

From the Lund Report, September 15, 2011 – by Amanda Waldroupe

The state’s new funding formula for allocating money to counties for mental health services takes funding away from some counties, gives money to others

Multnomah County’s board of commissioners voted this morning to use $8 million dollars of its one-time only and general fund reserves to make up a total of $12.4 million in state cuts affecting the county’s safety net services.

The county is using a mix of one-time only funding, remaining general funds, and the county’s Verity funds to pay for the programs, which include everything from domestic violence services, anti-poverty services, and behavioral health care.

Obviously, not all programs and services are being saved from the chopping block: the county is choosing to accept state cuts effecting mental health services for adults and children; gang intervention; juvenile detention services, and community prevention services relating to the county’s sexual transmitted disease (STD), HIV, and Hepatitis C program.

Much furor came from $5.56 million in cuts to the county’s mental health crisis services, which serve uninsured and low-income people with severe mental illnesses. Those cuts would have eviscerated the county’s safety net services, said County Commissioner Deborah Kafoury.

Approximately $4.7 million of the cuts were added back by the state, and preserve funding for adult residential services, addiction services, and commitment services for adults sent to the Oregon State Hospital when they have a severe mental breakdown.

It is not clear why the money was added back, but could be the result of a September 13 meeting between Joanne Fuller, the county’s chief financial officer, and Richard Harris, administrator for the state’s Addictions and Mental Health office. Neither returned a call for comment.

But at a September 13 Oregon Health Policy Board meeting, Harris told the board that the state’s mental health services serve less than forty percent of the demonstrated need. “As the population has grown, we have not kept up with services,” Harris said.

The cuts are the result of a new state funding formula that calculates how many state dollars each county gets for crisis mental health services. Karynn Fish, spokeswoman with the Oregon Health Authority, says the funding formula is based on a county’s population, as well as the prevalence of individuals with severe mental illness living in each county.

The funding formula applies to all counties with populations over 50,000 people, and the formula’s purpose is to equitably distribute state dollars.

Fish said the state cuts will not be finalized for another six weeks. But projections, which were shared with legislators in January, show that not all counties lost state funding. Some are actually getting additional funding, such as Deschutes, Lane, and Washington counties.

The Authority, Fish said, was “working with counties to make them aware of the fact” that the funding formula would change.

“There’s winners and losers,” said Rep. Tina Kotek (D-Portland), who has followed the state cuts. “The funding formula has helped faster growing communities.”

Cindy Becker, the administrator of Clackamas county’s human services department, said the county is losing approximately $285,000 from the state, but she is not alarmed by it. “It’s always a big issue for us,” she said. “You cut the funding, but the services don’t go away.”

Jessica van Diepen, the interim executive director of the Association of Oregon Community Mental Health Programs, said the recently announced cuts did not put the association in a “panic.”

“We were part of that conversation, originally” to change the funding formula, she said. And she points out that “we live in a world, in the last 10 or 15 years, where we see cuts on a regular basis…it’s a no win situation when money is short.”

During a county budget work session last week, Fuller said that the state cuts may become the “new normal” for funding mental health services.

Kotek hesitated to agree, but did say that Multnomah County needs to work with surrounding metro counties to find an appropriate balance of services.

“The funding formula is here to stay based on population,” she said. “[Multnomah County] argues that they serve more people. If they are serving people from other counties, they need to show that. It’s not okay for the counties to have their own silos.”

The Lund Report requested that Multnomah County provide data showing the prevalence of mental illness in Multnomah County. Dave Austin, the county’s spokesperson, did not provide that data.

Becker points out that some counties do not have enough people needing particular services, such as acute care or detox services for people with alcohol and substance abuse addictions, to warrant operating particular services in the county.

“We don’t have the critical mass to be able to sustain them on a county by county basis,” she said, making it necessary for some counties to contract with others that do have those services, such as Multnomah County. “We can’t afford to have those services.”

Kotek said she has requested that an informational hearing be held during the Legislature’s interim meeting in November to learn more about the funding formula’s effect on counties. Van Diepen did not say that the funding formula necessarily needs to change.

She said, “it’s a healthy tension we need to continue to have conversations with each other about.”

Richard L. Harris, Director of Oregon Addictions and Mental Health Division

I wanted to provide a brief update on Oregon Health Plan health system transformation (HB 3650) and our Addictions and Mental Health Division system change efforts.

First, the four work groups convened by Governor [John] Kitzhaber to provide input on health transformation and the creation of Coordinated Care Organizations (CCOs) have begun to meet. The meetings are open to the public and public participation is encouraged via e-mail and online survey. I encourage you to learn more about the work groups and make your voice heard by visiting www.health.oregon.gov. It is very important that the voices of Oregon’s addictions and mental health community are heard in this process.

As you may know, in addition to our work on health system transformation, Addictions and Mental Health Division [the state agency which manages contracts with counties and private vendors for mental health and addictions providers] has undertaken a system change effort to bring better outcomes and greater flexibility and accountability to publicly-funded mental health and addictions services that are outside of the Oregon Health Plan. As part of that effort, a design advisory group of partners and stakeholders is meeting from August through early October to gather input and feedback on how to best provide the non-OHP mental health and addictions services through the state-county partnership. The meetings are open to the public and public participation is encouraged via e-mail and online survey. I urge you to learn more by visiting our web site at www.oregon.gov/oha/mentalhealth/systemchange/.

Finally, in the coming weeks, the Oregon Health Authority will sponsor several community meetings across the state chaired by executive staff from the Governor’s office and Oregon Health Authority. These public meetings will be an important opportunity for addictions and mental health stakeholders to learn about health system transformation and discuss local needs and expectations for health reform. Look for announcements by e-mail and at www.health.oregon.gov.

Richard L. Harris, Director
Addictions and Mental Health Division
Oregon Health Authority
500 Summer St NE E-86
Salem, OR 97301-1118
richard.harris@state.or.us