Mental Health Association of Portland

In 1999, in the wake of the shuttering of Garlington Center, several public deaths of people with mental illness, and a distressing countywide site review by the state mental health division, a wide-open, concerted, public conversation about Portland’s mental health system was launched by County Chair Beverly Stein.

The conversation became more complex as the County Mental Health Division was unable to provide basic data for an initial survey by a blue ribbon task force, chaired by Elsa Porter, a systems engineer. The media became alert.

Read – Mental Health Care Needs Overhaul, Panel Says, from The Oregonian, March 2000

Read – County Department Offers Mental Health Ideas, from The Oregonian, April 2000

Consumer and family members, invited into the discussion for the first time, insisted the system be overhauled, that the system be redesigned to suit the needs of people with mental illness instead of County bureaucrats and vendor agencies. Ed Blackburn from Central City Concern wrangled ten or more committees over the summer of 2000, with over 100 participants, to spell out how services should work.

Once services were redesigned, a third committee was formed, led initially by County Chair Diane Linn, to implement the changes to the mental health system. Large government contracts were at stake and both the direction and the leadership of this committee veered through the Spring and Summer of 2001. The final controversial solution, offered by proxy from the State mental health division and by the County was Cascadia.

Read – Mental Health HMO Proposed for Multnomah County, from The Oregonian, May 2001

Read – Radical Shrink, from Willamette Week, May 2001

Largely designed by Kim Burgess, now with Washington County, Peter Davidson, now with the State Mental Health Division, Cascadia offered a managed care proposal where risk for hospitalization would be shared with a single large provider. This potent incentive for change caused the immediate creation of psychiatric outreach teams, and a drop in hospitalization. The saved costs were to be invested in infrastructure and services.

Read – Turnaround Against Odds Earns Support, high praise from Bob Landauer, May 2003

Read – Give County Credit That Is Overdue, again from Bob Landauer, December 2003

In 2004 or 2005 Multnomah County, under Derald Walker, now Cascadia CEO, shifted the financial model of Cascadia from managed care to fee-for-service leaving Cascadia with no incentive to manage hospitalization risk, and the most service-needy clients. Acute care suffered and hospitalization began to increase. Public oversight was limited at this point – the community trusted a fix had been made.

Because no outcome data is made public by the County or Cascadia – anecdotal information is all we know. This inferior data about the quality and quantity of mental health services is scattered, but uniformly critical. From every perspective, system witnesses remark access is limited, treatment services are poor, ancillary services such as housing and employment assistance are limited, staff turnover is high and moral is low. Homeless shelters, jails, hospitals, and public health clinics are overflowing with people seeking services which should be readily available from County-funded mental health clinics.

Below is a mish mash and incomplete collection of useful documents from 1999 to 2003 from the redesign process. Bookmark this page – the documents will remain here as an archive.

Read – Network Behavioral Healthcare’s 1999 contract with Multnomah County. Note the added language requiring and defining consumer and family participation.

Read – Treatment of the Mentally Ill in the Criminal Justice System – written in August 2000 by Bill Toomey, probably for the Design Team Criminal Justice group. A nice snapshot of that moment.

Read – Options for Persons with Mental Illness in Multnomah County’s Criminal Justice System – probably from Summer of 2000.

Read – DCJ mental health resources, Summer 2000

Read – Overview of DCJ Case Management for Mentally Ill Offenders, October 2000

Read – the charge for the Design Team, Spring 2000

Read – the charge for the Persons With Mental Illness in the Criminal Justice System Work Group, Spring of 2000

Read – the charge for the Client Transportation Workgroup, Spring of 2000

Read – the charge for the Community-Based Intervention Services Workgroup, Spring of 2000

Read – the charge for the Transportation Group, Spring 2000

Read – the charge for the Inpatient Services Workgroup, Spring 2000

Read – the charge for the Data Collection Workgroup, Spring 2000

Read – the charge for the Crisis Workgroup, Spring 2000

Read – the charge for the Best Community Mental Health Services Model Workgroup, Spring 2000

Read – the minutes for the Best Community Mental Health Services Model Workgroup, July 13, 2000

Read – the minutes for the Best Community Mental Health Services Model Workgroup, August 10, 2000

Read – the minutes for the Best Community Mental Health Services Model Workgroup, September 14, 2000

Read – the charge for the Best Community Mental Health Services Model Workgroup, October, 2000

Read – Interdepartmental Communications Workgroup Minutes, October 24, 2000

Read – Mental Health Design Team Coordinating Team Agenda, September 11, 2000

Read – Mental Health Design Team Coordinating Team Agenda, September 26, 2000

Read – Mental Health Design Team Coordinating Team Agenda, October 2000

Read – Mental Health Design Team Coordinating Team Agenda, November 2000

Read – Memo from Design Team Child and Adolescent Work Group, Summary of Priorities for Work Group Recommendations, September 2000

Read – Summary of Recommendations from Design Team Child and Adolescent Work Group, October 2000

Read – Recommendations from Design Team Child and Adolescent Work Group, September 2000

Read – governance structure for community mental health system, 2000?

Read – Multnomah County Behavioral Heath Division policy manual, 2001

Read – Memo on Administrative Changes and Support, November 2000

Read – Report of the Alcohol and Drug Systems Workgroup, August 2000

Read – Proposal for the Atypical Anti-psychotic Medication Project, Spring 2000

Read – system description of the Case Management for Offenders with Mental Illness, Spring 2000

Read – Evaluating the Health Of Multnomah County’s Mental Health System, by Elinor Hall, MPH, May 2000

Read – Introduction: Recovery-Oriented Mental Services, by Ed Blackburn, Summer of 2000

Read – letter from Pat Cosgrove to Lolenzo Poe, one of the many reasons the CTC was closed, Summer 2000

Read – What Do I Want? (consumer / survivor focused mental health services), by Scott Snedecor, Summer of 2000

By Robert Landauer – editorial columnist for The Oregonian, December 14, 2003. Not available elsewhere online.

The Multnomah County crisis line (503-988-4888) dispatched the county’s mobile crisis unit, Project Respond of Cascadia Behavioral Healthcare, to one of about 150 calls for mental -health assistance it receives weekly from the public and police. Julie Larson of the aid unit summarizes the case:

A Latina woman was hallucinating about rats. Spanish-speaking cultural specialists immediately began working with the family to ensure her safety and avoid hospitalizing her, if possible.

Family members attributed the woman’s disorder to a curse or spell. “We said it could be caused by other things also, and these pills could help.” The staff also reinforced things the family was doing with herbs and prayer and taught her husband techniques he might use to keep his wife calm. County and state workers developed a safety plan that kept the children in a familiar environment but out of range of any unpredictable behavior.

The mother had been discharged without support plans after previous two- to five-day hospitalizations. Once Project Respond became involved, a support plan was drafted, including instructions for family and support-group members to call for early help if specific behavioral indicators appear.

Crisis unit staff members’ visits to the family, originally three or four times a week, now are down to every other week, with phone calls in between.

Since Project Respond’s participation began almost six months ago, there have been no hospitalizations.
In 1999 and 2000, I sat through hearings of a citizen-led task force that was trying to figure out how to improve Multnomah County’s deteriorating mental -health system. Two anecdotes from those who testified have stayed with me.

One was from a woman who reported that her psychiatric-based hospitalizations and jailings rose from once or twice a year to once every two months as her social worker’s caseload rose to the point that he would visit her too rarely to see that she needed help to stop her unraveling.

The second was a complaint that the county’s lack of any Spanish-speaking mental -health professionals for almost 50,000 Latino county residents forced relatives to travel almost 300 miles to Burns to get culturally appropriate mental -health services in Spanish for family members.

A great deal has changed.

A county walk-in center at Southeast 43rd Avenue and Division Street is open full time to help prevent and to treat psychiatric emergencies. Project Respond’s 35 mental health caseworkers now include specialists with capabilities in 14 Asian languages, Spanish, Russian and Polish.

Also, Karifa D. Koroma, the crisis team’s criminal justice liaison, connects county jail inmates with mental illnesses to the services they need after release. Without that help, many would recycle back to jail more often, at $1,950 a month, than is avoidable.

Where is the evidence these and other changes make any difference?

The county’s premise is that the better its community-based supports are, the more they will shrink the need for costly acute-care hospital beds.

In one month, November 2001, mentally ill Multnomah County residents’ time in acute-care hospitals peaked at 3,485 patient bed-days. Since then, that bed-day tally has plummeted. As reforms have gained traction over the past 18 months, a chart showing mental -health bed days (at $700 per day) would look like a steep ski slope viewed from the top.

“We have achieved all-time lows in the past couple of months for residents who still have Oregon Health Plan benefits,” says Dr. Peter Davidson, medical director of county mental health and addiction services. Hospital-bed days per month for the last several months are in the low 300s — accomplished even as the county’s mental -health budget from Medicaid has been slashed by $10.5 million.

Let the record show that Multnomah County commissioners, especially Chairwoman Diane Linn and predecessor Beverly Stein, made politically risky changes and have produced amazing improvements to the delivery of mental health services.

By Robert Landauer – editorial columnist for The Oregonian, May 6, 2003. Not available elsewhere online.

Any darn-fool manager can make an agency look good when taxes flood in like high tide at full moon. When the tax tide ebbs, though, it takes brains, skill and grit to perform like a star.

As one who has often flayed Multnomah County’s mental -health programs, I have to confess: The county’s delivery of care to poor mentally ill residents is a virtuoso turnaround performance in our deep recession.

Let’s set the scene: The news here for several years reported uncoordinated mental -health services, impossibly large caseloads, a controversial closing of the crisis triage center and a plague of suicides among mental -health clients. The county jail was the Portland area’s largest mental -illness treatment center. Services were cruelly fragmented. They weren’t a system because the gears of interrelated health, mental health, courts, jail, housing, employment, alcohol/drug and Social Security components didn’t mesh.

Bev Stein, county chairwoman four years ago, launched a study that triggered an extensive reform process. Diane Linn, her successor as county chairwoman, staked her political reputation on carrying on with a large but unsettling reorganization despite budget woes.

Begin with a few numbers: About 70,000 low-income county residents were eligible until recently for the Oregon Health Plan; 13,000 received mental health services. State budget cuts have ended 20,000 people’s eligibility. The county has had to cut its mental -health patient load down to about 9,000 people. Some patients’ mental illnesses flare up several times a year, so the 9,000 patients account for a caseload of 2,600 mental -health interactions with the county each month.

Next, recognize that early help stops most mental disturbances before they become public as well as personal crises: jailings and hospitalizations; loss of jobs, housing and benefits; drug/alcohol abuse; personal isolation; and criminal victimization.

Now, accept as auditor-certified truth that treating mental -illness upheavals early is hugely less expensive and far kinder than coping with late-stage crises in hospitals and jails, then trying to build secure support systems for patients leaving confinement.

So, what has changed?

The total days per month that the county’s low-income mentally ill patients are in acute-care hospital beds is the indicator of choice. The better the community-based supports, the more surely early interventions will shrink the need for hospital care.

In April 2002, the county paid for 805 mental-health hospital days. The total climbed to 919 hospital days in May and peaked at 1,054 in June. At an average $700 a day, the peak-month bill was $737,800 — close to $9 million a year if that trend weren’t reversed.

But as reforms have gained traction over the past year, a chart showing mental -health bed days looks like a fairly steep ski slope viewed from the top. Bed days have fallen almost steadily, to 445, or $311,500, in March. That is almost 60 percent less than the peak-month bill — money that more usefully can be shifted to prevention.

Some heavyweight new or expanded services aiding this about-face are the 24-hour crisis line offering brief counseling and information about where to go for help; a 24-hour crisis walk-in clinic and a child and family after-hours walk-in clinic; and Project Respond, which has become a countywide culturally competent child/family/adult mobile outreach service.

One of the most striking advances is that county workers now know where every mental -health patient is hospitalized and begin coordinating supportive, stabilizing services for them right away. This is progress that few of us in 2000 thought possible this soon.

“For the first time, I feel like we have a system worth fighting for,” says Commissioner Lisa Naito, a hard worker on mental -health issues in the county’s criminal justice system.

But it is a fact, not a threat, that the county can’t maintain programs and extend reforms that keep mentally ill people out of hospitals and jails unless voters support Measure 26-48 in the May 20 mail election.

“For us dealing with mental health, Measure 26-48 is about saving money,” says Linn, the county chair.

By Robert Landauer – editorial columnist for The Oregonian, October 26, 2002. Not available elsewhere online.

Sometimes a negative is a positive, as in the steep drop in hospital days for mentally ill Portland-area residents.

In November 2001, the number of mentally ill Multnomah County residents in acute-care hospitals peaked at 3,485 patient bed days. At $700 a day, the bill totaled $2.44 million. That’s for one month. Since then, the mental -illness bed-day tally has plummeted to 2,150 (preliminary) in September. The 1,335 difference amounts to $935,000 less in monthly hospital bills.

Hospital stays aren’t down because local governments are sidestepping problems that are tough to solve.

Just the opposite. Reshaped agencies and new programs are stepping in earlier, before odd behavior caused by schizophrenia, depression, bipolar or other disorders unravels to the point that patients need hospital care to avoid danger to themselves or others.

The biggest changes are occurring as the county gains traction in its drive to make mental health service delivery more cost-effective. The notable advance was the formation last January of Cascadia Behavioral Healthcare. The community-governed nonprofit melded three mental health delivery providers into one unit. It treated more than 17,500 Multnomah County patients in the past year, about 80 percent of low-income Oregon Health Plan clients seeking mental health outpatient services in the county.

Three changes have been especially effective in reducing the area’s higher-than-average hospitalization rate: creation of Urgent Walk-in Clinics in four neighborhoods; expansion of a downtown-only mobile response team to two expanded outreach teams, eastside and westside, reaching patients countywide before they require inpatient care; and assigning county acute care coordinators to monitor people using crisis services and to arrange suitable follow-up treatments that are less expensive than hospital care.

Another indicator of progress came Tuesday when the Oregon Disabilities Commission recognized Employment Solutions Plus, in Portland, as its rehabilitation provider of the year. The program formerly was known as IPS+, shorthand for Individual Placement and Support Plus Enhancements.

Its idea is that specially crafted, coordinated, intensive services could help many severely mentally ill patients to get jobs that interest them.

This is a giant step in taking control of their lives because only 15 percent to 20 percent of adults with serious mental illnesses are believed to hold jobs compared with 81 percent of those without disabilities. People with disabilities are more than three times as likely as others to live in poverty.

Without jobs, mentally ill people often lose housing and can’t pay for prescription drugs. Street life leads to more time in jails and hospitals.

First-year program results showed that enrollees spent 65 percent fewer days hospitalized than in the prior year. Fewer individuals were hospitalized, and they got out faster (6.9-day stays before entry into the program and 2.4 days post-enrollment).

The project was able to help 38.6 percent of its 176 clients get work, placing them in a wide variety of competitive jobs in the community.

The results impress me for several reasons. Much of the job-placement advance occurred while the project fought headwinds of a slumping economy. Also, Employment Solutions Plus distinctly takes on clients that many other programs avoid or treat with little success, notably the high portion of alcohol and drug abusers among people with severe mental illnesses.

Cascadia’s and Employment Solutions’ actions testify that it is sound policy to invest in prevention efforts that cut down on mental health crises. Front-end staffing costs are repaid in big savings in hospital bills and in less wasteful use of police, court and jail resources. County commissioners should keep pushing to complete the mental -health reorganization.

Editorial by by Robert Landauer, October 26, 2002

Sometimes a negative is a positive, as in the steep drop in hospital days for mentally ill Portland-area residents.

In November 2001, the number of mentally ill Multnomah County residents in acute-care hospitals peaked at 3,485 patient bed days. At $700 a day, the bill totaled $2.44 million. That’s for one month. Since then, the mental-illness bed-day tally has plummeted to 2,150 (preliminary) in September. The 1,335 difference amounts to $935,000 less in monthly hospital bills.

Hospital stays aren’t down because local governments are sidestepping problems that are tough to solve.

Just the opposite. Reshaped agencies and new programs are stepping in earlier, before odd behavior caused by schizophrenia, depression, bipolar or other disorders unravels to the point that patients need hospital care to avoid danger to themselves or others.

The biggest changes are occurring as the county gains traction in its drive to make mental health service delivery more cost-effective. The notable advance was the formation last January of Cascadia Behavioral Healthcare. The community-governed nonprofit melded three mental health delivery providers into one unit. It treated more than 17,500 Multnomah County patients in the past year, about 80 percent of low-income Oregon Health Plan clients seeking mental health outpatient services in the county.

Three changes have been especially effective in reducing the area’s higher-than-average hospitalization rate: creation of Urgent Walk-in Clinics in four neighborhoods; expansion of a downtown-only mobile response team to two expanded outreach teams, eastside and westside, reaching patients countywide before they require inpatient care; and assigning county acute care coordinators to monitor people using crisis services and to arrange suitable follow-up treatments that are less expensive than hospital care.

Another indicator of progress came Tuesday when the Oregon Disabilities Commission recognized Employment Solutions Plus, in Portland, as its rehabilitation provider of the year. The program formerly was known as IPS+, shorthand for Individual Placement and Support Plus Enhancements.

Its idea is that specially crafted, coordinated, intensive services could help many severely mentally ill patients to get jobs that interest them.

This is a giant step in taking control of their lives because only 15 percent to 20 percent of adults with serious mental illnesses are believed to hold jobs compared with 81 percent of those without disabilities. People with disabilities are more than three times as likely as others to live in poverty.

Without jobs, mentally ill people often lose housing and can’t pay for prescription drugs. Street life leads to more time in jails and hospitals.

First-year program results showed that enrollees spent 65 percent fewer days hospitalized than in the prior year. Fewer individuals were hospitalized, and they got out faster (6.9-day stays before entry into the program and 2.4 days post-enrollment).

The project was able to help 38.6 percent of its 176 clients get work, placing them in a wide variety of competitive jobs in the community.

The results impress me for several reasons. Much of the job-placement advance occurred while the project fought headwinds of a slumping economy. Also, Employment Solutions Plus distinctly takes on clients that many other programs avoid or treat with little success, notably the high portion of alcohol and drug abusers among people with severe mental illnesses.

Cascadia’s and Employment Solutions’ actions testify that it is sound policy to invest in prevention efforts that cut down on mental health crises. Front-end staffing costs are repaid in big savings in hospital bills and in less wasteful use of police, court and jail resources. County commissioners should keep pushing to complete the mental-health reorganization.

By Robert Landauer – editorial columnist for The Oregonian, November 20, 2001. Not available elsewhere online.

Reorganizations foster stress. They breed discontent. Workers’ gripes are common. Multnomah County’s redesign of its mental health and addiction services fits the pattern: rumors galore and reports of delays, false starts and warfare among leadership rivals.

Yet listen to an unusual change of pitch in this background noise: unsolicited calls from county residents with serious mental illnesses who say that the new system is treating them with more care, consideration and respect than they had ever encountered and that their health is better because of it.

This isn’t evidence that the reorganization, still in its early stages, will be as effective as needed. It is just anecdotes, two unexpected testimonials from out of the blue. But just before Thanksgiving, I’m grateful for these clues that the changes are starting to work for people who need public-agency help.

The first call came from a man who had just been released from a several-week stay in the Multnomah County Jail. Nothing unusual in that. He has been a guest in jails all over the West, he says, as a result of run-ins with police because of a nasty drug habit that aggravates a serious mental illness.

He called to compliment his jailers! The jail’s mental -health ward had treated him better than any jail in his life, he said. He got care and medications that had him coming out of jail healthier than he had been in a long time. He had hopes that his life would improve because he had not just been kicked out the door. A transition worker had connected him with housing, mental -health and addiction services.

The second call came from a high-tech product manager whose bipolar disorder has her swinging between extreme agitation/exhilaration and extreme depression when not sufficiently controlled by medication.

While shifting to safer medications, she became ill and teetered on the edge of a manic episode. She feared that she would have to wait weeks for an appointment because her mental -health practitioner was on vacation.

She called the county’s mental -health crisis line and was told that there was a new service, a walk-in clinic (four are operating) that she could go to that minute for help.

“I went right over and I was seen by medical staff right away, and the person who saw me was warm, reassuring, and I knew I was in a safe place — even though I got there an hour before the psychiatrist was due. I can’t tell you how good and safe that makes you feel when you feel that bad.

“I was the second person the psychiatrist saw, but before he saw me he came out to say hello and told me that he’d be with me shortly, and, again, that was extremely reassuring.”

She described to the psychiatrist the difficulties she was experiencing with the new drugs. The Sept. 11 terrorist attacks had “unhinged me a bit” because she worried about New York friends and relatives, she said, complicating the adjustment to the new medications. “He understood my problem immediately. He took authority to increase my dosage, and that helped my whole course of treatment.

“When you get really good attention like that, you feel better right away, because part of mental illness is fear and anxiety. You feel like you’re going to be able to cope even before the new medications kick in.”

I expected her story to end there. But she continued. Her remarks showed that what might have been an isolated episode is being transformed into continuity of care.

“When my personal therapist at the health center came back a week later, she was thrilled with the attention I had received. Now this therapist is on leave for two months, and she gave me a sheet telling me all the places I can get support. And both she and I feel much more secure. Just knowing that I have the support stops the panic and anxiety that can trigger the attacks.”

In these two anecdotes, we see seven gold nuggets amid the gravel of county mental -health reorganization: easy and timely access; prevention and early intervention; care coordination; treatment services; support services; acute care; and protective services. This might yet turn out to be a rich strike for the 13,000 clients who rely on this county’s mental-health services.

By Robert Landauer – editorial columnist for The Oregonian, October 21, 2000. Not available elsewhere online.

The numbers vary little across state corrections departments: 70-80 percent of prisoners have alcohol and drug problems relating to their criminality.

Oregon’s 10,469 prison inmates fit that profile. Three-quarters have a history of criminal activity directly related to alcohol and/or drug abuse. For 45 percent, the problems are severe. For 32 percent they are moderate.

About three-quarters get some treatment before leaving prison, but that’s less than many need. “We need more intensive treatment for more people in every category,” says Gary Field, the system’s substance-abuse and mental health program manager.

Money is an issue. Anger over taxes and spending plays into cost-cutting sentiments of laymen and legislators who already are unenthusiastic about helping those who deserve punishment. Of the $840.3 million corrections operating budget, plus $190.6 million to build prisons, Oregon is spending $7.58 million this biennium on alcohol/drug treatment in prisons.

We are underinvesting. Strong evidence shows that treating inmates for alcohol and drug abuse is a smart investment in public safety.

The California Drug and Alcohol Assessment showed that each dollar spent for alcohol/drug treatment saved $7.14 in future costs, largely due to reduced crime. Crime dropped by two-thirds in the year after treatment among the 150,000 participants studied. This trend continued into year two for a smaller sample followed. The longer individuals stayed in treatment, the greater was the reduction in criminal activity among them.

RAND Corp.’s 1994 study of the cost-benefit of different ways of dealing with drug problems found that treatment is seven times more cost-effective than domestic law enforcement and 10 times more cost-effective than interdiction.

Evidence from Oregon is internationally respected as conservative and sound. “Societal Outcomes & Cost Savings of Drug & Alcohol Treatment in the State of Oregon,” a 1996 study done for the state, found that every treatment dollar saved $5.60 in future costs of law enforcement, corrections, welfare and publicly supported medical treatment.

Yearly, Oregon’s Corrections Department offers alcohol/drug education to 1,800 inmates; group treatment to 800 inmates; boot camp alcohol/drug treatment to 450; and day treatment programs to 950.

Nine months before release, 450 high-need inmates are separated from other prisoners and given intensive programs in residential therapeutic communities. Field: “Research has shown for years that something like 60 percent of offenses are committed by 6 percent of offenders. We can have the most impact on crime reduction in Oregon by targeting that population.”

Sixteen separate Oregon outcome studies over the past 12 years have shown an average of about 40 percent reduction in criminal recidivism across all programs — with some programs much higher than that. Building solid transitions from prison to community programs, an effort many years in the making, helps account for such good outcomes.

The success of Oregon’s and other prison-based treatment programs around the nation testifies that justice resources are lopsidedly dedicated to drug interdiction, arrest, prosecution and sanctions.

When we fail to invest in treatment, we lock the public into unnecessary recurring costs for arrest, arraignment, plea bargaining, trial, pre-sentencing, sentencing, probation, intermediate sanctions, jails and prisons, parole or mandatory supervision. It is warped policy to put the top effort into addressing problems after they occur.

The economic and public-safety indicators point in these directions:

• Serve more inmates.
• Provide more intensive levels of treatment and community follow-up to improve ability to reduce crime.
• Shift more drug-war investment to supportive treatment in prison, where abundant evidence documents the economic benefit to society.

By Robert Landauer – editorial columnist for The Oregonian, April 29, 2000. Not available elsewhere online.

Parishioners are grumbling. Some oppose welcoming the would-be neighbors. Many are leery. A few are in favor.

The issue is whether Madeleine Parish should lease an 18,000-square-foot building at 2330 N.E. Siskiyou St. to Mental Health Partners Inc. The nonprofit group wants to invest $400,000 to convert the 32-year-old building into a secure home for 15 severely mentally ill patients.

Beds at this level of care — one step down from the Oregon State Hospital — are scarce. Deinstitutionalization of Oregon’s mental hospitals has created an urgent need for housing. The U.S. Supreme Court made it clear last June that states must move confined mentally ill patients toward greater freedom when that can be done safely.

Unjustified segregation in institutions is discrimination because it perpetuates unfair assumptions that people with disabilities are incapable or unworthy of engaging in community life, the court held in Olmstead vs. L.C. Confinement also may become discrimination if the isolation severely curtails life activities, such as family relations, social contacts, work, education progress and cultural enrichment. Justice Ruth Bader Ginsburg’s 6-3 opinion puts high heat on states to increase community-based services.

So the neighborhood debate is a fragment of a national issue. What happens to the Archdiocese of Portland’s building, though, will be settled locally. The Rev. E.B. Painter Jr., the parish priest, will consult with an advisory council and decide some time after a meeting on Tuesday.

The neighborhood fears that surface almost everywhere group homes for the mentally ill or developmentally disabled are proposed have emerged here too: Property values will decline, safety will be eroded, traffic and parking will be congested, social services will saturate the neighborhood, the facility will be poorly managed and maintained, and it will attract unsavory people.

The presence of the parish elementary school intensifies some parents’ and neighbors’ worries. Others prefer that the building be reserved for preschool day care or senior housing services.

From this seat in the bleachers, it looks like the parish is addressing the parties’ concerns thoughtfully.

A facilitator from the Portland/Multnomah County Community Residential Siting Program has provided the Alameda and Irvington neighborhood associations all the information they requested. The parish also has invited the facilitator, a neutral party who is not an advocate of any position or result, to conduct the meeting next week among parishioners, neighbors, parents and the group-home operator.

The 2-month-old city/county program encourages early communication between neighborhoods and group-home operators. It explains the decision-making process, helps parties sift information and, if useful, assists them in working out good-neighbor agreements, says Rebecca Sweetland, program coordinator.

Getting stakeholders to the table early with reliable information usually reduces suspicion and fear of the mentally ill, research shows. There’s reason to hope that happens this time, too, because even my cursory look shows:

• More than 70 studies in the 1970s and 1980s dealt with property values, time on market before sale, crime rates and amorphous things like quality of community life. “They produced virtually uniform findings that mental-health group homes had no adverse impact on these neighborhood indices,” says Michael Allen, senior staff attorney of the Judge David L. Bazelon Center for Mental Health Law.
• Follow-up research shows that most opponents of mental -health group homes later agree that the residences have been good neighbors.
• The proposed mental -health group home here is likely to be even less threatening than the well-accepted treatment center for adolescents with drug and alcohol problems that operated at the Madeleine Parish site for 13 years until 1999.

The closer the parish looks at the details, the stronger the case becomes to say: “Maybe In My Back Yard.”