Advice for Multnomah County’s new sub-acute facility

This is the first in a series of articles / opinion columns from the Mental Health Association of Portland written for Street Roots Newspaper

On July 2 the Multnomah County Commission voted to fund and build a new facility to help persons who are acutely mentally ill.

In 2001, during a generational redesign of Multnomah County’s mental health system, a variety of providers, former patients, referring agencies, community members, and independent clinicians decided to close a simular facility – the Crisis Triage Center, or CTC.

The CTC was a 24 hour psychiatric clinic attached to Providence Hospital which planned to provide immediate treatment for anyone, and specialized in being a third choice for police, the first two being doing nothing and making an arrest.  The CTC started unpredictably and badly, with the tragic death of Emily Comeaux, a person with needs beyond the comprehension of the CTC staff.

Prospective patients, sick and in crisis, who were coached to seek services at the CTC, regularly waited hours before seeing a clinician. Sick children were kept in the same waiting room as adult patients.  Cost of care was high and rising.  Some patients and clinicians chronically overused the CTC, clogging the service for others.  Patients were put on psychiatric holds unnecessarily, given the wrong medicine, or complained their concerns were dismissed.

After some public debate, and critical events such as the death of Jose Meija Poot, Providence Hospital and Multnomah County, both pointing fingers at each other, quit the contract and closed the CTC.

A re-design was proposed.  The newly formed Cascadia would open five walk in clinics which would be open 24 hours, staffed with able bodied clinicians, and located in all five quadrants of the city. Anyone could walk in and get help in a few minutes. The costs would be lower because the clinics were uncoupled from a hospital.

The clinics opened with much media fanfare, but within a few weeks, bureaucrats were thinking of how to save money. If services could be reduced, costs could be cut. Cascadia closed one after another, leaving eventually only one, and not open twenty-four hours, and only available to certain sorts of people.

The closure of the CTC added a hard-to-measure burden on a variety of services and individuals which had no coordinated way of comparing experience and recognizing an additional set of responsibilities. We’d estimate the cost is of not having this service is in the tens of millions of dollars per year.

So we applaud that the county leadership recognizes this new facility is an important component of the continuum of county services.

NAMING THE FACILITY

The name and how this facility is referred to is extremely important. The facility should not be called or generally referred to as the “mental health crisis center” or any parallel term focusing attention on “illness” or “crisis” or “behavioral” or “assessment” or “mental” or “psychiatric.” Professionals might object – They’re not the ones coming for treatment.

We suggest the facility be named after someone in our community who is both deceased and would have made use of the facility. Emily Comeaux would be an excellent choice.

PEERS ARE IMPORTANT

Peer outreach workers should staff the front door of the facility 24 / 7. Peers have an education and orientation to recovery which is impossible to generate in a professional – though some professionals are in recovery themselves and some are good at faking it.

There value is to act as a human segue, a intimate problem-solver, a minder, a role model, a constant conduit.  And for persons contemplating the difficult changes required to gain sanity and sobriety there is value in having a relationship with someone who is NOT a professional.

OVERSIGHT

Create an oversight committee for the new facility which reports to the county chair. This committee should made up entirely of persons who would be likely users of the facility.

UNDERSTANDING TRAUMA

Just about everything we presumed was true about mental illness in 1996, when Emily Comeaux suicided in the CTC waiting room, we now think is wrong. In 1996 we looked back at the prior decade with the same skepticism.

What’s been true forever is compassion is a good guide. What we have learned in the past decade is there are a large number of people who may or may not have mental illness, but who act like it largely because they have been traumatized somehow and that trauma has been ignored or diminished by their community.

This is from a note Emily Comeaux left for her daughter,

“Now you listen real close to this. I DID NOT GIVE UP. I fought with every ounce of strength I had, you saw me fight, watched the battle many years. I’m not gone, you just can’t talk to me for a while. Baby I know this is going to hurt real bad but I also know I raised a fighter with a loud voice to shout that the system is wrong. I am doing this to help others.”


We suggest the entire staff of the agency which manages the facility, and those who sit on an oversight committee, or are staff of the county who provide fiscal or political oversight, receive training about trauma.