County approves steps to mend fractured mental health care

From The Oregonian, August 10, 2001

The Multnomah County Board of Commissioners on Thursday unanimously approved the first phase of the county’s long-awaited mental health redesign.

Commissioners also approved a budget outline for the acute-care plan but postponed until next month more specific — and potentially wrenching — decisions about how to pay for it.

With the backing of the 5-0 vote, board chairwoman Diane Linn said, “I believe the system will begin its road to recovery.” She called reform of the mental health care system “bar none, the most important thing we’ve considered, at least during my tenure” on the board.

“There’s an old saying that if it ain’t broke, don’t try to fix it,” said Commissioner Lonnie Roberts. “Well, it is broke.”

Thursday’s action capped two years of debate and a week of particularly intense negotiations. The wording of the agreement on mental health was not decided until minutes before the meeting started Thursday morning.

“If they had let this reform effort grind to a stop, they would have abdicated their responsibility for mental health care in this community,” said Jason Renaud, director of the National Alliance for the Mentally Ill in Multnomah County. “We’ve been talking about this for months.”

Commissioners approved the first six of 18 proposed “action steps” in the latest version of a plan for acute mental health care. That plan is sometimes called Phase 1 or the Gap Plan, because it tries to fill the gap left by the closure of the Crisis Triage Center at Providence Portland Medical Center on July 31. But parts of the plan also reach beyond the immediate gap in crisis services.

The approved steps include crisis phone lines, walk-in clinics, mobile crisis teams, a secure unit for evaluating patients deemed dangerous, improved alternatives to hospital beds and better coordination of acute care. They are designed to reduce costly hospital care by helping patients deal with a mental health crisis before it reaches the point at which a hospital stay is necessary.

Planners expect the redesign to reduce hospital costs by $3.6 million during the next three years.

The resolution also adopts recommendations of the county’s Cultural Competency Committee, aimed at ensuring that caregivers have the knowledge and skills, including linguistic fluency, to meet the needs of underserved racial or ethnic groups. Those groups include African Americans, Latinos, Asian Pacific Islanders, Native Americans and Eastern Europeans.

The importance of cultural competency was dramatized in April, when Jose Santos Victor Mejia Poot, a 29-year-old Mexican national, was fatally shot during an altercation with police at BHC-Pacific Gateway Hospital.

The latest plan pledges not to cut outpatient alcohol and drug treatment or services aimed specifically at children or minority populations.

“A single omnibus contract will not be offered to a single provider for mental health services,” the resolution states. Community groups and some specialized providers of care had worried that the redesign would consolidate all outpatient treatment into one giant contract that would leave them at a disadvantage.

Commissioner Serena Cruz said the really hard decisions would come Sept. 20, the new deadline for submission of a line-by-line mental health budget. “At this point,” she said, “we’ve got ideas about where the money will be coming from, but we don’t have specifics.”

The business plan approved Thursday reflects a consensus over categories of spending and revenues, but it allows for tweaking of specific numbers during the next six weeks.

“We have to come back next month with the line-item, nitty-gritty stuff — down to paper clips, basically,” said Jim Gaynor, the county’s chief of mental health redesign.

“It’s a very complicated thing, to redesign a system,” Dave Warren, county budget director, told the board. “So I’m asking you to be patient with the numbers. The numbers are going to move.”

Dale Jarvis, an accountant and consultant hired by the county to prepare the redesign’s budget, said Thursday’s votes by the board were “the best possible outcome,” given the difficulty of the negotiations. They allow the county to move ahead on contracts with mental health providers, he said, while giving officials six more weeks to crunch final budget estimates.

To cover a projected $7.5 million shortfall for acute care this year, the business plan suggests several strategies. These include cuts in administrative costs for the Behavioral Health Division of the county’s Department of Community and Family Services and Verity, the agency through which public mental health funds flow. That could eliminate 14 administrative jobs.

The plan also authorizes use of $1.7 million of the estimated $2.5 million in the county’s mental health reserve fund for emergencies.