From The Oregonian, July 31, 2001
With the closing of the Crisis Triage Center, Multnomah County must rely on a fledgling patchwork of services to keep mental patients from jamming hospital emergency rooms.
Two key “patches” in that quilt are neighborhood walk-in clinics and mobile crisis response teams aimed at solving mental health problems before they turn critical.
Until now, mobile crisis response in the Portland area has been limited to a business-backed downtown effort called Project Respond. The county mental health redesign envisions a countywide expansion of that model. “Project Respond on steroids,” the county mental health redesign chief, Jim Gaynor , calls it.
Mobile crisis response uses two basic approaches. One responds to urgent calls from or about people in the midst of a crisis — someone acting out or making threats, for example. The aim is to defuse the crisis before it reaches the violent or dangerous stage in which an arrest or hospitalization is necessary.
The other involves outreach to shelters, parks, hotels and other places where chronically mentally ill and homeless people tend to gather. It brings health care and support to people who, for a variety of reasons, don’t show up for appointments.
Both approaches are “extremely well established” throughout the nation and most of Oregon but not yet in Multnomah County, said Dr. Peter Davidson, a psychiatrist on the county’s mental health redesign team. Their effectiveness in preventing mental health emergencies and reducing hospitalization is well-documented, he said.
“It’s not rocket science,” Davidson said. “The more likely people are to have a mental disorder, the less likely they are to take their pills and show up for appointments.”
Expecting homeless or chronically mentally ill people to thrive in an appointment-based health care system is unrealistic, he said.
Mobile teams try to respond to crises in the least intrusive setting — an apartment, for example, instead of a police van — to lessen the chance that a dispute will escalate out of control.
“A police hold is not anybody’s first choice,” said Elise Thompson, coordinator of Project Respond.
Mobile response is costly because a team of trained professionals must be ready to go around the clock, said Leslie Ford, chief executive officer of Network Behavioral HealthCare, which is working on the expansion. “That’s expensive, but not as expensive as taking folks to a hospital at $800 a day.”
Project Respond started in 1993. It is financed by the Association for Portland Progress, a business group, and the Portland Bureau of Housing and Community Development.
Each mobile team includes two mental health specialists. Project Respond is available from 8 a.m. to 10:45 p.m. seven days a week. The program won a national award in 1997 from the American Psychiatric Association.
With limited resources and an escalating demand for crisis response, Project Respond has not been able to do much outreach work, Thompson said.
The proposed expansion calls for four teams, based in downtown, Southeast Portland, east county and North/Northeast Portland. At least one team would be on call overnight.
Thompson hopes to have more teams ready by September, but for now the service remains limited to Project Respond downtown.
Ideally, mobile outreach works closely with walk-in clinics, shelters and other community services to keep patients from having to go to the hospital unnecessarily.
“In the past, we didn’t have a lot of other options besides taking them to Crisis Triage Center,” Thompson said.
Both walk-in clinics and mobile crisis outreach are part of the so-called Gap Plan, the first phase of the county’s 2-year-old effort to redesign its mental health system, expand outpatient services and curb unneeded use of costly hospital care.