Oregon’s efforts to improve community mental health services came into focus at this week’s quarterly legislative days, with the director of the Addictions and Mental Health Division at the Oregon Health Authority discussing a long list of investments the state has made into county-based and other local programs.
Eds. Note – the figure of $56 million is ONLY money spent by the state on local mental health efforts. According to Governing.com, Oregon’s spending on “mental illness” for 2010 was $602,389,187 or $157 per capita. Obviously the quantity of spending has no bearing on the quality of service, and the larger figure does not include the state hospital, adult or juvenile jails, prisons, probation or parole, spending through public health offices, through private agencies, churches, public or private schools, from private agency treatment or through individual treatments. All told this figure can be conservatively estimated at over one billion dollars per year.
If asked, our organization would oppose most of these spending priorities.
The state has also given money directly to coordinated care organizations so that their reimbursement for mental health services could be raised.
“In some places, we had funding for every single program that made the request,” director Pam Martin told legislators. “In some places, we had to make choices.”
Oregon’s system has gotten so far off track that the U.S. Department of Justice had to force an agreement with the state so it would comply with the American Disabilities Act, particularly a Supreme Court decision from Georgia that dictated that states must offer a choice of services to people with mental disabilities, including the choice to receive essential care within their communities — not merely in institutions, as Oregon has traditionally done.
Chris Bouneff, the director of the National Alliance on Mental Illness — Oregon, told The Lund Report that he didn’t know what to expect from the next report, but that part of the problem with the last one was that not all of the state’s investments in community mental health were accounted for in January. In the spring, he said, the state and the federal government came to a better agreement.
He did question the state’s priorities in building a second brand-new state mental hospital in Junction City, while community mental health spending gets backed up. He particularly lamented the near-certain closing of the Portland Oregon State Hospital, and said the resource in the state’s largest metro area was more critical than a hospital near Eugene.
“Families are going to be torn apart when Portland closes unless we come up with some alternatives,” Bouneff said.
Adult Mental Health
The state Addictions and Mental Health Division doled out $56 million to organizations for mental health services, including $24.2 million specifically for children and adolescents who are either at risk of a mental health crisis or in need of services.
The state allotted $3 million to general mental health promotion and prevention. Five organizations received grants of $200,000 from this pool of money, including the Asian Health & Service Center in southeast Portland; Deschutes County and Lane County Public Health.
The state is spending $6.3 million in crisis services, with the biggest grant going to Benton County Mental Health — $836,000. Four other local organizations, including Multnomah County, received grants of $750,000 for crisis services.
Lane and Multnomah counties shared the top spot to pay for the $2.9 million the state put into jail diversion programs, with $500,000 each.
- Supported Housing & Peer-Delivered Services — $8.3 million, including $1 million to Mid-Valley Behavioral Care Network in Salem and $970,000 to ColumbiaCare in Medford.
- The National Alliance on Mental Illness, working with the Oregon Residential Provider Association, received $5 million. Bouneff told The Lund Report that they further received 10 applications for housing from across the state, including some that will build apartments at market-rate. NAMI also received two applications for step-down respite centers.
- Supported Employment Services — $1.5 million. Twenty-two counties or programs received funding; Jackson County was highest at $137,000, followed by Linn County at $78,000.
- Assertive Community Treatment case management — $5.3 million. Willamette Valley Community Health, the coordinated care organization in Salem, received $500,000, as did Intercommunity Health CCO in Corvallis.
Children’s Mental Health
The $24.2 million that’s earmarked for children was able to help the popular and successful evidence-based Early Assessment and Support Alliance expand to all but four Oregon counties with $1.8 million allotted for the program. With a $509,000 grant, the Clackamas County Behavioral Health Division can expand into that part of the Portland metro area. Smaller grants include $475,000 to Lane County Behavioral Health and $231,000 to Jackson County Health & Human Services.
The early assessment program works to provide a wraparound of service to youth who suffer a mental breakdown early in life. The hope is that by providing a heavy level of care and support at the first time of crisis, the program can help these young people avoid a lifetime of disability or worse.
“It keeps kids out of the hospital at a critical time in their life,” Martin said.
Senate President Peter Courtney, D-Salem, has given his impassioned support to the program, decrying how it had only been available in fewer than half of Oregon’s counties before the 2013 session, and had almost no presence in eastern Oregon. In part because of his leadership and a commitment from Gov. Kitzhaber, it will be available in 32 of Oregon’s 36 counties.
It’s still missing from Corvallis and most of the Coast, but the state wants to expand into those areas, particularly if the program is continued or enhanced during the 2015 legislative session. “We are currently working on plans to expand to the four remaining counties as well as Warm Springs,” health authority spokeswoman Rebeka Gipson-King told The Lund Report.
- School access to mental health services received $6.3 million, spread out across 27 counties and organizations. Despite its smaller population, Deschutes County came in first with $847,000 to Multnomah County’s $603,000 for this service. Lane County came in third with $474,000 with little Union County in eastern Oregon getting $424,000.
- The second-biggest chunk of money for children mental health services, $5 million, was directed to the coordinated care organizations, both to increase their funding rate and to fund infrastructure development projects. Ten CCOs received $75,000 each for the latter purpose.
- Funding for parent-child interaction therapy, which treats mental health across a family dynamic without rushing to label the child for the problem, received $2.6 million. The largest part of that money, $345,000 will go to Early Child scholarships to defer the cost of college and professional development for social workers. A similar sum, $329,000, will be dedicated toward training in this particular method. Martin said this was an area where the state’s goals had been limited by a lack of available providers.
- The budget carved out $2.3 million to Young Adult Community Hubs, including $756,000 to LifeWorks Northwest in Portland; $445,000 for PeaceHealth Oregon West Network and $405,000 for Jackson County Mental Health.
- $2.3 million will go to deal with the commercial sexual exploitation of children, the bulk of which, $2 million, is dedicated to Morrison Child & Family Services in Northeast Portland.
- Oregon’s Psychiatric Access Line for Kids, sometimes called OPAL-K, received $1.5 million, which creates a new contract with Oregon Health & Science University and starts Oregon toward the goal of statewide service, providing telehealth services between OHSU and providers in rural Oregon.
- $800,000 for a trauma initiative, including $785,000 to Portland State University.
- $530,000 each to expand an existing contract to provide technical assistance for family peer-delivered support and youth peer-delivered support with the Oregon Family Support Network, including Youth M.O.V.E.
- $500,000 to the Oregon Pediatric Society for adolescent depression screening.
- $80,000 to OHSU toward collaborative problem-solving regarding youth mental health.