Mayor Charlie Hales wants to cut city dollars for mental health crisis center

By Maxine Bernstein, The Oregonian, May 4, 2013

After her son died, Carol Slaney found help at the CATC.

After her son died, Carol Slaney found help at the CATC.

Carol Slaney woke up Jan. 31 to find her 26-year-old son dead beside her bed from an accidental drug overdose. She grabbed a .45-caliber revolver and disappeared, hiding in an abandoned house behind her Southeast Portland apartment.

“I just sat in that house, spinning the gun, planning my death,” Slaney said. “He was my world.”

Worried family members called police to check on her. As officers shined flashlights into the windows of her apartment, Slaney watched through the window of the derelict home nearby.

Slaney, who suffers from depression and post-traumatic stress disorder, had been placed on mental health holds before, a self-described frequent flyer at hospital emergency rooms. She didn’t want to return there, so she remained hidden from police.

On her fourth day alone, Slaney desperately called her case manager and pleaded, “I need to go to CATC.”

Peer support counselor Ashleigh Brenton

Peer support counselor Ashleigh Brenton

“In my darkest time, they just took my hand and walked with me,” Slaney, 49, said this week, as she sat inside the Multnomah County’s Crisis and Assessment and Treatment Center. “This place is personal and genuine. CATC is probably my savior.”

The 16-bed secure center opened in June 2011 off Northeast Grand Avenue to considerable fanfare by city, county and state officials. They touted it as a much-needed alternative to jail and hospital emergency rooms for people suffering a mental health crisis. Portland’s City Council resolution called the investment “a very high priority.”

But nearly two years later, Mayor Charlie Hales has recommended cutting the city’s annual $634,000 share of funding for the center, based on reports from Portland police that they haven’t found it useful.

CATC Administrator Dan Clune

CATC Administrator Dan Clune

Some veteran patrol officers dedicated to crisis intervention work say they didn’t know the center existed. The Police Bureau hasn’t encouraged officers to bring people they encounter there, largely because it doesn’t allow for drop-offs.

“It’s a valuable service,” said Lt. Cliff Bacigalupi, who is supervising the creation of a new police crisis intervention team. “It just wasn’t a good fit for us.”

Center managers, though, point to statistics that show while Portland police aren’t taking people directly to the center, many of the people they encounter are ending up there for treatment anyway.

To date, the center has treated 1,300 people. Of those, 942 patients came from emergency departments, where police likely took them initially, county officials said. Another 358 came from community referrals through social service agencies and the county jail. Of those referrals, 82 came from Project Respond staffers, who police regularly call out to mental health emergencies.

Peer support counselor Akil Stigler

Peer support counselor Akil Stigler

“We discovered the police have been using it indirectly,” said Jeff Cogen, Multnomah County chairman. “But it doesn’t have to happen that way.”

The center, on the second floor of the David P. Hooper Sobering Center, serves adults 18 or older who live in Multnomah County and have serious mental illness. They must be indigent or have insurance coverage through Oregon Health Plan-Health Share.

The locked floor with 16 rooms resembles a wing of a hospital, yet with a lounge area decorated with patients’ artwork, an outdoor patio with picnic tables and a kitchen. It’s the only short-term crisis center of its kind in the county.

Patients stay from four to 14 days, until their symptoms stabilize. They must have a diagnosed mental illness, be referred from either a community care provider, an emergency room or acute hospital unit. They also must have stable medical vital signs on arrival. Upon discharge, they leave with a plan for follow-up treatment.

A patient room at the CATC.

A patient room at the CATC.

Mental health clinicians, psychiatrists, nurses and peer support specialists are on staff 24 hours, seven days a week.

If the Portland City Council approves the mayor’s proposed cut, the county-run center expects to reduce its beds to 11 and serve about 200 fewer people a year. The city and county had agreed in 2010 to each pay 20 percent, or $634,000, of the center’s $3.5 million operating costs. The state picks up the rest.

Police say the center simply isn’t practical for patrol officers. In a March 2012 report, they said they can’t take people straight there and that the center doesn’t accept patients who are a danger to themselves or others, combative or assaultive, high on drugs or drunk. Instead, the report said, police end up arresting people in crisis and taking them to jail or driving them to local emergency rooms.

READPolice Bureau report on CATC, March 2012

Outside patio at the CATC.

Outside patio at the CATC.

The Police Bureau’s position baffles center administrators, particularly when federal investigators have demanded Portland police improve their encounters with people suffering from mental illness.

The county also has a dedicated line for police to call when dealing with mental health emergencies and the staff can refer them to the crisis center. But police have rarely used it.

Center managers said police can request workers from the nonprofit Project Respond to assess people in the field and refer them to the center for treatment when appropriate.

Project Respond tries to use the center as much as possible, said the agency’s director, Jay Auslander. “It allows some folks to avoid going to the ER, or helps shorten their hospital visits,” he said.

Staff meeting at shift change.

Staff meeting at shift change.

Center managers estimate that it takes an average of 15 to 30 minutes to admit a person, often a far cry from the lengthy wait police find at hospital ERs.

They also dispute that the police claim that the center doesn’t treat people who are a danger to themselves or others.

“We take those folks all the time,” said Kevin McChesney, the regional director for Telecare, which contracts with the county to operate the center. In fact, he said, most patients are considered a danger to themselves or others.

Center workers just want to make sure police have disarmed the people so they’re not an immediate threat, he said.

Artwork on the wall was done by a former patient.

Artwork on the wall was done by a former patient.

“We can certainly take people police pluck off a bridge who are suicidal,” McChesney added. But he acknowledged: “We’re not so certain about the person swinging an ax.”

It appears from his discussions with police, McChesney said, that they want a drop-off treatment center that accepts people without a referral, similar to the county-sponsored Crisis Triage Center that operated at Providence Medical Center until its closure in 2003.

“It seems to me they want an all or nothing solution. There needs to be a cooperative effort with police and so far that hasn’t occurred,” he said. “I think there are additional avenues where police can use this. There really hasn’t been a great dialogue about that, and I would welcome that.”

Police Capt. Sara Westbrook said most of the people officers place on mental health holds require a higher level of security and care than the patients accepted at the center. It just isn’t a good option for police, she said.

The mayor said the city is working to seal an agreement with the U.S. Department of Justice for police reforms on how to help people with mental illness.

“If it’s the county center or another resource, the bottom line is helping people who the police encounter,” Hales said by email. “… We’re actively engaged with a wide array of parties to determine the type of resources that would be of greatest practical assistance to our officers on the street.”

Slaney has been admitted to the crisis center at least five different times. She’s gotten to know the staff, many of whom had met her son, Jonathan, during his visits with her. He died from methadone and methamphetamine toxicity.

“Sometimes I get weak and fall astray and return here,” she said. “I didn’t think anyone could ever understand. I didn’t see no hope. But the staff here reminded me that I needed to honor my son’s memory. Regardless of my mental illness, you’re made to feel special here.”

Slaney recently packed up her son’s clothes and donated them to the crisis center.

“They don’t get enough credit for who they are and what they’re about,” she said. “I just knew where I was, and what they’ve done for me.”