With a new mayor, Portland should kickstart police reforms to help those with mental illness

Published in The Oregonian, January 19, 2017
By Jenny Westberg and Jason Renaud

As Portland shifts leadership from Charlie Hales to Ted Wheeler, it’s important to remember one Hales administration failure that continues to threaten the most vulnerable among us.

After more than four years of attempted compliance with legally-prescribed reforms, and despite new hires, media hand-wringing and millions spent on consultants and public process, the city’s police have yet to reduce their use of force against people with mental illness.

Force data summary reports now available on the Portland Police Bureau website show that, from spring 2015 through last fall, the number of use-of-force incidents involving persons with mental illness has remained flat, if not slightly increasing.

This apparent lack of improvement could reflect changes in how such incidents are counted and reported. But we suspect there’s more going on.

Foremost, the chronic underfunding and anemic management of the public mental health system leaves many people unable to get effective care when it would actually do some good: before the crisis, before the escalation, before the bullets.

Insisting mental health is not city business, Hales failed to engage county and state administrators in any relevant discussion about the problem as it relates to the city. He maintained the “It’s not my job” stance, arguing care for people with mental illness is the province of state and county, not city. But thoughtful observers note people with mental illness are patiently petitioning city bureaus, including housing, the Independent Police Review, police and fire; they’re giving testimony at City Council, participating in committees, and when they get hurt or killed, filing complaints.

The welfare of the sick and suffering is everyone’s business.

Instead, Hales waged a campaign to diminish and deny findings by the Department of Justice that the Portland Police Bureau had a “pattern and practice” of harming people with mental illness. He directed the city attorney to file petty appeals, thereby delaying reform. He refused to meet with a public oversight committee as required by a settlement agreement and failed to support it as members quit in frustration.

People so ill they need police engagement don’t respect clearly defined governmental boundaries. They hop from state to county to city to another state or county. This is a well-documented, well-understood consequence of not providing access to mental health care, so wholly a responsibility of all governments. As former County Chair, Wheeler has the experience to understand this consequence, and skills to bring all parties to the discussion.

We need police who are well-trained, well-resourced and accountable, who serve and protect, who treat all Portlanders with compassion and dignity, who don’t harm people for being different. Mayor Wheeler can do a lot to move us toward such a future and he should start now.

Jenny Westberg and Jason Renaud are board members of the Mental Health Association of Portland.

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Deaths on the streets in Portland – Winter 2016/2017 (updated = 5)

UNKNOWN, infant – born to mother with mental illness
Karen Batts, 52 – person with mental illness
Zachary Young, 29 – person with mental illness
David Guyot, 68 – unknown
Mark Johnson, 51 – person with alcoholism

A Baby is Dead After Being Found With His Homeless Mother at a Portland Bus Stop – The child lived less than 24 hours and never had a name.
Willamette Week, January 16 2017

Who were the homeless people who died this winter, and could there be more?
Oregonian, January 16 2017

From Rose Festival Court to death on frozen streets: Karen Batts’ lonely struggle
Oregonian, January 14 2017

Four homeless people die of exposure in Portland in first 10 days of 2017
The Guardian, January 11 2017

29-year-old’s (Zachary Young) mental illness led to living in woods where he died from exposure
Oregonian, January 12 2017

Man (David Guyot) dies of hypothermia; third to die of exposure this winter in Portland
Oregonian, January 10 2017

Woman (Karen Batts) evicted from low-income housing died of exposure three months later
Oregonian, January 9 2017

Portland Police: Woman Believed To Have Died Of Exposure During Storm
OPB.org, January 8 2017

Freezing temperature claims life of Portland homeless man
KGW.com, January 3 2017

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Coos County’s continuing inability to treat people with mental illness – illustrated

Bay Area Hospital turns away man despite hold order

The Coos Bay World Dec 6, 2016

COOS BAY — The Bay Area Hospital on Saturday turned away a Coos Bay man as too dangerous to hold despite a hold order being placed on the man by the director of Coos County Health and Wellness.

Coos Bay police apprehended a 25-year-old man Coos Bay Toyota, 2001 North Bayshore Dr., after the man allegedly used a knife to threaten people at the dealership. Police took the man to the hospital after a hold was placed on him, “but the hospital still did not hold him,” City Manager Rodger Craddock said.

Craddock said the hospital held the man for just a few minutes before determining he was too dangerous.

“We don’t have a mental facility in this part of the state,” Craddock said. “The hospital has a mental ward.”

Police took the man to Coos County Jail, where he was held while officers sought an emergency commitment from a judge in order to get the man into the state hospital in Salem. Police Chief Gary McCullough said Monday afternoon they still haven’t had the emergency evaluation.

“The hospital has refused to hold some people in the past,” McCullough said. “They are a private entity so ultimately have their own policies they operate under, which means they don’t have to take people they don’t want.

“I don’t necessarily agree with that since they are the only mental health lock-up facility in the county, but those are the parameters we operate under.”

However, Bay Area Hospital Director Paul Janke said the fact that they even take mental health patients is unusual.

“To put this whole issue in context, we’re one of the few hospitals outside of Portland, Salem and Eugene, in a community this size that even has an in-patient mental health unit,” Janke said. “We think it’s important and necessary, and that’s why we do it. As a hospital, we take our role and responsibility, especially caring for people with mental health issues, very seriously. I think we do a good job with that.”

Craddock said people whose mental illness causes them to be a danger to themselves or others need to have a hold placed on them.

“This is a great concern to us,” Craddock said. “The hospital seems like an obvious location, a place to sedate and maintain them. The jail, if a crime isn’t committed, doesn’t hold them because they don’t have the space and they aren’t a mental ward. It’s a difficult situation for the community.”

Mental subject still in custody

Bay Area Hospital says it handled situation “appropriately”
The Coos Bay World Dec 10, 2016

COOS BAY — The man who walked into the Toyota Dealership a week ago is still at the Coos County Jail awaiting an emergency evaluation from a judge.

But the Saturday, Dec. 3 incident spotlighted the problem local authorities have when dealing with the mentally ill who become violent.

Coos Bay police took the 25-year-old man into custody last week after threatening in the car dealership at knife point. He was ordered to be placed on a director’s hold from Coos Health and Wellness, but stayed only a brief time at the region’s only mental facility at Bay Area Hospital.

“We don’t have a mental facility in this part of the state,” Coos Bay City Manager Rodger Craddock said. “The hospital has a mental ward.”

Hospital workers called the police to take him out after he continued to be combative.

Police took the man to Coos County Jail, where he was held while officers sought an emergency commitment from a judge in order to get the man into the state hospital in Salem.

“The hospital has refused to hold some people in the past,” said Police Chief Gary McCullough. “They are a private entity so ultimately have their own policies they operate under, which means they don’t have to take people they don’t want.

“I don’t necessarily agree with that since they are the only mental health lock-up facility in the county, but those are the parameters we operate under.”

The hospital disagreed with the statement, announcing through a press release that the decision to turn the mental subject over to police was the “most prudent decision under the circumstances.”

Hospital manager of psychiatric services Kera Hood spoke with a representative from the Oregon Health Authority following the incident, stating that Keith Breswick, civil commitment coordinator, reviewed the situation and agreed that the hospital acted appropriately.

Breswick has not returned several calls from The World for an interview.

In the hospital’s press release, Hood explained that on the day the subject was brought to Bay Area Hospital at 9:09 a.m., he was evaluated and determined to meet hold criteria. But when he was transferred to the in-patient psychiatric unit at 11:30 a.m., he “immediately presented as aggressive, agitated and threatening. He was placed in seclusion due to his aggressive nature at 11:45, and a team meeting was called at noon.”

According to the release, the hospital can’t legally restrain and medicate an individual against his will except per individual acts of aggression.

“This unfortunately shows just how far we still need to go as a community to manage our mentally ill patients in a way that protects and serves all involved,” Hood said. “We have come a long way, but this shows we have a long way still to go in working to resolve a true community issue.”

“This is a great concern to us,” Craddock said in an earlier interview. “The hospital seems like an obvious location, a place to sedate and maintain them. The jail, if a crime isn’t committed, doesn’t hold them because they don’t have the space and they aren’t a mental ward. It’s a difficult situation for the community.”

Our mental health quagmire

The Coos Bay World Dec 10, 2016 – OPINION EDITORIAL

Hopefully, our story earlier this week about authorities juggling with the fate of a mental patient upset you.

An obviously disturbed man, wielding a knife, walked into the Coos Bay Toyota dealership last Saturday morning. Coos Bay police did as expected and subdued the man, then determined he was mentally disturbed. Instead of charging him with a crime, they sought mental health care for him. The county health director concurred and ordered a mandatory hold.

The only facility on the South Coast with a mental health ward is Bay Area Hospital. But after his initial admittance, the hospital refused to hold the man, saying he was too violent for them to handle.

So, a man clearly in need of psychiatric intervention ended up in Coos County jail, where there’s not even enough room for the sane people who need to be behind bars.

What’s wrong with this picture?

It would be easy to simply blame Bay Area Hospital, especially with the initial antiseptic response of hospital director Paul Janke.

“To put this whole issue in context, we’re one of the few hospitals outside of Portland, Salem and Eugene, in a community this size that even has an in-patient mental health unit,” Janke said. “We think it’s important and necessary, and that’s why we do it. As a hospital, we take our role and responsibility, especially caring for people with mental health issues, very seriously. I think we do a good job with that.”

Contrast that response with the reality. The hospital apparently isn’t equipped to handle patients like the man police encountered last week. And according to Coos Bay police Chief Gary McCullough, this isn’t the first time the hospital has turned away patients it determines it can’t handle.

We are reminded, too, of the bludgeoning death earlier this year of 64-year-old Richard Perkins, allegedly at the hands of his 36-year-old nephew Lucas Perkins. The arrest records say that the older man had tried repeatedly over the years to get the mental health care his nephew so desperately needed – and many would argue, he deserved. But the system currently in place allowed him to walk away from Bay Area Hospital after being placed there on a hold just weeks before the uncle’s murder.

Richard Perkins had told authorities: “Lucas will have to kill me before he gets any help.”

Again, who’s to blame here, realistically? Our current system doesn’t allow for people to be summarily held against their will for an indeterminate length of time. People with mental disorders still are entitled to the rights we all enjoy.

But when these cases become public health and safety issues, we need a better response.

We’ve written about this issue frequently over the years and we get the same responses from agencies we assume should be responsible. Public health and safety officials seem to sincerely want to be more effective, and have had monthly meetings for apparently a long time now, according to a hospital press release issued in response to our repeated inquiries four days after this incident. The press release was delivered with a comment from the hospital spokeswoman, saying, “You should have waited” for the official statement.

Despite the meetings, something is always in the way — funding, leadership, creativity in finding solutions, lack of coordination, etc. The list goes on. You should get upset about that.

Another disturbed person is going to walk into a public place somewhere here on the South Coast sooner than we’d like to think, and this whole scenario is destined to play out one more time.

You should be upset about that, too.

More than that, you should be pressuring leaders to focus on solutions. They exist, but it will take leadership, community resolve and a realization and acceptance that resources and effort must be steered toward those solutions.

Meetings and four-day response times don’t solve the issue. Actions do.

Bay Area Hospital takes exception with stories on mental patient

By Paul G. Janke, chief executive officer of Bay Area Hospital
The Coos Bay World Dec 26, 2016

As chief executive officer of Bay Area Hospital, I’d like to add my perspective regarding the recent mental health-related incident covered in multiple articles in The World. Bay Area Hospital staff takes pride in what we do. As a publicly-owned facility, we strive to be responsive to a wide variety of health needs in our community and the region. Offering psychiatric services is one challenging, yet vital, part of that mission. As one of the very few acute care hospitals in Oregon that offer inpatient psychiatric services, we take our responsibility seriously.

Situations such as the one currently under scrutiny by The World lead to frustrations from all involved. It can also lead, as it has in this case, to uncovering problems with communication among groups that need to be doing a better job working together. That miscommunication can snowball into bigger issues and to societal finger-pointing. Mental health is a community issue that requires a tremendous amount of collaboration. This is a community problem that needs to be solved by the community.

The World intimated that you should be upset with the status quo. In that, I believe, we are all in agreement. But, getting upset is only beneficial if it inspires action. Hopefully, this incident will compel all key agencies including the city, law enforcement, district attorney, the courts, county and state mental health and Bay Area Hospital to work more collaboratively. I am committed to doing my part to help make this happen. It is easy to assume the problem is lack of mental health resources. In this situation I do not believe resources to be the problem. What was lacking was effective communication, cooperation and problem solving.

To improve in that area we need to start by clarifying several specific statements and factual inaccuracies from the series of articles related to this incident. Specifically, the World articles stating “BAH turned away” this man, when nothing could be further from the truth. References were also made to the effect that BAH held the man for only a few minutes. Again, that is completely inaccurate. In truth, he was screened in the emergency department before being admitted to the inpatient psychiatric unit. He was cared for at BAH for 3 ½ hours before being transferred back to police custody.

An issue addressed in our press release that, for some reason, was not included in any of the follow-up stories by the paper was an explanation of why we felt that decision had to be made. BAH psychiatric unit staff determined that jail was a safer alternative based upon the population of patients who were on the BAH psychiatric unit at that time and the aggressive nature of the patient.

Workplace violence has become a huge concern for hospitals in Oregon and across the United States. Nearly 60 percent of all non-fatal assaults and violent acts that occur in the workplace occurred in the healthcare industry. Level of violence is also the reason 26.6 percent of emergency nurses have considered leaving their department for another unit. Patient and staff safety simply must be factored highly when making these types of determinations.

The articles also suggested a developing pattern of Bay Area Hospital turning patients back to the police. To put this incident in perspective, since January 2016, BAH has had 513 inpatient admissions to our psychiatric unit. 132 of these admissions were mental hold orders. Of that number, there was only one other time in the past year where we felt it more prudent to turn the patient over to police. It is very, very rare that we have taken the position we cannot safely care for patients in a mental health hold status.

There are other technical inaccuracies in the reporting, but I want to take this opportunity instead to focus on one additional factor I believe contributed to this situation. The man was placed on a mental health hospital hold and due to his violent behavior he was subsequently turned over to Coos Bay Police. It is my understanding that the patient involved has been placed on mental health holds at least twice in the past two months, including the weekend of the case in question. Each time the court chose not to commit. Bay Area Hospital cannot, by law treat a patient’s mental illness in the absence of a court order without the patient’s consent.

Finally, I feel a need to say I’m disappointed this matter is being litigated in the World. This is simply not an effective form of collaborative problem solving.

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CCO set to yank clients from Jackson County Mental Health

Mail Tribune, Dec. 21, 2016

A major client of Jackson County Mental Health is pulling its patients – putting a halt to the county’s ambitious plans for expansion and new hires.

Whether layoffs will result because of the reduction in Oregon Health Plan patients served by the county is yet to be determined, mental health officials said.

Beginning in January, Jackson Care Connect, a coordinated care organization, will begin shifting its OHP clients who get mental health treatment from Jackson County Health & Human Services to other providers.

It will begin referring adults to ColumbiaCare for outpatient mental health treatment. ColumbiaCare provides a variety of mental health services in the Rogue Valley, including residential treatment and supportive housing.

Youths will be referred to Kairos, a Grants Pass-based provider of residential and community-based mental health care.

The transition from using mental health workers employed by the Jackson County government to using ColumbiaCare and Kairos will happen over an 18-month period, said Jackson Care Connect CEO Jennifer Lind.

“We’ve worked really hard to minimize disruption in the community and to our patients,” she said.

Meanwhile, AllCare, a coordinated care organization also serving OHP patients, will keep using Jackson County mental health workers to directly serve patients, but will shift administrative duties such as claims processing to Grants Pass-based Options for Southern Oregon.

“Our hope is there will be little change and low or no impact. We want to make sure members’ needs are being seen to and we don’t destabilize any systems,” said AllCare Behavioral Health Director Athena Goldberg.

AllCare and Jackson Care Connect have been paying Jackson County to provide mental health services to OHP patients. The number of county residents on OHP skyrocketed from 30,000 four years ago to about 65,000 after Congress expanded coverage through the Affordable Care Act.

Jackson County received about $15 million annually from Jackson Care Connect to provide mental health care, and another $13 million from AllCare, said Health & Human Services Director Mark Orndoff.

To meet the demand for mental health services, the county has been recruiting workers from around the country and currently has the equivalent of 240 full-time mental health employees, Orndoff said.

Jackson County had been trying to fill 60 vacancies, but will now put those hiring plans on hold because of the changes with the coordinated care organizations, he said.

Orndoff and County Administrator Danny Jordan said they aren’t certain yet whether the changes will lead to any layoffs of existing staff.

The county had hoped to lease a building in Ashland to provide more mental health services on the south end of the Rogue Valley, but will also postpone that expansion, Orndoff said.

Jackson County has a mental health worker embedded with the Ashland, Talent and Phoenix police departments, and another worker stationed at Southern Oregon University, he said.

The county had hoped to expand drug and alcohol treatment services and begin accepting patients with private insurance, but those plans are being reassessed as well, Orndoff said.

Lind said Jackson Care Connect and Jackson County were not able to come to an agreement during negotiations. Cost was one of the issues.

Lind said the Oregon Health Authority is requiring coordinated care organizations to do a better job of integrating physical and mental health care. Jackson Care Connect needs to stay within its budget.

She said organizations are entering an era of increasing scrutiny over the use of resources. Jackson Care Connect’s goal is to increase services at a sustainable rate.

Dr. Mark Bradshaw, chief medical officer with AllCare, said Oregon has made an agreement with the federal Department of Justice to improve care for people with severe, ongoing mental health issues.

For decades, Oregon has moved to deinstitutionalize people, with the goal to shift them into community care settings. But too many people fell through the cracks, with chronically mentally ill people sometimes ending up homeless and without treatment.

Coordinated care organizations are facing deadlines to get people coming out of the state psychiatric hospital into community housing, Bradshaw said.

“We’re under scrutiny to meet the expectations,” he said. “We’ll be under the watchful eye of the Oregon Health Authority.”

Bradshaw said Options has more experience with supportive housing, but AllCare wants to keep Jackson County as the main provider of mental health services for patients.

Orndoff said Jackson County will continue to provide a range of mental health services to local residents, including Assertive Community Treatment for high-risk patients who would otherwise bounce around hospitals, the criminal justice system and sobering facilities.

The county’s Early Assessment program will keep helping youths with emerging mental illness so they stay connected to work, family members and the community.

Other ongoing Jackson County mental health services include crisis services and a wrap-around program for children and their families with complex needs.

Orndoff said Jackson County and the coordinated care organizations are trying to minimize disruptions, but he remains concerned.

“We’re very concerned about our most vulnerable clients and the impact of this transition,” he said. “We’re also concerned about impacts to our staff.”

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Every 20 minutes, someone dies from overdose – but treatment isn’t keeping pace

The Bend Bulletin, Oct. 20, 2016

The abuse of prescription pain killers and illegal drugs has tripled the rate of opiate overdoses in the U.S. since 2000.

Every day, 78 people die of heroin or prescription opiate overdose, a rate of about one person every 20 minutes.

Yet, the nation’s capacity to treat opioid addiction has not kept pace. A report issued last week by the Democratic staff of the Senate Committee on Finance highlights a treatment gap of more than one million Americans addicted to opiate drugs but not receiving the treatment they need.

“This is not spin. Those are hard numbers that indicate that the overwhelming majority of people are waiting in line for treatment and can’t get it,” Sen. Ron Wyden said. “This is really urgent, and we need to push back every which way.”

Treatment for opioid addiction can include individual or group therapy, outpatient or residential treatment or inpatient hospitalization. But there is strong evidence that medication assisted treatment, which uses prescription drugs to impact the opiate receptors in the brain to minimize the euphoric effects of drug use and ease withdrawal symptoms, might be the most effective approach.

The Food and Drug Administration has approved three medications — methadone, buprenorphine and naltrexone — to treat opiate addiction, but significant barriers exist preventing patients from accessing any of the three. Patients can get methadone or buprenorphine through opiate treatment programs, commonly referred to as methadone clinics.

But the number of treatment programs haven’t kept up with demand. In 2000, Congress passed the Drug Addiction and Treatment Act, which allowed physicians to apply for waivers to prescribe buprenorphine in office settings, but the number of doctors taking that step has been underwhelming.

Naltrexone has fewer regulatory restrictions, but is expensive and many health plans won’t cover it.

“Far more patients are in need of treatment than can currently access it,” researchers led by Christopher Jones with the FDA’s Office of Public Health and Analysis wrote in the American Journal of Public Health last year.

According to the most recent National Survey on Drug Use and Health, the rate of past year opioid abuse increased from 634 per 100,000 individuals 12 and older in 2003, to 892 per 100,000 in 2012, with 2.3 million people addicted in 2012.

But Jones and his colleagues found that in 2012, the maximum number of patients that could be seen by doctors with waivers was about 1.09 million. Another 311,000 patients were seen in methadone clinics. That represented a best-case scenario that still left some 914,000 individuals in the treatment gap.

It’s likely the shortfall is even greater. Physicians with waivers can treat up to 30 patients with buprenorphine in their first year, and then can apply for a waiver to increase that total. Congress increased that limit from 100 to 275 in 2016.

Surveys show, however, that prior to the expansion, physicians with waivers treated 57 percent of their maximum case load, and one in four physicians with a waiver saw no patients at all. About 55 percent of doctors with waivers agree to be listed on a federal treatment locater that links patients with services in their area. That increases the potential treatment gap by another half million patients, to as many 1.4 million people.

In Oregon, 13 out of every 1,000 individuals were addicted to opiates in 2012, second only to West Virginia, but the capacity for buprenorphine treatment though waivered physicians could treat fewer than four of those 13. While Oregon has 15 methadone clinics, most are operating at 80 percent capacity or higher. In 2013, 85 percent of the state’s residential beds and 75 percent of hospital inpatient treatment beds were full, leaving little room for additional growth.

Oregon has the highest nonmedical use of prescription painkillers of any state, but only one in 10 individuals with opiate addictions receive treatment. Oregon ranked 49th in the percentage of patients who needed care that received it, in the latest national drug use survey. As as result, opioid-related deaths continue to climb, reaching 522 in 2014, up 13 percent from the previous year.

Rural concerns

The problem is compounded in rural areas of the country. A 2015 study from the Rural Health Research Center at the University of Washington, found that fewer than half (46.6 percent) of U.S. counties had at least one physician with a waiver. Thirty million people, just under 10 percent of the population, resided in counties with no waivered physicians, and 82 percent of those counties were rural. Moreover, the majority of rural counties also lack mental and behavioral health professionals, leaving few options for treatment.

Nationwide, 2.2 percent of physicians had obtained waivers, concentrated mainly along the the coasts, with large swaths through the middle of the country with almost no waivered physicians. Ten Oregon counties, mainly in the eastern part of the state, had none.

Holly Andrilla, a biostatistician who worked on the analysis, said about a third of all waivered physicians are the only ones with waivers in their county.

“They don’t have any backup,” she said. “That’s really problematic, if they go on vacation, or if they retire or they move.”

Andrilla and her team recently surveyed rural physicians to find out why more aren’t signing up for waivers. She said most doctors were concerned about the risk of diversion. Buprenorphine, commonly known by the brand name Suboxone, has a street value because it can help addicts with withdrawal symptoms in between heroin use.

Physicians also cited the lack of other mental health providers that could deal with the depression or other mental disorders that often accompany opiate addictions. Without the help from behavioral health specialists, many felt ill-equipped to handle such complex patients on their own in a primary care setting.

While treatment centers in Central Oregon generally don’t have waiting lists for addiction treatment, Rick Treleaven, executive director of Redmond-based BestCare Treatment Services said there aren’t nearly enough methadone clinics to meet the need.

“The number of providers in the state hasn’t changed in 15 years,” he said. “We added Bend Treatment Center here but Ontario lost theirs.”

Insurance coverage

Recent data shows about 50 percent of those on the Oregon Health Plan who have an opiate addiction are receiving treatment. Commercial plans, on the other hand, continue to place severe limits on access, particularly to medication assisted treatment, despite parity laws that require equal coverage for physical and behavioral health services. Veterans Affairs and Medicare, which covers individuals with disabilities as well as the elderly, also have significant barriers for accessing treatment and for treatment providers to get paid.

“So it’s not the poor people, it’s the middle class that often have more limited access,” Treleaven said. “If someone gets into an accident at work and is disabled, and then they get strung out on painkillers and they want treatment for that, well, they’re on Medicare so no access.”

The federal parity law for mental health and substance abuse treatment was passed in 2008. The Affordable Care Act passed in 2010 also listed substance abuse treatment as an essential health benefit that all plans must cover. But health plans still use a variety of tactics including prior authorization, requiring patients try other less expensive types of treatments first or limits on the number treatments or the duration of therapy.

“None of this has been tested in courts of law,” said Dr. Dennis McCarty, director of the Substance Abuse Policy Center at OHSU. “I think the insurance companies are vulnerable, but they’re going to make it difficult to access the benefit, until they are told they can’t.”

In other areas of the state, the limited supply of treatment slots is already leading to longer wait times.

“People try to get into treatment and they say come in for an intake appointment in four weeks, or if you try to get into residential treatments you can go on a waiting list for two or three months,” said Eric Martin with the Addiction Counselor Certification Board of Oregon. “That in and of itself is evidence of the need. You double or triple the number of your heroin addicts, but you don’t double or triple the number of methadone clinics.”

A national study published earlier this year, found 40 percent of individuals with addictions waited three to seven days for an initial appointment, and 12 percent waited longer than a week. The wait time for treatment averaged 43 days, and more than a third had not been linked with treatment after three months. Many simply gave up.

“One set of challenges stacks up on the other,” said John McIlveen, a policy analyst who serves as Oregon’s State Opioid Treatment Authority.

Expanding capacity

Methadone clinics are expensive to open and require a critical mass of patients nearby to justify the costs. Increasing the number of physicians with waivers could bring treatment to underserved areas faster, but doctors have not been enthusiastic about signing up.

To obtain a waiver, physicians must undergo an eight-hour training and adhere to a number of regulations that make it more complicated to prescribe than a cholesterol or diabetes medication.

“It doesn’t fit into the clinical workflow very well,” said. Dr. Amy Kerfoot, with Northwest Permanente and a member of the Oregon Medical Association. “The patient population can sometimes be challenging … They don’t always play well by all the rules.”

Many doctors say they fear losing their regular patients if they apply for the waiver and wind up with a waiting room full of drug addicts.

“The reality is they already have the waiting room full of addicts,” McCarty said. “If they’re prescribing opioids, they have patients addicted to opioids in their practice.”

Dr. Todd Korthuis, an addiction medicine specialist with Oregon Health and Science University, said doctors need more support to incorporate addiction treatment into their practices. He recently spoke with a rural physician seeing more than 1,000 patients in his primary care practice. Although the doctor was nearing retirement, he obtained a waiver and now treats 15 patients with buprenorphine.

“For him to go to the 30 patients he’s allowed to see, and still take care of all his little old ladies with diabetes and heart disease, it’s just overwhelming, so he feels like 15 is kind of his limit,” Korthuis said. “But that’s a success story. A lot of doctors don’t want to do the training, because they don’t want to see those patients in their waiting room.”

Increasing access, he says, needs to start with medical training. Most doctors had little training in addiction during medical school, and the field of addiction medicine is relatively new. OHSU is approved to train four addiction specialists per year, and has a surplus of applicants. But the medical school only has funding for one slot.

OSHU also has an addiction consult medicine line, which doctors can call to get help managing their patients. Starting this winter, addiction specialists will meet via video link with physician practices to go over their cases and help resolve problems funded by a federal grant.

Local efforts

That could help physicians in Deschutes County, which remains one of the hot spots for opiate abuse and overdoses within the state.

“If we could connect all the people who were motivated or willing to get engaged, who could benefit from medication assisted treatment, we would probably be woefully inadequate in our current supply,” said Dr. Mike Franz, medical director of behavioral health for PacificSource Health Plans, who chaired a medication assisted treatment workgroup for the Central Oregon Health Council.

The group is now working to increase capacity in the region through a hub and spoke model. Bend Treatment Center, as the hub, would start patients on medication assisted therapy and treat the more complex cases. Established patients would be handed over to the spokes, primary care providers and specialty behavioral health providers in the community with waivers.

Wyden is pushing for Congress to provide $920 million in funding to increase treatment capacity. The Comprehensive Addiction and Recovery Act passed earlier this year included a number of initiatives that would reduce the supply of opiates and increase the capacity for treatment and prevention. But Congress recessed this summer without passing the spending bills to fund the act’s provisions.

A continuing resolution provided $7.1 million in funding for the opioid addiction efforts, including $3.27 million in treatment grants. Oregon would get about $11 million of the $920 million. The state was also recently awarded a targeted capacity enhancement grant that will focus on underserved areas including Central Oregon.

“We looked at the places that have the toughest access, the highest hospitalizations and the highest death rates,” McIlveen said. “That’s where we went to focus our efforts in those areas.”

(Editor’s note: This article has been corrected. The original version misidentified John McIlveen’s title. He works for the Oregon Health Authority Health Systems Division and serves as the State Opioid Treatment Authority. The Bulletin regrets the error.)

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Homeless outreach in Lane County: White Bird Clinic’s CAHOOTS

Turning Point

By: Ben Lonergan

Sitting quietly in the passenger seat of a squeaky, white van, Brenton Gicker types quietly on a laptop as police dispatch rattles off instructions over the radio. Gicker, an eight-year veteran of White Bird Clinic’s Crisis Assistance Helping Out on The Streets (CAHOOTS), is employed by the city as a crisis worker and Emergency Medical Technician (EMT) with CAHOOTS. CAHOOTS, a local outreach outfit, supplements city operated police and medical programs by providing crisis counseling, outreach services, and medical care to at risk, displaced, and homeless community members. Gicker and his partner Maddy Slayden typically serve 12-hour shifts where they can encounter everything from welfare checks to rides to rehabilitation centers and housing centers.

Nearly 60 percent of the calls that CAHOOTS workers respond to involve those who are homeless either chronically or in a short term capacity. “The homeless community looks a lot of different ways,” Gicker said. “It’s very complex.” While Gicker’s work with the homeless delivers him more facetime with at risk populations than the typical first responder, he finds that his perceptions on the homeless have not changed much.

“I reject the conservative, right-wing caricature of homeless people as being unmotivated losers and criminals who just behave badly because they’re bad” Gicker said, “[but] I also reject liberal-left caricatures of homeless people all being innocent victims of injustice and capitalism”

Gicker, a long-time resident of Eugene, Oregon, initially became interested in CAHOOTS while working for another White Bird Clinic program. After having piqued his interest in CAHOOTS, Gicker began to join CAHOOTS teams for ride-alongs furthering his interest in the program. Gicker remembers initially being drawn to the experience due to its similarities to the movie “Bringing out the Dead” (a film about paramedics in New York City Gicker watched as a teenager). Three to four years after his first ride-along, a position opened at CAHOOTS and Gicker began working for CAHOOTS in 2008 as a crisis intervention worker.

“Working for CAHOOTS reinforced my interest in doing social work,” Gicker said. “And [it] also led to me developing an interest in medicine.” Gicker took his experiences with CAHOOTS to pursue medical trainings, first as an EMT, then followed shortly by his licensure as a Registered Nurse.

Although Gicker now works part time at Riverbend Hospital he continues to put his time and effort into CAHOOTS, and hopes to see the program grow and expand over the coming years. “I plan to continue working for CAHOOTS for a long, long time,” Gicker explained. “I want to see the program continue to grow locally and I also want to see it exported to other areas since I think CAHOOTS style programs could be successful in many places.”

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CAHOOTS to begin 24-hour service in Eugene January 1

KVAL, Dec. 12, 2016

CAHOOTS (Crisis Assistance Helping Out On The Streets), a free, confidential mobile crisis clinic staffed by counselors and medics, is extending will begin operating 24 hours a day in Eugene beginning January 1.

“Things like homelessness never sleeps. People are always homeless. Suicidality never sleeps. Mental health doesn’t sleep,” CAHOOTS Crisis Councelor Ben Adam Climer said. “People can get us all hours of the day. It’s going to be super nice for us to be able to say, you can call for us whenever you need us.”

In June, Eugene’s City Council increased CAHOOTS funding by $225,000 a year. This allowed CAHOOTS to transition into a 24 hour, 7 days a week service.

CAHOOTS members say due to the volume of calls they get, the extension to a 24-hour service is absolutely necessary.

“We’re always looking to grow. This community is always going to be in need of a different approach,” CAHOOTS Program Manager Tim Black said. “When we went to two vans in 2011, we were getting maybe 10 to 20 calls a day. And five years later we’re seeing 30 to 40 a day on average in Eugene.”

CAHOOTS members say the new shift will bring new challenges, like training more teams and finding resources late at night. But, they say the benefits outweigh any problems.

“We can help that person get some place a little earlier in the day, we can help them get access to services a little earlier in the day,” Climer said.

CAHOOTS was established in 1989 as a collaboration between White Bird Clinic and the City of Eugene. CAHOOTS responds to mental health crises, substance abuse, family mediation, calls for aid from people who are homeless, and much more.

CAHOOTS in Eugene is dispatched through the Eugene non-emergency police phone line at 541-682-5111.

CAHOOTS also operates in Springfield as CAHOOTS Metro, but CAHOOTS Metro is not switching to a 24 hour schedule. Black says they’re hoping to extend CAHOOTS Metro hours from 12 to 16 hours sometime in March 2017. CAHOOTS Metro can be reached through the Springfield Police non-emergency number at 541-726-3714.

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Garlington Health and Wellness Center and Cascadia Affordable Housing

Cascadia Behavioral Healthcare is planning for a new facility that combines treatment, resources and housing.

Ground is scheduled to be broken this summer on 1.5 acres in Northeast Portland. A two-story,

29,000-square-foot center will provide integrated primary care, behavioral health and wellness services. Next door, a four-story apartment building will hold 52 units – including about 10 for individuals with mental illness and 10 others for veterans; The remaining ones will be available to low-income residents.

Cascadia’s CEO, Derald Walker, said the Garlington Health and Wellness Center and Cascadia Affordable Housing will provide “a new model of integrated care for those most in need.” That ties in with Cascadia’s mission “to provide healing, homes and hope for people living with mental health and addiction challenges.”

Cascadia Behavioral Healthcare manages about 600 Portland-area apartments for the mentally ill, but Garlington Center will be the first to provide on-site services to the mentally ill as well as low-income housing for the general population.

“This is the first clinic to combine both services in this specific model that I know of,” Walker said in a statement.

Cascadia’s other developments are solely for people with mental illness and this is the first development that also includes affordable housing, which Walker said is needed in the area.

The $21 million project is receiving $500,000 from FamilyCare Health, $250,000 from an anonymous donor, $250,000 from Meyer Memorial Trust, $100,000 from the Mitzvah Fund of the Oregon Community Foundation as well many smaller contributions.

The foundation has raised about $1.7 million of its own. Officials expect to secure in six months approximately $1.8 million more so that construction can finish by fall 2017, Walker said.

Architectural plans for the Garlington Center, at 3034 N.E. Martin Luther King Jr. Blvd., were released last week by Scott | Edwards Architecture. Principal Lisa McClellan described the project.

“The site is like a series of several rooms with a courtyard between the housing and clinic, which was a community garden site,” McClellan said. “We will recreate the community garden and also have outdoor plaza areas as an extension of the wellness center.”

The two-story wellness center will have a through lobby from the parking lot to Martin Luther King Jr. Boulevard, she said.

“The wellness center will be primarily on the ground floor with the integrated behavioral health center on the second floor,” she said.

The new center will offer medical and counseling teams and preventative care and healthy lifestyle classes as well as a kitchen, food pantry and exercise room.

The apartments not filled by mentally ill residents or veterans will be open to the “general affordable population,” McClellan said.

The fourth floor of the four-story apartment building will be a common room for residents, she said. Support offices will occupy the ground floor.

“There is also potentially a small retail component on the northwest corner between Morrison and Monroe (streets),” she said.

The apartments will be comprised of six studios, six two-bedroom units and 40 one-bedroom units, McClellan said.

“There is also a strong desire to incorporate public art … visible from the southwest corner of Martin Luther King” Jr. Boulevard, she said.

McClellan said she is excited to work on the all-new project.

“They’ve been there about 14 years and they want to expand their services and provide wellness as well,” she said. “It’s designed to front on a prominent corner of MLK, the public face of the Garlington Center complex. I’m excited to have been able to create an integrated campus with a courtyard in between.”

Garlington Health and Wellness Center and Cascadia Affordable Housing
Location: 3034 N.E. Martin Luther King Jr. Blvd.
Cost: $21 million
Anticipated construction start: fall 2016
Anticipated construction finish: fall 2017
Owner and developer: Cascadia Behavioral Healthcare
Architect: Scott | Edwards Architecture
Engineers: ABHT Structural Engineers, Capital Engineering, Interface Engineering
Landscape architect: 2.ink Studio
General contractor: Colas Construction

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