Privacy laws prevent scrutiny of mental health system’s role

From the Portland Tribune, April 21, 2010

For years, community activists have pressured the Portland City Council to reduce violent confrontations between the police and the mentally ill.

But while police have been placed under the public spotlight as a result of these confrontations, the mental health system doesn’t get the same level of scrutiny. And some activists say that state and federal privacy laws make it impossible to know whether the mental health system should be held accountable along with law enforcement officers.

“It’s a huge issue,” admits Jason Renaud of the Mental Health Association of Portland, who has been one of the most vocal police critics. “Right now, we have no way of knowing whether the mentally ill are receiving the best possible treatment.”

Pressure on the council began to mount more than three years ago when James Chasse, a diagnosed schizophrenic, died after fighting with several Portland police officers and Multnomah County sheriff’s deputies. It increased this year when Portland police killed Aaron Campbell, who was suicidal, and Jack Collins, a transient who had cut his throat with a utility knife.

Multnomah County grand juries cleared the police of criminal wrongdoing in all three cases, helping to fuel anger among the activists. But all police records have been released in the three cases. Grand jury transcripts from the Campbell and Collins cases also have been released, allowing the public to judge the actions of the police leading up to the deaths.

But the mental health files in the three cases remain secret – even though police records indicate Chasse and Campbell were treated by mental health professional before their deaths. Collins may also have been in contact with such professionals, too. Because these records are not made public, however, citizens have no way to determine what efforts were made to help the three men lead normal lives, why those efforts failed and what lessons have been learned from their deaths.

The files are restricted because state and federal laws guarantee the privacy of medical records, including those related to mental health and addiction treatment. The privacy laws even apply to internal reviews conducted by public agencies who fund such services.

Renaud says such privacy laws are essential to encourage mentally ill and addicted people to seek treatment without fear of exposure. At the same time, he acknowledges that the restrictions prevent the public from learning whether everything possible is being done to prevent such tragedies.

“There’s no way to measure the effectiveness of the mental health system,” says Renaud, a candidate for City Council who is not running an active campaign.

And the transparency gap between the local law enforcement and mental health systems is growing even larger. In the wake of the three deaths, the council increased public oversight of the Portland Police Bureau. On March 31, it unanimously voted to strengthen the role of the Independent Police Review Division of the City Auditor’s Office in alleged police misconduct cases.

Yet none of these reforms apply to the mental health system.

Laws keep records sealed

Mental health services are provided by a range of licensed professionals, including psychiatrists, psychologists and addiction counselors. In Multnomah County, the publicly funded mental health system is overseen by the Mental Health and Addiction Services Division of the Department of County Human Services. It contracts with numerous nonprofit organizations to provide a range of services to those who cannot afford private care. The organizations include Cascadia Behavioral Healthcare, Central City Concern and Outside In. The current budget is around $78 million. County-funded programs assessed and served around 45,000 people last year.

The privacy of everyone who receives such services is protected through federal and state laws. The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 includes privacy provisions covering all medical records. Oregon laws also guarantee that alcohol and drug treatment records are private.

“People have the right to expect that their medical records are confidential, and that includes mental health and addiction-treatment records,” says Christina Gardner, the division’s HIPAA compliance officer.

Even law enforcement officials are prevented from accessing a person’s medical records. This means that when police encounter people who appear to be mentally ill, they cannot easily learn whether they are under someone’s care.

In most cases, Gardner says, this is not a serious problem. If police are worried enough, they can contact the Mental Health Call Center operated by the county or Project Respond, a mobile mental health crisis response team operated by Cascadia on behalf of the county.

In both cases, mental health workers will be dispatched to the scene with access to a database of everyone in the county mental health system. If the person is in crisis, the mental health workers are allowed to provide the police general information about the individual’s condition to help resolve the situation.

But this did not happen with Chasse, Campbell or Collins – primarily because the confrontations that led to the deaths escalated too rapidly or unfolded differently than expected.
Numerous contacts with system

Because of the privacy laws, county officials cannot disclose or discuss whether Chasse, Campbell or Collins ever received mental heath or addiction treatment. However, police records released after their deaths indicate that they did.

Chasse died after being chased and fighting with police on Sept, 17, 2006. One month before his death, according to police documents, caseworkers were concerned Chasse had stopped taking his medication and needed to be hospitalized. Two days before his death, a mental health worker and police officer went to see Chasse at his apartment, but he ran away.

Campbell was shot and killed by Portland police after an hourlong standoff on Jan. 29. When police were called to the apartment complex where Campbell was staying, they were told that he was suicidal and had a gun. After his death, Campbell’s girlfriend told police that he had spent time in a “mental hospital” after trying to kill himself a year early. She said Campbell received psychiatric medicine from the hospital but had stopped taking it “because of his ulcers.”

Collins was shot and killed on March 22 after charging an officer with a utility knife. He was a longtime alcoholic who had lived on the streets for years. During that time, Collins was repeatedly cited for drinking in public, suggesting he may have also visited or been taken to the Hooper Detoxification Center, which is operated by Central City Concern.

Eleven days before his death, Collins walked into Central Precinct and asked for mental health treatment. He was directed to Cascadia, but there is no way to know whether he showed up because any record of his visit would be confidential.

“The mental health system is supposed to be accountable internally, but there’s no way for the public to learn the results,” Renaud says.

First call shouldn’t always be to police

In the wake of the controversial police shooting of Aaron Campbell, the Skanner newspaper published an editorial urging its readers not to call 911 if they were in an emergency situation.

“The fact is, we at The Skanner News simply have to warn our readers away from calling the police when they are in a crisis situation,” wrote the paper, which is primarily aimed at African-Americans in North and Northeast Portland.

The Feb. 15 editorial has repeatedly been cited as proof that Portlanders no longer trust the police. But some points in the editorial happen to be directly in line with what authorities recommend. When someone is facing a mental health crisis, there may be a better option – 503-988-4888, the number of the Mental Health Call Center operated by Multnomah County. It also can be reached at 1-800-716-9769.

According to county spokes-person David Austin, the call center is “the hub” of the mental health system. It is operated by professionals who are trained to quickly understand whether the crisis is so serious that the police must respond. If not, the operators can instead dispatch mental health workers to the scene.

“The call center is not as well known as 911, but in many cases involving the mentally ill, it is a better option,” Austin says.

The privacy of all crisis calls to the center are guaranteed by state and federal laws. It received over 45,000 calls in 2009, the most recent full year for which figures are available.