Redesigning services: gold amid gravel

By Robert Landauer – editorial columnist for The Oregonian, November 20, 2001. Not available elsewhere online.

Reorganizations foster stress. They breed discontent. Workers’ gripes are common. Multnomah County’s redesign of its mental health and addiction services fits the pattern: rumors galore and reports of delays, false starts and warfare among leadership rivals.

Yet listen to an unusual change of pitch in this background noise: unsolicited calls from county residents with serious mental illnesses who say that the new system is treating them with more care, consideration and respect than they had ever encountered and that their health is better because of it.

This isn’t evidence that the reorganization, still in its early stages, will be as effective as needed. It is just anecdotes, two unexpected testimonials from out of the blue. But just before Thanksgiving, I’m grateful for these clues that the changes are starting to work for people who need public-agency help.

The first call came from a man who had just been released from a several-week stay in the Multnomah County Jail. Nothing unusual in that. He has been a guest in jails all over the West, he says, as a result of run-ins with police because of a nasty drug habit that aggravates a serious mental illness.

He called to compliment his jailers! The jail’s mental -health ward had treated him better than any jail in his life, he said. He got care and medications that had him coming out of jail healthier than he had been in a long time. He had hopes that his life would improve because he had not just been kicked out the door. A transition worker had connected him with housing, mental -health and addiction services.

The second call came from a high-tech product manager whose bipolar disorder has her swinging between extreme agitation/exhilaration and extreme depression when not sufficiently controlled by medication.

While shifting to safer medications, she became ill and teetered on the edge of a manic episode. She feared that she would have to wait weeks for an appointment because her mental -health practitioner was on vacation.

She called the county’s mental -health crisis line and was told that there was a new service, a walk-in clinic (four are operating) that she could go to that minute for help.

“I went right over and I was seen by medical staff right away, and the person who saw me was warm, reassuring, and I knew I was in a safe place — even though I got there an hour before the psychiatrist was due. I can’t tell you how good and safe that makes you feel when you feel that bad.

“I was the second person the psychiatrist saw, but before he saw me he came out to say hello and told me that he’d be with me shortly, and, again, that was extremely reassuring.”

She described to the psychiatrist the difficulties she was experiencing with the new drugs. The Sept. 11 terrorist attacks had “unhinged me a bit” because she worried about New York friends and relatives, she said, complicating the adjustment to the new medications. “He understood my problem immediately. He took authority to increase my dosage, and that helped my whole course of treatment.

“When you get really good attention like that, you feel better right away, because part of mental illness is fear and anxiety. You feel like you’re going to be able to cope even before the new medications kick in.”

I expected her story to end there. But she continued. Her remarks showed that what might have been an isolated episode is being transformed into continuity of care.

“When my personal therapist at the health center came back a week later, she was thrilled with the attention I had received. Now this therapist is on leave for two months, and she gave me a sheet telling me all the places I can get support. And both she and I feel much more secure. Just knowing that I have the support stops the panic and anxiety that can trigger the attacks.”

In these two anecdotes, we see seven gold nuggets amid the gravel of county mental -health reorganization: easy and timely access; prevention and early intervention; care coordination; treatment services; support services; acute care; and protective services. This might yet turn out to be a rich strike for the 13,000 clients who rely on this county’s mental-health services.