Richard Harris takes on Oregon’s Mental Health and Addictions Division
Interview by Amanda Waldroupe, published by Street Roots, October 24 2008
The Oregon office of Addictions and Mental Health Division is moving and shaking.
On September 12, it was announced that Richard Harris, 68, the retiring executive director of Central City Concern, would replace Bob Nikkel and serve as interim director of the division.
Tapping Harris to head the Addictions and Mental Health office, which is a division within the state’s Department of Human Services, is nothing short of bold: His admirers say Harris is perhaps the only person in the state who has the integrity and experience to tackle the challenges facing Oregon’s mental health and drug treatment systems.
Some of those challenges include a dilapidated state hospital that was taken through the wringer by an investigation conducted by the Department of Justice released in January of this year, determining the future of Cascadia after its April financial implosion, bolstering the state’s community health systems, and all in times of scarce financial resources.
Harris has a solution, one that he has found working for Central City Concern for 29 years. The social service agency’s nationally recognized way of providing alcohol, addiction and mental health services—combining supportive services with housing in a supportive community—is a model he hopes to begin replicating at the state level.
Harris started the job on Monday, September 29. In an interview with Street Roots, Harris talked about his plans for being interim director and some of the challenges he faces.
Amanda Waldroupe: Why are you coming out of retirement to be the interim director of Addictions and Mental Health Division?
Richard Harris: I was on the track to retire. I had a series of meetings with Bruce Goldberg (Director of the Oregon Department of Human Services). After one of those meetings, he asked me if I would consider coming to AMH on an interim basis while the department did a national search. I wrestled with that about a month, trying to understand what it really meant. Bruce and I had several conversations. I think we came to the understanding that we had a mutual interest. My interest was in preparing the AMH in adopting an integrated model or approach to the problems of addiction and mental health. That means combining health, housing, employment services, and drug services in a more coordinated and integrated fashion. I think that’s Bruce’s dream, and I think that’s my dream.
A.W. What is important about an integrated approach? Why is it needed?
R.H. My experience on the ground here, operating programs over the last 25 to 29 years, has been a gradual understanding of how powerful housing combined with services becomes if you’re trying to intervene with problems like homelessness, addiction, and mental health.
The synergy that comes from housing combined with services is pretty amazing. When we started, we thought were just trying to get people into addiction and drug treatment services. Only later when we started combining the services did we understand why services were more effective when people are in more stable housing. And housing worked better for people if they had adequate services. This integrated service model is not easy to do. It’s very challenging. We see the outcomes. Since the state of Oregon is not organized, it requires working with all levels to find common ground here. That is the dialog I want to see get started.
We’ve learned a lot about how we make alcohol and drug services effective. I think we have (Central City Concern) about the most effective alcohol and drug treatment program certainly amongst any alcohol and drug programs I know of. A lot of it has to do with providing housing, and providing recovery mentors, on top of what we might call normal outpatient services. If you’re dealing with a late stage alcoholic population, getting people to live in sober environments is huge. If you put the right pieces in place, you get much better results. What we’ve learned is that we get very good outcomes with serious heroin addicts when we provide mentors, acupuncture, health care, alcohol and drug treatment and housing. If you took any of those elements out, you get less outcomes.
A.W. What works and what doesn’t work?
R.H. Housing is critical to the issue. Not only does it meet a basic need that people have, but we’ve come to see housing as a place and environment where not only healing takes place but positive relationship building. 8 NW 8th is more about a supportive based community. You build self-esteem and it comes from other people. Personal relationships are what matters. People will stay clean and sober because they’ve incorporated it into their lives. People who want to stay clean and sober will do it better when they have support from their peers. Housing creates a sense of community for someone. Their thinking is not all jumbled up with drugs. Housing does two things: creates a supportive community, and it does put a sense of security in your life. All of those are elemental.
I have learned so much from people in recovery. We need to make sure part of who we’re listening to is people effected by services. It’s inspirational, motivational, but because of experience, they have a unique view of how to deliver services. I intend to listen to and rely on a lot of people who have been through these issues.
A.W. You believe the Oregon Health Plan (OHP) should be playing a larger role in helping individuals dealing with a mental health problem. What would you like to see change with OHP?
R.H. I think the Oregon Health Plan was a bold move to advance this type of health insurance program, and we’ve just backed off of it by chopping it down. It’s cost us more money to leave uninsured people on the streets.
One of the things I want to look at is adding people back into the plan, particularly people who have alcohol, drug, and mental health issues. What are the cost drivers in our criminal justice system, in our mental health system? Ultimately, what you come down to is if you don’t treat addictions, you do it in the jails. Over 70% of people in prison are there as a result of addiction or a drug related crime.
A.W. How does spending money on policies like mandatory minimums affect Oregon’s ability to provide adequate mental health care?
R.H. We’re in a situation where if you spend money on jails and prisons you’re not going to spend it on health care and mental health. The two ballot measures (Measures 57 and 61) are likely to have a huge financial impact. It’s a problem.
I’m very much interested in how our next Attorney General (John Kroger) is going to take this on, because he clearly understands if you don’t do something about addiction issues, you can’t get a hold of criminality issues. The most effective way to reduce crime is to get addicts off the street. But where is he going to get the money? If you’re spending resources on more prisons, it’s less money in the zero sum game we have in the state budget.
A.W. What do you think is the single biggest challenge for Oregon’s mental health system?
R. H. I’m not sure. I’m an outsider. I don’t spend my everyday thinking about what the biggest challenges are to the mental health system. I think there are a lot of challenges. I do believe that people will probably agree that there are a lack of resources to deliver the quality of services that people deserve. It goes without saying that it’s under funded. The question is how you focus and prioritize resources, and how you make services more effective.
A.W. Since Cascadia defaulted on a 2.5 million dollar credit line, the county, state and service agencies have stepped up to continue funding Cascadia or taking over some of its services. What if Cascadia, Oregon’s largest mental health provider, fails or gets so small that it cannot offer the same services to its clients?
R. H. We’ve downsized it so far and that seems to be working. That means there’s far less pressure on Cascadia. It’s down to a manageable size. They’ll be more focused. That probably will work. If it doesn’t, it means another agency may need to consider taking on some of the services Cascadia provides. Cascadia needs to be successful. This is a complicated population of people to serve. I’m fairly optimistic that (the actions taken) will help them stay solvent.
A.W. The Department of Justice investigation on the conditions and practices of the Oregon State Hospital (OSH), released in January of 2008, concluded that “numerous conditions and practices at OSH violate the constitutional and statutory rights of its residents.” What do you think are appropriate responses to improving the conditions at the Oregon State Hospital?
R. H. It’s not an area I’m particularly knowledgeable about, but ultimately, someone else is responsible for that. The thing I would say about the State Hospital…is that they are necessary services for some, and that they should be seen as they typically are, as services of last resort. You enhance state hospital programs by providing effective community health services. Funding adequately that kind of community mental health structure has never really happened in Oregon. We have been struggling with this issue for a long time.
A.W. The big missing lynchpin of Multnomah County’s mental health system is a sub acute center. There have been movements lately to get one started. What can the state do to help the county achieve this?
R.H. That’s a really good question. I’m not sure if I know enough about the way state resources can be directed to counties for certain things. That’s something I need to learn more about. It’s going to take some assistance from the state to create the services.
A.W. The anniversary of James Chasse’s death recently passed (on September 17). What do you think of the strides Multnomah County and Portland have made since his death?
R.H. My understanding is that there’s been some additional training for the police and added resources. Is that enough? I think you have to look at what kind of services you’re going to provide and whether they’re going to be adequate. Because he (Chasse) was involved in services. He had housing. I’m not sure that this won’t repeat.