In your future office, what powers will you use to affect positive change in mental health services? What changes will you pursue?
I would work with the City bureaus that often respond to persons in mental health crisis (both police and fire), with non-profits, the State, and the County to prepare for the implementation of Federal health reform in 2014, which will extend Medicaid to all adults below 133% of the poverty line. We need to work together to identify in advance the people who should be signed up for Medicaid as soon as possible, and identify how to most efficiently and effectively use the Federal resources that will suddenly become available to care for people.
I would work to shift resources from prisons to prevention, including expanded mental health treatment for people who come into contact with the criminal justice system, by working to persuade counties, the Legislature and the Governor that the State should adopt a new model for budgeting for public safety, in which the State gives each county a lump sum budget for public safety, and the cost of housing prisoners sentenced in that county comes out of the global budget. This would give counties an inventive to conserve on prison dollars and an opportunity to increase treatment and prevention dollars. In the current system, local governments have fixed budgets for every aspect of public safety except prisons, for which DAs in effect have an unlimited budget: any sentence they can get, the State has to pay for it. I have already spoken with Chair Cogen, Governor Kitzhaber and some legislators about this concept.
I would work to expand the options (other than jail and the emergency room) police and firefighters have when responding to people in mental health crisis who clearly need to be taken somewhere for help and observation. The Citizens Crime Commission told me about one model in Virginia (their description appears below):
“When Virginia mapped out their system of crisis response system they got everyone around the table to identify gaps and to discuss the concerns and motivations of the partner organizations:
Law enforcement wanted to:
- Decrease officer injuries dealing with mentally ill persons in crisis
- Decrease the amount of time officers had to spend with the mentally ill person which took them off the street
- Improve the outcomes for the people they were dealing with
Hospitals wanted to:
- Decrease the money spent on ER visits by mentally ill people in crisis
- Decrease the injuries to their nurses and security dealing with individuals in the ER
Jail wanted to:
- Decrease the number of inmates with mental illness in custody
Everyone wanted system integrity, accountability and improved public safety.
They set out to measure what was happening in their community – following the adage, if you can’t measure it you can’t manage it. Police called dispatch and gave a disposition of a 911 call for mentally ill “931” with sub codes for resolved at the scene, voluntary transport somewhere, involuntary transport (ECO) or arrest. Using 911 to code the data allowed them to prioritize their efforts and resulted in a 24/7 non refusal center for police to take people experiencing a mental health crisis. The result of this change in their community resulted in achievement of many if not all of the desired outcomes of the collaboration partners. The 9 counties in Virginia call it a Crisis Diversion center and it is attached to the UVA hospital emergency room with a collaborative funding model. It allows officers to bring individuals in mental health crisis and transfer custody to university police so they can get back out on the street. The location is secure with mental triage and medical care right there. They used MOU’s and changes in necessary state law to achieve their goal. The CIT coordinator reported that all the participants saw such a return on their investment in time and resources that they meet monthly as an operational team to troubleshoot problems as they arise.
On January 27 the Mental Health Association of Portland sent questions to all Oregon political candidates. This is one response. This post is not a political endorsement but an opportunity to speak out about mental illness. Minor changes may have been made to the text for clarity.