Wallowa County faces immense cuts to mental health

Editorial by Stephen Kliewer, from the Wallowa County Chieftain, April 23 2009

The state of Oregon has stated that it is going to cut 30 percent of the funding for addictions and mental health this coming year. An ugly number considering such services are already underfunded and there is a rising demand for services.

But the real story is even worse. That 30 percent cut includes the total elimination of non-Medicaid community mental health services to adults and seniors. It includes a 100 percent cut of substance abuse treatment services to adults and seniors. It includes a 100 percent cut to crisis services, meaning that there would be no mental health hotline for suicidal people, or people with a severe mental health crisis. Those people would have to call law enforcement, or the emergency room. But there would be no funded mental health support for the ER staff. It includes a 100 percent cut to addictions prevention. A small amount of funding remains for high needs children, but that is all that is left.

Some in Salem argue that these lost services will be made up in the expansion of OHP standard membership. There are dangerous flaws in this reasoning. It may be over a year before people can actually get enrolled. During the six to 18 months before any of the people who lose care will be enrolled and able to access Medicaid services, uninsured people with severe mental illness and addictions will have no recourse besides emergency rooms, jails, and the streets.

Many of the people who currently rely on non-Medicaid services, the “sliding fee scale,” will never be eligible for OHP. These include military veterans who live too far from a VA facility to access care but too close to be exempted to see non-VA providers, Medicare beneficiaries whose needs for rehabilitative services are not covered, and the remaining uninsured and underinsured.

The funding that is being cut provides for adult and seniors mental health, crisis services and alcohol and drug services.

This money helps support psychiatric services, therapy, case management, nursing care, and a variety other services that provide stability for people with mental illness. If we do not have a system that provides these services we will pay for it in a cost shift to emergency rooms, law enforcement, courts, jails, prisons and the state hospital.

What do these cuts mean for Wallowa County? Let’s start by looking purely at dollars. Not counting the prevention dollars, which go to Wallowa Valley Together Project, Wallowa Valley Center for Wellness currently receives around $212,000 a year into the county to provide non-Medicaid services. The current budget being put forth at this time cuts $183,400, or 86.5%, of that amount. The OHP increase, when it begins to be felt 6-18 months after services are eliminated on July 1st, would at best replace only around $46,000 of those funds, a cut that still is around 65%. This represents at least 2 full-time clinicians from a system that is already stretched thin by need. Thus it is not merely the loss of services to those without insurance that is at stake, it is the ability of community-based health programs across the state to maintain the level of staffing needed to meet the needs of all people with mental health and addictions issues, including those with insurance. These cuts would effectively decimate the community-based mental health system for everyone.

What is tragic is that for the past ten years the state has been developing a system of care based on a healthy community-based mental health system. They have moved people into the community from residential programs. They have encouraged the development of drop-in centers such as Wallowa’s Riverside Center. They have moved people from hospitals to homes such as Wallowa River House, putting more and more of the responsibility on the local programs. And now they propose to cut the funding that allows stable programs to exist. Even the state admits that it will have to suspend the Oregon Administrative Rules (OARs) if they do this because the providers who survive the cuts will not be able to do what the state has mandated they accomplish. Even if funding returns several years down the road, the provider system in many communities will have disappeared. Key personnel will have been lost and the system may never recover.

Meanwhile, back in Salem, the bureaucracy that has been developed to oversee these endangered programs, cuts are also being made. But let us look at those cuts. They are taking a 4% cut in the personnel salary line, and a 2% cut in supplies. To me this is astonishing, perhaps even immoral. While the local programs, which actually provide the services to people in the local community, are being cut between 65% and 86.5%, the people sitting in cubicles who supposedly oversee these programs get cut 4%.

This does not make sense to me. I doubt it if will make sense to the person who cannot get out of bed and to work because of severe depression. Or to the wife whose husband is suffering from alcoholism, but does not have a local treatment program available. I doubt if it will make sense to the person who is suicidal, and in desperation calls the crisis phone, but finds that there is no one on the other end of the line to help them stay alive. Something is wrong with this equation.

I believe that these cuts, if implemented as proposed, will do two things. It will mean that the cubicles in Salem stay filled with bodies, while around half of the clinical offices in Wallowa County will stand empty.

It will mean that someone will continue to commute to work and push papers related to programs that no longer exist (who has to oversee OARs that are suspended?), while somewhere in Oregon, perhaps somewhere in Wallowa County, a suicidal person will die; a family will be torn apart by alcoholism; a youth will start drinking early and heavily, a severely mentally ill person without support will end up first on the street, and then in jail.

If you think the way these cuts are currently structured makes sense, then do nothing. If you think they don’t make sense, then contact Senator Nelson (503-986-1729, sen.davidnelson@state.or.us) or Representative Smith (503-986-1457 or rep.gregsmith@state.or.us) Demand that the necessary cuts be spread equally across the whole system, not taken out of direct services for the sake of administrative overburden. You may also testify to the Ways and Means Hearings. The closest hearing is Saturday, April 25 at the Pendleton Oregon National Guard Armory, 2100 N.W. 56th Drive 10 a.m. to noon. Representative Smith will hold a Townhall in Enterprise on May 2nd at 10am at Community Connections.