A better way ahead on mental illness

Published in The Oregonian, March 14, 2010. Author Mark R. Webb is a county judge in Grant County.

State leaders have an important decision to make regarding the future of Oregon’s mental health care system.

The Oregon State Hospital Framework Master Plan Phase I Report, released in 2005 as a guide to the future of mental health care in the state, identified problems within the system. The Phase II Report, released in 2006, recommended changes to address those problems. The changes involve developing new state hospital facilities and significantly enhancing community-based mental health resources.

Adequate community-based resources are critical because they provide services that help stabilize individuals within their home communities. Evidence shows this frequently provides them with a more appropriate and effective level of care that helps to avoid costly long-term institutional care. The Phase II Report stresses that successful, cost-effective treatment at the institutional level requires that an enhanced community-based system be in place before the new state facilities open.

Despite this, state leaders appear to have largely ignored the report’s community-based recommendations. Rather, they have focused on developing new facilities: upgrading the Oregon State Hospital in Salem and moving to build a new hospital in Junction City, 50 miles away. According to a report presented to the state Senate Committee on Health and Human Services, the new facility would serve about 320 patients, employ about 1,500 new staff and cost the state’s general fund about $120 million or more annually to operate.

Greater Oregon Behavioral Health Inc., of which I am a board member, is a managed-care organization that oversees county mental health services in Oregon. It has proposed an alternative, community-based approach in which the state would not build a new state hospital in Junction City, at least for now. This would enable the state to save the $120 million or more required annually to run the facility and to invest it in community-based programs in creative and important ways.

Because Medicaid cannot be used to fund services at the state hospital but can be used to fund community-based services, GOBHI recommends that $40million of the $120 million saved each year be used to match Medicaid funds to increase community-based resources. This would generate $60 million annually in federal funds to provide an additional $100 million annually to better fund community programs. It also would send an additional $40 million to community programs as discretionary general fund dollars to facilitate more flexibility and provide services for those not covered by Medicaid.

So what? The community-based approach would net Oregon taxpayers at least $40 million in savings annually over the state’s approach; turn an $80 million state general fund investment into a $140 million community mental health investment; provide a broader and far more adequate array of community-based resources to meet mental health needs; and, finally, as a consequence, increase the effectiveness, while lowering the cost of institutional care at the state level.

The community-based approach could do one more thing: It could eliminate the need for a new state hospital, with its high annual operating costs.

Oregon should heed the advice in its own reports. The community-based approach is the fiscally responsible one to take. And it’s a far more fair and effective way to provide mental health services statewide, across a broader range of counties.

How state leaders respond to this opportunity to set the course for mental health care in Oregon will say a lot about how serious they take their fiscal and mental health care obligations.

We agree with Judge Webb. Politics and money drove the state’s decision to build new state hospitals. The beneficiaries are local construction contractors, public employee unions and local vendors. Jobs, yes. But the purpose of providing care and welfare for persons with mental illness should not be a jobs program.