County turns negative into positive

Editorial by by Robert Landauer, October 26, 2002

Sometimes a negative is a positive, as in the steep drop in hospital days for mentally ill Portland-area residents.

In November 2001, the number of mentally ill Multnomah County residents in acute-care hospitals peaked at 3,485 patient bed days. At $700 a day, the bill totaled $2.44 million. That’s for one month. Since then, the mental-illness bed-day tally has plummeted to 2,150 (preliminary) in September. The 1,335 difference amounts to $935,000 less in monthly hospital bills.

Hospital stays aren’t down because local governments are sidestepping problems that are tough to solve.

Just the opposite. Reshaped agencies and new programs are stepping in earlier, before odd behavior caused by schizophrenia, depression, bipolar or other disorders unravels to the point that patients need hospital care to avoid danger to themselves or others.

The biggest changes are occurring as the county gains traction in its drive to make mental health service delivery more cost-effective. The notable advance was the formation last January of Cascadia Behavioral Healthcare. The community-governed nonprofit melded three mental health delivery providers into one unit. It treated more than 17,500 Multnomah County patients in the past year, about 80 percent of low-income Oregon Health Plan clients seeking mental health outpatient services in the county.

Three changes have been especially effective in reducing the area’s higher-than-average hospitalization rate: creation of Urgent Walk-in Clinics in four neighborhoods; expansion of a downtown-only mobile response team to two expanded outreach teams, eastside and westside, reaching patients countywide before they require inpatient care; and assigning county acute care coordinators to monitor people using crisis services and to arrange suitable follow-up treatments that are less expensive than hospital care.

Another indicator of progress came Tuesday when the Oregon Disabilities Commission recognized Employment Solutions Plus, in Portland, as its rehabilitation provider of the year. The program formerly was known as IPS+, shorthand for Individual Placement and Support Plus Enhancements.

Its idea is that specially crafted, coordinated, intensive services could help many severely mentally ill patients to get jobs that interest them.

This is a giant step in taking control of their lives because only 15 percent to 20 percent of adults with serious mental illnesses are believed to hold jobs compared with 81 percent of those without disabilities. People with disabilities are more than three times as likely as others to live in poverty.

Without jobs, mentally ill people often lose housing and can’t pay for prescription drugs. Street life leads to more time in jails and hospitals.

First-year program results showed that enrollees spent 65 percent fewer days hospitalized than in the prior year. Fewer individuals were hospitalized, and they got out faster (6.9-day stays before entry into the program and 2.4 days post-enrollment).

The project was able to help 38.6 percent of its 176 clients get work, placing them in a wide variety of competitive jobs in the community.

The results impress me for several reasons. Much of the job-placement advance occurred while the project fought headwinds of a slumping economy. Also, Employment Solutions Plus distinctly takes on clients that many other programs avoid or treat with little success, notably the high portion of alcohol and drug abusers among people with severe mental illnesses.

Cascadia’s and Employment Solutions’ actions testify that it is sound policy to invest in prevention efforts that cut down on mental health crises. Front-end staffing costs are repaid in big savings in hospital bills and in less wasteful use of police, court and jail resources. County commissioners should keep pushing to complete the mental-health reorganization.