Portland wants to build a ‘one-stop-shop’ for people in crisis

From OPB.org, January 7, 2021

The project, still in its infancy, is a significantly more ambitious undertaking than a simple replacement of the sobering center.

When it comes to drug and alcohol abuse, 2020 was a year marked by grim milestones for the city of Portland.

The Portland Police reported 60 overdose deaths by October — the same number they’d seen in all of 2019. Kaiser Sunnyside Medical Center’s Addiction Treatment Unit took in over 366 people for alcohol detox, the most ever in the hospital’s history. And, for the first time in half a century, the city had no designated place for people to sober up.

Portland’s sole sobering station abruptly shut down last January. The center, run by nonprofit Central City Concern and funded by the city, was meant to provide a safe place for intoxicated people across the region to recover. The space resembled a holding cell with a big concrete room for people to sleep, eat, and clean up. Floors were slanted to make it easy for staff to rinse away vomit into the drains.

The facility was basic, but advocates say the space historically served a clear, if limited, purpose for those left outside who were too intoxicated to care for themselves.

“It was a really safe place for drunks to be,” said Jason Renaud, founder of the Mental Health Association of Portland. “Not in the streets, not in the rain, not in the snow, not literally being run over by people, not being jackrolled by crooks.”

Central City Concern shuttered the center, citing an outdated facility and safety concerns. More people were coming in with multiple drugs in their systems. Methamphetamine use was up. Rather than sleeping it off, those high on the stimulant often lashed out — at staff or at themselves. Assaults were rising at the facility, as were incidents of self-harm.

The closure set off a wave of panic within the city as staff tried to find a new provider to step in and fill the void. No one was interested.

A full year later, as advocates warn of a pandemic-fueled rise in drug and alcohol abuse, city officials are ramping up the push for a far more ambitious replacement. The current vision is being billed as a “one-stop-shop” for those in crisis — both filling the vacuum left by the sobering center’s closure and catering to the number of people who experience a psychiatric crisis on Portland’s streets.

The move is the latest in a series of attempts by city and county government to address the region’s lack of mental health services.

According to a one-page briefing on the project, the current proposal is for a “24/7, multi-partner, robust triage and assessment unit” that would build upon the services available at Unity Center’s psychiatric emergency room. The project, as currently envisioned, would include an on-site sobering center and walk-in clinic and serve as a referral hub, sending people to detox, outpatient clinics, and other community resources. The proposal describes a “single point of access for the community” accepting people from local agencies, EMS, families members, and law enforcement.

“It’s 2 o’clock in the morning, 30 degrees outside, and a guy is standing in the middle of the street wearing nothing but shorts, screaming and yelling and sweating profusely. You think, well, is he high on meth? Is he in a mental health crisis?” said Bob Day, a former deputy police chief who was tapped by the city last February to spearhead a replacement for the sobering center.

“Nobody — not even a trained psychologist or psychiatrist — is going to be able to tell you what the problem is. We have to get them to a safe, secure environment where they can be treated, have a chance to get stable, have an assessment done.”

Day, who had led the behavioral health unit at the police bureau, said he spent the year corralling stakeholders around a proposal to replace the sobering center. The city and CareOregon, a Portland-based Medicaid insurer, are now driving the project, paying a healthcare consultant — Aaron Lones of Lones Management Consulting — to refine the project.

Similar projects

The new proposal is at least the third project in the pipeline of local government that seeks to address the void of mental health services in the Portland region. The county is moving ahead with a similar-sounding behavioral health resource center downtown, serving people experiencing homelessness with mental illness. Officials say they’re hoping to be up and running by the summer or fall of 2022.

Commissioner Jo Ann Hardesty’s office, meanwhile, is pushing forward with the Portland Street Response, a highly-anticipated program that will dispatch a non-police response to 911-calls regarding people experiencing homelessness or in a mental health crisis. A pilot program is expected to launch this winter in the Lents neighborhood.

City and county officials say these budding efforts are not redundant. Ebony Clark, the director of the county’s Mental Health and Addiction Services Division, said, unlike the city’s latest proposal, the center is not meant to be a drop-off location for people who are “significantly impaired or intoxicated.” The Portland Street Response only deals with dispatch and transport.

It’s possible a project like the mayor’s office envisions, which would add to the number of treatment options for people in a crisis, could work well with the Portland Street Response, which would send out a team to calls for people in crisis and take them to already available services. Robyn Burek, program manager for the Portland Street Response, said she’s currently hearing concerns that the program’s success will be hampered by the limited number of places to take people in need of mental health services. She said they won’t have a clear idea of what kind of impact this will have on the program until it launches.

“We are aware that that is a potential problem and a pitfall for us — for certain,” said Burek. “… I mean, Oregon is one of the state’s ranked lowest in mental health, in part because we don’t have enough infrastructure in place to meet the demands.”

Significant discussions between Hardesty’s office and the mayor’s office about the proposal do not seem to have occurred. A spokesperson for Commissioner Jo Ann Hardesty declined to make the commissioner available for an interview saying their office is still gathering more info on the sobering center proposal.

Concerns

Three mental health advocates reached by OPB had not heard of the proposal to replace the sobering center. After reading the one-page write-up, their reviews were mixed.

Renaud of the Mental Health Association of Portland said his interest was piqued by the idea of a hub that streamlines referrals and spares patients and their families from wading through an unnavigable “patchwork quilt of services.” But after a summer of racial justice protests that demanded the city cut funding from police, Renaud expressed doubt that the city could get buy-in for a proposal that would rely on law enforcement to transport people in crisis.

“The mandate from the protest is to defund the police, and this is going in the opposite direction from that intention,” said Renaud. “This is adding services to the police budget.”

Day said it’s unclear whether that will be the case.

“The short answer is that’s a risk. We don’t know how it’s going to shake out. We don’t know how it’s going to get funded. Assuming this continues to stay a need for police, that’s definitely a possibility.”

For advocates like Beckie Child, the former head of Mental Health America of Oregon, this would be a deal-breaker.

“If the police have control over the place? No. Just absolutely no,” said Child, adding she believed the setup would perpetuate the criminalization of mental illness.

Mental health advocates point to many reasons for skepticism. Behavioral health is traditionally in the county’s domain and not an issue on which the city has a proven track record. Big questions, namely, where the funding will come from and who will operate it, have yet to be answered. And the facility this project most closely seems to be mirroring — the emergency room at Unity Center for Behavioral Health — has been plagued by reports of safety problems.

“I mean if they design what they’re proposing right now like they designed Unity, it’s gonna be a complete mess,” said Child.

Child said she sees the same need as the city: A place where people experiencing a psychiatric crisis could be dropped off 24 hours a day. But she said she believes the city’s model is wrong-headed. She wants to see a voluntary peer-run model, managed by people who themselves have received mental health services. And she believes the fact that she hadn’t yet heard of the proposal, despite more than a decade as an advocate, meant the city isn’t prepared to change course.

“It’s too far along,” she said. “I think they have a design in mind and they’re not really interested in community feedback.”

Kevin Fitts, head of the Oregon Mental Health Consumer Association, said he believed the city is engaging in “shuttle diplomacy,” hunting for a way to hand off people with complex behavioral health issues instead of focusing on the issues that brought them to the crisis point.

“We can’t move a person from point A to point B, intervene them here with acute care, the jail, street outreach, etcetera without answering the larger question, which is: We’re 30-40,000 units short of low-income housing for people with serious behavioral health and substance use issues.”

“No matter how efficient this new system looks, I don’t think it really addresses the issue,” he continued.

The new system may never get off the ground. Day said he expects there will be a fine-tuned proposal this summer at which point stakeholders will decide whether to move forward.

“All these decision-makers that will be involved in the process can look at it and say do we want to do it or do we not want to do it? Do we want to put our skin in the game?” said Day. “And I guarantee you that right now everybody is saying, “Yes, yes, yes, we need alternatives. I’m curious what they’re going to be saying in June when they see what it’s actually going to cost and require of them.”