Proposed state mental health program concentrates on prevention

From the Oregonian, Sunday, March 4, 1973 – not available online

‘We’ve got to go where the people are…’

Charlie O. has a problem. In fact, Charlie has quite a few problems.

He’s heard rumors that the construction company he works for is going to lay off a dozen men. He thinks he may be one of them because he’s missed a lot of work lately and he’s been late getting to the job site several times.

His wife’s new job is keeping her away from home more and more and Charlie doesn’t like it.

His 14 year-old son has been getting into trouble at school, and his 16 year-old daughter is getting difficult to handle.

Charlie’s been hitting the bottle a lot lately. And, at 36, Charlie is beginning to consider himself a failure — as a man, as a husband, and as a father.

Where can Charlie turn for help?

He says he’s not an alcoholic, so he won’t call Alcoholics Anonymous. He’s sure he’s not crazy, so he won’t call the state mental hospital.

Charlie wants to talk to someone, but he can’t afford the price of a private psychiatrist.

Right now, Charlie is trapped in a void. Help may not come his way until he kills someone in a drunk driving accident. Or until he’s lost his job and is forced to seek public welfare.

Or help may never come for Charlie. He may drink himself to death, or kill himself — accidentally or on purpose.

The answer for Charlie, according to Dr. J.D. Bray, administrator of the state’s mental health division, is a sweeping revamping of the state’s mental health programs with a strong emphasis on prevention and rehabilitation.

“We need what we call a whole-istic approach, a human approach,” said Bray.

“We’ve got to take our programs where the action is — in the communities, in the jails, in the bars. We need a team approach, a multi-disciplined mental health program located in the community in an old house or in a shopping center — anywhere people in that area will feel comfortable,” said Bray. “And we don’t even have to call it a mental health clinic. We can call it anything, just as long as we can get people to come in.”

To accomplish that, Bray is proposing a new Comprehensive Community Mental Health Program which is now before the Legislature.

Primarily, the package is focused on catching problems early — before hospitalization is required — and finding community-based alternatives to hospitalization for every type of mental illness, from neurosis to psychosis to mental retardation and developmental disorders.

In brief, the state would agree to fund county mental health centers up to 100 per cent. These programs could contract with other private or public agencies to supply necessary services otherwise not available.

Sorely needed alcohol and drug abuse education and treatment programs, now heavily concentrated in the greater Portland area, would be available in every community. Day care centers, activities centers and job training centers for the mentally retarded or children with developmental disabilities would be located near home to be used as alternatives to hospitalization.

When necessary, patients could enter local general hospitals on a short term basis, rather than being sent miles away from home and family to the nearest state hospital.

A “one-in-all” hot line telephone number would be available for anyone to call with any type of problem — alcohol, drugs, depression, or information on how to deal with a mentally retarded child or a generation gap with a teenager.

The caller would be gently urged to “drop in” to the center, where a counselor could then talk with the person, his or her spouse or the entire family. All aspects of the person’s problems would be dealt with, Bray said, not just the one symptom which had already become obvious.

In all cases, emphasis would be on the prevention of acute problems, rehabilitation of current problems without dislocation from the community, and a “human approach to the problems of people.”

In terms of dollars, the division is asking for $83,795218, an $11.6 million increase over the current biennium. Bray said about $2 million of that is based on cost of living increases and $1 million is earmarked for capital construction. The remaining $8.6 million will be used for growth and change in mental health programs.

To make the package work, the division is urging the passage of eight bills, three of which are crucial to the success of the overall proposal.

The first bill amends the current community mental health clinic statutes by redefining basic services required of the programs, adding the developmentally disabled to those persons served by the division, and providing for state funding of the local programs.

The second bill changes the commitment laws, calling for a probable cause investigation by the division before a person can be brought before a judge. It also directs the judge to commit a person to the division, rather than to a particular state hospital, therefore permitting mental health experts to decide what type of treatment — not necessarily hospitalization — would best help that person.

A third bill would enable drug dependence to be treated as a medical, rather than a criminal problem. Treatment would become an alternative to criminal prosecution in certain cases.

The implications of the package are potentially enormous.

First, the division itself would undergo a massive structural change which has been carefully planned by Bray to avoid hostilities within and maintain balance between mental health special interest groups.

Second, Bray believes a well-run preventive community program will reduce the population at that state’s mental institutions. This will be a savings in terms of tax dollars as well as the “human savings,” as Bray calls it, of solving a person’s problem before they reach insurmountable heights.

Third, although each case differs, making estimated cost comparisons difficult, Bray said he believes person now receiving help would see a savings in their own mental health bills.

Fourth, and by far the most important according to Bray, a person would be treated as a whole entity, not “labeled” with a particular problem or illness. The door to mental health treatment would be easily accessible to the general public. And a team of experts focusing on one individual would replace the need to knock on several doors in order to get a full range of services.

“In future years, you won’t find a gap in service in any community,” said Bray.

“Immediately, you will see a dramatic increase in needed services for alcohol and drug abusers. If an individual has an acute mental disorder or severe retardation that in the past put him in a state facility at some distance from his home, it is highly likely that his need will be met at home, with a team focusing on his strengths and the strengths of his family and community.”

OBITUARY – James Donald Bray, died December 3, 2009