A Review of Multnomah County’s Mental Health System Finds Widespread Dissatisfaction

The system is confusingly complex, lacks adequate peer supports and doesn’t meet patients’ needs.

Willamette Week, June 28, 2018

Last year, Multnomah County spent $93.4 million a year on mental health services, serving 38,000 county residents.

That’s a big portion of what the county health department does, but it’s difficult even for top county officials to determine how effective the services provided are.

Last year, Commissioner Sharon Meieran, an emergency room physician, brought in a consultant, the Human Services Research Institute, for an evaluation.

HSRI interviewed 139 stakeholders in the system over six months and produced a 132-page draft report.

The findings describe a system in which those being served are trapped in a complex maze of overlapping regulation and administration, served by overworked, underpaid staff who don’t reflect the diversity of their clients or provide sufficient community-based peer support.

“Our stakeholder engagement process reflected widespread views that Multnomah County lacks a vision–shared a cross all major system stakeholders–that can be translated into action,” the consultants found.

Kevin Fitts, the executive director of the Oregon Mental Health Consumers Association said he was glad the county commissioned the report and that included a recommendation for the creation of a director-level position for a person who’d experienced a mental health condition but he hopes to see people held accountable for the system’s shortcomings.

“When do they announce who is getting fired for their responsibility in managing, overseeing, and funding contracts for a system that creates such a lousy product for most people who seek services from the mental health system?” Fitts asked in a statement.

The county is now soliciting feedback on the draft report and will finalize it late next month.

READ – Multnomah County Mental Health System Analysis June 2018

County’s mental health system a confusing labyrinth, report says

July 03, 2018 – Portland Tribune

Consultant urges hiring a leader with ‘lived experience’ to help those needing assistance better access services.

Thanks to the unfulfilled promise of state health reforms, the local mental health system is not much of a system, according to a new report. Rather, it is a confusing and fragmented labyrinth whose different parts don’t work well together, making it difficult to navigate for the people who need it most.

The $60,000 study, done for Multnomah County by Boston-based consultant Human Services Research Institute, concluded that the county needs a mental health leader with “lived experience” of mental illness, while officials and advocates need to share information and forge a common vision for the system to help address the gulf between them.

“There’s a real disconnect between how the system perceives itself as working and how people actually using the system perceive it,” said Multnomah County Commissioner Sharon Meieran, the emergency room doctor who sought the study after running on a campaign of social service reform.

The consultant who spearheaded the report, researcher Bevin Croft, interviewed 139 people to get the lay of the land in local behavioral health services that serve 38,000 people a year locally.

Given the national prominence of Portland-based mental health advocates, and the area’s progressive leanings, Croft was surprised to find that the system here is not any better at satisfying advocates’ and users’ expectations, she said.

“I wouldn’t say that this system is worse off than others,” she told the Portland Tribune. “Funding for mental health services is inadequate and has been for years, everywhere in the country … I was surprised, though, by the extent to which stakeholders were concerned about the system.”

The findings are not exactly new. The county’s mental health system has been the subject of scathing reports for years and years.

What’s interesting is the problems described by the report were supposed to be repaired, or at least improved, by now — thanks to reforms to the Oregon Health Plan six years ago that were meant to coordinate care better. When it comes to people with behavioral or mental health issues, however, the improvements and integration of the two types of care largely have not happened in Multnomah County — and they remain separate and apart, the consultant found.

“The system as it’s set up right now is incredibly complex. It has layer upon layer of administrative complexity and, unfortunately, efforts to integrate behavioral health and physical health and really wrap around the needs of the (patient) haven’t been realized in the region,” Croft said.

As a result of having to navigate the system, people who are homeless or have high needs are disproportionately denied care or “fall through the cracks,” Croft said.

Aggravating the problem, local experts in the system told Croft, is that many homeless people move to Portland thinking they’d have more access to services, only to face unexpected barriers.

Like a lot of West Coast cities along Interstate 5, she said, “There are a lot of people in Portland that have very complex needs.”

Complexity limits study

The county system was so complex that Croft was unable to complete one of her contract’s three main tasks, to follow how money flows through the system.

That, in itself, says something, Meieran said: “It shouldn’t be that hard.”

The system is so complex in part because responsibility is shared between the county and Health Share of Oregon, a consortium of local hospitals and health systems that is contracted by the state to serve low-income members of the Oregon Health Plan. The county is a partner in Health Share.

But that has been an uneasy relationship. In 2014, due to concerns about the mental health system, the county paid a consultant $83,000 to explore pulling out of Health Share, citing concerns that hospital executives running the consortium were using their clout to get the county to pay inappropriate claims from hospitals.

The study found that in about $125 million in spending by the county Mental Health and Addiction Services division, about $14 million went to administration, $17.5 million to addiction services, and the rest to behavioral health.

‘Launch pad’

At the county board hearing Thursday, Meieran called the report “a launch pad for the real work” of making improvements.

The report made many recommendations, including that a person with “lived experience” in behavioral health should be installed at a director-level positon at the county.

The county board did not act upon the recommndations, leaving that for a later time.