HSRI survey of Multnomah County’s mental health system

The Human Services Resource Institute of Cambridge Massachusetts has been hired by Multnomah County to make a survey, or system analysis, of the county’s mental health system.

READ – HSRI’s proposal to Multnomah County
READ – Multnomah County Contract with HSRI
READ – HSRI interview consent form

The modest contract is underway as of January 2018. It’s spearheaded by County Commissioner Sharon Meieran, who campaigned for office intending to make repairs for the diminished and underfunded agency.

The County’s mental health and addiction health services were “redesigned” in 2000 by consolidating and merging dozens of agencies and contracts to create a more manageable service system to provide crisis services, and equal services to children and adults. The Commission then intentionally underfunded those agencies and contracts, causing our current homeless crisis in Portland, which they currently ascribe to a lack of affordable housing.

Further – the County’s direct services were to be entirely replaced by the Coordinating Care Organizations, Heath Share Oregon and FamilyCare, in coordination with CareOregon. These three administrations, replacing one, intended to integrate mental and addiction health with primary and dental care. That has not been successful. Presenting a business model from the 1990s, FamilyCare went out of business in 2018. Health Share largely offers their insured customers the same community mental health services forged in 2000, but without useful regulatory oversight. And the county continues to provide a variety of services, creating a fourth third administration, including protective and investigative services, testing, and outreach to youth.

There is much to be done. Briefly here are the seven top problems from our perspective.  We’ll see if the County’s survey matches ours, or finds different problems to try and solve.

  1. The quality and effectiveness of both addiction and mental health treatment services in the county is unknown, but anecdotally services for people with mental illness and addiction are uniformly poor, over-stretched and disorganized. Services are left in disrepair by State, County, and now the CCO administrators. Over decades, this reputation for disrepair and disorganization created a pervasive message to people in need of recovery that public services – whether managed by CCO or the County – are unable to help or worse, dangerous. Result of this estrangement is pervasive and destructive across agencies and governments, and considering the decades spent not repairing it, entirely intentional.
  2. There is no data or navigational map for services.  This information gulf gives customers – patients – little or no choice about providers. Even social workers, agency administrators, doctors and nurses, lack any coherent understanding of “the system.”
  3. Recovery from mental illness requires the patient integrate several unwieldy bureaucracies, including primary care, psychiatric care, housing, continuing support from family and friends, employment, exercise and nutrition, and too often the criminal justice system.  This burden alone makes their lives unmanageable.
  4. Long queues for service and fast churn of agency staff makes it difficult to maintain a clinical relationship. This is an intentional barrier to treatment and tens of thousands of eligible persons are estranged from services because of it.
  5. The State has made dangerous drugs – alcohol, marijuana, nicotine, and over-prescribed medication, legal and abundant. These “revenue streams” will kill thousands of Oregonians and have tens of thousands of proponents, including public schools, unions, active addicts and alcoholics, taxpayers, and the media.
  6. The State and County remain intentionally ignorant about supportive housing and instead have pursued other sorts of public housing, including endorsing outdoor camping and unsustainable “tiny houses,” essentially committing another generation of 5000+ people to be homeless in Portland. This thinking is changing – but at a glacial pace – and has many opponents.
  7. The criminalization of mental illness and addiction remains constant despite meager interventions. Our jails and prisons are filled with people who were impaired and needed medical help at the time they committed their crime. We should consider victims when we acknowledge supporting recovery is crime prevention.

We’ll add to this post as the survey in completed and released.