Mental health facility doesn’t satisfy police

From the Portland Tribune, October 22, 2009, & see OUR COMMENT below.

Frustration builds as county crisis center proposal falls short

The closet-sized room near the emergency department entrance at Oregon Health & Science University isn’t much — a few chairs, a footstool and a counter. It’s not a place police officers want to spend time, but frequently it is a place where they spend half their day, or more, finishing paperwork or just hanging around.

That’s because nearly every day Portland police officers pick up people from the streets who are suffering psychotic episodes and might be dangerous to themselves or to others. The officer has the option of taking that person to jail, which police say usually doesn’t make sense. The other option is a trip to a hospital emergency room, where staff can assess the newly arrived patient and eventually find placement, most likely in a hospital psychiatric room.

That’s where the little waiting room comes in. Police officers are required to stay with people they have brought in until a physician tells them they can leave. But with inpatient psychiatric rooms often filled, and hospital psychiatrists often unavailable, assessment and placement can take hours. So the police officers wait.

Police had hoped that a solution to this longstanding issue was at hand, now that Multnomah County is proceeding with a new crisis assessment and treatment center for mental health patients. But ironically, as plans for this project become clearer, it appears that police officers still will be left frustrated — and still waiting.

In July, county commissioners voted to build the new crisis center, also known as a sub-acute facility, to fill what police, mental health providers and hospitals have long seen as a serious gap in mental health services. The new center would share space in a building that houses nonprofit Central City Concern’s David P. Hooper Detoxification Center, east of the Burnside Bridge. Remodeling for the new center is expected to begin next spring.

In most American cities, police can take people displaying psychosis to a psychiatric emergency room — similar to a regular hospital emergency room but set up to quickly triage psychiatric patients and get them off the hands of the police. Portland hasn’t had such a facility since the county’s Northeast Portland crisis triage center closed in 2001, but some sort of triage center is what Portland Assistant Police Chief Brian Martinek would like from the new sub-acute facility.

He’s not going to get it, however, largely because a number of conflicting interests have prevailed.

Administrators at local hospitals would like the center to relieve them of the hundreds of psychiatric patients — many uninsured — who clog their emergency departments even though they don’t need traditional emergency services.

Mental health advocates want a place where people in need of immediate psychiatric care and assessment are not mixed in with others who may be experiencing severe psychosis and needing physical restraint.

So the county’s plan calls for a 16-bed facility that would use the sanctuary model of care favored by many hospital psychiatric facilities, and that emphasizes minimal use of restraint and seclusion on patients who appear to be out of control.

Not enough money

Joanne Fuller, director of the Multnomah County Department of Human Services, which runs the public mental health system that will include the new center, says the renovation project is expected to cost between $3 million and $4 million. The county has spent $1 million to move the detox center, freeing up space at the Hooper building, which freed up $2 million of Portland Development Commission funds for the remodeling. Fuller says the county is still working on finding the last $1 million to $2 million.

The county estimates that operating the new center could cost around $3 million per year, about half of which could come from Oregon Health Plan coverage of patients. Fuller says the county doesn’t yet know where the rest of the money is going to come from — though some money currently spent on hospitalization of mental health patients might be reallocated to the center.

The shortage of available cash will require the new center to perform a limited role, with most patients there no more than 10 days. The hope is that short stays will help patients stabilize to the point that they can access community outpatient mental health services.

What nobody wants, according to Ed Blackburn, Central City Concern’s executive director, is a repeat of the last version of a crisis triage center. Blackburn says that plans for that facility were too grand, including 10 units of housing, case managers to help residents, a sub-acute facility with four holding rooms for triage, and a pharmacy.

In the end, Blackburn says, there wasn’t enough funding to support the old facility.

“What you had was a lot of people coming in to get their prescriptions refilled and it was a drop off place for police. Once the services started being taken away it collapsed,” Blackburn says.

No place for restraint

The less ambitious sub-acute center, which the county hopes to open by late 2011 or early 2012, has a chance of succeeding, according to Blackburn.

“This is going to be much more focused on people who are actually in crisis,” he says. “We’re not going to try to do too much.”

That is why the police won’t have their dropoff station.

Fuller says the new center will not be the place for people who need restraint, but it might be appropriate for some patients in psychosis who don’t appear violent.

Under current plans, if police officers think they have someone appropriate for the new center, they first would need to have the county’s mental health call center or Cascadia Behavioral Healthcare’s mobile Project Respond unit authorize placement at the new center.

But assistant chief Martinek says Project Respond too often is not available to police, who need an immediate response. And calls to the crisis line will put police officers in the position of having to assess the status of the person they’ve just picked up — a role Martinek says police would rather not have.

But that extra assessment step, Fuller says, will help keep the new center from becoming overloaded with patients who need detox from drugs or drinking more than they need mental health services — a problem at the previous crisis triage center.

The police often pick up people who need emergency medical treatment before they need mental health triage. County officials want to keep those pickups from overcrowding the center as well.

“If you become a triage center, you become an emergency center and you fill up too soon,” says David Hidalgo, senior operations manger for Multnomah County’s mental health division.

All of which leaves the police still looking for a way to disengage from assessing and spending time with psychotic citizens.

“This doesn’t solve the police problem,” Martinek says. “The mental health field and the law enforcement field are in way different places philosophically.”

OUR COMMENT – The Portland Police Bureau are not the users of this facility, or the deciders about what services are provided by this facility. The PPB, and the City of Portland, are not financial contributors to the project. The County has a long-standing agreement that it’s mental health services are PATIENT CENTERED. That means the needs and interests of the PATIENT are the foremost consideration in the planning and delivery of services.

The police are impatient for a solution to what they now are recognizing as a long-term shortcoming in their orientation to the issue of mental illness. For thousands of years they’ve been the cruel cudgel, the push out the door, the clang of a cell door. Now, with limited insight into their role as punishers of persons with mental illness, they’re seeking quick solutions.

Secondly, this facility is far from defined. The county plans many public meetings to develop a complete service plan. The police are going to be part of that planning – but it won’t be a drag-and-drop.