Mental health HMO proposed in Multnomah County study

From The Oregonian, May 16, 2001

This week, Multnomah County officials are getting their first look at a controversial plan to revamp the county’s beleaguered mental health care system.

The draft proposal is aimed at preventing what its authors call a “train wreck” in acute mental health care. It recommends, in effect, a county-run managed care plan to curb costs and help keep patients from needing hospital care.

The current system is “extremely fragmented and fraught with wasteful redundancies,” according to the draft, and fosters scapegoating more than good care.

“All too often,” the draft concludes, “it is the consumer caught in this dysfunctional crossfire.”

But in a meeting Tuesday to discuss the mental health plan and its budget, Multnomah County commissioners hammered both. The commissioners complained repeatedly that the new plan looked nothing like what they had requested.

The proposal caps a process that began two years ago, when former county board chairwoman Beverly Stein appointed a task force to look into mental health reform.

The draft will be presented to the Mental Health Coordinating Council at a public meeting 4:30 p.m. today in the Multnomah Building, 501 S.E. Hawthorne Blvd. The council — including the Multnomah County Board of Commissioners, care providers and mental health patients and family members — is overseeing reform of the county’s mental health system.

“Basically, we want to keep people out of the hospital,” said James Gaynor, director of redesign for the council and author of the draft.

Previous efforts to encourage hospitals to discharge patients more promptly failed, he said, because hospitals had no “step-down” place to send them. Nor were adequate community services available to keep patients out of the hospital in the first place.

“There’s this huge gap,” Gaynor said. “It’s a glaring hole in the system.”

To fill that gap, he said the county needs more mobile crisis teams and safe drop-in centers that can help patients who are having a crisis but do not need to stay in a hospital.

“We can’t keep looking to the police as the mental health ambulance system,” Gaynor said.

“There are people scared to death to have a crisis,” he said. “It usually means the cops picking you up and transporting you to the Crisis Triage Center (at Providence Portland Hospital) in handcuffs.”

Mental health HMO

Under Gaynor’s proposal, a newly formed entity called Verity Integrity Behavioral Healthcare Systems would become the county’s main mental health agency. Verity would be “a prepaid health plan for all intents and purposes,” much like Kaiser Permanente, he said.

Gaynor’s draft drew support from Jason Renaud, executive director of the National Alliance for the Mentally Ill of Multnomah County, an advocacy group.

“We don’t need to add any new money to this,” Renaud said. “We just need to stop flushing money down the toilet.”

He acknowledged that the draft was written in broad-brush generalities, leaving the specifics for later. “How you get from these homilies to real change is a fascinating problem,” he said.

Gaynor calls his draft a “lightning rod for discussion. If somebody has a better idea, I’d love to hear it.”

Commissioners’ concerns

He got his wish, sort of, on Tuesday. Interim Commissioner Pauline Anderson said the plan must look at other counties that are able to run programs within the appropriations from the state.

The redesign team was told to rework the plan to address the commissioners’ concerns and return for another discussion in early June.

It’s not that patients are being hospitalized when they don’t need care, said Dr. Jerald Block, a psychiatrist. It’s that community resources are not available to keep patients stable so they don’t go into crisis and require hospitalization.

“The key is in the details,” Block said. “If those facilities aren’t funded adequately, nothing is going to change.”