Mental health services reach out to neighbors

From the Hillsboro Argus, April 23, 2010

The counties that make up the Portland metropolitan area say they need to establish a more collaborative approach in providing mental health services, but not at the cost of long established local connections with their communities.

This was the conclusion of a Three-County Leadership Group from Washington, Multnomah and Clackamas counties who met in January with Facilitator Barbara Mauer of MCCP Consultants to discuss the first steps toward regionalization of mental health services.

Washington County Health Services Director Rod Branyan says a simplified cross-county mental health care delivery system avoids costly duplication of services and ensures availability of essentials.

The regional entity would be responsible for both Medicaid and non-Medicaid services.

With proper management, a regionalized system could provide far-reaching benefits, especially through economies of scale.

This could range from such collaborative efforts as joint purchasing, mutual aid, lead agency designation, fiscal agent designation and joint ventures.

Branyan said users of mental health services also want the freedom to be able to move from one city to another within the metropolitan area without having to fill out a kaleidoscopic variety of forms from several different providers.

But an outright merger must be careful to avoid concentrating available resources disproportionately in urban areas, said Washington County Mental Health Director Kim Burgess. While Multnomah County has 1,613 persons per square mile, Washington County has only 722, and Clackamas only 201.

“We have really different demographics in each of the three counties,” she said. The populations also differ in their Oregon Health Program enrollment, poverty, homelessness and distribution of ethnicities and language.

Per county, mental health services required by the state cost between $21 million and $52 million. In Washington and Multnomah counties, almost all are subcontracted to nonprofits, while in Clackamas County they are performed by county workers, Burgess said.

A merger could also increase overall administrative costs and defeat the whole purpose, she said.

Washington County Commissioner Andy Duyck said it’s clear the entire region is reaching critical mass when it comes to taking care of the mentally ill.

Burgess said it’s most important to establish a uniform authority form for returning services. A simple set of rules would give the counties the ability to work on collaborations already in motion, while preserving community services not typically served by large regional entities, she said.