From the Lund Report, September 15, 2011 – by Amanda Waldroupe

The state’s new funding formula for allocating money to counties for mental health services takes funding away from some counties, gives money to others

Multnomah County’s board of commissioners voted this morning to use $8 million dollars of its one-time only and general fund reserves to make up a total of $12.4 million in state cuts affecting the county’s safety net services.

The county is using a mix of one-time only funding, remaining general funds, and the county’s Verity funds to pay for the programs, which include everything from domestic violence services, anti-poverty services, and behavioral health care.

Obviously, not all programs and services are being saved from the chopping block: the county is choosing to accept state cuts effecting mental health services for adults and children; gang intervention; juvenile detention services, and community prevention services relating to the county’s sexual transmitted disease (STD), HIV, and Hepatitis C program.

Much furor came from $5.56 million in cuts to the county’s mental health crisis services, which serve uninsured and low-income people with severe mental illnesses. Those cuts would have eviscerated the county’s safety net services, said County Commissioner Deborah Kafoury.

Approximately $4.7 million of the cuts were added back by the state, and preserve funding for adult residential services, addiction services, and commitment services for adults sent to the Oregon State Hospital when they have a severe mental breakdown.

It is not clear why the money was added back, but could be the result of a September 13 meeting between Joanne Fuller, the county’s chief financial officer, and Richard Harris, administrator for the state’s Addictions and Mental Health office. Neither returned a call for comment.

But at a September 13 Oregon Health Policy Board meeting, Harris told the board that the state’s mental health services serve less than forty percent of the demonstrated need. “As the population has grown, we have not kept up with services,” Harris said.

The cuts are the result of a new state funding formula that calculates how many state dollars each county gets for crisis mental health services. Karynn Fish, spokeswoman with the Oregon Health Authority, says the funding formula is based on a county’s population, as well as the prevalence of individuals with severe mental illness living in each county.

The funding formula applies to all counties with populations over 50,000 people, and the formula’s purpose is to equitably distribute state dollars.

Fish said the state cuts will not be finalized for another six weeks. But projections, which were shared with legislators in January, show that not all counties lost state funding. Some are actually getting additional funding, such as Deschutes, Lane, and Washington counties.

The Authority, Fish said, was “working with counties to make them aware of the fact” that the funding formula would change.

“There’s winners and losers,” said Rep. Tina Kotek (D-Portland), who has followed the state cuts. “The funding formula has helped faster growing communities.”

Cindy Becker, the administrator of Clackamas county’s human services department, said the county is losing approximately $285,000 from the state, but she is not alarmed by it. “It’s always a big issue for us,” she said. “You cut the funding, but the services don’t go away.”

Jessica van Diepen, the interim executive director of the Association of Oregon Community Mental Health Programs, said the recently announced cuts did not put the association in a “panic.”

“We were part of that conversation, originally” to change the funding formula, she said. And she points out that “we live in a world, in the last 10 or 15 years, where we see cuts on a regular basis…it’s a no win situation when money is short.”

During a county budget work session last week, Fuller said that the state cuts may become the “new normal” for funding mental health services.

Kotek hesitated to agree, but did say that Multnomah County needs to work with surrounding metro counties to find an appropriate balance of services.

“The funding formula is here to stay based on population,” she said. “[Multnomah County] argues that they serve more people. If they are serving people from other counties, they need to show that. It’s not okay for the counties to have their own silos.”

The Lund Report requested that Multnomah County provide data showing the prevalence of mental illness in Multnomah County. Dave Austin, the county’s spokesperson, did not provide that data.

Becker points out that some counties do not have enough people needing particular services, such as acute care or detox services for people with alcohol and substance abuse addictions, to warrant operating particular services in the county.

“We don’t have the critical mass to be able to sustain them on a county by county basis,” she said, making it necessary for some counties to contract with others that do have those services, such as Multnomah County. “We can’t afford to have those services.”

Kotek said she has requested that an informational hearing be held during the Legislature’s interim meeting in November to learn more about the funding formula’s effect on counties. Van Diepen did not say that the funding formula necessarily needs to change.

She said, “it’s a healthy tension we need to continue to have conversations with each other about.”