Numbers confirm crisis in mental health

From the Oregonian, July 20, 2001

The Multnomah County Board of Commissioners got its first detailed look Thursday at the numbers behind the county’s mental health system crisis — and the proposed redesign for dealing with it.

The board is scheduled to vote Aug. 9 on the so-called Gap Plan to deal with the imminent closure of the Crisis Triage Center at Providence Portland Medical Center.

The slew of numbers released by consultant Dale Jarvis add up to a business plan for the first phase of the mental health redesign that has been under discussion for more than two years.

The numbers portray a system in crisis, even without the closure of the triage center. They show an acute care system that relies too much on costly hospitalization and too little on more nimble ways of helping people in crisis. They show a fragmented yet redundant system of provider groups with little accountability or incentive to curb costs.

And it’s going broke.

“This system is in deep trouble,” said Jarvis, an accountant with the Seattle firm of MCPP Healthcare Consulting Inc. He was hired six weeks ago to crunch the numbers for the mental health system redesign.

Commissioners Serena Cruz and Maria Rojo de Steffey said they had many questions about the proposed plan, even while acknowledging the need for moving swiftly to avert a crisis. They said it would be premature to give a formal go-ahead to the plan’s specifics without further discussion.

But Diane Linn, chair of the Board of County Commissioners, said proceeding with the Gap Plan would not preclude tinkering with the redesign’s longer-range objectives and budgets over the next few weeks.

The immediate crisis is a gap between the closure of the Crisis Triage Center at the end of July and the planned mid-September opening of a 10-bed unit for evaluating adults and older teen-agers at Woodland Park Hospital in Northeast Portland.

The Crisis Triage Center, a clearinghouse for people having a mental health crisis, saw nearly 9,000 patients last year. The center evaluates patients and sends them to secure mental health units, if necessary, or stabilizes them before discharging them to other care.

The center’s contract with Multnomah County expired June 30, and negotiations to renew it broke down. Providence agreed to keep the center open an additional month to give county officials more time to shore up alternative sources of care.

“With the closing of the Crisis Triage Center, these gaps are going from problematic to critical,” the Jarvis proposal concluded.

Hospitals, county officials and mental health care providers are worried that emergency rooms will be flooded with patients in crisis.

Rising costs are the other concern. With hospitals shifting to individually negotiated contracts this year, the average cost of a hospital bed for an Oregon Health Plan patient is expected to jump from $423 a day to about $700.

Total hospital costs for mental health care are expected to rise from $9.9 million last year to $14.2 million this year — and possibly higher, Jarvis said.

Hospital care accounts for 20 percent of the mental health costs in Multnomah County, more than in any other part of the Northwest, Jarvis said. In Seattle, the figure is 13 percent.

Jarvis’ plan for the current fiscal year estimated acute care costs of $21.8 million. With an estimated $14.7 million in available money, that leaves a projected shortfall of $7.1 million.

Jarvis and the mental health redesign team recommended several ways of making up that deficit, including use of emergency reserve funds and a 5 percent cut in administrative budgets for the county Behavioral Health Division.

Even critics of the county’s mental health system seemed pleased to have real numbers to debate.

“We’ve been waiting for these numbers for two years,” said Jason Renaud, executive director of the National Alliance for the Mentally Ill of Multnomah County. “Now we’ve got them. That alone is spectacular.”

Whether the plan behind the numbers would work, only time will tell, he said.

“For better or worse, this is a plan,” said Dr. Constance Powell, a psychiatrist who will become president of the Oregon Medical Association next year. “Before this, it was all vapors — deep and meaningless statements about treating people well.”