Posted in The Oregonian – May. 13, 2024
Oregon ranks dead last in balancing the prevalence of youth mental illness with access to care, given high rates of youth with mental health conditions and the lack of available treatment, according to advocacy and monitoring nonprofit Mental Health America.
At 21%, the state has the highest percent of youth who said they have experienced at least one depressive episode, according to the nonprofit’s 2023 study based on data from 2020.
That, coupled with the crisis of readily available cheap fentanyl and other hard drugs, has culminated in a dire trend of young people turning to substances to deal with the feelings their mental illnesses bring.
Despite the extremely high levels of need for care, Oregon has struggled to keep youth services open and operating. Programs such as DePaul Treatment Centers’ youth services in Portland, Yes House Adolescent Residential Treatment in Corvallis and Northwest Behavioral Healthcare Services in Gladstone have all shuttered in recent years, among others.
Q: The most recent Mental Health America report, which the Oregonian/OregonLive has reported on extensively, ranks Oregon last compared to other states in balancing the prevalence of youth with mental illness with access to care. Can you comment on the accuracy of the study and how it aligns with Oregon’s reality as you see it?
A: The report talks about major depressive order but that is just one disorder of many. It’s not inaccurate, but it is just a very narrow slice of the population. What that means is that there is still a broader need. What we are seeing in Oregon, and across the world, are increases in anxiety, trauma-related concerns, eating disorders and Autism Spectrum diagnoses. However, it is true that youth in Oregon are not always able to access the care they need or have delays in accessing care. We are still setting up systems to understand waitlists.
Q: We know inpatient options for youth in need of behavioral health treatment can have waitlists of up to eight weeks. How is the state working to address the lack of access?
A: The Oregon Health Authority has invested in renovating and expanding current residential programs as well as creating new programs. The $7 million that was given to OHA during the 2021 legislative session has just started seeing work materialize. One new facility is currently breaking ground in Boardman that will serve children five to 12 years old. This is a huge need in our state with only one current provider, Trillium Family Services, for this age group.
Another program in the Portland metro area, Madrona Recovery, expanded early this year using Oregon Health Authority funds and is now licensed to serve (older) youth with co-occurring substance use and mental health needs. These recent efforts, plus others, have resulted in 32 new beds.
OHA is also investing in intensive programs to hopefully prevent youth from needing residential treatment. These include intensive in-home behavioral health treatment that provides youth and families therapy, peer support, medication management and a 24-hour crisis system. There has been a lot of focus on expanding the adult system, but more investments are needed for youth mobile response and stabilization services.
Q: We know it is hard to track all the youth outpatient options in the state. But many families feel it is nearly impossible for them to access therapists who treat children or teens and even harder to find outpatient options that treat both mental illness and substance use disorder simultaneously. How is the state working to expand such options for youth?
A: It can absolutely feel difficult to find a provider that is a good fit for youth and their family. Over the past few years, multiple new outpatient providers have opened across the state. Oregon’s Coordinated Care Organizations are responsible for ensuring that there are enough providers to meet their members’ needs.
For Oregon families with Medicaid coverage, their local regional website is an excellent place to find information about providers who specialize and work with youth, have expertise in substance use disorders or other key aspects of their care like gender or other specialties. The state has also created a Medicaid benefit for children ages zero to 21 that eliminated some barriers to access last year. It has also worked to pilot new medical centers that offer a combination of physical and behavioral health to create a one-stop shop with a different kind of payment method for providers.
Additionally, the state invested money to train providers on how to treat co-occurring diseases and if providers participate in that training, they get a higher reimbursement rate for the services they provide for either youth or adults. Connecting youth to substance use disorder services is still very complicated. Even with Measure 110 and new legislation to make access better, access for youth hasn’t improved. Often youth are accessing help once their substance use disorder is very far along and has reached a dangerous peak. That means we are not getting to them early enough.
Q: Given that many teens told us they didn’t understand how various substances would impact them differently, ranging from cannabis to fentanyl, how will the state increase education on these topics? Can you talk about what those campaigns will look like and what messages they will be sending?
A: Oregon Health Authority’s public health department has multiple programs for substance use prevention and education, including social media campaigns, school prevention supports, and community activities. One example is the Rethink the Drink campaign, providing information related to alcohol use and abuse. The Oregon Department of Education is responsible for school curriculum related to health impacts of substance use and different types of substances. After legislation passed in 2023, additional school curricula on substance use and abuse and the risks of different substances (will be) required as well. The state is working to support the development of these new lesson plans to be provided to Oregon’s 197 school districts.
Q: When we last talked, you mentioned the Oregon Health Authority was working to create a centralized referral system for youth inpatient services. What does that system look like now and how will it change how families access services? When will this change happen?
A: We continue to make progress towards collecting referral and program capacity data in our new system … A few providers have already started piloting inputting their data.
Q: Has the centralized referral system given the state better information about how much unmet need there is for inpatient treatment and what type of care is least available to meet the need? If not, what information does the state know about how far short of demand the current inpatient offering are?
A: Intensive treatment services capacity, which include psychiatric day treatment programs, residential treatment programs, secure inpatient programs and acute psychiatric inpatient units, remains a critical concern to the child and family behavioral health system.
Each week we receive data on capacity for acute psychiatric inpatient beds, psychiatric residential treatment facility beds and substance use disorder residential beds. The number of psychiatric residential treatment facility beds still falls below the 286-bed goal. As of January 2024, only 135 beds were staffed due to both lack of beds and lack of staff.
Q: What parts of the youth behavioral health system are on your radar to expand most imminently?
A: More psychiatric residential beds … intensive in-home behavioral health services and youth mobile crisis response. Because of lingering impacts from the pandemic coupled with ongoing staffing issues, the new programs have taken longer than hoped to roll out. While money has been distributed and invested, some of the programs are still trying to hire staff and open up. More peer youth services, early childhood intervention and culturally specific providers are also needed. Overall, pay needs to increase for workers too.
Q: Both outpatient and inpatient youth providers told us the financial structure of youth services compared to adult services is a barrier to keeping their businesses viable. Is the state working to address this?
A: Even before the pandemic, there was not enough capacity in the youth mental health system to meet the needs of youth and their families. Many dedicated but underpaid staff left the workforce, forcing programs to scale back treatment. Programs continue to struggle to pay staff livable wages, and the work is often complex and difficult. While the adult system has largely bounced back, the youth system continues to struggle due to staffing shortages. To address workforce needs, Oregon Health Authority has invested in rate increases for providers, specific funds for recruitment and retention, and has created programs to support the behavioral health workforce, including student loan reimbursement, access to clinical supervision, and child care and housing stipends. The state is now working on workforce supports designed specifically for the youth-serving system.
Q: What else would you like readers to know?
A: We have a current roadmap for children’s behavioral health. We don’t have money for everything, though, so we need to prioritize what to invest in. And we want youth, families and providers to help us make those decisions. There is a system of care we are trying to work towards. We have a lot of catching up to do and we have a staffing crisis, but we also have dedicated people working at every level to make it better.