In 1999, in the wake of the shuttering of Garlington Center, several public deaths of people with mental illness, and a distressing countywide site review by the state mental health division, a wide-open, concerted, public conversation about Portland’s mental health system was launched by County Chair Beverly Stein.
The conversation became more complex as the County Mental Health Division was unable to provide basic data for an initial survey by a blue ribbon task force, chaired by Elsa Porter, a systems engineer. The media became alert.
Read – Mental Health Care Needs Overhaul, Panel Says, from The Oregonian, March 2000
Read – County Department Offers Mental Health Ideas, from The Oregonian, April 2000
Consumer and family members, invited into the discussion for the first time, insisted the system be overhauled, that the system be redesigned to suit the needs of people with mental illness instead of County bureaucrats and vendor agencies. Ed Blackburn from Central City Concern wrangled ten or more committees over the summer of 2000, with over 100 participants, to spell out how services should work.
Once services were redesigned, a third committee was formed, led initially by County Chair Diane Linn, to implement the changes to the mental health system. Large government contracts were at stake and both the direction and the leadership of this committee veered through the Spring and Summer of 2001. The final controversial solution, offered by proxy from the State mental health division and by the County was Cascadia.
Read – Mental Health HMO Proposed for Multnomah County, from The Oregonian, May 2001
Read – Radical Shrink, from Willamette Week, May 2001
Largely designed by Kim Burgess, now with Washington County, Peter Davidson, now with the State Mental Health Division, Cascadia offered a managed care proposal where risk for hospitalization would be shared with a single large provider. This potent incentive for change caused the immediate creation of psychiatric outreach teams, and a drop in hospitalization. The saved costs were to be invested in infrastructure and services.
Read – Turnaround Against Odds Earns Support, high praise from Bob Landauer, May 2003
Read – Give County Credit That Is Overdue, again from Bob Landauer, December 2003
In 2004 or 2005 Multnomah County, under Derald Walker, now Cascadia CEO, shifted the financial model of Cascadia from managed care to fee-for-service leaving Cascadia with no incentive to manage hospitalization risk, and the most service-needy clients. Acute care suffered and hospitalization began to increase. Public oversight was limited at this point – the community trusted a fix had been made.
Because no outcome data is made public by the County or Cascadia – anecdotal information is all we know. This inferior data about the quality and quantity of mental health services is scattered, but uniformly critical. From every perspective, system witnesses remark access is limited, treatment services are poor, ancillary services such as housing and employment assistance are limited, staff turnover is high and moral is low. Homeless shelters, jails, hospitals, and public health clinics are overflowing with people seeking services which should be readily available from County-funded mental health clinics.
Below is a mish mash and incomplete collection of useful documents from 1999 to 2003 from the redesign process. Bookmark this page – the documents will remain here as an archive.
Read – Network Behavioral Healthcare’s 1999 contract with Multnomah County. Note the added language requiring and defining consumer and family participation.
Read – Treatment of the Mentally Ill in the Criminal Justice System – written in August 2000 by Bill Toomey, probably for the Design Team Criminal Justice group. A nice snapshot of that moment.
Read – Options for Persons with Mental Illness in Multnomah County’s Criminal Justice System – probably from Summer of 2000.
Read – DCJ mental health resources, Summer 2000
Read – Overview of DCJ Case Management for Mentally Ill Offenders, October 2000
Read – the charge for the Design Team, Spring 2000
Read – the charge for the Persons With Mental Illness in the Criminal Justice System Work Group, Spring of 2000
Read – the charge for the Client Transportation Workgroup, Spring of 2000
Read – the charge for the Community-Based Intervention Services Workgroup, Spring of 2000
Read – the charge for the Transportation Group, Spring 2000
Read – the charge for the Inpatient Services Workgroup, Spring 2000
Read – the charge for the Data Collection Workgroup, Spring 2000
Read – the charge for the Crisis Workgroup, Spring 2000
Read – the charge for the Best Community Mental Health Services Model Workgroup, Spring 2000
Read – the minutes for the Best Community Mental Health Services Model Workgroup, July 13, 2000
Read – the minutes for the Best Community Mental Health Services Model Workgroup, August 10, 2000
Read – the minutes for the Best Community Mental Health Services Model Workgroup, September 14, 2000
Read – the charge for the Best Community Mental Health Services Model Workgroup, October, 2000
Read – Interdepartmental Communications Workgroup Minutes, October 24, 2000
Read – Mental Health Design Team Coordinating Team Agenda, September 11, 2000
Read – Mental Health Design Team Coordinating Team Agenda, September 26, 2000
Read – Mental Health Design Team Coordinating Team Agenda, October 2000
Read – Mental Health Design Team Coordinating Team Agenda, November 2000
Read – Memo from Design Team Child and Adolescent Work Group, Summary of Priorities for Work Group Recommendations, September 2000
Read – Summary of Recommendations from Design Team Child and Adolescent Work Group, October 2000
Read – Recommendations from Design Team Child and Adolescent Work Group, September 2000
Read – governance structure for community mental health system, 2000?
Read – Multnomah County Behavioral Heath Division policy manual, 2001
Read – Memo on Administrative Changes and Support, November 2000
Read – Report of the Alcohol and Drug Systems Workgroup, August 2000
Read – Proposal for the Atypical Anti-psychotic Medication Project, Spring 2000
Read – system description of the Case Management for Offenders with Mental Illness, Spring 2000
Read – Evaluating the Health Of Multnomah County’s Mental Health System, by Elinor Hall, MPH, May 2000
Read – Introduction: Recovery-Oriented Mental Services, by Ed Blackburn, Summer of 2000
Read – letter from Pat Cosgrove to Lolenzo Poe, one of the many reasons the CTC was closed, Summer 2000
Read – What Do I Want? (consumer / survivor focused mental health services), by Scott Snedecor, Summer of 2000