Steps urged to improve mental health services

From the Oregonian, March 23, 2000. Not available elsewhere online.

A group finds that the system needs more money and better accountability and coordination.

A Multnomah County task force on mental health issues said Wednesday that the current system needs more money, improved accountability and more coordination between physical and mental health care treatments to help end the deterioration of services.

The task force adopted recommendations in those areas as it wrapped up six months of study of the county’s mental health service system. The recommendations go to the Multnomah County Board of Commissioners next week. The county commission will hold a public hearing April 24.

The county-appointed task force debated a statement in a draft version of its report that took the position that poor leadership has contributed to the decline in mental health services. The tense debate over that proposed language ended with a decision to tone down the document.

The draft included a strong criticism of unnamed county government officials and called for new leadership within the county’s mental health system.

“Unaccountably, the system has fallen victim to inept and inattentive leadership,” the task force said in a report adopted Wednesday. “A sense of powerlessness pervades the agency together with a culture of defensiveness and blame.”

Committee Chairwoman Elsa Porter said before the meeting that the report was referring to Lolenzo Poe and Floyd Martinez, who work in the county’s Community and Family Services Department. Poe has been in charge of the department for more than six years, while Martinez serves as manager of the department’s behavioral health division.

“The basic driver of getting things accomplished in the mental health field is going to come from people who can collaborate, cooperate and who are open to sharing information,” Porter said. “Unfortunately, we don’t have that now. People need to stop being defensive and listen.

“They are still working off the old bureaucratic management system,” Porter said. “Their employees are intimidated into not giving input or ideas. (Poe and Martinez ) don’t listen.”

Poe scoffed at the task force’s contentions, saying he has a sterling record of achievement.

“I’ve had six years of excellent evaluations based on my leadership and I’m willing to submit to a survey” of CFS employees to prove it, he said.

“Let’s not hide behind accusations and innuendo,” he said. “I want to know where the proof is. I think it’s all personal.”

Martinez said before the Wednesday meeting that the statement was a total surprise.

“I think there is no substantiation,” he said. “If the task force wants to talk about leadership, I’ll be more than happy to do so. I have 32 years of leadership in this field, all in places bigger than this.”

But while some task force members wanted to tone down the language, Constance Powell said she felt strongly that the issue should be addressed. She said a style of management creates fear and intimidation for some employees, who she said were afraid to speak to the task force. “They slip us notes,” she said.

The 12-member task force, formed last August, set out to offer suggestions on how to improve a system that has deteriorated since late 1997. That’s when the state began a shift from fee-for-service to managed care and expanded eligibility for mental health services. It found its path strewn with obstacles because of inadequate data about program costs and services.

Many task force recommendations are merely foundations for improvements to a system that serves an estimated 10,000 or more county residents.

The recommendations include:

  • Establishing a single mental health department “where accountability and responsibility can clearly be placed.”
  • Eliminating both the county’s managed care organization, named CAAPCare, and the for-profit managed care organization Regence and Family Care, named Ceres. The organizations should be replaced with a single management agency.
  • Improving care through better coordination, linking alcohol and drug treatments with mental health services.
  • Organizing meetings with state officials, legislators and insurance plans and creating a forum for discussing issues specific to minority patients in mental health services.
  • Establishing a strong central data authority to coordinate an effective data collection system.
  • Creating a job of assistant to the chairman of the county’s Board of Commissioners responsible for children’s services.
  • Supporting additional funding as soon as possible and using new state dollars to improve housing and crisis care services. The task force hopes the state will provide $2 million in the next two years.