Letter to the editor of The Oregonian, by Greg Monaco, from January 2, 2003 – not available online

I have a personal interest in The Oregonian’s special report about the breakdown in the mental health safety net (“Out of the Shadows,” Dec. 29-31), not just because I am a Multnomah County civil commitment investigator, but because I facilitated the commitment of Elise John, one of the suicide victims profiled. Believe me, our goal as mental health professionals, whether in a clinic or hospital setting, is not to set people up for suicide or to disregard concerns of loved ones.

Having said this, I still believe, as I have since the suicide of John, that oversight of critical incidents has been poor. The Oregonian’s articles make it obvious that sufficient monitoring is lacking on both the state and county levels –monitoring that should include not only formal review of suicides, but also sanctions and binding recommendations for quality improvements on a systemic level that would prevent similar tragedies.

As it stands, there doesn’t appear to be a clearly designated entity, at least one with teeth, on either the state or county level to conduct comprehensive investigations. In fact, no one on the state or county levels even seemed to be aware of the magnitude of what The Oregonian discovered until they were asked for comment on the findings. They didn’t know, or they didn’t want to know. Either is unacceptable.

Most bureaucracies do a poor job of policing themselves. Particularly in the current fiscal environment, there may be a resignation that “bad outcomes” such as suicides are unavoidable because of cuts to certain services. Harboring this bias of inevitability, some administrators may be tempted to throw up their hands (before washing them), trying to deflect blame.

What may also happen is blaming the victim, or an individual professional, rather than the administrative lapses that set them up for tragedy.

Unless we want to be left with the cynical view that tragic outcomes, such as those being reported, are acceptable losses, or that lawsuits are what it’ll take to change things, improved and coordinated monitoring is needed now more than ever as services are cut or rationed. Besides promoting accountability, improved oversight would have the benefit of penetrating the mind-set that may set the stage for tragedy and setting acceptable standards of care, having value as both correction and prevention.

If the state mental health bureaucracy cannot organize itself to improve this essential service within the current structure, then the governor should appoint someone — in the form of a temporary or permanent watchdog — with the authority to do the job.

Improved oversight is not just the right thing to do for the sake of suicide victims and their families. It is also prudent. Particularly in a lean system, a more comprehensive oversight entity would set standards of care, advocate that those standards be adequately supported by legislation and funding, and thereby promote the changes needed to guarantee we are doing the very best with what we have.

Greg Monaco of Portland is a Multnomah County mental health worker.