Walk-in clinics, mobile teams part of new plan

From The Portland Business Journal, September 16, 2001

The Crisis Triage Center was the centralized care center for Multnomah County mentally ill needing urgent care. The center served more than 8,700 people in the last fiscal year and still it turned away another 400 patients in emergency vehicles because it was full.

The closure of the Crisis Triage Center on Aug. 1, left emergency personnel with no designated place to take area residents in psychiatric crisis.

“They are going to ERs of the hospitals in the area,” said Kent Ballantyne, a senior vice president with the Oregon Hospital Association. “We are triaging those patients through the acute care setting, which is an expensive and inappropriate place to do this kind of care.”

Ed Riddell, the head of the Portland Police Crisis Intervention Bureau, called the closure “devastating” to police officers because of the extended period of time officers have to wait in emergency rooms with patients in custody before patients can be seen or transferred to a more appropriate setting.

Dr. Christopher Richard, head of OHSU emergency room operations, said the closure of both the CTC and Pacific Gateway has resulted in significantly longer emergency room waits for all patients.

“The ER is not a destination,” he said. “If we can keep our length of stay down to the traditional three or four hours, we’re much better off. Unfortunately, our length of stay has gone way up and it’s a problem.”

In an attempt to treat mental illness less expensively, walk-in clinics were established in three different areas of Multnomah County the same day the CTC closed; another is due to open this month.

Eventually, each of the clinics will also have a mobile team of mental health care professionals attached to it and they, rather than the police, will respond to requests for urgent and emergent mental health crises.

Mobile mental health teams are vital to community-based mental health services, according to Jason Renaud, executive director for the National Alliance of the Mentally Ill of Multnomah County.

“They depend on building a friendship, a relationship with people,” he said. “And these are very sick people who don’t want to be in treatment and routinely hang up the phone, slam the door, walk away, don’t take their medication, don’t want to be involved. These teams are very effective at getting these folks involved.”

The Crisis Triage Center opened on Jan. 13, 1997 as a state-of-the-art psychiatric triage facility which was located on the Providence Portland Medical Center campus in Northeast Portland. It served everyone from private clients to Oregon Health Plan enrollees in psychological crisis. The CTC contract with Multnomah County expired June 30th and talks to renew it broke down over escalating costs.

The CTC was too expensive, according to county officials, and provided less crisis response services than originally agreed to. In addition to the cost overruns, the county redesign task force found that the usefulness of the CTC was compromised because more appropriate, less costly alternatives were not available to provide adjunct services.

Jim Hlava, program director of rehabilitation services for Network Behavioral HealthCare Inc., said business has been brisk at his clinic at 43rd and Division in Southeast Portland, and that is true for the clinics in North Portland and Gresham as well.

The building, which will house another clinic in the downtown area, is still undergoing renovations and should open this month.

However, the clinics are already helping to keep patients out of hospitals.

“We’re part of the solution,” he said. “We’re seeing between 10 and 20 patients here a day, and we originally thought there would be between five and 10 patients a day across all of the clinics. So we’re busy, but we’re not overwhelmed.”

Hospitalization is less likely to happen if clients can request services in a clinic setting when they need it but the clinics send their emergency cases to local ERs if they can’t be stabilized there.

“If clients are a danger to themselves or others, we send for the police,” he said. “That’s the system that’s in place right now because we don’t have our crisis services completely up and running.”

The county is also in negotiations with Woodland Park hospital to contract for psychiatric beds, but the talks have been clouded by recent allegations of safety and patient care by former employees.

A preliminary investigation found some procedural and record keeping problems but a final report will not be available until later this month.

Pacific Gateway, meanwhile, may reopen under different management.

“The potential buyer intends to operate the hospital as a behavioral health facility,” said Beth Page, a spokesperson for Ardent Health Services, who owns and operated the facility.

“And we are hopeful these negotiations will be concluded in the near future.”