Q&A: Heather Jefferis talks about the past, present and future of behavioral health

Heather Jefferis is the Executive Director of the Oregon Council for Behavioral Health (OCBH). OCBH was formed in 2018, merging two addiction recovery associations, Oregon Prevention Education & Recovery Association and Oregon Residential Providers Association. Their mission is to advocate for legislation that creates substance abuse prevention programs and accessible  substance use disorder (SUD) treatment programs. They also strive to promote public awareness of behavioral health prevention and treatment.

In this Q&A, Jefferis talks about the impact of COVID-19 on the behavioral health sector, the OCBH’s future legislative agenda and the progress of Measure 110


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Patrick Jones: What is some important context for understanding the behavioral health crisis in Oregon?

Heather Jefferis: “We entered COVID-19 with some significant challenges for the sector that had already existed before the pandemic. The pandemic exacerbated those long standing challenges we had nationwide, and particularly in Oregon. The long standing challenges we’ve had in Oregon with our behavioral health system is workforce, sustainable programs and access. Meanwhile, we’ve had  successes in that we’re very innovative, and we often get national recognition for our innovative programs. I think the most recent one that’s easy to talk about is CAHOOTS. This model is getting lots of national press. But at the same time, on the challenges of Oregon, there’s only one community that has CAHOOTS.

COVID-19 has compounded and exposed the fragility of the system that we have. Also, we are more highly attuned to racial justice and equity than we ever have been nationwide. It really does come down to sustainability. Behavioral health services are steeped in the history of structural racism and stigma. The foundational way we’ve been supported has been one of the largest barriers to getting to adequate access, especially equitable access, because the field itself has suffered in those systems.”

PJ: Tell me more about how behavioral health has been impacted by COVID-19?

HJ: “We’ve closed programs because they’ve been unable to be sustainable in the crisis, because people are not coming for face-to-face care, which has impacted referral and access. Congregate facilities like detox, residential and SUD have also been significantly impacted because they had to make changes to their facilities and reduce the amount of people they serve. The state did get a waiver to provide some support to those congregate programs for the beds that normally would be filled. You still need all the staff and services to serve 12 people where they used to serve 16, but they couldn’t make the revenue to pay the staff. We are very thankful to them for that. If they had not done [the waiver], we probably would have lost half of the programs in the state. The organizations that provide behavioral health care to Oregonians do not have reserves like physical health organizations. OCBH members report most of them have started using reserves to maintain operations and be open to see consumers. It’s rough out there. COVID has had pretty catastrophic impacts on the sector.”

PJ: So as we have recently passed a halfway mark of the session, what are some behavioral health bills that have gone through committee that are important for improving behavioral health here?

HJ: “There’s some excellent work being done on the workforce that we’re supportive of, this includes scholarships, tuition reimbursement, paid internships and supporting paying for supervisors. In such a lean funded system, to train the workforce well, you want them to have really good supervisors and plenty of supervisor time. It’s a healthcare practice, just like medicine. Having trained supervision will help develop new healthcare workers to feel more confident in their toolkit to deliver care to the consumers that they want to serve. We are also excited about some interesting strategies on recruiting diverse employees into the behavioral health sector. We want to make sure we are inviting people to a livable wage, that would be just another form of systemic racism to invite people to underpaid positions. We’re excited those conversations are happening and are part of the workforce legislation.”

PJ: Can you give an update on the progress of Measure 110?

HJ: “There is Senate Bill 755. I think that we’re all feeling optimistic because a lot of the mechanics have been addressed in SB 755 will help make the law implementable with the vision to change systemic racism and to encourage equitable access. Our members have been moving to a healthcare lens through partnerships with hospitals and engaging in different ways. Measure 110 is going to infuse some resources, more administrative support and legal support to help all of our providers do that even quicker. The people of the OAC [Overview and Accountability Council] are a brave and amazing group of people, and they have a lot of work to do.”

PJ: Is there anything else you might want to add relating to the state of behavioral health policy and just initiatives or any sort of developments today that you might want to highlight?

HJ: “Well, I am excited about the discussions around systemic racism. I think that systemic racism and stigma are part of creating behavioral health funding mechanisms and administrative oversight, because the populations that we serve in that sector came out of charity care and stigma. As a society, we placed lesser value on behavioral health services, because of stigma and institutional racism that physical health doesn’t experience in the same way. In fact, there was so much stigma and racism that physical health purposefully distanced itself from delivering those services over the years. I think that if we want to change the dial, and really make behavioral health care part of healthcare, the time is overdue.”

This interview has been edited for clarity and length