Video and highlights: “5 Slides: Strengthening the behavioral health system”

Last week, State of Reform held a virtual conversation titled “5 Slides We’re Discussing” on strengthening the behavioral health system in Oregon. Topics discussed included  the rise in drug use, the struggles with access to behavioral health services and the efforts to divert patients from the emergency room (ER). 


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The conversation included Mike Franz, MD, medical director of behavioral health at PacificSource, Maree Wacker, MPP, CEO of DePaul Treatment Centers, and Paul Giger, MD, medical director of behavioral health at Providence Health Plan

All panelists highlighted the increased prevalence in behavioral health crises among their communities due to COVID-19 and a lack of services like ER behavioral health professionals. 

Wacker said that it is imperative that health systems increase access to behavioral health emergency services to decrease the non-therapeutic visits to the ER and to assist ER health care professionals who do not have the expertise to handle these patients. 



Wacker’s slide shows the frequency of ER visits for behavioral health cases on the left. The graph on the right provides the results of a demonstration project from DePaul which studied the effects of counselor assistance in the ER to talk with — and treat — behavioral health crisis patients. The program took place over four years. 

“It is a tool for us to access patients at their moment of greatest need and begin to show them the pathway and have the conversation for thinking about [further] treatment.”

Giger emphasized that the ER should not be the portal for patients to receive behavioral health emergency care. He recommended further study into potential solutions for this problem. 

“It has to be emphasized as an area for innovation and diverting people to better settings.”

Next, Giger presented his slide about the yearly increases and decreases of accidental overdose deaths in Oregon.



Giger highlighted the rise and danger of methamphetamine, heroin and synthetic opioid deaths. Giger said  the rise in these deaths indicates the lack of access to medication assisted treatment to the degree needed. 

“[Medication assisted treatment] is increasing, but it is kind of a trickle where it really needs to be a firehose.”

According to Franz, these drugs often start out as prescriptions and later become deadly street drugs. 

Lastly, Franz’s slide shows the increased use of telehealth and its usage in the behavioral health sphere.



According to the graph on the right, 80% of telehealth visits in Oregon are for behavioral health consultations. Due to this increase, Franz continues to think about the quality and equity of telehealth accessibility. 

Franz is working on creating a model of reimbursement payments differentials between audio visits, video visits and in-person visits. He is also working to assist community members find access to data plans, internet and broadband to get underserved individuals into the virtual office. 

“In the Medicaid line of business, he had a non-emergency medical transport to get them to the brick and mortar office. Maybe we need to think about what will be the new benefit and new investment that gets them on the digital highway to the virtual office that’s equitable for everyone.”

Giger said that 98% of behavioral health visits can be effective, if not better, through telehealth. In his experience during the pandemic, telehealth has been more effective at getting patient access to treatment. 

“As the pandemic hit and [telehealth usage increased], our no show rates went down, our fill rates went up and more people were accessing care. I mean you think about it and it’s just common sense. People don’t have to go to their car, find parking or get a babysitter.”