Oregon’s Mental Health System Faulted in DOJ Report

DOJ

The U.S. Department of Justice (DOJ) has determined that Oregon is “far behind where it needs to be” to meet the goals of increasing community-based mental health programs and reducing the number of patients in institutionalized settings, especially the Oregon State Hospital.

In a recently issued report, the DOJ states that Oregon has made “limited progress” in reducing its use of restrictive, institutionalized settings.

The DOJ issued the report in early January as part of a four-year settlement agreement reached with the state of Oregon following a 2010 investigation into the quality of Oregon’s mental health programs.  In the agreement, Oregon agreed to beef up its community mental health programs in order to avoid being sued for civil rights violations under the Olmstead Act.

Among the report’s findings are that Oregon lacks an adequate supply of services like Assertive Community Treatment, housing and employment.  The DOJ also found that the state’s mental health services are not necessarily evidence-based and are not appropriately distributed throughout the state.

The report also calls into question some of the data reported by the state’s Addiction and Mental Health Services Division, particularly on how it reports caseloads for intensive case management services.  Data on the county’s mental health programs showed a caseload of 64 patients to one provider, whereas managed care organizations providing the same service report a much smaller caseload, the reported noted.

Legislators discussed the DOJ’s interim report on the state’s progress at a hearing in mid-January.

Rep. Carolyn Tomei, D-Milwaukie

Rep. Carolyn Tomei, D-Milwaukie

“It feels like we’ve been hearing this for years and years and years,” said Rep. Carolyn Tomei, D-Milwaukie, chair of the House Committee on Human Services and Housing.  “I’m very concerned that we’re not moving away from institutionalization.”

Oregon’s struggles with its mental health care system are an odd juxtaposition to the innovative reforms recently made to the state’s Medicaid program, specifically the creation of coordinated care organizations (CCOs).

For example, the CCOs have been particularly effective in reducing emergency room visits for non-emergent care. According to the most recent quarterly report detailing their progress, CCOs reduced emergency room visits by 13 percent, on average, between April 2013 and October 2013.  In contrast, the DOJ’s report found that emergency room use among mentally ill individuals in general decreased by only 5.6 percent during the same period

Although Oregon officials “have expressed their desire to create a community-based mental health care delivery system, this is not yet happening,” the report states.

In 2013, the Oregon Legislature added money to community mental health programs for the first time in many years, to the tune of $40 million.  During a September special session, another $20 million was added.

The results of that additional funding weren’t necessarily reflected in the DOJ report, said Oregon Health Authority Acting Director Tina Edlund.  “We will begin to see improvements in the community mental health system in a matter of months,” she told lawmakers.

But advocates for Oregon’s mentally ill say the DOJ report shows more funds are needed.

Cindy Becker, director of human services for Clackamas County, spoke on behalf of the Association of Oregon Counties at the hearing. “The question becomes one of resources, quite honestly,” she told legislators.  “If you’re looking at a sea change…the resources available are not sufficient.”

The DOJ report adds pressure on the state to continue increasing funding for community mental health programs, but there appears to be little wiggle room for adjusting the state’s 2013-2015 budget.

While the legislature withheld approximately $154 million from agency budgets last year, that money is expected to pay for an expensive fire season and to fill holes in the budgets of the Department of Corrections and the Department of Human Services.  The next revenue forecast will be released on Feb. 12, which could yield more revenue.

But the state set aside $26 million generated from scaling back its senior medical tax deduction specifically for senior and disability programs.  Currently, $3.5 million has been proposed for senior mental health programs and another $3.3 million for caregiver training. Together, that money could help geriatric patients leave the Oregon State Hospital, enter community settings, and potentially free up general fund dollars for other mental health services.

Some lawmakers expressed a sense of urgency over pushing for more changes to the state’s mental health system.

Rep. Sara Gelser, D-Corvallis

Rep. Sara Gelser, D-Corvallis

Rep. Sara Gelser, D-Corvallis, spoke during the hearing about a call she made to a mental health crisis line to learn how the system works.

She said she was put on hold, told she would be put in touch with a manager, put on hold again, then was told no one could be found but that she could leave a message and would be called back the next day.

“I wasn’t having a personal crisis when I called, but I felt like I was having one by the time I hung up,” Gelser said.