Lack of access to higher levels of behavioral healthcare putting pressure on Oregon’s providers


Shane Ersland


Recruitment and retention barriers have plagued Oregon’s behavioral health system for many years, and those challenges continue today. Health leaders discussed those challenges and possible solutions during the 2023 Oregon State of Reform Health Policy Conference.

Oregon Council for Behavioral Health Executive Director Heather Jefferis said the state’s behavioral health system has not recovered from staffing purges that occurred in 2001

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“Not only are we dealing with long-standing stigma, stagnation, (and) lack of clarity in our system, but in Oregon, we went through a period in 2001 where many agencies had to lay off somewhere between one-third and 40-50 percent of their staff,” Jefferis said. “Not only have we dealt with stagnation, but we have less programming now than we did in 2001.”

A striking example of that is the lack of substance use disorder (SUD) residential treatment services for youth, Jefferis said. 

“Youth residential had 11 providers and roughly 140 beds in around 2001,” she said. “We now have four providers with roughly 35 beds; these are beds for both commercial and Medicaid. There’s been program loss across all providers for many years. Pre-COVID, (in) our industry on average, most folks had positions they could not fill in a timely manner running at about 18-20 percent. During COVID, we saw that rise to roughly 50-60 percent.”

Jill Archer, vice president of behavioral health at CareOregon, said the system’s biggest challenge is providing access to higher levels of mental health and SUD treatment (programs like secure residential treatment for adults, co-occurring SUD services, and inpatient psychiatric capacity).

“I think that’s driving a lot of the challenges we see. In the last three years, (at) Oregon State Hospital, which is where those with the highest level of severity or civil commitment would go for treatment and support, (they) have not had access at all. Unless they’re in a criminal justice system, the state hospital is no longer available. 

So what we’re seeing is those 300-500 people who have access to that level of care are now in a level of care that did not meet their needs. And a lot of them are potentially now houseless. That has caused pressure across the entire system. That is a high driver of workforce burnout, particularly in some of those higher level programs.”

— Archer

Linda May Wacker, director of the Behavioral Health Talent Academy at Central City Concern, said the organization’s addiction treatment services team continues to try to find solutions in coping with the state’s fentanyl epidemic.

“At every level of care, we’re having a harder time effectively serving people and keeping them in the services that will be life-saving for them,” Wacker said. “This is especially bad in residential (care).”

Archer said CareOregon has partnered with Health Share of Oregon, Central City Concern, and Providence’s Center for Outcomes Research and Education to conduct analysis to examine the prevalence of Health Share members that have opioid use disorder, stimulant use disorder, psychosis, or a combination of the three. 

“Because we had a hypothesis that the prevalence was increasing exponentially over the last few years,” Archer said. “But we actually found that the number of people with any of those disorders hasn’t necessarily increased substantially, but people are a lot sicker. Their needs are much higher. Their acuity is a lot higher. Because of the lack of access to those higher levels of care.”

CareOregon increased reimbursement rates for behavioral health providers and SUD services in 2021 to help support the state’s workforce, Archer said. 

“Because of that we are seeing some increased stabilization in the system, particularly in the lower levels of outpatient (care). We’re also looking to see how we can reduce administrative burden, reduce prior authorization requirements, (and) reporting requirements just to alleviate some of that workforce stress.”

— Archer

Wacker hopes the development of its new Behavioral Health Talent Academy will help Central City Concern respond to the workforce crisis. 

“CareOregon is funding this endeavor, which is essentially to work on retention of the behavioral health workforce, and (engage) them in training, education, and credentialing while they’re on the job,” Wacker said. “Typically, if you wanted to get your entry level behavioral health credentials, you would have to pay out of pocket for a lot of that training.

In year one, we’re looking to educate 40 folks on the staff, and they will continue to work their full-time jobs, and get all the training and education they need to get their credentials. And hopefully they want to stay at Central City Concern and take one of our many vacant positions, or go into the field and provide behavioral health services in our community.”

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