Read the executive summary on this page and download the pdf for the full report.

Mental Health Audit Report (529.92 KB)

Mental health audit presentation to the Board of County Commissioners

What we found

Multnomah County’s ability to serve adults with serious and persistent mental illness is limited and faces imminent risks. Currently, over half of people who are involved with the civil commitment system are not receiving the most intensive services the county offers, including care coordination and Assertive Community Treatment (ACT) services. For those who receive them, these intensive services seem to be working as intended for many people. However, the Mental Health and Addiction Services Division should do more work to examine outcomes. 

The sustainability of some of the county's community mental health programs for people with serious and persistent mental illness appears to be at risk. Demand for services is not being met and is unlikely to abate. Revenue for services has essentially been flat and is unlikely to rise. The division has reserved funds for future program needs, such as housing developments. This adds risk to state funding and potentially constrains program access. Structural obstacles, like the cost of housing, are preventing more people from successfully moving through the programs. 

Why we did this audit

Adults with serious and persistent mental illness, especially those involved with the civil commitment system, are a vulnerable population at high risk of institutionalization. It is important that the county serve this population well. In the last few years, the State of Oregon has lessened the availability of institutional care without sufficiently investing in community services, which has affected mental health programs and added significant risk of services being insufficient. 

What we recommend

We recommend that the Mental Health and Addiction Services Division: 

• Publicly report to the Board of County Commissioners on funding priority decisions, state funding status, and progress for developing housing resources. 

• Obtain written approval from the state for plans to reserve state grant funding. 

• Analyze and report on options for addressing ACT accessibility. 

• Update county Choice policies and clarify criteria. 

• Take steps to ensure that people who could benefit from services are identified. 

• Advocate for more dedicated supported housing units for this population. 

• Take steps to ensure data and information are available for evaluation purposes. 

• Develop a process to routinely measure outcomes for Choice and ACT, including identifying racial disparities in outcomes. 

• Allocate staff for ACT contract management.