Dear friends and neighbors,
Happy holiday season and welcome to winter! I am looking forward to spending time with family and friends over the next couple of weeks, and I hope you are able to do the same.
As I’ve described in previous newsletters, I am leading an effort to engage in a deep analysis of our mental health system in Multnomah County, and I want to provide an update. Last week, we hosted a Community Listening Session on Mental Health, and it was truly amazing. The meeting space was filled to capacity, and I was inspired and moved by the many people who shared their personal stories. We heard from people with lived experience navigating the mental health system, family members, people who work in the mental health field, and many others. The incredible level of interest just confirms for me how important this topic is to our community and how important it is for us to work together toward meaningful change.
I’d like to briefly outline some of the major themes we heard (though I can’t possibly capture the passion, emotion, detail and scope in a newsletter):
- Access - We heard about the need to improve access to mental health services across the board, regardless of insurance status or type of insurance.
- Coordination - People spoke of disconnected, fragmented services that don’t link together, both at the systems level and at the individual level. In particular, we heard about a need for coordination around hospitalization, so that people don’t cycle through emergency services without a clear next step.
- “Meeting people where they’re at” - We heard from virtually everyone that mental health services are often most successful when they “meet people where they’re at”, both literally and figuratively. People need meaningful access to services in the community where they live, work, gather, study, etc. They also need services that are low-barrier, to help ensure that people can participate even if they have struggles that make engagement really challenging.
- Culturally-specific services - We heard about the tremendous need for culturally-specific services, including services specifically directed toward immigrants and refugees.
- Children and seniors - People spoke about the profound need for increased access across the spectrum of mental health services for children and seniors.
- Housing - Many people spoke about the connection between housing and health, and the difficulty managing services and recovery without a stable place to live.
- Peers - We heard a lot about the need for peers to be involved in policy and decision-making around mental health services, as well as engaged in the provision of services. We also heard about a need to better coordinate peer services and ensure quality and accountability, especially as peer models expand and grow.
- Decriminalization - Many voiced a strong concern about how people with mental health issues end up cycling through our criminal justice system. We heard ideas about alternatives to arrest, better mental health services for people who are already incarcerated, and improved connections between corrections, housing, and mental health.
For many, these are familiar themes. What is exciting to me is that, working with Human Services Research Institute (HSRI), we have a process for putting the pieces together and a mechanism to work toward systems change. And we continue to collect more information, including quantitative data and qualitative feedback. To that end, I am eager to see HSRI’s report in early 2018. I hope it will provide us with a shared and holistic understanding of our system -- one that will help identify immediate actions we can take, along with guidance for moving toward a longer-term action plan.
If you weren’t able to attend the listening session last week, it’s not too late to provide feedback! You can use our online form to share your thoughts and ideas. HSRI will also continue to conduct individual and group interviews. And stay tuned for information about another community event in early 2018!
On another topic, Commissioner Vega Pederson and I plan to bring our ordinance to address wood smoke pollution, one of the largest environmental contributors to poor health and increased cancer risk, to our January 4 board meeting. We have held three public hearings about our draft ordinance, and heard from many people expressing both support and concern. I appreciate everyone who has weighed in. I believe that our ordinance will have a very positive impact on people’s health, with minimal burden on people’s use of their woodstoves and fireplaces. The ordinance will limit wood burning on only the very worst air quality days in winter. There are a number of exemptions, including for people who use wood as their primary source of heat. There will be one more public hearing where you can testify on the proposal, at our Board meeting on January 4. And you can always send feedback to me via email at email@example.com.
Finally, I am very happy to share news about a new winter shelter for families, named Mitzvah House, sited at Congregation Beth Israel in Southwest Portland. Mitzvah House opened last week, fittingly, on the first night of Hannukah. It’s not every day that I get to support something that makes me this proud both personally and professionally, and I feel truly privileged to be part of a congregation that so values community and social justice. Thank you to all the congregation members and volunteers for showing such compassion to families in need, and thank you also to our partners for making Mitzvah House a reality.
With that, I wish you all a very happy holiday season and a wonderful new year! I look forward to continuing to work for you and with you in 2018!
In good health,
Dear friends and neighbors,
Happy holidays! I hope you had a wonderful Thanksgiving with your family and friends. It’s been a busy month at Multnomah County, and I’ll share some highlights later in this newsletter.
But first, I want to share some information about an important effort to improve our mental health care system that the county is undertaking and invite you to join me on Monday, December 11, from 5:30 - 7:30 p.m. for a Community Listening Session on Mental Health.
As you hopefully know from my campaign for office and from reading my newsletters, one of the main reasons I ran for Multnomah County Commission was to improve what often seems like a fragmented or broken system of mental health care delivery. As an ER doctor, I too frequently see people experiencing mental health crises who were unable to access services prior to falling into crisis, and once they have a crisis, there is nowhere for them to go. I believe that meaningful access to effective mental health care is one of the most pressing needs facing Multnomah County. This need is not new -- it has been painfully apparent to people suffering from mental illness and their families and friends for years. But, it’s an issue I see increasingly becoming part of the public’s consciousness. The system may seem like a tangled knot, but I believe that the only way to untie even the most complicated knot is to search for a strand or two and begin to slowly and intentionally untangle. That is what we’ve set out to do.
With a goal of identifying strengths, gaps, and opportunities for change, I have advocated for Multnomah County to engage in an intentional and in-depth process of mental health systems analysis, with a specific focus on consumer and provider experience of the system, review of relevant data and prior research, and connections and coordination between departments, which is so often where people seem to fall through the cracks. Human Services Research Institute (HSRI), a health and human services policy and research firm with expertise in local mental health systems, will assist us in conducting a study of how mental health services are provided throughout the county. They will provide a quantitative and qualitative analysis, including a detailed inventory of mental health services available in our community, connections between those resources, and funding and reimbursement mechanisms which so often drive how services are provided.
As part of the study, we are meeting with members of the community on Monday, December 11, to learn about people’s experiences, and hear their thoughts on what a better mental health care system could look like. I invite you to join us! The goal of this community listening session is to help the County and the HSRI team understand how the system is actually working in Multnomah County, and to identify opportunities for meaningful change. Here are complete details about the event:
If you can’t attend on the 11th but want to provide feedback, do so here. Please distribute the information about the event and our online feedback form widely because we want to hear from as many people as possible.
In addition to inviting you to this important event, I wanted to share some other updates from the County:
Earlier this month, Multnomah County joined with the City of Portland to launch Home for the Holidays, which invites rental property owners, property managers, and neighbors to offer affordable housing units to families currently in shelter, with the goal of housing 40 families by January 15. This is especially important now since we know the housing crisis is hitting families hard - more and more families are seeking shelter each night, and wait times for housing once families are in shelter have almost tripled. Through Home for the Holidays, three families have already moved into affordable housing this month.
In other news, Commissioner Vega Pederson and I have held two of three community hearings about our proposed ordinance to improve our air by limiting wood burning on the worst air quality days in the wintertime. If you’re interested in this proposal, please attend our third community hearing on Thursday, December 7, from 9:30 - 11 a.m. in the Multnomah County Board Room at 501 SE Hawthorne Blvd. Or, you can provide feedback via the online form available on this page.
Finally, you may have heard media stories about the Board’s vote earlier this month to approve a purchase and sale agreement to sell the Wapato Jail facility. I’d like to briefly provide some insight as to why I voted in favor of the sale. When I was first elected as a Multnomah County Commissioner, I had felt, like some of you have shared with me, that there should be some way to cost effectively and humanely use the facility - as a homeless shelter, or a residential substance abuse treatment center, or something. There is such a desperate need. I entered the process with an open mind and a desire to do what is best for the community. However, after reviewing extensive prior evaluations and conducting my own inquiries, I unfortunately discovered a web of challenges that made it unfeasible to use Wapato as a homeless shelter, or really for any other County function. Despite costing taxpayers $58 million to build, the facility was most recently appraised at $8.5 million. I am as disappointed as anyone about the legacy of wasted time and resources that Wapato represents, and I truly wish the situation were different. But given the challenge we inherited as a Board, I am proud that we were able to approve a purchase and sale agreement to sell the facility for $2.3 million over its appraised cost, dedicate the $10.8 million in potential proceeds toward affordable housing, and get the property back on the tax rolls. Read more about the history and challenges.
If you have questions about these or any other topics, please don’t hesitate to contact me. And I hope to see you on Monday, December 11, for the Community Listening Session on Mental Health!
Multnomah County District 1 Commissioner
As a county commissioner, one of the issues I am asked about most often is homelessness. This topic is complex, and it will be impossible to do it justice in a newsletter. But given how important the subject is, I will do my best to at least provide some background as to the causes and consequences of homelessness, and share some of the actions that we at the County are taking to address this issue.
Causes and Consequences
There are countless causes for homelessness, and “homelessness” doesn’t have just a single definition. People may live on the street; doubled up with another family in an apartment; on a friend’s couch; or in a car. But there are some broad categories of experiences shared by many who become homeless, such as exposure to trauma, mental health issues, substance use disorder, income loss such as from job loss or illness, physical disability, exposure to domestic and sexual violence, and rising rents and housing costs. Some of these can cause housing instability and lead to homelessness. Some can be experienced as a consequence of being homeless. And some can be both cause and consequence.
Regardless of the cause, once someone becomes homeless, they experience even greater challenges in being able to reverse their situation. Imagine trying to make an appointment to get your medications or see a health care provider when you don’t have a place to live, a phone, or a calendar. Try to even think about finding a job, let alone interview, when you can’t take a shower or clean your clothes. Imagine trying to do homework when you are a kid living with your family in a car, or doubled up with another family in a one-bedroom apartment. If you have ever been evicted, for any reason (or no reason at all, as currently allowed under Oregon state law), the likelihood you will be rented to in the future is compromised, especially in a competitive rental market such as we are experiencing.
Actions Being Taken
For the past three years, Multnomah County, the City of Portland and a team of partners have been united in building a more rational, robust and compassionate response to homelessness. Through “A Home For Everyone,” we identified and began investing in a proven set of strategies to address homelessness: (1) Prevention; (2) Shelter; and (3) Permanent housing. Last year, we cemented that partnership with the establishment of the Joint Office of Homeless Services.
The first arm of this strategy is to prevent people from becoming homeless in the first place. We know that, although the economy has been improving, not everyone has benefited equally. People with low and fixed incomes are not experiencing the economic upturn and are frequently priced out of housing. Families and low-income seniors are some of the most severely impacted as rents rise while incomes stay stagnant. Once people fall into homelessness, it can be much more challenging to recover and keep housing, and so prevention can have a huge positive upstream impact. Prevention strategies include rent assistance, housing navigation, job training, and other supports that can help keep people from losing their housing.
The second arm of our strategy is to ensure that, when people do become homeless, we provide a safe place to sleep. We do this through rapid re-housing efforts and shelters. Shelters are not an end-strategy in and of themselves, but they are a critical stop-gap for individuals and families without another place to go, and shelters are sometimes the only place people can connect with services. The need for shelter is a reality -- we cannot ignore that real people, right now, need a safe place to stay and sleep. But shelter beds are an expensive investment, and, when we add shelter, we are not actually addressing the root causes that drive homelessness nor moving toward strategies that will actually solve the problem of homelessness.
The third arm of our coordinated strategy, and the only real solution for addressing homelessness, is transitioning people into permanent housing. This is challenging even in the best of conditions. Today, we have a market where incomes are stagnant, housing costs are skyrocketing, and vacancy rates are near zero.
Since the inception of A Home For Everyone we set and exceeded goals in prevention and shelter. This past winter, for the first time, we counted more people in shelter than facing the elements on the streets. However, even in the face of this progress, the fact is that more people are homeless than ever before. And this is the crux of the problem: There simply is not enough permanent, stable, affordable housing to support all the people who need it.
Imagine a bathtub being filled: the flow from the faucet represents people becoming homeless; the water in the tub represents the number of people experiencing homelessness; shelters are like buckets bailing out excess water from the tub, but this water goes straight back into the faucet; and the drain represents people attaining permanent housing. When the faucet runs slowly and all the systems are working, the water level will go down. But currently, the drain is clogged and the faucet is on high. We are not able to keep up, and the water keeps rising.
Some individuals face even more severe challenges than others who are homeless, and their number is increasingly represented. They are often the most visible and the most vulnerable of all who experience homelessness. They face physical disabilities, mental illness, or addictions -- sometimes all at once -- and struggle with other challenges that make housing difficult to attain. Even if they do get into housing, it may be very difficult to sustain because of their underlying conditions. They often cycle through shelters, ERs and jails, which are the most expensive, least effective and least humane places to deal with their underlying issues. But there is an alternative that is both effective and saves money - Supportive Housing. Supportive Housing is deeply affordable housing combined with services that help people facing complex challenges to live with stability, autonomy and dignity.
In the ER, I frequently see the same people over and over again, many of whom suffer from mental illness and/or addiction. The costs to care for these individuals in the ER are staggering, even though the ER is one of the worst environments for people who have multiple serious chronic needs. I once calculated the cost for a woman I saw in the ER with intense medical and mental health needs, housed for a month in the ER because there was nowhere else for her to go: At about $2,000/day, the cost of that visit alone was almost $60,000. Compare this to supportive housing, where this same woman could have a place to live and all the services she needs to stabilize, at a cost of $24-$54/day. Channeling our resources into housing with wraparound services to support the needs of those who are most vulnerable and frequently need multiple services is not only effective and humane, but saves money.
As I mentioned above, our coordinated strategies do work. In the past two years we have set and exceeded goals in prevention and shelter. We have helped thousands of people stay in their homes or transition to permanent housing. This past winter, for the first time, we counted more people in shelter than facing the elements on the streets. And we have committed to investing in the proven effective strategy of supportive housing.However, we have a long way to go, and, unfortunately, change cannot happen overnight. I look forward to continuing the hard work of addressing homelessness in our community. And I especially look forward to exploring opportunities to have our systems work together to make a real impact on this seemingly intractable problem.
Many of you have already provided me with innovative thoughts and ideas, or have directed me to programs that have worked in other places to address homelessness, because, sadly, this issue is not unique to our region. And many of you have let me know of the issues you see every day in your neighborhoods. Although we can’t solve these problems overnight, please know that I hear you, I understand what you are telling me, and I share your concerns. Please continue to share your ideas and ask questions. I can’t tell you how much I appreciate your engagement.
Finally, I have heard great feedback about my STEPtember walk over the Tilikum Bridge, and I’m planning to host another walk - rain or shine! - in November. Keep your eyes peeled for more information soon!
In good health,
Multnomah County District 1 Commissioner
Dear Friends and Neighbors,
Early fall is one of my favorite times of year, and a time to dive deeply into our work at Multnomah County.
One of our greatest challenges emerged during a powerful hearing around our employees’ efforts to formalize a Workforce Equity plan. On September 14, the Board passed a Workforce Equity Resolution. The resolution explicitly calls out Multnomah County as being in a unique position to advance workforce equity through our hiring, promotion, and retention policies and formalizes a countywide effort to develop a workforce equity strategic framework.
But our hearing on September 14 was not just about this resolution. A few days earlier, we had received a letter from Tricia Tillman, who served as Multnomah County’s Public Health Director since January 2015. In her letter, Tricia, the first African American to lead a public health department in Oregon, detailed a troubling account of her departure from the County and called on the Board to take a hard look at institutional racism and disparate treatment within County government. At our Board meeting we heard painful and heartfelt accounts from employees and community members who courageously stepped forward to share their frustrations, concerns, and personal experiences with racism and oppression in the workplace. It was a powerful and moving experience, and one that I will never forget.
We must respond with urgency to the experiences we heard about at the meeting. A resolution is an important step in making our commitments clear, but we need to take action. We as a county must take on the hard work of confronting institutional racism and ensuring all County employees are safe, supported, and free from oppression at work. I joined my fellow Commissioners in calling for an independent review of what led to and how the County handled Tricia Tillman’s departure, as well as the larger issues of the county’s hiring, management, and promotion practices regarding people in protected classes. I will look for results of the independent review and seek to hold departments accountable for implementing recommendations.
I also want to highlight October as Domestic Violence Awareness month. In the emergency room, I’ve become all too familiar with the many impacts of domestic violence, also known as “intimate partner violence,” on individuals and families. More than 1 in 3 women will experience domestic violence in their lifetime, and the costs to our communities are staggering. For example, the Institute for Women’s Policy Research reports that victims of intimate partner violence are at higher risk of health and certain mental health problems than women who have not suffered such violence, and that health care costs for those experiencing abuse were 42 percent higher than the costs for non-abused women. While this particular study focused on women, domestic violence can affect anyone. The total cost of intimate partner violence to society in the U.S., including health costs and productivity losses, is an estimated $9.3 billion every year.
Homelessness and housing instability both contribute to and are caused by intimate partner violence. In Multnomah County, our 2017 Point in Time Count of people experiencing homelessness found that 743 women -- more than half of all women surveyed -- reported being victims of domestic violence. A 2016 statewide census of adults and children seeking DV services in Oregon reported that, of the total number of unmet requests for services, 86% were survivors who needed housing. This deeply troubling finding tracks with what we already know nationally about intimate partner violence as a leading cause of homelessness among women, especially women with children. To reduce the impact of intimate partner violence, we must continue to advocate for affordable, stable housing for survivors as a crucial part of the solution.
Multnomah County’s Domestic and Sexual Violence Coordination Office (DSVCO) provides a continuum of trauma-informed and culturally-responsive services to DV survivors. To thrive after abuse, survivors and their children need safe housing, flexible economic resources, and other support that promotes stability. The prevention and intervention strategies developed and coordinated by DSVCO are used by the city of Portland, Multnomah County and community agencies to promote individual, community, and societal change.
It’s been busy, and a lot more has happened than I can fit into a newsletter, but hopefully this will give you a feel for some of what I’ve been thinking about and working on. As always, please contact me or my office with any questions, comments, ideas or concerns. I always appreciate your sharing your perspective, and holding me accountable even when (and especially when) the issues are challenging, profound and uncomfortable. It really does make a difference.
In good health,
Multnomah County District 1 Commissioner
Dear Friends and Neighbors,
I hope your summer has been going well! For me, it has been flying by. Although a tremendous amount of work is happening at the County, in this newsletter I want to focus on two specific issues.
First, I am very happy to report that in the closing days of their 2017 session earlier this month, the Oregon Legislature passed a bill raising the minimum sales age for tobacco and vape products from 18 to 21. I strongly advocated for this policy, called Tobacco 21, which will save thousands of lives and millions of dollars. Research shows that youth are especially susceptible to tobacco addiction, and with e-cigarette use on the rise among kids and teens, raising the sales age will keep youth from experimenting with and becoming addicted to tobacco and nicotine products. I look forward to implementing this important policy in Multnomah County.
Second, at the Board of County Commissioners meeting yesterday morning, I sponsored a resolution describing the devastating impact of the opioid epidemic in Multnomah County. We invited several guests to speak on the topic, and their presentations were moving.
Opioids are a class of drugs that includes illegal drugs like heroin, as well as prescription painkillers such as oxycodone. People often think that prescription opioids are safer than illegal drugs because they are prescribed by a healthcare professional, but this is simply not true. As Dr. Alisha Moreland-Capuia from OHSU described in her presentation yesterday, prescription opioids can cause addiction, overdose and death, just like heroin. And in fact, many heroin users started with an addiction to pain medications and transitioned to heroin. This trend is something Haven Wheelock, who manages Outside In’s needle exchange program and who also spoke at our meeting yesterday morning, says she has seen more and more over the past several years among the people she works with.
So what’s driving this epidemic? Prescribers did not cause the opioid epidemic, nor did the people taking these medications. There is a backstory that reads like a John Grisham novel but unfortunately is not fiction. Providers prescribed opioids because large pharmaceutical companies like Purdue Pharma (the manufacturer of Oxycontin) convinced oversight boards that these medications were safe, had minimal abuse potential, and were not addictive. They made these assertions based on essentially no evidence. They gave money to agencies overseeing hospitals and state medical boards to create pain management courses and guidelines for prescribers, essentially recommending that all pain be treated with opioids and minimizing any safety concerns. Oversight agencies then began requiring doctors to follow the guidelines. In fact, physicians were disciplined for NOT prescribing opioids. For decades, physicians were taught that the only way to help their patients in pain was to prescribe opioids. So that’s what we did. Though there are certainly a handful of bad actors, our current devastating epidemic was caused not by careless doctors, but by the irresponsible and aggressive manufacture, marketing and distribution of opioids by large pharmaceutical companies. And we have all had to pay the price.
During the board meeting, we heard two personal stories which brought the issue home in a powerful and profound way:
Mike, a father of three and a former teacher, was prescribed opioids to manage chronic pain. He became addicted, and, when his medications became too expensive, he started using heroin. Mike described the painful losses stemming from his addictions -- his housing, his kids, his job, his stability. Today Mike has a little over 6 months clean, is in a sober living community, and is in recovery.
Tiffany, a mother of three, became addicted to opioid medications when they were prescribed after her c-section. Since then, she’s struggled with addiction to heroin and pain pills, and worked hard to shield her kids from the effects of her habit. Today, she’s celebrating over a year clean and is working for Central City Concern, one of the great community organizations that has supported her recovery.
I’m hugely grateful to Tiffany and Mike for sharing their stories with us. This crisis is real, and the people being hurt are our families, friends, neighbors and co-workers.
On a broader scale, data show that there are huge amounts of opioids flowing into our community -- more than 280 million pills in the state every year. In 2015, retail pharmacies dispensed 1.4 million opioid prescriptions to residents of the Tri-County region alone, which amounts to nearly one opioid prescription per person living in the area. Oregon consistently ranks among the states that have the highest non-medical use of prescription painkillers in the country. And from 2009 to 2015, there were 861 opioid related deaths in Multnomah County, along with over 1,900 non-fatal opioid overdoses between 2013 and 2015. One of the panelists yesterday morning, Dwight Holton from Lines for Life, put these statistics into terrible perspective: with one overdose death occurring every 30 minutes on average, that’s two lives lost just in the span of time it took us to discuss and pass the resolution during the board meeting.
As an emergency physician, I have treated the people brought in to the ER by ambulance after they have overdosed. I’ve seen the impact on individuals firsthand. But the damage is not just to individuals and their families. The harms caused by the influx of these opioid pain medications are felt by our entire community, and the cost has been staggering. In Multnomah County, the demand for substance abuse treatment far exceeds the availability of services, and people are left without anywhere to get help. We have had to devote a larger and larger share of our public resources to deal with the effects of opioid addiction. Dr. Paul Lewis, Multnomah County Health Officer, described these direct impacts on the county -- from our health clinics, to our corrections system, and even to our libraries, there are few county services that this epidemic doesn’t touch in some way. And each dollar spent on the opioid epidemic is a dollar less that we can spend on other desperately needed services.
The resolution I introduced yesterday lays the groundwork for the County to seek reimbursement of some of these costs from Purdue Pharma and others for flooding our community with the drugs that have caused the opioid epidemic and created so much harm. As your County government, we’ve made significant expenditures trying to clean up the damage from this epidemic, and we are now going back to the source of the problem to seek compensation. Our action yesterday sets the stage to do this.
It’s been quite a month, and a lot more has happened. I hope you’ll consider joining me for my constituent coffee coming up tomorrow, Saturday July 29, from 10 to 11:30 a.m. at Home Forward’s Pearl Court Apartments (920 NW Kearney Street). I will discuss these and other issues we are working on at the County and will be available to answer your questions. See below for more details.
I hope you enjoy the rest of summer! There will be no newsletter in August, so I look forward to connecting again in September. As always, please contact me or my office with any questions, comments, ideas or concerns. I love hearing from you, and it really does make a difference.
In good health,
Since my last newsletter, a lot has happened at the County. But before I provide some highlights, I want to tell you how I’m feeling right now about the US Senate Republicans’ effort to abolish the ACA and the life-saving and life-changing services it has provided to millions of Americans. I am angry, disgusted and disheartened (but, sadly, not surprised). As an emergency physician, I know what the impact of such legislation would be, and it would be devastating. If the bill passes, people will die. People will lose their homes and their livelihoods. I want you to know that I will do everything in my power to ensure that, whatever happens, we will be here standing up for those who need services most - our seniors, children, immigrants and refugees, those who are living on our streets, and others who are most vulnerable.
Okay, now that I’ve gotten that off my chest, I do want to share what has been going on at the County, because it’s been a lot! Given how much has occurred, I will only be able to share a few highlights below, but I will also continue to provide updates on my website and through social media.
New County Budget
I am especially proud of the Board’s unanimous vote to approve the County’s budget for the next fiscal year, which begins on July 1. We were working under significant constraints and had to make some very difficult decisions. Given the challenges, I am proud that we worked collaboratively to do what we feel is right for our County. To read more about the budget and the choices we made, please see this article and the resources available on the County Budget Office website.
Housing & Homelessness
Addressing the homelessness and housing crisis in our community is one of my top priorities. No one can maintain their physical or mental health, treat their addiction, or sustain a job when they do not have a safe place to live. As rents continue to rise dramatically in the Portland metro region, it’s becoming increasingly difficult for individuals and families to maintain their housing without help. For minimum wage workers, rent increases since 2005 have made it virtually impossible to afford housing and other basic needs. Prior to my joining the Board, in 2016 Multnomah County and the City of Portland established the Joint Office of Homeless Services to oversee the delivery of services to people experiencing homelessness in Multnomah County. The work of the Joint Office supports strategies adopted by the A Home For Everyone Initiative, a community coalition of cities, county, businesses, faith leaders and community organizations to pursue unified plans to end homelessness. Chief among these strategies are prevention and housing retention; emergency shelter; and placement into permanent supportive housing.
At least every two years, the federal government requires all metropolitan regions that receive funding from the U.S. Department of Housing and Urban Development to do a “point in time” count. This is a count of people sleeping in shelters, transitional housing or in places not fit for human habitation. This measurement uses data from service providers coupled with a “street count” to provide a snapshot of the breadth and depth of homelessness in our region. In February, dozens of outreach workers and volunteers engaged directly with people living on the streets and in shelters to gather the information that helps us gauge our success and pinpoint areas where we need to do better.
The 2017 point in time count data affirm that our comprehensive strategies are working, but also show that we have a long way to go. Fewer people are living on the streets -- including people who have been chronically homeless. But this is in part because more people have accessed temporary shelter, and we know that this is not the answer to the housing crisis. Sadly,the data do show an increase in the overall number of people who are homeless (this number includes people living in shelter), particularly among those who are most vulnerable - people with disabling conditions, unaccompanied youth, and the elderly. This is sobering evidence that we have a lot of hard work ahead of us.
For the budget, I strongly advocated for maintaining our shared County and City budget investments to address and prevent homelessness. The point in time data show that our strategy is making a difference. Last year, under the leadership of Chair Kafoury, the County and City partnered to put $20 million toward this effort. This year, we maintained that shared investment and also partnered to add more than $4.5 million in new resources that will support our existing shelter capacity - including family shelters, domestic violence shelters, women’s shelters, and winter shelters - while also increasing the housing placement and retention services that are so critical for ensuring our most vulnerable people stay in housing. For more information about who we’ve served as well as our budget investments in fiscal year 2018, see the Joint Office of Homeless Services budget presentation.
I continue to carefully follow the Oregon Legislature’s work on a range of important topics. One area that has been a priority for me has been consideration of a statewide Tobacco 21 - or “T21” - policy to raise the minimum legal age to purchase tobacco and vape products from 18 to 21. Raising the legal sales age is a smart, simple change that will save thousands of lives and millions of dollars in our healthcare system, with minimal if any budget impact. I am hopeful that the Legislature will adopt this important public health policy before they adjourn in July. However, if that does not happen, I am prepared to act swiftly in Multnomah County. I have time held on the July 13 Board of County Commissioners meeting (9:30 a.m. at the Multnomah Building, 501 SE Hawthorne Blvd.) for a public hearing to discuss our own policy to raise the legal age to purchase tobacco to 21 years. I encourage anyone interested in this topic to hold this meeting time on their calendar.
There is so much more, but these are some highlights. Thank you so much for taking the time to read this newsletter. I value your input and feedback. And -- as always -- my door is open. Please do not hesitate to call or email with any thoughts, ideas, questions or concerns.
In good health,
- Our health department offers a crisis line and an urgent walk-in clinic if you’re experiencing a mental health crisis.
- The health department also provides services for children and families, including early assessment and intervention services offered in schools and at neighborhood health centers.
- A large percentage of people in our jails are experiencing mental illness, and the County offers assessment and treatment resources within jails (although these resources aren’t adequate and are within a larger public safety system that limits their effectiveness, as I covered in my March newsletter [see below]).
- Our homeless service system is seeking to help people experiencing homelessness who also have histories of cycling through our mental health and corrections systems.
- Our K-12 education system offers mental health resources for students.
- Our hospitals and health clinics are responsible for treating people experiencing mental illness who come to an emergency room or are seeking care.
To be clear, the mental health care services available are not adequate. As a nation, we haven’t invested in adequate community-based mental health care since deinstitutionalization in the 1980s. The lack of investment shows in the fact that the resources we do have are constantly operating at capacity and people often experience prolonged wait times to access treatment. We’ll need to continue to advocate for funding. But in addition, a significant part of the problem is that these systems operate within silos, and some services are duplicated while others are missed completely. I’m interested in ensuring these systems fit together to catch people who are vulnerable to slipping through the cracks. We must advocate for a system that works more holistically and effectively and catches people before they slip through the cracks.
During the County’s budget process over the past month, I have been advocating for targeted investments that will better align our mental health resources. This year, projected revenues are not keeping pace with needs, and the Chair asked Departments to propose two percent reductions. Given these constraints, I’m especially glad to see the Chair has recognized the importance of mental health care - avoiding reductions from the mental health crisis system and investing new resources in mental health treatment in jails. I wholeheartedly support these investments. I also support the investment in the budget in enhanced mental health services in schools. Additionally, I’m seeking funding for a research project dedicated to describing the mental health services available in our community, connections between those resources, and funding and reimbursement mechanisms so we can identify gaps and develop strategies to improve the system as a whole, even within the constraint of our current resources. The Board will vote on the final budget on May 25.
This Sunday, I will be joining in the 15th Annual NAMI Walks with Multnomah County. Please come walk with me and thousands of others to raise awareness!
Finally, as we wrap up the County budget process for the year, I invite you to join me for my first constituent coffee this Saturday, May 20, from 10 - 11:30 a.m. in the Community Center at Stephens Creek Crossing (6719 SW 26th Avenue). I will be available to tell you what’s been happening at the County, to answer your questions, and, most importantly, to listen. Please come for a cup of coffee or tea, I would love to hear from you!
In good health,
Multnomah County District 1 Commissioner
In the last two weeks, we’ve heard news about at least two local Dreamers protected by the Deferred Action for Childhood Arrivals (DACA) program but detained by Immigration and Customs Enforcement (ICE) officers. Francisco Rodriguez Dominguez and Emmanuel Ayala Frutos are members of our community. While both men have been released from ICE custody, these and other ICE actions have caused many of us to become increasingly angry and fearful about what the Trump administration is doing now and what else might happen in coming months. With this in mind, I wanted to share some relevant information about what we’ve been doing at the County, and also provide some resources.
Locally, we’ve moved quickly to take decisive action. In January, the Multnomah County Board of Commissioners issued an official statement condemning ICE activities in the Multnomah County Courthouse. In February, we asked the public to report ICE activity at Multnomah County courthouses, helping us uphold our policy of not assisting ICE or other federal officials in enforcing federal immigration laws. In the past month, the Board of County Commissioners voted to provide emergency funding to nonprofits offering legal aid to immigrant residents, declared Multnomah a “Welcoming County,” and investigated and explained why we do not expect to lose federal funding as we follow state and federal law. We collaborated with Congresswoman Suzanne Bonamici and Congressman Earl Blumenauer on legislation they introduced in late March to block ICE enforcement in “sensitive locations,” including the County’s courthouses and county health clinics.
Although the stance being taken by the federal government is frightening, resources are available to provide some guidance as we navigate these unprecedented actions. The ACLU has provided this document as a guide to ensure that people know their rights if questioned about immigration status. The Immigrant Legal Resource Center (ILRC) engages immigrants to participate in issues critical to their communities and provides expert technical assistance to immigration law practitioners and community organizations. The Welcoming America Coalition, which Multnomah County joined in March, provides resources and technical assistance to a network of cities and counties across the country dedicated to becoming more inclusive toward immigrants and all residents.
Other issues I’ve been actively working on include advocating for raising the age to buy and use tobacco from 18 to 21, continuing to learn all that I can about our system of mental health care, and preparing for the County’s budget process, which kicks off for the Board when Chair Kafoury releases her budget tomorrow. I’m also looking forward to hearing the Chair present her annual State of the County address at the City Club of Portland this Friday at 12:15 p.m..
If you have ideas, questions, or concerns about anything I’ve mentioned (or any other topic!) I invite you to contact me at District1@multco.us or call my office at 503.988.5220. In addition, please check out the upcoming list of budget meetings and other community events below. In particular, I hope you’ll join me on Saturday, May 20 from 10:00am-11:30am, for a Coffee with Constituents at Stephens Creek Crossing-- a Home Forward housing community in District 1 with 122 affordable apartments. I look forward to sharing more about my work as a Commissioner so far, and hearing about what’s important to you.
In good health,
Multnomah County District 1 Commissioner
Dear friends and neighbors,
One of my top priorities as a Multnomah County Commissioner is to improve our system of care for people suffering from mental illness. This priority came into sharp and disturbing focus late last month when Disability Rights Oregon (DRO) released their report about conditions in the Multnomah County Detention Center.
As the report indicates, roughly 40 to 80 percent of inmates in the county’s jails suffer from mental illness. The report calls attention to the serious challenges and human impact of the gaps in our mental health care system, particularly with respect to those who are incarcerated. I’m very concerned about the findings, and I’m committed to working with Sheriff Mike Reese, Chair Deborah Kafoury, leadership in our County Health Department and Department of Community Justice, along with the DRO and other advocacy organizations, providers and individuals with lived experience of mental illness, to ensure that our corrections system treats people with dignity and respect, provides them with appropriate care and keeps them safe. Click below for a full copy of my response to a letter from DRO about the report’s recommendations.
But the problems with our mental health care system stretch far beyond the walls of the jail. We have to keep fewer people with mental illness from ending up in jail, on the streets, and in the ERs. How? Clearly, housing is a huge part of the solution. The Joint Office of Homeless Services and A Home for Everyone Initiative have made significant strides including opening more shelters and improving the supply of affordable housing. But we need more and better supportive housing, shelter options, and services readily accessible to people who are homeless and living with mental illness. We need to meet people where they are at, and provide services in ways that are meaningful to them.
As I prepare for my first Multnomah County budget process as a commissioner this spring, I am learning about existing investments the County makes in mental health care services, and I will be looking for ways to use our limited resources as effectively as possible. Beyond the budget process, I believe we need a thorough inventory of our mental health system as a whole to determine where there are gaps and where we might be able to better align policies to make a difference.
This issue does not lend itself to easy solutions. But taking a deep dive into our system of mental health care is one of my top priorities, and something I will be looking at every single day. I look forward to keeping you updated about this critical work, and, as always, appreciate your input.
I also wanted to share a few other highlights of recent weeks. On Saturday, I attended a town hall held by Congressman Earl Blumenauer at Benson High School. I had the opportunity to meet Zaira Flores and Leo Reyes, who started the amazing Purple DACA Letters campaign sharing stories from students and others who have been able to work and live legally in the United States under the Deferred Action for Childhood Arrivals (DACA) program. Last week, I testified in front of the Oregon Senate Environment & Natural Resources Committee to advocate for cleaning up diesel emissions, which create a heavy burden in health impacts for Multnomah County. As a doctor, I see the downstream impact of this pollution in the emergency room; we can do better by cleaning up diesel at its source. And finally, two exciting developments on Tobacco 21, a priority of mine: just this week, the Lane County Board of Commissioners passed a local Tobacco 21 ordinance, becoming the first county in Oregon to raise the minimum legal age of purchase to 21! I was also happy to see the statewide Tobacco 21 bill pass out of the Senate Health Care Committee. It's now headed to the Senate Floor for a vote. As I work on this issue here in Multnomah County, I'm energized and emboldened by this progress across the state.
In good health,
Multnomah County District 1 Commissioner
Welcome to my newsletter! I am honored to have been sworn in as Multnomah County Commissioner for District 1 on January 3, and I look forward to communicating with you about what’s going on at the County and my priorities, as well as hearing about what’s important to you so I can represent your voice at the County. Please subscribe to this newsletter to stay informed about my work and events.
I’ve hit the ground running (or I should say sliding, on ice and snow…), but, sadly, one of the defining characteristics of my first month in office has been watching what’s unfolding in our federal government. Like many, I’ve been following President Trump’s executive orders closely, and I’ve been shocked and dismayed. It’s been easy to become overwhelmed, disheartened and even despondent as our democracy appears to be undermined with every new Tweet. But what’s happening nationally makes it even more urgent that we work at the local level and uphold our values. I’ve been energized by the power of our collective voice as we’ve marched for women’s rights, rallied for immigrant and refugee rights, and attended town halls with record-breaking participation. I am working with amazing women on the County Board, and I intend to do my part to ensure that our systems continue to support and protect everyone in our community, particularly those who are most vulnerable.
So many of you have contacted me to ask “What can I do??” I know exactly how you are feeling. When I first started advocating for the issues I care about, and I wasn’t sure where to begin, a friend told me “Just show up.” I started showing up at town halls, board meetings, and anywhere I felt I could play a role. Initially I didn’t say much, but soon I began to feel empowered to take the next steps. I spoke up. I engaged. We each need to take action in whatever way we can. If you’re able, donate your time and/or money to support organizations that exemplify your values. Attend rallies and town halls and board meetings. Join advisory panels and community engagement groups. To get involved in County panels and efforts, visit the Office of Community Involvement website at https://multco.us/oci.
Despite the uncertainty at the federal level, I feel a sense of optimism and inspiration being at the county, where I know we can make a difference. I’m working as a County Commissioner to address the priorities I identified during my campaign. Homelessness and affordable housing, mental health care, and public safety are at the heart of the challenges we face as a community. We’ve all noticed how much more visible homelessness has become, something I see as a clear downstream effect of rising rents, unpredictable disruptions to tenancies, and wages that haven’t kept pace with the cost of getting and keeping stable housing. I also know many people have told me they are concerned about people who are homeless and in mental health crisis. During the winter storms, four people who were living on the streets died due to the extremely cold weather, despite the fact that shelter was available. We need to improve the availability and accessibility of mental health treatment, as well as substance abuse treatment. Over the next four months through the County’s budget process, I’ll be focused on protecting critical treatment services despite projected budget cuts, as well as seeking efficiencies and accountability to get better value for the money we have. I’ll also be tracking statewide policy efforts to improve housing stability, and exploring options we have for local action.
See below for articles about our work so far, and please be in touch any time you have an idea, question, or concern. You can call my team at 503-988-5220, email me at firstname.lastname@example.org, and/or follow me on Facebook and Twitter. I look forward to hearing from you!
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