Commissioners combine physical, public and mental health services to "treat the whole person"

January 15, 2015

Liesl Wendt, left, director of County Human Services, and Joanne Fuller, director of the Health Department, both supported an aligned system.

Multnomah County Commissioners on Thursday voted to align the county’s public, physical and behavioral health services in a single department. The board directed the Department of County Human Services to begin transferring the Mental Health & Addictions Services Division into the Health Department.

Commissioners will still need to adopt an ordinance to revise the Multnomah County code in June. But the Jan. 15, 2015 decision allows staff to incorporate the information in the upcoming 2016 budget discussions.

The Board’s action, (which you can watch here) responds to the challenges of health reform. Marissa Madrigal, chief operating officer, said the county’s goal is to achieve better care and better outcomes for people on the Oregon Health Plan and the larger population.

In July, Chair Deborah Kafoury directed Joanne Fuller, Health Department director, to evaluate whether combining services under a single department would help achieve those aims. After many conversations with community members, mental health providers, coordinated care organizations, the chief judge and Mental Health and Addictions Services managers, Fuller's analysis supported creating an integrated health system to better treat the whole person, body and mind.

Fuller said an integrated system prepares the county for the full implementation of the Affordable Care Act in 2017. It aligns Multnomah County’s structure for health services with those of the Oregon Health Authority and Clackamas and Washington counties. And, it allows county staff to better coordinate the plans required as the Public Health Authority and the Local Mental Health Authority.

If the board proceeds with the final ordinance, the Division’s $109 million annual budget and 186 full-time employees would transfer to the Health Department on July 1, 2015.

“This creates the foundation for improved client outcomes. It doesn’t change the fundamental challenges we have," Fuller said.

Fuller said community members largely expressed support but some were concerned mental health would be overshadowed by the culture of physical health care. Others fear that the county would stop contracting with non-profit providers and take over providing services.

“ I assured people that is not the vision for this move,’’ Fuller said. “That would be a huge change in policy for the board and I did not see that as what was going to happen now and into the future.’’

David Hidalgo, Mental Health and Addictions Services Division director, said the move will allow for earlier intervention with children, and better coordination with school-based health centers, suicide prevention and public and mental health planning. The Division operates the largest mental health insurance Medicaid plan in the state and the Health Department operates the largest Medicaid physical health system in the state. “There is an opportunity here,’’ Hidalgo said.

Liesl Wendt, director of County Human Services, said the shift will allow her department to further focus on poverty, the lack of housing and other upstream issues that contribute to poor health outcomes.

Amy Anderson, a community volunteer who gets physical and mental health care with the county, said “I am completely excited that physical and mental health are merging.”

“This is a no brainer,’’ said Daryl Quick, the head of Western Psychological and Counseling Services. “This is one of the transformations that has to take place that will make a difference in the long run.’’

Commissioners then voted unanimously voted to take this initial step.

“It’s clear mental health belongs with health care,’’ said Commissioner Jules Bailey. “What we’re moving toward is a more integrated, holistic model."