Silos, gaps and hopes for change in mental health care

December 13, 2017

Laura Idica has been hospitalized an estimated 30 times for suicidal thoughts. She’s bounced on and off disability benefits, and landed on and off the streets. Today she sleeps in a women’s shelter operated by the Salvation Army, and spends her days at the Old Town Clinic, where peer support specialists help her navigate social and medical services.  

“It’s amazing,” she said of the support network.

Charles Johnson said the mental health service network should invest in more peer support services.

Charles Johnson spent the early hours of Monday morning in an isolated room in the Good Samaritan emergency department, escorted there in an ambulance by two paramedics and three police officers. Why couldn’t a peer support specialist have responded to his psychiatric episode, he wondered. It would have saved taxpayers money and freed first responders to focus on higher priorities. 

Idica and Johnson were among more than 100 residents who gathered this week to share their frustrations of and vision for mental health services with Multnomah County Commissioner Sharon Meieran.

Meieran, an emergency room doctor, has often expressed dismay that people experiencing mental health crises land in emergency rooms ill-equipped to treat their needs. As a first-term commissioner, she has spearheaded an analysis of mental health services as one of the leading initiatives during her first year in elected office.

“One of the main reasons I ran for Multnomah County Commission was to improve what I perceived as a fragmented and often, I have to say, dysfunctional system of mental health care delivery,” she said Monday night to a packed room at the Central Library. “Too often, our systems don’t seem to work together as effectively as they could, and there are gaps that result in people falling through the cracks.”

Meieran secured $60,000 from the county General Fund to map the mental health care system. The evaluation includes an examination of funding sources, silos, overlap and gaps in services. The county’s Mental Health and Addiction Services Division is one of the area’s largest  safety-net providers. With a staff of 237 and a budget of more than $97 million, it offers long-term and crisis mental health services in partnership with nonprofit providers.

Human Services Research Institute began the work on the mapping project this fall and plans to present findings to the Board of County Commissioners in the spring of 2018. Researchers are interviewing experts, pulling data and holding listening sessions with service providers and members of the public who have had to navigate the system.

Among those who attended this week’s session were state Sen. Lew Frederick, Sen. Laurie Monnes Anderson, Rep. Alissa Keny-Guyer, and mental health providers from Central City Concern, Telecare and ColumbiaCare.

Participants gathered shoulder-to-shoulder in small groups to share their frustrations and aspirations. Many echoed the concerns of resident Johnson about police and jails being employed where social services would be a cheaper — and more effective — intervention.

Kevin McChesney, regional director of Telecare said the problems are many: too few mental health providers accept clients on Medicaid. Providers operate in silos rather than collaborating to serve shared clients. And clients moving from one level of care to another often make that transition alone, with a long wait in between.

​Ben Solheim, a provider with ColumbiaCare, said not only do clients face long waits when they move within the system, but “there are the highest levels and the lowest levels of service, without anything in between,” he said.

Saara Hirshi, a client advocate with the nonprofit African Youth and Community Organization (AYCO), said that despite having a degree in psychology and years of experience helping refugee clients navigate social services, she still struggles to understand the region’s mental health service network. And clients who do get services struggle to get what they need from providers. She wants to see providers receive training on how to work with clients who have different cultural backgrounds and who speak languages other than English.

The problem is compounded by “the language, the culture, the stigma of mental illness,”  she said. “The provider doesn’t understand the culture. The client doesn’t trust the doctors.”

After two hours of discussion, Meieran thanked participants for coming out on a bitter cold evening to share personal stories and ask for change.

“Thank you all so much for taking the time to be here tonight,” she said. “Your feedback is a truly critical piece of this.”

She encouraged residents who could not participate to submit written comments before Feb. 1, 2018.