When Portland's mayor last week announced the city's plan to address federal concerns about police treatment of people in mental health crisis, he highlighted a key feature: a drop-off or walk-in center where police could take patients in need. He said a center would open in mid-2013.
But the issue is far from settled. Leaders of the health care organizations that Mayor Sam Adams said would open the centers say they haven't ironed out what one would look like, where it would be, how it would be funded or even whether such a facility is the best solution. Multnomah County officials say they were not involved in any talks. And other mental health providers called the deadline unrealistic.
"How this effort will be funded is a good question, and we don't have an answer to that right now," said Janet L. Meyer, interim chief executive office of Health Share of Oregon.
Health Share is one of the state's two new coordinated care organizations for Multnomah County -- a network of health care providers to serve people under the Oregon Health Plan.
"To have something as complex as a drop-off center organized, established and operational by mid-2013 seems, quite frankly, beyond what would be considered possible," said Derald Walker, chief executive officer of Cascadia Behavioral Healthcare.
Written into Portland's negotiated agreement with federal justice officials is the expectation by the U.S. Department of Justice that the state's new local coordinated care organizations will create one or more of the centers for people in need of immediate mental health care by mid-2013.
Meyer said her management team worked closely with the mayor to assist in Portland's response to the Justice Department inquiry. The team's role, she said, was providing background information.
"We agreed that if the outcome of our work indicates a need for a drop off center, then it would be incumbent on everyone -- Health Share, FamilyCare and the county mental health authority -- to facilitate the creation of such a facility."
She called next year's deadline "a challenge."
Jesse Gamez, chief operating officer for FamilyCare Inc., said Thursday he had talked with the mayor by phone before the Justice Department agreement was released, but doesn't know where the mid-2013 deadline came from.
Gamez described the opening of a crisis drop-off center as "one of the options" where police might take people in need of immediate mental health care. "To me, it's unclear how the funding stream is going to occur."
"We are there to partner with the city. We are going to be involved in the process moving forward," Gamez said.
Multnomah County spokesman David Austin said county mental health providers have been involved with the city in "broad-based" discussions on how to improve the mental health-care system.
"We were not involved in any plans or discussions with the city or CCOs around building new drop-off centers," Austin said. "We were not a party to this."
For years, Portland police have lamented the 2003 closing of the Crisis Triage Center at Providence Medical Center, where officers could drop off someone they encountered during a call who needed immediate mental health care.
But the triage center quickly became overrun with patients. And, despite the center's ability to keep patients on mental health holds up to 72 hours, patients often were let out after that period. Budget cuts closed the center.
After the 2006 death in Portland police custody of James P. Chasse Jr., a 42-year-old man with paranoid schizophrenia, the city and county moved to open a new, 16-bed Crisis Assessment Treatment Center. The Portland Development Commission provided $2 million for development, and the state contributed $1 million to renovate the second floor of the David P. Hooper Sobering Center for the new center.
The center opened in June 2011 off Northeast Martin Luther King Jr. Boulevard. Its staff provides patients up to 10 days of assessment and treatment, and develops a treatment plan for after they leave the center. Police, hospital ER staff or mental health care providers can refer patients by calling the county's Mental Health Call Center. But the Crisis Assessment and Treatment Center is not a "drop-off" center for anyone who wants services.
Oregon's U.S. Attorney Amanda Marshall said that before the federal-city agreement was reached, she had attended a brief meeting with the mayor, Central City Concern, hospital officials and other community-based health care groups. "We discussed the need to have the private sector come together to work with the city and state," on mental health care reforms, Marshall said. But any details about deadlines or drop-off centers were negotiated by the mayor, Marshall said.
Adams and Commissioner Amanda Fritz said the mid-2013 deadline came from their talks with coordinated care organization representatives over the past several months.
"Everything in that agreement regarding the drop-off centers, they agreed to," Adams said Thursday.
But the mayor and Fritz said no details on location or funding have been ironed out. Adams said those questions would be answered by a coordinated care organization-subcommittee that includes city and county representatives. "Having us at the table redesigning mental health community services is key," he said.
Fritz added, "We think it'll end up being cheaper to take care of people in crisis."
The mayor said his early conversations with community-based health care organizations suggested it would take 18 to 24 months before the CCO "could get to local mental health service reform."
"At my request, I am very grateful they moved it up to mid-2013."
Walker isn't convinced the mayor's timeline is achievable for a drop-off center. "As much as we would like to have something like that set up" he said, "that strikes me as overly ambitious."
Maxine Bernstein;
Source: http://www.oregonlive.com/portland/index.ssf/2012/11/new_mental_health_center_key_t.html
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