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Give County Credit that is Overdue

Robert Landauer

The Multnomah County crisis line (503-988-4888) dispatched the county's mobile crisis unit, Project Respond of Cascadia Behavioral Healthcare, to one of about 150 calls for mental-health assistance it receives weekly from the public and police. Julie Larson of the aid unit summarizes the case:

A Latina woman was hallucinating about rats. Spanish-speaking cultural specialists immediately began working with the family to ensure her safety and avoid hospitalizing her, if possible.

Family members attributed the woman's disorder to a curse or spell. "We said it could be caused by other things also, and these pills could help." The staff also reinforced things the family was doing with herbs and prayer and taught her husband techniques he might use to keep his wife calm. County and state workers developed a safety plan that kept the children in a familiar environment but out of range of any unpredictable behavior.

The mother had been discharged without support plans after previous two- to five-day hospitalizations. Once Project Respond became involved, a support plan was drafted, including instructions for family and support-group members to call for early help if specific behavioral indicators appear.

Crisis unit staff members' visits to the family, originally three or four times a week, now are down to every other week, with phone calls in between.

Since Project Respond's participation began almost six months ago, there have been no hospitalizations.

In 1999 and 2000, I sat through hearings of a citizen-led task force that was trying to figure out how to improve Multnomah County's deteriorating mental-health system. Two anecdotes from those who testified have stayed with me.

One was from a woman who reported that her psychiatric-based hospitalizations and jailings rose from once or twice a year to once every two months as her social worker's caseload rose to the point that he would visit her too rarely to see that she needed help to stop her unraveling.

The second was a complaint that the county's lack of any Spanish-speaking mental-health professionals for almost 50,000 Latino county residents forced relatives to travel almost 300 miles to Burns to get culturally appropriate mental-health services in Spanish for family members.

A great deal has changed.

A county walk-in center at Southeast 43rd Avenue and Division Street is open full time to help prevent and to treat psychiatric emergencies. Project Respond's 35 mental health caseworkers now include specialists with capabilities in 14 Asian languages, Spanish, Russian and Polish.

Also, Karifa D. Koroma, the crisis team's criminal justice liaison, connects county jail inmates with mental illnesses to the services they need after release. Without that help, many would recycle back to jail more often, at $1,950 a month, than is avoidable.

Where is the evidence these and other changes make any difference?

The county's premise is that the better its community-based supports are, the more they will shrink the need for costly acute-care hospital beds.

In one month, November 2001, mentally ill Multnomah County residents' time in acute-care hospitals peaked at 3,485 patient bed-days. Since then, that bed-day tally has plummeted. As reforms have gained traction over the past 18 months, a chart showing mental-health bed days (at $700 per day) would look like a steep ski slope viewed from the top.

"We have achieved all-time lows in the past couple of months for residents who still have Oregon Health Plan benefits," says Dr. Peter Davidson, medical director of county mental health and addiction services. Hospital-bed days per month for the last several months are in the low 300s -- accomplished even as the county's mental-health budget from Medicaid has been slashed by $10.5 million.

Let the record show that Multnomah County commissioners, especially Chairwoman Diane Linn and predecessor Beverly Stein, made politically risky changes and have produced amazing improvements to the delivery of mental health services.

© 2003 Oregonian Publishing Co. All rights reserved. Used with permission of The Oregonian.

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