Shattered

[April 1st, 2009]

A woman in a flowered dress sits in a waiting room in Southeast Portland, two kids playing on the chairs beside her. Across the room, two men sit apart, staring at the floor.

The room is well-appointed, even bland, by clinical standards. The casual visitor might not guess it’s a refuge of last resort for people in a mental health crisis with nowhere else to turn.

The simply titled Urgent Walk-In Clinic is the only place in Portland where uninsured or underinsured residents can see a psychiatric nurse free of charge. Open seven days a week, it serves more than 5,000 clients each year, many of them indigent.

But the economic crash brought huge changes to the mix.

“We’re seeing a new demographic of people—‘I just lost my BMW, I lost my house, and I will kill myself before I become homeless,’” says Greg Borders, clinical and crisis services director for Cascadia Behavioral Healthcare, which runs the clinic.

With the economy cratering, Borders says this is the worst time to cut funding for mental health services. But the latest version of the state budget would turn Portland into a city without a safety net for the most vulnerable residents struggling with mental crisis and substance abuse.

Multnomah County officials have put Cascadia and other nonprofits on notice they may lose nearly all their funding for key mental health services, closing the walk-in clinic and leaving police and emergency rooms to clean up the mess. The same goes for residential addiction treatment.

The news has thrown county officials and service providers into a panic and threatens to eliminate the fragile web of social services for Portland’s most needy.

“If you don’t need us, you don’t see us,” Borders says. “But if we weren’t there, you would see your neighborhood looking very different.”

For the past eight years, the county has faced budget cuts to services because its costs are rising faster than revenue (see “To Have and Have Not,” WW, April 25, 2007).

With the state now also in budget freefall, this year is the most severe yet for the county, which provides most social services and public health programs in Portland.

If this budget gets through, “we’re getting decimated when it comes to mental health and addiction services,” says David Austin, a county spokesman.

County officials frantically shuttled to the Capitol last week to plead for preserving programs facing draconian cuts in the most recent version of the 2009-2011 state budget.

Gov. Ted Kulongoski’s proposed budget calls for a 100 percent cut in residential drug and alcohol treatment and a 90 percent cut in adult outpatient mental health services. He said he believed Medicaid expansions and the addition of more patients to the Oregon Health Plan would pick up some of the costs (see “Gray Anatomy,” WW, March 25, 2009), but those hopes remain in flux.

“This was a very difficult budget to craft,” says Kulongoski spokeswoman Anna Richter Taylor. “Some really hard choices had to be made, and this was one of those.”

Kulongoski wrote his budget in December, even before economists last month tripled the state’s projected shortfall to $3.3 billion. The Democratic-controlled Legislature is now writing a new budget, with Kulongoski’s proposal serving as a rough blueprint. It plans to finish by June.

The Legislature hopes to improve funding for human services, but there are no guarantees, says Sen. Margaret Carter (D-North/Northeast Portland), chairwoman of the Ways and Means Committee.

“There are potentially more cuts yet to come,” Carter says. “How much, we don’t even know.”

Without other numbers to go by, the county must use Kulongoski’s budget for guidance as it renews contracts with nonprofits that provide addiction and mental health services. Facing its own overall $45 million shortfall, the county can’t buy those services without state money.

That’s left nonprofit directors in limbo, not knowing if they should lay off staff or stop accepting clients for longer-term care.

Also on the chopping block is Project Respond, which dispatches mental-health providers to deal with crises on the street. It served 2,700 people last year, taking calls from cops, store owners, neighbors and bystanders. Residential addiction services would be equally hard hit.

Gone would be 138 of 154 beds for drug and alcohol treatment, leaving out about 690 clients each year. The waiting time already is six weeks.

“These are people who will be on the street or in jail,” says Sheila North, who runs the De Paul Treatment Center downtown. “There will be more deaths. I don’t want to be Chicken Little about it, but that’s the reality.”

Yet providers cite studies showing the state saves more than $5 for every $1 spent on treatment.

“You cut alcohol and drug treatment in the morning, in the afternoon you see increases in other areas, whether it’s criminal justice, child welfare or lost worker productivity,” says Timothy Hartnett, director of Comprehensive Options for Drug Abusers. “It’s really bad economic policy.”