The questions are simple enough. With an eye to improving
Multnomah County's mental-health services, a special task
force is trying to find out how well the current system
works--how many people it serves, how much it costs, who
pays for it, and what the results are.
The answers, according to an interim report, are Not
sure, Couldn't say, Don't know, and We're checking on
that.
"What the data workgroup finds is a mental health system
without the basic mechanisms of system accountability,"
concludes a report issued Nov. 17 by a working group
of the county's mental-health task force. "It cannot
easily explain to the taxpayer how much money is being
spent, for what, and with what results."
"We don't have a system in Multnomah County," translates
task-force member Floyd Martínez, the manager
of the county's Behavioral Health Division. "We have
a non-system."
The non-system--an acronymic labyrinth of federal,
state and county bureaucracies containing a riot of
psychiatrists, psychologists, counselors, social workers,
nurse practitioners, nurses and patients--is so complicated
that the task
force was not even able to compile a list of all
the mental-health programs, let alone how much money
is being spent on them. The task force reckons that
various governmental entities spent at least $100 million
on mental health. But they were baffled by the question
of who the cash is spent on. Their estimates of individuals
who used county mental-health programs last year range
from 9,479 to 22,782.
"I think it's embarrassing," says Jason Renaud of the
National Alliance for the Mentally Ill of Multnomah
County, an advocacy group representing people with mental
illness and their families.
"This is a serious problem," says Beverly Stein, chairwoman
of the Multnomah County Commission. "I am concerned."
But while key questions remain murky, the data uncovered
by the task force so far suggest that the ultimate picture
will not be pretty. The Oregon Health Plan--which was
supposed to make health care available to more people--slashed
state and federal money for mental health in Multnomah
County from $59.7 million in 1997 to $44.3 million in
1998, a drop of 26 percent. At the same time, more people
are now eligible for services (but don't ask how many).
"The mental-health system in Multnomah County is deteriorating,"
says Mike McCracken, a former state legislator who is
working as a consultant to the task force. "The effects
are dramatic, they're profound and they're sad."
In October 1995, for example, Network Behavioral HealthCare
Inc., a local nonprofit agency that provides mental
health and addiction services to 6,000 people in the
Portland area, received an average of $487 per client
per month. By February 1999, that figure had plunged
to just $245--a drop of almost 50 percent. "It's huge,"
says Network president and CEO Leslie Ford. "The drop
in revenue has overshadowed everything else."
The money squeeze means clients get less attention.
Before the Oregon Health Plan went into effect, Network
averaged 11.3 visits per client. Now the average is
just 6.6 visits.
Meanwhile, the number of mentally ill inmates booked
into Multnomah County jail has doubled since 1995, according
to the Multnomah County Corrections Health department.
"This is what we've been shouting about," says NAMI's
Renaud.
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Willamette Week | originally
published December 15,
1999
