Letters to The Editor: Exploring a way forward to improve certain mental health programs in Lincoln County
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From Mental Health Advocate Chandler Davis:
Lincoln County Commissioner Bill Hall recently posted to me what he would have to hear, in order to change his mind and restore the cuts to the Department of Health and Human Services mental health and addictions treatment services. Commissioner Hall asks, “What happens if we’re still in a deficit situation with this program a year from now? Given that the program hasn’t built enough clientele in 18 months to be self-sustaining, why should we believe that will be the case a year from now?”
I’m happy to suggest a few places to start:
First of all Commissioner Hunt’s asserts in his last-minute May 25 media release that “after 10 more months of operation, or sometime shortly after the New Year, the county would again be facing a serious financial shortfall of some $1.7 million. And again, the county would be faced with reducing staff to balance the budget.” This assumes that the county is planning to continue with the same “allegedly” incompetent management, failed policies, and lack of either transparency or collaboration that created this situation in the first place.
So, let’s not do that. Instead:
1. The Behavioral Health Division is as large or larger than all the other divisions combined. Get a DHHS Director in place and a County Commissioner in place to oversee the program that has a solid understanding of mental health and addiction treatment as opposed to a banker (Commissioner Doug Hunt) and the former director of a public health division that our committees have been trying for two years to convince the county that mental health and substance use disorders need to be treated and fully acknowledged as major chronic diseases. They are considered as such in the Public Health Division’s Community Health Assessment and Health Improvement Plan.
2. A little collaboration would be nice too. The current designated County Commissioner in charge of the Department of Health and Human Services for the past six years has been to (count ‘em) ONE MEETING of the Addiction Prevention and Recovery Committee and has NEVER, to my knowledge, attended a single meeting of the Mental Health Advisory Committee in the last six years.
3. Get a Behavioral Health Division Director in place to address deficiencies in customer service and staff management in the division that were alleged in the Soyring Consultants report.
4. Get an auditor in place to make sure that the Behavioral Health Division Director and the DHHS Director know about problems before it is too late to correct them.
5. Ask our two private for-profit treatment clinics how they manage to always have plenty of clients, excellent treatment outcomes, and to recruit and retain staff (often for many years) with generally lower salaries and fewer benefits than the county offers. Ask them how they get clients and referrals with effective common-sense marketing, proactive public outreach, excellent customer service, easy and convenient access to services and a reputation for treating clients with empathy and respect. Have them show you how to manage a clinical team in a way that makes clients feel well served and makes professional staff want to stick around for a few years. They are members of the behavioral health committees and they are at most of our meetings and they would be delighted to help.
6. Talk to the folks from the rural Siletz Tribal Behavioral Health Program that is fully staffed, has a great reputation and innovative programs. They are getting out in front of the deadly opioid crisis by offering treatment and ambulatory detox at the Siletz Clinic that Lincoln County and Samaritan Health Services don’t provide. They are at most of our meetings and would be delighted to help.
7. Talk to actual County mental health and addiction clients as researchers did in compiling the recent Soyring Consultants Report which revealed practically impossible barriers to access, delays in getting urgent care, ever-rotating counselors and general indifference they have experienced at DHHS.
8. Ask an actual professional counselor how it feels to have to turn away clients – as many as 75% of them – seeking treatment at one of the private clinics – because the County has a lack of treatment for clients with co-occurring disorders. But then we hear that the county claims they don’t have enough clients to support the full co-occurring disorders program.
9. Talk to the folks in law enforcement and with the courts about the tragedy and unnecessary drain on their resources caused by the lack of treatment, detox services, and the full continuum of mental health and addiction treatment in the community. Talk to the folks at the local hospital emergency room. Talk to the folks at the jail. Talk to the folks in the faith community who are working with the homeless and who are frustrated by the lack of County support for their programs.
10. Participate in a discussion, as we have had at our meetings in just the past few months, about the deficiencies in our responses to our exceptionally high suicide rates in Lincoln County, deficiencies in addressing the mental health and treatment needs of our seniors, the County’s lack of response to a greatly accelerated rate of Hepatis “C” cases on the coast that has alarmed the Oregon Health Authority. Or the upcoming discussion at our next addiction committee meeting on June 7 about what we’re doing about the opioid crisis – along with some GOOD NEWS about possible significant help from the Oregon Health Authority!
11. I am asking that the money be ALLOCATED, not foolishly squandered and spent immediately. It will take time to get back up to full capacity with some combination of re-hired counselors (if we hurry) and new hires. In the meantime, if there is anyone seeing three clients a day, put them to work supporting other perpetually understaffed, high-turnover behavioral health programs like the mobile crisis team and the mental health respite facility that still hasn’t been opened.
Address some of the problems mentioned above that aren’t even on the public radar yet. Beef up the very well regarded and successful School Based Health Clinics whose one and only addiction counselor and adolescent treatment specialist were also fired in the recent round of layoffs.
12. Develop relationships with the Tribe and private providers to avoid duplication of services without jeopardizing other programs. Stop erecting artificial barriers like the one preventing well-qualified addiction counselors from treating anyone with a co-occurring disorder or a dual diagnosis, except in very severe cases that may legitimately require a masters degree mental health counselor. Most counselors will tell you that most clients coming in for substance abuse disorder treatment will probably turn out to have some diagnosed or undiagnosed co-occurring disorder.
13. Work with Samaritan Health Services to convince them to take on more of the responsibility for treating the chronic diseases of mental illness and addiction ON PARITY with their treatment of cancer or diabetes, as Oregon’s parity laws would seem to require. THEN you can talk to us about cutting back on the County’s investment in behavioral health treatment.
14. GET OVER the idea that mental health and addiction treatment must be self-sustaining. That’s why we have government – to fill the gaps that private enterprise can’t fill. We accept that many primary health care programs like emergency rooms and fire departments and police departments are not self-sustaining. Why are we demanding that treatment to save the lives of people with mental illness and substance abuse disorders pay for themselves?
FINALLY, TELL THE COMMUNITY THE TRUTH – including the citizens advisory committees – about problems and challenges at DHHS instead of covering them up. Month after month during the past six years the Behavioral Health Division Director has told us in her monthly reports that, other than trouble filling vacancies and the constant turnover, the Co-occurring Disorders Program was the best thing since sliced bread – right up until they fired the DHHS Director. The County Commissioners who were themselves in charge of overseeing the department for the past six years started telling us that everything that was wrong with the behavioral health program was all the past director’s fault. (I don’t think they mentioned climate change, but I get the impression that was probably her fault too.)
To citizens of Lincoln County: Please call the County Commissioners’ office at 541-265-4100 to let them know how you feel or EMAIL the budget committee staff with your written comments: firstname.lastname@example.org
In response to Mr. Davis’ observations above, Lincoln County Commissioner Bill Hall offered these remarks:
Chandler Davis makes many valid points in his commentary and a lot of these are already in the works. We have changed leadership at the top of HHS. The director of the co-occurring disorders program has resigned. The Health and Human Services finance officer has resigned. We are actively searching for a new leader for the department. There may be additional staff and management changes ahead.
We do have yearly audits as required by law, but they are limited in scope. They assess whether we have complied with Oregon budget law but they are not performance audits, as such. They do not measure a program’s effectiveness. The Soyring Report, delivered at the beginning of this year, said there appeared to be no linkage between performance goals, outcomes, spending and staffing.
We need to build better working relationships with our community partners. We need a better marketing and outreach strategy to make sure we get people through the doors in numbers sufficient to sustain staff and programs. We need to streamline the intake process. I am still trying to understand why that didn’t happen before we increased staffing. Every one of the issues Mr. Davis has identified has been identified by county management, and we’re starting to make headway on them. But that will take time.