Major Changes for Mental Health System?

The legislature’s Ways and Means Committee ponders how to address fragmentation in Oregon’s mental health system.

Thanks to the miracle of WIFI, I am sitting in the gallery of a state legislative hearing that is discussing whether the state mental health delivery system needs some fundamental changes.  The Oregon system has been criticized for being “fragmented” and “inefficient.”  Senator Bates and Representative Kotek have raised the question of whether the state system should be “regionalized” and “integrated” with physical health services.

For over a century, publicly-funded mental health services in Oregon have been county-based.  By state law, each of the 36 counties must have a mental health authority that provides an array of services.  In recent years, many small rural counties have combined forces to provide services regionally.  During the 1990s, the Oregon Health Plan (OHP) spurred the creation of regional managed care organizations that administer OHP money for mental health services.  Non-OHP money from the state continues to go directly to counties.

The state Department of Human Services has weighed in, suggesting that three major pilot projects be established to test whether regionally-administered and funded services would save administrative costs and deliver better services.  It also wants to test whether health outcomes for individuals needed public mental health services can be improved.

Having heard some of the testimony, it seems that folks that run community mental health services are supportive of the goals but skeptical about the approach of regionalization.  Hospitals and managed care entities seem to welcome carefully-implemented change.  Advocates seem to be eager for change.  Counties are feeling threatened.

There can be no doubt that in this time of fiscal austerity, efficiencies are welcome.  Treatment approaches that keep people in their homes and support healthier lifestyles are welcome.  But people involved with mental health services have good reason to be wary.  Years of chronic underfunding have been punctuated by periods of serious racheting back of support.  Will efficiencies merely result in loss of local control and a loss of financial support that is never returned?  Or will changes result in more uniform access to quality services across the state and elimination of the 25 year life-expectency gap for people with mental illness?  The conversation ensues.