Why is Oregon’s approach to spending on mental health services like a confidence game?
I’ve just observed the 37th anniversary of my arrival in Oregon. It was a sunny June day in 1976 when we pulled our pickup truck into The Dalles, having driven all the way from the East Coast. After a night in a cheap motel, it was on the Portland where I would study for the Oregon Bar Exam and prepare for my first law job as a VISTA volunteer attorney in the Klamath Falls Legal Aid office.
I was thinking back to my native soil of New Jersey this week as I examined the still-developing Oregon mental health budget for 2013-15. As a teen, I would take the bus into New York and just hang out. Manhattan hadn’t been neatened up back then and the streets offered lots of entertainment including the guys enticing you to play three card monte. A key to that game, for those who don’t know, is the art of misdirection. The dealer gets you to pay attention to one hand while assuring your doom with the other.
So what does this have to do with Oregon and our mental health budget? Well, here in the land of “transparency,” there is still a need for hard-ball politics. And here in the land of socially progressive policy, there is still a need for, well, hard-ball politics.
Consider all the hoopla that accompanied the Governor’s recommendation that the coming budget include a large increase for community mental health services. Add to that the additional hoopla that surrounded a bill from the Senate President to add even more money to the community mental health coffers. Now, all this noise may have been for the benefit of the US Department of Justice that has been investigating why Oregon spends so much on its state mental hospitals compared to its community system. Or perhaps it was trading on the public’s fears and remorse about the shootings in Connecticut and at Clackamas Town Center. Maybe the death of James Chasse and other death-by-police situations had caught lawmakers’ attention. But whatever it was, the legislature seemed to have discovered a new enthusiasm for community mental health services.
What we haven’t heard much about, either through press releases, hearings or public discussion is the legislature’s quiet march to build a new state mental hospital in Junction City and to fund a new pod of group homes near the old Blue Mountain Recovery Center in Pendleton. As one long-time mental health administrator told me, no other state in the country is building new, large state hospitals. In this, Oregon appears to be unique. Other states are certainly not moving in-patient services away from their major population centers. Oregon is. Most states are working to lessen the segregation of its mental health services by moving away from the 20th century model of building big hospitals next to prisons on the outskirts of town or in rural areas where there is less public resistance. Not Oregon.
Take, for example, the plans in Pendleton. Creating a pod of group homes that are physically isolated from the town (in fact, these would be located on the site of the old Eastern Oregon Training Center) achieves the goal of segregation of mentally ill persons while cleverly leveraging federal Medicaid money by pretending that these are “community-based services.” It’s a perfect solution for Oregon: it avoids community resistance to having “those people” within sight, it brings a federal match for state expenditures, and it allows the state to claim that it is offering community-based residential services rather than continuing segregated institutional care.
Now that we are in the late stages of legislative budget formation, we will see whether the promises of increased funding holds up. But, at the same time, the very quiet process of approving the release of bond funding for Junction City Hospital and paying for the debt load for Oregon’s new institutions is moving steadily forward. Oh, and did you know that it will cost close to $200 million dollars, vastly more than either the Governor or legislators have proposed for improved community mental health services? I bet you didn’t.
So while Oregon makes lots of noise about how it wants to expand community services, the real money goes to perpetuating the segregation of people with mental health needs while paying for the jobs to build and staff new institutions. And in years ahead, those buildings will need to be maintained and there will be a strong and ongoing constituency from labor and local communities demanding that those jobs be protected and well compensated. Meanwhile, funding for community services will be subject to all the inconsistency that history has shown to plague them. It is the lack of dependability for community services that has been bemoaned for over 40 year and is generally blamed for the failings of what some call “deinstitutionalization.”
But as the guy on the New York street corner of my youth would tell you, you shouldn’t be looking over there. Just give me your money.