New beds for psychiatric residential treatment and intensive therapy will help, state officials say
|Originally published by Oregon Capital Chronicle. For more coverage related to Oregon state government, politics and policy, visit the Oregon Capital Chronicle website.|
When Angela Weirich moved her family to Pennsylvania in June, they had relief from trauma. Her daughter, who had repeatedly tried to kill herself in Oregon, seemed happy.
But a crisis soon shattered the calm.
Her daughter tried again to kill herself.
Weirich, who had repeatedly struggled to get enough help for her daughter in Oregon, called Pennsylvania’s child services. They told her she had to obtain permission from a state official for crisis treatment.
She got it.
EDITOR’S NOTE: This is the last of a four-part series on the problems facing children’s mental health care providers in Oregon. Deputy Editor Lynne Terry interviewed more than a dozen providers, parents and state officials and reviewed state records. For anyone needing immediate help, call the Lines for Life for youth at 877-968-8491 or seek help in a nearby emergency room.
“We talked to the mental health delegate there and told him her story,” Weirich said. “They found her a bed in an inpatient (facility) in six hours.”
In Oregon, children wait months for admission into a mental health residential facility, provided they are lucky enough to even find an opening.
The state has allocated millions of extra dollars towards children’s mental health and addiction services programs over the past two years. But the money has been slow to work its way to providers who have long struggled to attract enough workers.
When the pandemic hit, a shortage turned into a crisis, they say.
Over the past year and a half, providers have lost employees who needed to stay home to care for their own children or they were afraid of becoming infected with the coronavirus. Others felt the jobs paid too little or were too difficult so they found other employment.
Their departures have forced providers to slow or stop admissions, leaving even more parents and children in the lurch.
Their only source of help is the local emergency department but that’s often not good enough.
“Until we establish more of a crisis response system, our emergency departments provide a place for children and families who are experiencing an acute behavioral health crisis to go,” Chelsea Holcomb, child and family behavioral health director at the Oregon Health Authority, said in an email. “The ED is able to conduct a medical evaluation, support children with substance use or overdoses and assess symptoms to help determine what level of care is needed and stabilize crises.”
But parents told the Capital Chronicle they had trouble getting their children properly diagnosed and treated in emergency departments. Some hospital workers dismissed the children’s behavior as self-serving to gain a parent’s attention. Others sedated the children and sent them home. Sometimes staff refused to hold them overnight.
Rainy Williams, a single mother of three in Salem, has repeatedly had to take her 8-year-old son to Salem Health’s emergency room in a crisis. Often he’s been violent, threatening to hurt her and himself. Sometimes 9-1-1 dispatchers declined to send an ambulance because he wasn’t injured.
The first time in an emergency room was the worst, she said. He kicked, screamed and spit at staff. They restrained him and asked for permission to sedate him.
“This was the first time I’d ever taken him to the emergency department, and I didn’t know how it was supposed to go,” Williams said. “So I said yes.”
After a second shot, he became quiet.
“My son’s eyes were rolling to the back of his head,” Williams said. “And he was saying, ‘Mom, I’m hungry.’”
But hospital workers said he should not be fed to “teach him that this behavior is not OK,” Williams said.
Weirich also complained about the response from Salem Health emergency department staff to her daughter who tried repeatedly to kill herself.
“They sent her home hours after an attempt,” Weirich said.
In response, Salem Health said it couldn’t comment on a specific case but that its staff is dedicated to caring for young people experiencing a mental health crisis.
“We know this is an area of significant concern and need,” it said in a statement. “While the Salem Health emergency department and psychiatric team are skilled at helping patients in an acute mental health crisis, many patients with mental health challenges require care and treatment after stabilization from an acute episode. Salem Health is not equipped to provide minors with long-term psychiatric care. This care is the expertise of residential treatment facilities.”
Some changes afoot
Gov. Kate Brown and state leaders recognize that Oregon faces a crisis in children’s behavioral health care. The lack of staff and residential care facility beds means that children never get the kind of long-term treatment they need to be able to live at home normally, overcome their emotions and stabilize.
Over the past two sessions, the Legislature shored up the sector with more money, including bolstering in-home services. But just as those were getting ramped up, the pandemic shut them down.
Another thing that’s slowed the system is the Oregon Health Authority’s focus on equity, Holcomb said.
“We’re really calibrating our work to support health equity,” Holcomb said
The state is trying to ensure that all segments of the population have fair access to care.
The Oregon Health Authority and Department of Human Services have offered some stopgap solutions during the pandemic.
They include $3 million for staff for children’s residential treatment facilities, a 10% rate increase to June 2021 and $15 million for recruiting and retaining employees for facilities serving either adults or children by the health authority. The agency proposes extending the rate increase through Dec. 31.
In June, the Human Services Department allocated $16 million for staffing. The department suggests adding nearly $11 million over 20 months to financially stabilize providers, including those who’ve been hit with Covid-19 outbreaks, and creating “float pools” of employees to work in group homes serving children and adults with developmental disabilities.
That would cost $8 million to pay 100 employees for a year, the state calculates.
These proposals were presented to the governor’s office in October to consider for further action.
“I think our hope is to continue working with the partners to figure this out together,” Holcomb said.
Providers have welcomed the short-term measures but they say a long-term fix is needed.
Behavioral health care providers depend on reimbursement from Medicaid and commercial insurers to pay the bills, which includes everything from rent and salaries to IT services.
Right now reimbursement rates pay 70% of the cost of doing business, said Heather Jefferis, executive director of the Oregon Council for Behavioral Health.
“This means about 30% of these revenues must come from donations, grants and other contracts to allow for the agency to provide the service and keep the doors open,” Jefferis wrote in an email.
The amount the nonprofits can raise from donors is limited, she said.
The system does not allow for the expansion that is needed, providers said.
Chris Bouneff, executive director of the National Alliance on Mental Illness Oregon, suggested the state conduct a market survey to nail down the cost of care and competitive pay rates.
“NAMI’s proposal is an emergency infusion to get hourly compensation to a competitive level for a long enough duration to get more solid data on rate structure that put providers in a position to compete in the labor market and provide high quality of services,” Bouneff wrote.
Existing facilities adding beds
Fariborz Pakseresht, director of the Department of Human Services, has reason for hope. Though some providers have closed, new beds are being added.
He cited Looking Glass Youth and Family Services in Eugene as an example.
Craig Opperman, president and CEO, said Looking Glass plans to provide12 mental health treatment beds in a new “state-of-the-art” facility at some point. But his focus now is getting enough staff for the company’s residential crisis center. It’s licensed for 14 beds but even with state money and contract workers it’s only currently operating nine.
“It’s almost impossible to look at an expansion right now when we’re hanging on to keep what we already have,” Opperman said.
Pakseresht hopes their plans can move forward soon.
“That’s something that’s actually very needed at this time,” Pakseresht said. “Those are very difficult services to establish.”
Providence Health & Services, which has an acute psychiatric unit for 22 children and adolescents in Oregon City, just expanded its services.
In 2019, it opened a program at Providence St. Vincent Medical Center in southwest Portland for 26 teens with mental health issues. The teens go to the facility up to five days a week for up to eight hours a day, working with therapists and their peers. The program takes adolescents with severe psychiatric conditions referred by emergency departments and primary care providers.
Providence recently opened a new facility in Oregon City, which can accommodate up to 26 teens.
Pakseresht said further expansion will depend on the economy and the labor market.
“It will take months, if not years, to develop new capacity,” Pakseresht said.
Weirich could not afford to wait. Though Pennsylvania is not perfect, the services her daughter has received have outshined Oregon, she said.
When the family called a crisis helpline, a mental health professional ordered that her daughter be taken to a hospital for evaluation. Doctors there recommended that she receive treatment at a residential treatment facility.
That’s the only place where her daughter can receive the kind of therapy she needs to get better over the long term, Weirich said.
When her daughter was discharged from residential treatment in Pennsylvania, she received outpatient therapy sessions. They were intensive – four sessions a week, which is exactly what her daughter needed.
When her daughter was discharged from a psychiatric residential program in Oregon City, she was put on a waiting list for home-based services, Weirich said.
That was in March.
In early October, Weirich got a call from Oregon.
“They said it was Grace’s turn on the list,” Weirich said.