PORTLAND, Ore. — Director Sharon Maylan says Multnomah County's behavioral health system is in desperate need of help and hopes the state of Oregon will step in and do whatever it takes to make everything right. .
Meyeran is a frequent critic of county leadership and has a background as an attorney and emergency room doctor. Although her qualifications are not specific to behavioral health, she has made that issue, and homelessness, central to her political platform as a commissioner.
The Story's Pat Dorris met with Mayeran last week and told Gov. Tina Kotek on Jan. 19 that she would like to bring in state resources and explain what she believes the county's behavioral health system is like. I spoke to him about his request to loosen the knots that are currently in place. Doris and Meylan also touched on the county's decision earlier this month to close warming shelters for a week of winter weather.
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Maylan explained that in Oregon, county governments are the primary local authorities for behavioral health, and that umbrella includes both mental health services and services related to substance use. In other states, including Massachusetts, states directly manage behavioral health resources at the local level.
Oregon's model allows each county to approach behavioral health somewhat differently. Ideally, this means each county is responding directly to local needs with the resources it has.
“Personally, I think this is a great approach. In fact, as long as there is some degree of centralization and someone is overseeing with a bigger plan to make sure this all fits together, this kind of I believe things can be managed locally,” Meylan said. “So we need both (state-level) leadership and coordination and functioning counties that can make the system work.”
Instead, Mayeran argues, Oregon lacked state-level coordination and responsive county governments.
“I mean, we haven't had either for as long as a lot of people can remember, maybe even decades,” she continued. “There hasn't been prioritization or investment at the state level, and deinstitutionalization has been driven by the idea that we should invest in local communities and provide mental health services there. , If we do that, people won't need mental health services.'' That kind of institutionalization. ”
Perhaps exiting state-run psychiatric hospitals had promise, but was not accompanied by the local investment needed to make a significant contribution to success. Communities did not have the resources to replace what was lost at the state and federal level.
“And in places like Multnomah County, for example, even if we had the money, we couldn't do it right,” Meylan said. “So it's a combination. If you have a system of functioning in the community, if you have deinstitutionalization, if you have local investment…our system can work. It's possible. It's possible. We've seen examples where it works, and the entire state of Oregon has had such terrible leadership when it comes to behavioral health.”
Mylan blamed former Gov. Kate Brown for the failures of the Oregon Health Authority, calling it “bordering on criminal incompetence,” but said that doesn't excuse the county for failing to do its job as a local behavioral health agency. added.
Mr. Brown undoubtedly disagrees with Ms. Meylan's characterization, and deinstitutionalization was underway long before she became governor in 2015. In Doorris' exit interview, Brown said much the same thing as Meylan about her departure from psychiatric facilities and the failure of state support. For the county.
Meylan said some counties in Oregon are very adept at running behavioral health programs. She cited Washington County, Clackamas County and Lane County, among others, as examples of adjustments in place.
What are your plans?
When she first ran for commissioner, Maylan thought her experience in the ER would help guide Multnomah County's behavioral health system. But she said she had a terrible awakening when she realized she had no plan in place and no shared vision to speak of. So the county commissioned a third-party analysis of its mental health system, which resulted in about 70 recommendations, both large and small, she said.
“So I brought together a group of community leaders and colleagues and people with lived experience and said, 'Okay, these are the people who I've worked with for over 10 years in this system itself and as an advocate. These are the people I know in the UK.'' It was a catchy name: A blueprint for improving behavioral health, an alliteration that means “analyze, adjust, act.'' was. The goal was action. Because we have all served on more committees and task forces than you can imagine. ” Meylan said. “So we were working on that. We actually even created a matrix of prioritizing things and putting them together and creating a plan that Multnomah County needs to have. And, you know, , COVID-19 happened, and other work started, and the chair decided not to support that work anymore – support my work, not support my work. – And everything changed.”
During this period, Deborah Kafoury served as Multnomah County Chair. Her seat will be up for grabs in November 2022, with fellow Commissioner Jessica Vega Pederson defeating Meylan in that race by about 27,000 votes.
Commissioners are limited to two terms, and Meylan has less than a year left in his second term. She had hoped that the new chair would create new opportunities to start a blueprint for better behavioral health, but that didn't happen, she said.
“She wasn't interested,” Meylan said. “And I'm going to provide information, context, stakeholders — the people who are involved in this effort — leaders at the state level — and develop a strategic plan for behavioral health,” she said. .Unfortunately, that hasn't happened.”
To be sure, the Multnomah County Health Department has suffered from a leadership vacuum. Interim Director of Behavioral Health Heather Mirasol has been in the position for less than a year, after years of separation and instability. Ebony Clark led the county's behavioral health program from 2018 to 2020, then served as director of the entire health department before being selected to become director of behavioral health at the Oregon Health Authority. She was the last person to permanently hold the position for an extended period of time.
“Hiring is not prioritized,” Meylan said. “We still don't have a behavioral health director, and it hasn't been a priority for local mental health officials. This is one of the biggest crises facing our county. It's one thing and it affects everything we do. It affects homelessness, it affects everyone.”
ask for help
Meyeran frequently points out that county commissioners have little power in making policy. The county mayor is the chief executive and handles most of the day-to-day administration. That leaves Maylan swayed by her idea of a cohesive plan that the county doesn't have or intend to create.
“Multnomah County currently doesn't have the ability to organize, plan and execute. We don't have the relationships and trust with our leadership community to be able to do that,” Meylan said. “And given that the responsibilities of local mental health authorities are statutory and state-mandated assignments of authority…
“I went to the governor and I know she cares and I know her wife is very involved. She is actually a mental health provider and she But she's working. And I know she understands that. She's trying to do all of the work in the central city, but paying attention to this area and this area. And I think this is the problem: For the state to be successful elsewhere, Multnomah County needs to be successful. They're really starting to get going. The county is We're doing a great job. We need Multnomah County to work, and the system we have doesn't allow that to happen. So I didn't ask the state to take it over, but I asked the state to arbitrate. I asked them to find a solution.”
Although Maylan has criticized Multnomah County's role in overseeing its work, the best explanation for what the county has done since pivoting away from its own “Analyze, Adjust, Act” is that behavioral health It can be found on the Emergency Coordination Network. BHECN released its recommendations in October.
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Initially, BHECN focused on replacing the long-closed Central City Concern Sobriety Center, but when the proposed replacement had no takers, BHECN focused on various behavioral health proposals. I expanded it. Some elements of the later BHECN proposal have already been funded and are currently in the works.
