City Club Report Critical of County’s Mental Health System

March 31, 2011 -- The City Club of Portland released an in-depth report of Multnomah County’s mental health system today which concluded that the county’s mental health system, which served nearly 30,000 people in 2009, is not patient-centered and is egregiously flawed.

 

“In Multnomah County, the system of mental health care needs to be completely restructured,” the report said.

 

In its most stunning criticism, the City Club suggests that Multnomah County may not be the appropriate governmental entity to provide mental health services, and the county should explore working with the Oregon Health Authority to establish a regional authority.

 

Nine members of the City Club analyzed the mental health system, interviewing more than 100 service providers, advocates and policy makers. Its 45-page report looks at how the county manages and negotiates its contracts, its budget, patient outcome measurement, and how that system coordinates with the criminal justice system, hospitals, drug treatment programs, other counties and other systems.

 

Multnomah County contracts with providers using a fee-for-service system, reimbursing providers for the services they perform.

 

There isn’t a structure to decide whether to contract for services or provide them directly, according to Karl Brimner, director of the county’s mental health and addiction services division.

 

That lack of structure is a handicap, according to the City Club’s report because “the county relies on the experience and judgment and individuals running the division,” and contracting decisions are “based on the judgments of key administrative personnel.” There is the potential for misjudgment, individual biases, and subjectivism which can color the decision making process.

 

“The subjective judgment of individuals, no matter how dedicated or accomplished, cannot be the basis for an enduring and effective system of mental healthcare delivery in a community,” the report said.

 

Contracts also do not explicitly spell out standards of performance and outcomes that providers are expected to accomplish. Such contracts should be unambiguous and clearly identify “clear standards of acceptable performance,” the report recommends.

 

“Without uniform data collection and clear standards of performance, objective judgments of the quality of performance are not possible.”

 

The City Club also raised serious concerns about the lack of transparency in the division’s budget. Currently its budget doesn’t show how money the division receives from various funding streams for particular providers, programs and services. 

 

Its analysis “found it impossible to determine exactly how much money is spent for mental health services in the county. “It is difficult, if not impossible, to know how much each department spends on direct delivery of mental health services.” Instead, the City Club recommends the division create a line-item budget and make such information available to the public. 

 

The report also criticizes the lack of specific guidelines and desired outcomes in the division’s contracts, and “the effectiveness of treatment cannot be ascertained.”

 

And, it found “poor coordination” between the division and its service providers, the criminal justice system, hospitals and other entities serving mentally ill people. The result is that patients do not receive appropriate care.

 

 

To read the reaction by Karl Brimner of Multnomah County, click here.

 

To read a complete copy of the City Club report, click here.