Douglas County is getting out of the business of providing mental healthcare -- joining the majority of Oregon counties where private nonprofits are in charge.
But the county is going one step further than all but two – Umatilla and Klamath – in ending its role as the local mental health authority, which means they’ll no longer have any hand, as most counties do, in planning for mental healthcare.
Officials in Douglas County cited a careful decision designed to merge physical and mental healthcare for residents by handing off responsibility to the local coordinated care organization -- Umpqua Health Alliance.
At the same time, the decision, which came in late March, surprised Umpqua Health Alliance board chair Dr. Robert Dannenhoffer, he said, and set off a hectic three-month push to set up a new nonprofit and hire workers to provide the same services.
"It's somewhat of surprise," Dannenhoffer said. "We didn't know anything about it until February of this year."
The Umpqua Health Alliance covers most of Douglas County.
"To bring this about in three and half months is really a lot of work," Dannenhoffer added. "We had to do everything. We didn't have anything.”
But Dannenhoffer said that the new, independent nonprofit would be able to handle the work. “From the CCO we're confident they're going to do a good job," he said.
Just over 100 workers are being laid off by the county as part of the decision, county officials said.
But “90%” will be hired by Community Health Association, the new nonprofit, said Oregon Health Authority (OHA) spokeswoman Rebeka Gipson-King.
“We are confident we’ll have a successful transition within the 90 days,” Gipson-King said in an email.
“One thing that gives us confidence is that Community Health Alliance (CHA) was going to offer positions to approximately 90% of the Douglas County Mental Health employees, meaning that much of the leadership and clinical staff would remain the same and a much more seamless transition for clients.”
The change in structure will represent a chance to improve healthcare, integrating physical and mental health, said Kevin Campbell of Greater Oregon Behavioral Health, which is helping to set up the CHA.
“None of us want to be told we want to go to mental health service,” he said, noting that the ideal is to address mental and physical healthcare at the same time.
“In any given year, 20% of the population can benefit from mental health services.... In reality, our mental condition or behavior conditions are paramount to our overall health.”
Douglas County is also going to “be the first in the state” to use an integrated system for electronic records on physical and mental health, he said. “It's better patient care from my perspective.”
The majority of Oregon counties have already privatized mental healthcare. The state contracts with nonprofits, instead in those cases.
Within the last two years, Klamath and Curry counties also contracted out their mental health, though Lake County took back over the care, according to OHA data.
According to OHA, 21 Oregon counties contract out the work to nonprofits: Mountain Valley Mental Health (Baker), Clatsop Behavioral Healthcare (Clatsop), Columbia Community Mental Health, Inc. (Columbia), Lutheran Community Services (Crook), Curry Community Health (Curry), Community Counseling Solutions (Grant, Gilliam, Morrow, Wheeler), Symmetry Care (Harney), Mid-Columbia Center for Living (Hood River, Sherman, Wasco), Best Care Treatment Services (Jefferson), Options for Southern Oregon, Inc. (Josephine), Klamath Youth Development Center (Klamath), Lifeways, Inc. (Malheur, Umatilla), Tillamook Family Counseling, Inc. (Tillamook), Center for Human Development for Union County (Union) and Wallowa Valley Center for Wellness (Wallowa).
Two other counties -- Multnomah and Washington --subcontract out almost all the work but maintain responsibility for it, according to OHA. And the remaining 13 countries do most of the work, but may subcontract out some of the work: Clackamas, Coos, Benton, Deschutes, Douglas, Jackson, Lane, Lake, Lincoln, Linn, Marion, Polk, Yamhill as well as the Confederated Tribes of Warm Spring.
"The change has to do with the new CCO and the way of doing healthcare in Oregon. The advent of CCO's has created an opportunity to look at healthcare differently,” said Douglas County Health Administrator Peggy Madison, echoing Campbell’s comments.
Madison said the decision was “definitely not budgetary” and that Douglas County’s mental healthcare program was "self-supporting."
Asked about the decision to cease being the local mental health authority, she wrote in an email sent to The Lund Report, “This was a Board of Commissioners’ decision.”
Unlike in Douglas, some county officials believe in maintaining their role as a mental healthcare provider as well as supplementing the federal and state resources to address the needs of local residents.
Cindy Becker, Director of the Clackamas County Department of Health, Housing and Human Services, said there’s a reason for at least some counties can do a better job of mental health than CCO’s.
“CCO’s come from the physical health world. That's the wheelhouse,” she said, adding counties have developed an expertise and have the “local relationships” with homeless services, foster care and police.
Clackamas has a good working relationship with their CCO -- as do many counties, she said.
“We try to take the best of both worlds capitalizing on the expertise that each of us bring to it,” she said, noting in addition the county has invested financial resources as have other counties. “They've done it for a long time. They are vested.”
According to the Community Health Assessment for Douglas County conducted by the CCO, which was previously covered by The Lund Report, Douglas County has more than its share of mental health problems. Proportionally fewer Douglas County residents said they were in good mental health between 2006 and 2009 than Oregonians over all. Rates of suicide deaths were higher in the last decade than in Oregon over all. And the problems affect Douglas County youth "with one in four 8th graders reporting a depressive episode in the past year,” according to the assessment.
Chris Bouneff, executive director of National Alliance on Mental Illness--Oregon, said he was hopeful that efforts to improve mental healthcare in Douglas County would prove fruitful.
“You're seeing people tinker, try to do a better job. I think people are doing it with the best intentions,” he said. “We are hopeful as an organization that these changes will pay dividends. It's initially encouraging. They're working with entities that have some expertise in delivering healthcare.”
"Mental health was not working in this state,” he added. “I don't think anyone can say one way's better than the other. At this point, nothing’s worked.”
Rachel can be reached at [email protected].
The image for this story is by Gary Halvorson, Oregon State Archives [Attribution], via Wikimedia Commons.
I think Douglas county shifting mental health to the CCO is the right step for achieving true integration of all things health care and is a step in the right direction. The 90 day transition is not ideal to say the least. I can't think of many decisions that any county government has made in 90 days especially with this level of magnitude.
The most significant service that is probably being shifted is involuntary or court ordered inpatient admissions. I have worked in that area in the past and it's very sensitive and very challenging. While standard mental health services being run out of the CCO doesn't seem like that significant of a change, possible control of involuntary admissions is.