Legislation Targets Gap In Mental Health Support

Kevin Fitts suffered through a sleepless night, battling suicidal thoughts and delusions. By early morning, he was hysterical. He needed to escape his apartment and see someone.

Feeling desperate, he sought help at Legacy Good Samaritan Medical Center in Northwest Portland where doctors put him in a room and interviewed him. After 12 hours, they determined that he wasn’t going to immediately harm himself or others, so they made him leave. He went home and went on a weeklong drinking bender to calm down.

Fitts, who’s battled schizophrenia for decades, has fled to the ER dozens of time in an emotional breakdown. Sometimes he was admitted, but often he was forced out after physicians determined he didn’t pose an immediate threat.

Those hospital visits were expensive, and they didn’t really help. He didn’t need medication, he said. He didn’t need to be committed. He needed someone who understood what he was going through.

“What would have helped is someplace to go to be with my feelings and my pain and not have to be alone through the storm,” Fitts said.

Oregon has a psychiatric hospital in Portland, Unity Center for Behavioral Health, for mental health patients in a crisis, and it has expensive emergency rooms where people like Fitts go out of desperation. There’s also the Oregon State Hospital, which admitted more than 1,000 people at its two campuses in Salem and Junction City last year. Nearly two-thirds of them were “aid and assist” patients who were arrested but unable to participate in their own defense because of mental illness.

There’s nowhere for people to seek refuge outside of an institutional setting, but Fitts, executive director of the advocacy group, Oregon Mental Health Consumers Association, is trying to change that with a legislative bill. House Bill 2831 would create three respite homes for people experiencing a mental health crisis: one in the Portland metro area, one in southern Oregon and one in central or Eastern Oregon.

Each home would be designed to fit local needs, Fitts said. They would be free to patients and have anywhere from two to eight beds where people could stay for several nights while working through their crisis. They would be staffed by peer support specialists -- individuals who are trained and certified by the state to help patients in a breakdown and who can relate to them on a personal level because they’ve also battled mental illness.

The system, supported by Dr. Jeffrey Eisen, chief medical officer of Cascadia Behavioral Healthcare, encourages people who share similar struggles to interact.

“The peer aspect of this approach is really useful,” Eisen said. “It helps to reduce isolation people feel around mental illness.”

Unlike doctors or nurse practitioners, peers don’t dispense medicine. Instead, they offer comfort and understanding.

“This is a not a medical facility,” Fitts said. This isn’t for people who have chronic health disease for example. "This is a place where you go if you have an acceptable level of self-management of symptoms," he said, "and have a (strong) need for emotional support or connection.”

The bill would allocate $2.25 million to open and operate the centers, or $750,000 per year for each home. Fitts would like to see the homes funded several years on a trial basis.

“We want a four- to six-year pilot project,” Fitts said.

Models In Other States

Peer respite houses already exist in 14 other states, but they vary in operation and financing.

Adrian Bernard, program director for the 2nd Story Respite House in Santa Cruz, California, said the home doesn’t have structured activities like some mental health facilities. Instead, guests drive to the ocean or see movies together -- whatever they feel like doing. Bernard said he tries to hire staff who are loving and supportive and who’ve experienced hurdles of their own. Even Bernard has wrestled with his own anxiety and financial fears, which he said has helped him to guide others in distress.

“It’s a place where people can let down their guard and be treated like a human again,” Bernard said. “I think the greatest gift that I’ve seen 2nd Story create (is that it) offers balance to the system, and it’s become a place where providers and family members can see peers being empowered.”

“In doing that, we’ve created deep relationships with people,” Bernard said.

But financing has been difficult.

Second Story opened in in May 2011 with federal funds from the Substance Abuse and Mental Health Services Administration, which promised $3 million over five years. But two years into the program, the federal agency cut grants across the country including half of 2nd Story’s funding. California does not use state funds for respite homes, as Oregon would if the bill passes, so the facility turned to Santa Cruz County to pay for the other half of the grant money. After the grant ran out, the county health board took over funding, Bernard said. Last year the county announced that it would no longer fund respite centers, forcing 2nd Story to turn to fundraising to stay afloat. Bernard said an anonymous donor stepped up and gave the home with enough money to buy the property outright and remain in operation through 2021.

“Now we’ve got to look at sustainability,” Bernard said.

With California Gov. Gavin Newsom now in office, Bernard said he hopes to get guaranteed state funding through legislation. He’d like to see  2nd Story services accepted by California’s Medicaid program, allowing the home to bill for peer respite care.

In contrast to 2nd Story’s fight for funds, Wisconsin supports three respite houses with state money. Tfhe state's 2013-2015 budget dedicated $1.2 million to the homes, according to Elizabeth Goodsitt, spokesperson for the state Department of Human Services. She said the three homes served nearly 400 patients last year.

Wisconsin’s respite houses are managed and staffed by individuals with mental health issues or substance use disorder who have learned to conquer their problems. The state considers the homes crucial to its mental health services, which also include a peer-run crisis call service that handled over 9,000 calls last year, Goodsitt said.

Besides these two state examples, a study of 2,200 patients, including 400 in respite centers and nearly 1,800 who used other medical facilities, found that these homes saved more than $2,000 a month in Medicaid dollars between 2009 and 2016, nearly three fewer hospitalizations per month.

Support In Oregon

In Oregon, Reps. Rob Nosse, D-Portland, and Cedric Hayden, R-Roseburg, have signed on as chief sponsors of the bill. Both are vice chairs of the House health care committee, and Nosse is co-chair of a joint Ways and Means subcommittee.

In a statement, Hayden said Oregon needs more options for mental health patients.

“Opening peer respite centers in Oregon will close one of the gaps in our mental health system where the choices right now seem to be either expensive hospitalizations or people in need of treatment languishing in our justice system with no care,” Hayden said. “Sometimes what a patient really needs is a break from the patterns they’re stuck in, where support from a peer with similar past experiences can create the most effective form of healing.”

The bill has bipartisan support. Besides Nosse and Hayden, House Democrat Carla Piluso of Gresham has signed up as a sponsor along with four Republicans: Reps. Daniel Bonham of The Dalles; Shelly Boshart Davis of Albany, Millersburg and Tangent; Lynn Findley of Baker, Grant, Harney Malheur and parts of Lake counties; and David Brock Smith of Port Orford.

The bill was introduced into the House. To move forward, it needs to be scheduled for a hearing, probably the House health care committee. If it passes, lawmakers would have to approve the funding.

Have any tips about state health care policy or the Legislature? Contact Alex Visser at [email protected].