This story was updated with comments from the Oregon Health Authority.
The state has commissioned a study of behavioral health services in Oregon that is intended to identify treatment gaps and inform Gov. Tina Kotek’s five-year strategic plan for building up the system.
The study comes amid a flurry of spending kicked off during the 2021 Legislative session when lawmakers put more than a billion dollars toward improving the behavioral health system and Measure 110 took effect, directing about $300 million toward addiction care services. Additional investments continued in 2022 — and in the legislative session that just ended — with lawmakers putting another $164 million in new investments toward behavioral health programs.
Slow to roll out, much of the spending from the historic investment in 2021 was dedicated to mental health care. When asked in May how many new treatment beds for the other side of behavioral health — addiction care — would result from the Legislature’s 2021 spending, spokespeople for the Oregon Health Authority and Gov. Tina Kotek told The Lund Report they did not know. This was consistent with reporting from The Lund Report last year that found the state lacked a strategy for effectively addressing gaps in the addiction treatment and recovery system.
Kotek vowed to establish a plan for seeing through existing and new investments in both sides of the system, tasking Oregon Health Authority’s Behavioral Health Director Ebony Clarke earlier this year with studying the problem and formulating a plan to bring to state legislators next year.
In a step toward that goal, Oregon Health Authority signed a $300,000 contract with Public Consulting Group on June 23 for the study, which is slated to wrap up before the start of the 2024 session of the Oregon Legislature.
The Boston-based firm was hired to examine the capacity of Oregon’s mental health and substance use disorder treatment systems and develop a system for prioritizing development initiatives in each region of the state. It’s also been tasked with developing a method for distributing funds for capital, or construction, costs and drafting a report of recommendations due to the agency for review by Dec. 1, according to the contract.
The study is required to estimate the number and types of residential care beds that are needed, analyze the balance of investments in supporting existing capacity versus adding new capacity, and it will examine whether those investments are working to improve the behavioral health of Oregonians, according to the health authority.
To those keeping a close on the state’s progress in fixing the behavioral health system, some of this may sound familiar. A similar study the Oregon Health Authority commissioned to support the state’s Alcohol and Drug Policy Commission’s five-year plan for fixing the substance use disorder treatment system was released this past September. That study, from researchers at the OHSU-PSU School of Public Health, found Oregon’s addiction services system is half the size it should be.
Leading up to its release, state officials touted the study, saying it was going to provide the inventory analysis they needed to begin making more strategic investments.
In February 2022, then-director of the Alcohol and Drug Policy Commission, Reginald Richardson, told The Lund Report that the study would answer questions about what services existed and what would be needed over the next 5-10 years. “I think this study will help us figure that part out,” he said.
But that analysis, which also cost the state $300,000, didn’t count the number of beds, it didn’t account for travel time across counties to access services, and it contained errors that The Lund Report identified when trying to verify its count of drug and alcohol withdrawal management facilities.
“These new studies will provide a higher level of analysis to include what we are spending at a local level for residential care,” Tim Heider, a spokesperson for the agency told The Lund Report in an email.
In a commentary she wrote for The Lund Report in March, Clarke said the Oregon Health Authority’s upcoming study is intended to update last year’s analysis. “It will tell us if we’ve turned the corner in plugging holes in our treatment system and where we need to focus next,” she wrote.
As of June, there were 1,370 residential treatment beds for substance use disorder licensed in Oregon, though not all are necessarily in operation, according to the Oregon Health Authority.
Spokespeople for the Oregon Health Authority and Kotek said at the time they couldn’t say how many treatment beds would be created with new investments from the 2023 Legislature.
However, the landscape that’s resulted from disjointed efforts to reshape the behavioral health system over the past three years may finally come into focus under the new administration at Oregon Health Authority and in the governor’s office.
Leading up to the end of the year in her efforts to create a plan for the 2024 Legislature, as head of the agency’s behavioral health department, Clarke has been tasked with examining how all the spending is working as a whole.
In addition to looking at treatment beds, she will evaluate “the needs of Oregonians compared to the current availability of treatment,” Heider said. He said that includes evaluating investments the Legislature has made over the past three years in behavioral health housing, workforce and residential services, as well as the formation of addiction care networks with Measure 110 funding. He said Clarke is also examining how well mobile crisis and crisis stabilization services created through the implementation of the 988 hotline are meeting the needs of Oregon communities.
This makes me wonder whether we've got the right metrics for developing/reorganizing the mental health system. With all the talk of beds it can sound like a mattress factory rather than a service system. To talk of needs and capacity begs the question "for what?". What are the intended outcomes of this system and how can they be meaningfully tracked and fed back into continuous improvement of the system? What kinds of services (besides just a staff member to greet you at the door) do those outcomes require? What kind of training and management systems are necessary to effectively deliver those services? These are questions to ask before, not after, the system is rebuilt.