Evidence-Based Mental Health Programs Await Better Funding
February 22, 2013 — If left improperly treated, someone suffering from psychosis can have a bleak life ahead of them: years of drifting in and out of the medical system or the prison system. A psychotic break can often set up a person for a life on the margins living off meager disability payments.
The Early Assessment and Support Alliance aims at changing that. By working with teens and young adults during the first year of a psychotic break, the program can help guide clients toward accepting and managing their condition, helping them to stay out of the hospital, out of prison and in school while removing environmental barriers that may be exacerbating their disorder.
“Our goal is to provide support to people as early as possible,” said Tamara Sale, the program coordinator at the Mid-Valley Behavioral Health Network in Salem. “It’s not easy for families to find the help that they need. Half of people who call us have no signs of psychosis, but they do need some kind of help.”
Sale said clients are treated in an evidence-based but holistic fashion, tailored to the individual’s needs. A number of people who have gone through the program are not only staying out of taxpayer-funded institutions but working toward college degrees. Program coordinators also work to stay in touch with clients after they finish the two-year intervention.
“It’s really about helping people gain some context,” for their condition, Sale said. “Our goal is to avoid them ever going to the hospital again.”
The program served 600 families between 2008 and 2011, but it’s still not funded statewide. Three Western Oregon counties that recently joined the program — Clackamas, Lane and Douglas — were funded by one-time private grants.
Kotek lauds EASA
In a state with millions of dollars in unmet mental health funding needs, House Speaker Tina Kotek, D-Portland, pointed to EASA as a high priority.
“She’s called that out as a successful program, and the kinds of programs we ought to be funding,” said her spokesman, Jared Mason-Gere.
Senate President Peter Courtney, D-Salem, specifically mentioned the EASA program when he called for a “game-changing” increased mental health investment of $331 million at the start of the legislative session. Added revenue in the governor’s proposed budget would boost EASA, but the money that Courtney suggested would allow for a greater expansion.
“We need services that can intervene and make a difference in someone’s life before they wind up in the Oregon State Hospital or one of our prisons,” according to an earlier press release from Courtney. “More than half of the adults with mental illness are slipping through the cracks.”
Courtney’s proposal is roughly six times what Gov. Kitzhaber submitted in his 2013-2015 budget to legislative leaders, while funding for Courtney’s proposals was unclear.
“The governor strongly supports Senator Courtney’s mental health initiative and appreciates his leadership for taking on an important issue that’s been neglected for too long,” said Tim Raphael, the governor’s spokesman. “The governor stands ready to help in anyway possible.”
While Kitzhaber’s proposals could come from the general fund, Courtney’s “game-changing” investment would require a new revenue source — and bipartisan approval of two-thirds of the Legislature or a direct vote of the people.
Courtney holding meetings
At the press conference, Courtney cited raising the beer and wine taxes as one possible revenue source, but said he was open to other ideas. Courtney’s spokesman Robin Maxey told The Lund Report this week that there have been discussions with players behind the scenes, but nothing he was ready to make public.
“We have to do something,” said Rep. Jim Thompson, R-Dallas, who’s the ranking Republican on the House Health Committee. But he hadn’t been privy to any discussions over funding sources and was noncommittal to raising revenues. “New taxes -- those are always so popular with the people.”
The governor’s budget predicts that the Medicaid expansion in 2014 -- thanks to the Affordable Care Act -- will save Oregon roughly $44 million for what’s currently spent from the general fund on indigent mental healthcare because those people will eventually come onto the Oregon Health Plan.
But instead of cutting that money from the general fund or allocating it elsewhere, Kitzhaber has proposed rolling the dollars back into state community mental health programs, and adding another $12 million.
The governor’s budget also includes $1.8 million for the EASA program from the general fund, which Sale said would allow the program to become statewide. All the EASA sites do receive some support from the state’s 15 coordinated care organizations, but those sites require more revenue to remain sustainable, she said.
Systems needs more money
Chris Bouneff, the executive director of the National Alliance on Mental Illness of Oregon, said it was encouraging to see Kitzhaber increase mental health funding after several years of flat funding, but the system still was not properly funded as well as it should be.
“You have a mental health system that is stretched to the limit,” Bouneff said. “We have some programs that we know work, they’re just not widely available.” He also stressed the serious need for housing for people with mental illnesses.
EASA started in Salem in 2001 and has since expanded to 19 counties around Oregon. But it’s still not available in much of Eastern Oregon or two of the state’s largest cities, Medford and Corvallis. Once funding becomes available, Sale said they had agencies ready to go east of the Cascades and in Benton County.
Although the CCOs are tasked with integrating mental and physical health services, Bouneff said it’s too early to credit much success to them, other than diverting some patients from the emergency rooms.
“I think it’s overly optimistic to expect the CCOs to have much impact in the first year on mental illness,” he said. “The CCOs came into existence before we had any plans … If they work as intended, there’s a lot of potential.”