Guest Opinion: Oregon’s Behavioral Health System Faces Critical Juncture

Oregon’s Behavioral Health system covering substance use disorder and mental health has been shaped in its access and capacity by periods of gains and constraints. 

Gains of clinical innovation, best practice implementation, emerging culturally specific practices, health care integration and delivery technology have been alternately hindered by constraints of stigma, divestment, cuts and a lack of parity relative to other health care sectors. The most recent recessions of 2001 and 2008 have left indelible fragility. 

We are facing a critical decision point for the future of our behavioral health system and for those who rely on our services. The COVID-19 emergency and looming budget impacts have disproportionately siphoned funding from behavioral health. 

Oregon entered the pandemic ranking among the bottom of states in access to behavioral health care and is facing further divestment and cuts as a result of this crisis. Systemic underfunding and stigma have resulted in a sector which has failed to address the culturally specific needs of Black and Brown communities equitably across the state. 

Research shows disasters and traumatic events precipitate behavioral health crises linked to anxiety, depression and relapse. A system capable of responding to these crises is critical to individual and community recovery.  Walking back any recent progress for the sector will decimate our ability to return to serving the pre-existing need, let alone the dramatic increase in demand predicted due to the trauma experienced by our communities this year.  

A lack of action means it will be even harder for Oregonians to access treatment. Lives will be lost due to untreated substance use disorder and mental health issues. We will also place the onus of these unmet behavioral health needs on sectors ill-equipped to address it such as public safety, emergency departments and child welfare. These outcomes are unacceptable when we have the knowledge to implement effective care.

Oregon has consistently placed innovation ahead of sustainability, creating strong services in a fragile and fractured continuum. Projects funded through grants and pilot mechanisms thrive, create impact, then languish as general fund dollars are clawed back with each new federal investment. Behavioral health services are still lacking the coverage and reimbursement other live-saving health care interventions enjoy.

Oregon’s leaders must recognize this critical opportunity to reverse the pattern. 

In the policy discussions focused on rethinking both law enforcement intervention strategies and the development of a “new normal” for our health care system, behavioral health is often touted as a critical part of the solution. Yet we will have our hands tied, unable to contribute to addressing these challenges, without the resources necessary to deliver quality care to every Oregonian who needs it. 

We’ve learned the lesson many times before: Divesting in behavioral health when times are tough only leads to increased costs downstream.  We hope we don’t have to learn it again.

Heather Jefferis is the executive director of the Oregon Council for Behavioral Health. She can be reached at [email protected].

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Oregon ranks 14th in per capita funding for mental health and addiction treatment but 50th in quality (the system will not let me post websites but these figures are easy to access). The problem is not money (not entirely) but organization. Until someone has the balls to cut through the Gordian knot of turf and bureacracy nothing will change. I have been in the practice of psychiatry for almost 30 years and the EXACT same problems surface year after year.