Oregon's struggling behavioral health care system will see some changes in the coming year, with lawmakers in Salem passing several bills directing new approaches — and new money — to address some of the state’s longstanding challenges.
After much hand-wringing over finances, lawmakers approved tens of millions of dollars for mental health including spending to address staffing shortages and add new residential treatment capacity.
But with the May revenue forecast about $750 million less than expected, many funding requests had to be dialed back and many proposals didn’t make it. (Read more about the fate of other bills here.)
Rep. Rob Nosse, chair of the House health care committee, said he had to tighten his funding requests, but he did win approval for additional funding for mental health care. Though lawmakers did not invest in any big, new health care programs as they have in recent years, Nosse is pleased that they are funding core services to address Oregon’s mental health and addiction crisis.
“Our community mental health programs are the backbone of the public behavioral health system across Oregon,” Nosse said in prepared remarks on the Oregon Health Authority budget bill. “These aren’t flashy things, but they’re what keep the whole system moving.”
The state has continually had dismal rankings on mental health. Oregon has the highest prevalence of mental illness in all 50 states and Washington D.C. along with the highest rate of depressed youth and people who’ve considered suicide, according to the annual report by Mental Health America. It also has one of the highest rates of young people with an addiction to illegal substances.
Civil commitment gets a rewrite; workforce incentives
Late in the session, lawmakers bundled a set of controversial behavioral health bills into House Bill 2005, which they ultimately passed. The bill rewrites the state’s civil commitment criteria, loosening some requirements to make it easier to force someone into treatment if they are found to be a harm to themselves or others.
The change in civil commitment law was widely supported by mental health advocates, hospitals and Gov. Tina Kotek, who have criticized existing laws for making it too difficult to commit someone in need of care.
It also changes state law to limit how long some criminal defendants can be required to stay at the Oregon State Hospital, based on the severity of their offense. It essentially puts into state statute the intent of a controversial federal ruling from 2022 that limited stays in an effort to open up more beds for incoming defendants found unable to aid in their own defense. The state has been found in contempt for repeatedly failing to admit on a timely basis patients facing charges, which comprise the vast majority of the state hospital’s residents.
The bill also seeks to encourage additional residential treatment facilities by limiting the ability of local governments to block development on the basis of zoning, permits and other local planning requirements.
That change goes in tandem with another bill lawmakers approved that will help fund more treatment beds.
House Bill 2059 was Nosse’s biggest spending proposal, and it initially asked for $90 million to expand residential treatment facilities for people with severe mental illness. Budget writers approved more than $65 million over two years, more than most bills got.
The bill aims to ease demands onrelieve the Oregon State Hospital — as well asnd also on hospital emergency rooms, which end up “boarding” patients because they have nowhere else to go.
A report last year called for the state to spend nearly $170 million a year to build an average of 645 beds a year to meet the demand. The $65 million approved by lawmakers would fund nearly 130 beds a year.
Rep. Mike McLane of Powell Butte asked in a budget hearing whether the money would actually do what it promised.
“We said ‘no’ to a lot of things to say ‘yes’ to this,” McLane said in a budget hearing last week. He indicated he had little faith the money would be well spent.
Sen. Kate Lieber, a Beaverton senator and co-chair of the budget-writing committee, said Oregon has been trying to catch up from a lack of past investment in mental health.
“It's something that I've been working on the whole time I've been here and will continue to work on,” Lieber said.” So are we making progress? We're building out beds, and people are getting help. And I think we're chasing a bit of a tsunami of mental health.”
Another bill addressing Oregon’s chronic shortage of the behavioral health workers, House Bill 2024, passed the Legislature last Tuesday. Nosse asked for $45 million for mental health care providers to recruit more workers. Budget writers approved $7 million.
The money will be used to provide incentives, including scholarships, tuition assistance, loan repayments and stipends, for people studying behavioral health care.
Creating a statewide strategy for drug prevention
The Legislature passed two landmark bills to develop a statewide strategy to equip young Oregonians with tools and skills to fight addiction later in life. Studies show that more than 90% of adults started using in their youth, and the longer young people delay taking substances, the less likely they are to become addicted.
House Bill 3321 and House Bill 2929 directs the state Alcohol and Drug Policy Commission to develop a state strategy based on the latest research to prevent drug use and addiction, specifically calling out a strategy for people up to age 26. The commission would be responsible for coordinating among local communities and state agencies, tracking current efforts, advising youth treatment providers and reporting to the Legislature on prevention efforts.
Advocates hailed the bill, and so did the commission, which will be in charge of prevention and held accountable. Oregon has not had an addiction prevention program in the past decade, during which time overdoses soared.
One of the most controversial bills of the session, House Bill 3835, was backed by behavioral health providers, hospitals and others who said they hoped to increase access and quality of care for young people in the state’s custody. But it would have modified laws concerning the restraint and seclusion of children in child care facilities, including children with developmental disabilities and those in foster care. It also would have marked a return to out-of-state options for treatment. The bill, which divided Democrats and drew Republican opposition, failed to pass.
Disability Rights Oregon led the opposition, citing the state welfare system’s tragic history in sending children to out-of-state facilities, which was routine until numerous reports of serious abuse and neglect were brought to light. The scandal led to a lengthy class-action lawsuit against the state, which then ended the practice.