Mental Health Primed To Get Top Billing In Oregon Legislature

With the state’s legislative session fast-approaching, mental health has moved into the crosshairs for Oregon lawmakers, with a number of proposals on the horizon that seek to transform the future of behavioral care in the state.

The proposals coincide with an emphasis by the Oregon Health Authority on improving mental health care for Medicaid recipients. There’s wide recognition that the Oregon Health Plan, which serves one in four Oregonians, has often left mental health patients in the lurch, with too few providers to serve the demand. In its next iteration of Medicaid, which starts in 2020, the health authority has identified mental health care as a priority area along with social determinants of health like housing and education and a change in the pay model for insurers and providers.

Though session starts later this month, lawmakers and others have already filed so-called legislative concepts, or initial bills, on an array of subjects. At least a handful of proposals concern mental health care in Oregon, covering everybody from children to older adults. Some of the ideas would make incremental changes; others would require more substantial shifts.

Critics, who’ve blasted the state for years over its response to mental health needs, say the bills are good but don’t do enough to address the problem on a systemic level. Chris Bouneff, executive director of the National Alliance on Mental Health’s Oregon chapter, said the initial implementation of state health-care reform was rushed without much regard to mental health, and that the new requirements for coordinated care organizations aren’t much better.

“They’ve been explicitly mentioning mental health since they did this, and so far there hasn’t been any actual attention,” Bouneff said. “We haven’t moved the needle at all.”

Two proposals from the House Committee on Health Care address the health of students. One would add mental health to the list of excusable absences, while a more ambitious and potentially controversial bill would require students in grades 6 through 12 to undergo an annual mental health screening.

The latter proposal would force each school district or public charter school to conduct annual wellness checks with language that fosters honesty and reduces the existing stigma around mental health issues. The results would be reviewed by a qualified counselor or mental health professional, although the legislative concept’s writing does not specify any further action.

Bouneff said school-aged years are the most important for mental health, and he expressed concern that the proposal’s writing is too vague and does not do enough if signs of mental illness are discovered during the wellness checks.

“It’s almost a lottery whether or not you get a good counselor who knows what they’re doing,” he said. “What we have to build is a real system that takes the student and takes that family, and helps guide them into the type of services and education services that they need to not only recuperate, but stay on a trajectory that leads to a positive outcome.”

Rep. Rob Nosse, D-Portland, vice chair of the House Health Care Committee, said ideas like this are part of an overall thrust to improve schools around the state.

“Not just a longer school year and more teachers, but what other things do we really need to have schools be better?” Nosse said. “They want more help for mental health, they want school-based clinics.”

The bill is not attached to any one representative but rather is associated with the House Health Committee as a whole because of its controversial nature, Nosse said.

The proposal coincides with a rising concern among public health officials about suicide rates across the country. According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death for Americans aged 10 to 34-years-old, and Oregon ranks 16th in the country in suicide rates.

Nosse said that Oregon has prioritized teachers over nurses in recent years and that the state now has one of the worst school-to-nurse ratios in the country. He expects the House and Senate education committees to address the issue this year.

Another proposal on mental health would see the creation of peer respite centers where those experiencing distress and anxiety could find support. Drafted by The Oregon Mental Health Consumers Association, it would provide up to two weeks of voluntary peer support in a home-like setting for up to six individuals experiencing emotional trauma that might precipitate a need for hospital services.

A couple of other proposals target older adults and people with disabilities, emphasizing an increased effort on the part of community programs.

One plan would provide the Oregon Health Authority with $10 million of general fund money to expand resources for mental health and addiction issues, suicide prevention, counseling and opioid response and education. The aim of this initial bill is not only to expand behavioral health programs, but also to bring them to areas and communities that lack access, including in rural parts of the state.

Another proposal would use $2 million from the general fund to establish the Center of Excellence on Behavioral Health for Older Adults and People with Disabilities, an institution designed to create programs for those with mental health or substance use disorders. The center’s creation would be completed as a collaboration between the Oregon Health Authority and the Department of Human Services.

Increased cooperation between the two agencies is paramount, said Jon Bartholomew, AARP Oregon’s director of government relations. Bartholomew said that AARP supported mental health bills of this nature, especially if they work to dismantle barriers between the authority and the department.

Bouneff also mentioned government fragmentation, saying that a big part of the problem is that the state targets mental health issue-by-issue, instead of looking at the big picture.

“We cut up these buckets of factors and hope they find a way to collaborate,” Bouneff said. “They don’t.”

Bouneff challenged Oregon leadership to act more boldly on mental health care, focusing more on preventive care rather than trying to deal with illness after it’s developed.

“We don’t intervene until you’re worse off as can be,” he said. “By then it’s too late.”

You can reach Alex Visser at [email protected].

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It's about time Oregon looked into funding peer respite services for mental health clients during this legislative session. Half of the states with the best continuum of mental health care in the country have peer respites and this service model could help a lot of people in Oregon from falling through the cracks, too. ( )

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