Some 600,000 Oregonians are in need of mental health services, 145,000 Oregon adults have a mental health crisis and 32,000 youth suffer major depression. Forty percent of the Multnomah County jail population has a diagnosed mental illness, Dr. Tony Melaragno, vice president of behavioral health at Legacy Health, told Health Share of Oregon’s Community Advisory Council last week.
He said those statistics highlight the need for Unity Center for Behavioral Health, a proposed psychiatric emergency room based on what’s known as the “Alameda study,” a California behavioral health initiative that reduced hospitalization with early, aggressive treatment for patients in mental health crises. Alameda also could sustain its programs using a Medicaid code that paid for up to 20 hours of fee-for-service for medical crises.
Legacy saw 11,000 patients last year with behavioral health crises and other hospitals saw similar volumes. Of the Legacy patients, Melaragno said, 5,000 came in an ambulance, police brought in another 1,000, and the rest were brought by family members or came on their own. What happens to them once they reach an emergency room?
“We keep them safe by putting them in a room. If we’re worried about them, we put someone in the room with them,” Melaragno said. “That’s’ not the right thing but that’s the best we have to offer right now.”
So far, a partnership among Adventist Health, Kaiser Permanente, Legacy Health and Oregon Health & Science University has raised $24 million of the $40 million needed to open the Unity Center, the first comprehensive behavioral healthcare center in Oregon since Multnomah County stopped funding a behavioral crisis center at Providence. Legacy is contributing $10 million in real estate.
Slated to open in late 2016 after eight months to plan programs, get them approved by the city and another year of renovations to the 77,000 square feet at Legacy's Holladay Park campus in North Portland, Unity will provide 79 adult beds and 22 child and adolescent beds. It also includes a “great outdoor space,” which Melaragno described as “very important.”
Unity improves upon the Alameda model, which Melaragno called a more “treat ‘em and street ‘em” approach. He said Unity will provide a “warm hand off to make sure patients receive proper care when they leave our facility.”
“One real key is to have partners to get patients in the right setting” after they leave the hospital, Melaragno said.
As usual, the Health Share Advisory Council had many questions and suggestions. What about addiction services? “Half of patients have dual diagnosis,” Melaragno said, prompting a pilot project with Central City Concern to fast-track patients to Hooper Detoxification Center.
What about naturopathic care? Ronda Harrison, who works for the National Alliance on Mental Illness of Washington County, said she’s seen “phenomenal success with alternative therapies.”
Melaragno said Hooper offers acupuncture and he’s in favor of programs used in Canada for indigenous populations using traditional methods.
What about the special problems of the elderly with depression, dementia and the difficulty geriatric populations have finding outpatient care because many psychiatrists won’t take Medicare?
Melaragno agreed few options exist for geriatric psychiatric care, saying the elderly have more medical needs in addition to mental health needs “and that’s a problem because we’re all getting older.”
“Tons of studies show if you help somebody with behavioral health, you’ll help them with their medical health,” Melaragno said.
Also, Amy Anderson and Joseph Lowe, who also serve on the Ride To Care Transit Advisory Committee, told council members about problems with outdated member addresses, phone numbers and other missing information during the first 60 days of the new non-emergency medical transportation system.
During public comment, Kirk Foster of Wapato Shores Transportation said changes to the non-emergency medical transportation system have “dramatically increased the cost to all the providers” due to changes in policy requiring drivers to wait longer for patients who are not ready, slower payments to providers, and a new, more onerous computer system to comply with federal privacy laws.
“Some providers are not sure how they are going to stay in business,” said Foster.
Health Share CEO Janet Meyer pointed out the Oregon Health Authority changed the payment model and the patient accommodation policy which was a joint decision by Health Share and FamilyCare.
Jan can be reached at [email protected].
