Sam, a 16-year-old Oregonian, pondered suicide and was unable to get intensive mental health services for months.
Sam’s mental health worsened, but residential providers turned them away. After bouncing in and out of emergency departments, Sam ended up in an out-of-state hospital’s psychiatric care wing. After four months there, Sam eventually found a residential facility in Oregon.
The personal account, contained in the Oregon Health Authority’s Ombuds Program report released Wednesday, offers a window into the struggle that families across Oregon face as they try to access outpatient or residential services for their children with behavioral health needs. The Ombuds Program advocates on behalf of Oregonians as they struggle to access services, usually Medicaid-funded treatment and programs through the Oregon Health Plan. The report’s release coincided with separate announcements Wednesday of plans for expanded residential treatment in the Portland area.
The Ombuds Program’s report looks at the needs of Oregon children, teens and young adults as they try to access behavioral health services and makes recommendations for how the state can better serve people in their communities. The Ombudsman Program, which operates independently from the Oregon Health Plan, has received 115 reports from Oregonians since 2019 about the lack of mental health services or poor quality of care related to those services for young people.
Like Sam, each case represents a human life: A grade-school child without access to mental health care. A child in the foster care system needing mental health care who was moved from a family to a hotel with child welfare staffers.
Thousands are in peril. From mid-2021 to mid-2023, 4,725 Oregon Health Plan members 25 and younger visited hospital emergency rooms and received a mental health diagnosis. On average, each visit lasted 14 hours, but some patients lingered there for days. Emergency rooms are not set up to treat mental health issues, and emergency care is among the most expensive but people end up there as a last resort.
Nearly half a million Oregon residents 18 or younger are enrolled in the Oregon Health Plan, and they represent about one-third of the 1.45 million Oregonians in the program that provides medical, dental and behavioral health services to low-income people.
Cate Drinan, senior ombudswoman with the office, said the report looks for ways to improve services in communities for children before they need intensive residential services.
“We decided to ask the question: What could or should exist in the communities that these youth and families live in that if it did exist there would prevent them from needing to rise to that level of crisis in the first place?” Drinan said in an interview. “So it really turned our focus away from residential care and toward community-based mental health for children and youth and families.”
Systemic problems
The Ombuds Program flagged specific shortcomings across the state in different areas.
For example, the state’s mobile crisis services, which includes the 988 suicide and crisis hotline and response teams in each county, has problems that prevent the best care possbile. For example, there is a lack of interpreter services, inadequate workers to help youth and long wait times when the service tries to connect them to community mental health services.
In one instance, a youth in a mental health crisis in school could not access the mobile crisis response team that arrived due to a school policy. Instead, police were called and officers responded while the trained behavioral health responders waited outside, the report said.
There also are disparities across the state. For example, Black young people make up a disproportionately high share of youth who spend more than 24 hours in a hospital emergency department before release or going to a different level of care. In Oregon, Black youth represented 8.1% of young people with emergency room stays of more than 24 hours, but they make up just 2.75% of the state’s population.
Gaps like that, as well as the lack of translator and culturally specific services, are disheartening, said Sarah Dobra, ombuds program manager.
“The gaps to experience and access children’s mental health is significant throughout the state,” Dobra said.
The Ombuds report also found a lack of coverage for a state Medicaid-funded program that provides intensive in-home treatment for youth 20 and under. The program can help them stay in their communities and avoid residential settings.
But only nine of Oregon’s 16 coordinated care organizations – Medicaid insurers – have provided those services since 2022. This means the seven others have not.
Just 321 youth received in-home care from 2021 to 2023, and the state is uncertain how many families have been turned away because of a lack of access.
The report also found families have spotty access to respite care, which gives caregivers of children a break with short-term care.
Heather Jefferis, executive director of the Oregon Council for Behavioral Health, which represents providers, said the report captured the needs in Oregon and made good recommendations to help people access services.
“We just do not have the right services,” Jefferis said. “We just don’t have capacity for appropriate services really anywhere in the state for families, children and youth. Access is an outcome. Timely, appropriate access to the right service at the right time is a very very critical outcome and we are not achieving that outcome.”
Several recommendations
The Ombuds report recommends how Oregon can improve behavioral health care services.
Those include a requirement for Medicaid insurers, which operate regionally, to have an Oregon Health Plan statewide network for inpatient and outpatient mental health services for better access.
The Ombuds report also recommends that the state better fund community mental health services in a way that is comparable to adult mental health funding.
The report calls for culturally appropriate services for people of different races and languages, a strengthened workforce and for youth to receive quicker access to outpatient mental health services through mobile response teams.
The office is also recommending that all Medicaid insurers fully implement the intensive in-home behavioral health treatment program.
The report also calls for the creation of an independent Office of the Ombuds for Children and Youth in Oregon under the governor’s office to focus on children, youth, young adults and families in need of services across multiple agencies and systems. A spokeswoman for Gov. Tina Kotek said the office is reviewing the recommendations and declined further comment on what the response will be.
If you are struggling or having suicidal thoughts, help is available. Call or text the 988 Suicide & Crisis Lifeline or chat at 988lifeline.org.
