Oregon’s Behavioral Health System Faces Deep Challenges After Pandemic

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Oregon’s behavioral health care system faces a widening crisis.

People need more help than ever after months of isolation. Providers grapple with low reimbursements. Looming state budget cuts threaten to limit services, with no relief in sight.

These were among the challenges that came up Tuesday in testimony from providers and health officials before the House Interim Committee on Behavioral Health Care. The presentations are a starting point for lawmakers who will have to balance Oregon’s budget with Gov. Kate Brown. 

The state’s behavioral health system, which struggles to attract and retain talent, is a priority. But Oregon faces a budget hole of nearly $3 billion from revenues lost during the pandemic. The Oregon Health Authority has submitted a proposal for a 17% budget cut that would slash more than $370 million from the agency, including $42 million from Oregon State Hospital and $233 million from Medicaid, which helps pay for behavioral health care. 

The silver lining -- if there is one -- is that Oregon behavioral health providers quickly learned how to provide more services for clients through telehealth video conferences or telephone calls. 

Steve Allen, director of behavioral health at Oregon Health Authority, said the state is very concerned about the additional people who have been impacted due to social isolation. The state’s move toward telehealth, Allen said, has helped providers serve patients. Oregon obtained an emergency waiver through the Centers for Medicare & Medicaid Services that gives providers more flexibility to bill for telehealth work. 

Allen said he is concerned about the prospect of budget cuts. 

“We’re looking at cuts to the system that will further undermine our ability to meet the needs of Oregonians,” he said. 

Lori Coyner, Medicaid director of the authority, said people in rural communities who often have long drives to go to an office are well served by a visit on the phone or computer.

Telehealth is changing the dynamics of patient visits. James Schroeder, chief executive officer of Health Share of Oregon, said two separate 25-minute telehealth sessions sometimes work better with patients than a traditional 60-minute visit. 

But telehealth is not a solution for everyone. Rep. Andrea Salinas, D-Lake Oswego and committee chairwoman, said she remains concerned about rural people lacking broadband access and elderly people unaccustomed to the technology. 

Providers agreed.

“We’ve got to keep our eye on the ball,” said Dr. Mike Franz, medical director of behavioral health for PacificSource Community Solutions, a Springfield-based coordinated care organization.

Franz said patients need to receive primary and behavioral care in the same setting to ease access to care. In central Oregon, more than 90% of PacificSource members receive care in an integrated clinic, Franz said.

Rep. Duane Stark, R-Grants Pass, said he supports the concept of patients having  a behavioral health checkup just like they do for regular physical checkups. That would reduce stigma and catch issues before there is a full-blown crisis, Stark said. 

Some providers urged lawmakers to consider long-term solutions to paying for behavioral health care.  

Dr. Jeffrey Eisen, chief medical officer at Cascadia Behavioral Health in Portland, said the state needs payment reform so funding for behavioral health care is sustainable. 

But cuts aren’t the answer, officials said.

Ebony Clarke, director of mental health and addiction services at Multnomah County Health Department, said COVID-19 has  increased the anxiety and sense of isolation in people who are often already in a crisis. Slashing programs would damage community mental health programs at a critical time, Clarke said.

“Our system will be decimated, and we cannot do more with less,” Clarke said.

There’s also the issue of attracting and retaining talent. Counselors make about $53,600 a year on average, according to Larry Conner, a licensed professional counselor and president of the Coalition of Oregon Professional Associations for Counseling and Therapy. But newly minted therapists usually rack up about $150,000 on average in student loans after three years of graduate school. He said Oregon needs student loan forgiveness and better rates for mental health providers to build up the state’s workforce.

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.

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