Oregon’s Burdened Mental Health System Faces New Challenges From Coronavirus
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Oregon’s mental health system was overloaded before coronavirus hit the state.
COVID-19 adds a new challenge for clinics already suffering from a lack of workers and inadequate public funding. Providers and support groups are now scrambling to help a vulnerable segment of the population that often suffers the most when a disaster strikes.
"We have a badly underfunded mental health system that's overburdened by people in a normal situation,” said Jason Renaud, an advocate with the Mental Health Association of Portland. “This is going to completely overrun it.”
The coronavirus pandemic has fueled anxieties across society, as people stay at home and avoid others and worry about contracting a deadly disease. It’s even worse for people suffering from anxiety disorders, depression and other conditions, mental health experts said.
Facing stepped-up demand, hospitals, clinics and providers serving mental health patients have had to shift their practices.
Mental health providers are offering telehealth consultations to avoid COVID-19 from spreading. Oregon State Hospital is no longer accepting civil commitments so it can designate units for COVID-19 cases and high risk patients. Patients are missing out on the benefit of in-person support.
One big question on the horizon: How will mental health needs change as Oregonians spend more time sequestered inside their homes away from restaurants, senior centers and other social gathering places?
There is no clear roadmap for what lies ahead. But natural disasters like Hurricane Katrina in 2005 are a stark reminder that mental health needs do not go away during a disaster. Studies have found that the rate of mental illness increased in the population hard hit by the hurricane.
Bob Nikkel, a former Oregon commissioner for mental health and addictions, said the situation forces program providers to adapt.
"I think mental health and addiction programs are going to have to find ways to adapt to this -- not just short term, but mid and long term,” he said. “I think we're talking months."
For example, an online chat room is in place at Dual Diagnosis Anonymous, where Nikkel is the board chair. Nikkel said social connections are crucial.
The demand for mental health services is likely grow, especially in rural areas, where people who depend on senior centers and other group activities to socialize will become lonely.
“That’s an impact and it’s going to create additional anxiety and probably some depression when people can’t get their needs met the same way,” Nikkel said.
Experts and advocates say natural disasters harm those with mental illness the most because they face barriers to accessing services and help. A pandemic that isolates people is no exception.
“It’s much like almost a natural disaster,” said Chris Bouneff, executive director of the Oregon chapter of the National Alliance on Mental Illness. “We’re in those early stages of rapid response to very stressful and quickly-changing circumstances.”
NAMI’s state office is in the process of purchasing virtual software that’s compliant with federal privacy regulations to run support groups for people in crisis or in need of counseling, he said.
“How do we deliver some of that support that is vital to help people maintain or reach recovery?” he said. “We’re all scrambling.”
He doesn’t know yet the extent of demand that NAMI will see, but it’s likely to grow as Oregonians adjust to the need for extreme social distancing to block the spread of the virus.
"There is a period of time where it's sort of shock and awe where everybody's scrambling to adjust to new services,” he said. "There comes a point hopefully in this current situation where news isn't changing from hour to hour and reaches a new stability in this new normal."
Gov. Kate Brown said in a call with reporters on Wednesday that mental health funding is a growing concern and one of a “number of things on the table in terms of funding immediate needs.”
A special session of the Legislature is expected soon for funding tied to fighting coronavirus and other state budget needs that lawmakers were unable to pass when the session ended after a Republican-led walkout to kill a cap-and-trade bill.
Oregon State Hospital Enacts Restrictions
The Oregon State Hospital was struggling with capacity issues before coronavirus hit Oregon. Inmates in need of treatment before standing trial, so-called “aid-and-assist” cases, have overwhelmed the state-run mental health hospital.
In response to the pandemic, the hospital enacted temporary emergency restrictions to limit admissions. It will now only accept patients found guilty except for insanity in criminal cases and defendants in “aid-and-assist” cases. The restrictions started Monday, according to a March 14 letter to providers by Dolly Mattecci, the hospital superintendent and CEO.
The hospital has no patients who have tested positive for COVID-19 or are being monitored due to an exposure. The hospital has two people who have been tested. Those results are pending.
The hospital has identified 251 patients at risk of serious illness from COVID-19 infection. Officials are designating protective units for these patients and specialized units to treat COVID-19 cases.
“There are shortages of personal protective equipment and medical equipment needed to protect individuals from COVID-19 and to respond to the disease itself,” the letter says. “Health care staff, beds, quarantine or isolation areas and medicines and other treatments to treat persons currently admitted to the hospital are also limited, and they will become more scarce as COVID-19 spreads and if COVID-19 cases present in the hospital.”
Community Mental Health Services Shift Focus
Mental health services are still necessary during a pandemic.
Community mental health providers are focused on essential services such as 24/7 crisis interventions, mobile crisis services, abuse investigations and helping high-risk clients, said Cherryl Ramirez, executive director of the Association of Oregon Community Mental Health Programs.
Providers try to use the telephone and video calls as much as possible, but in-person care, including medication management, is still necessary and continuing. Group therapy sessions are limited now.
“That’s not because they’re nonessential,” Ramirez said. “It’s just because they don’t want people to get infected.”
The association is hoping for a suspension of some of the regulatory rules for Medicaid requiring time-consuming data entry and reports so providers and staff can focus on immediate needs of clients, Ramirez said.
Mental health providers are not limiting their services to phone calls. But Ramirez said she’s heard reports that counselors, therapists and other practitioners face shortages of personal protective equipment.
"One of the top needs expressed was for protective personal equipment and supplies because a community mental health program still must see people in person, and they're going to crisis situations,” Ramirez said. “They’re reaching out to homeless individuals. There’s just not enough of the personal protective equipment to go around."
Community mental health faced a funding crunch before coronavirus. A pilot federal program with a dozen clinics in Oregon needed state funding to get federal matching dollars and provide expanded services, primarily in rural areas. The Legislature adjourned without passing that funding in March during the walkout over cap-and-trade, and now the clinics may face layoffs.
Cascadia Behavioral Healthcare, a Portland-area behavioral health and substance abuse treatment provider, is working closely with Multnomah County to reach out to vulnerable people, including those experiencing homelessness.
Cascadia is triaging patients at their health centers by asking them questions about travel and their symptoms, and, if necessary, referring patients to a primary provider for further evaluation.
Cascadia also has an incident command center to aid in prevention and preparedness efforts.
“We have daily calls, often multiple times a day, to track progress, share best practices, and adapt to changes within the community that we may need to address,” Dr. Jeffrey Eisen, chief medical officer for Cascadia Behavioral Healthcare, said in a statement.
Eisen said Cascadia will adjust and make changes as necessary as the situation evolves.
“We remain committed to delivering the same level of care clients would expect at any other time,” he said. “One change we are making, in line with all other health care organizations, is to offer telephonic and telehealth solutions so that we can meet the needs of clients regardless of where our clients or colleagues are located.”
Peer Support Groups Cancel Training
The Mental Health & Addiction Association of Oregon cancelled an 80-hour peer wellness specialist certification training scheduled to start this week. Due to the interactive nature of the training, it wasn’t realistic to transform that into an 80-hour online course, said Adrienne Scavera, director of training and outreach at the peer-run nonprofit.
“In these ever-changing times, that will be a challenge that we face: how to continue to provide high-quality, interactive training in a way that is accessible and responsive to the changing needs of our community,” Scavera said.
The organization’s peer support specialists are using phones, Skype, Zoom and Facetime applications to provide virtual peer support for those with online access.
Renaud, with the Mental Health Association of Portland, said he’s concerned about the homeless in Oregon.
He said officials need to put homeless people in safe places, including shuttered schools.
Every public school that is now vacant could be used for shelter, Renaud said. “But they don't have the political vision to think about what would save these people's lives.”
Kevin Fitts, a mental health advocate, said social distancing will provide fewer opportunities for vulnerable people to connect with people who can help them. He is also worried about the impact on people already facing loneliness and substance use disorders.
“I suspect we’re going to see a spike in severe mental health episodes,” said Fitts, executive director of the Oregon Mental Health Consumers Association, a small policy group. “But I don’t think we’re going to be tracking them significantly.”