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Oregon should do more to fix fractured behavioral health system, report finds

The state’s failure to provide the sort of treatment considered the most effective ends up increasing costs elsewhere in the system, according to researchers
May 21, 2024

At least tens of thousands of  Oregonians have been diagnosed with both mental illness and a substance use disorder. However, a new study has found the state’s treatment providers are too often geared to treat one type of situation or the other— and not both at the same time.

In Oregon, people are significantly more likely than the national average to be diagnosed with both mental illness and a substance-use disorder. But providers in the state often don’t offer the sort of integrated treatment shown to be the most effective, according to the study.

And substance use treatment providers that do treat the different disorders together often require costly commercial insurance coverage that people in need don’t have.

The study released by the Oregon Health Authority comes amid increased awareness of meth-induced psychosis and at a time when Oregon’s reported rate of meth use ranks among the nation’s highest. 

The new findings are significant because the spread of meth and associated mental illness has inflamed Oregon’s ongoing addiction, mental health and homelessness crisis — but with little response by state officials, an investigation by The Lund Report found in 2022.

Mental illness also can contribute to substance use disorder, experts say, and Oregonians’ level of access to needed mental health services has long ranked among the country’s worst.

“These clients, who may benefit most from fully integrated treatment settings, are at highest risk for untreated illness resulting in emergency room, state hospital, or carceral stays,”

The study is the latest of several trying to measure gaps in the state’s behavioral health system even as lawmakers increase funding to address those gaps. Researchers with the School of Public Health shared by Oregon Health & Science University and Portland State University produced it with funding from the Oregon Health Authority.

The study indicated that lack of appropriate care increases health care costs, noting federal recommendations that people with high severity substance use disorder and mental illness receive intensive integrated treatment. 

“These clients, who may benefit most from fully integrated treatment settings, are at highest risk for untreated illness resulting in emergency room, state hospital, or carceral stays,” reads the study. 

Among the study’s findings: 

  • While 81% of Oregon’s mental health providers treat both disorders, many don’t integrate treatment. 
  • Only half of mental health providers combined treatments for clients who were also diagnosed with substance use disorders. 
  • Meanwhile, less than half of Oregon’s substance use programs offered treatment for clients who also had a serious mental illness.
  • Only about a third of providers offered programs specifically for young adults or people from the LGBTQ. About the same proportion of programs offered services in Spanish and half offered services in sign language.  

The study referenced an analysis prepared last year for the Oregon Alcohol and Drug Policy Commission and the health authority. It found the state has about half the level of substance use prevention, treatment and recovery services it needs. 

The new study also cited federal data indicating that of roughly 24,500 Oregonians receiving treatment, a little more than two-thirds have a co-occurring mental health disorder, compared to 59% nationally. Additionally, 37% of people receiving mental health treatment in Oregon also have a diagnosed substance use disorder, compared to a national average of 27%. 

“We’re not healing our dual-diagnosis client any better today than we were 10 years ago,”

Different billing codes, different providers

Asked about the report, Heather Jefferis, executive director of the Oregon Council For Behavioral Health, said part of the problem is pay. In an email she wrote that with lower pay, behavioral health workers don’t have the same incentives to obtain multiple licenses and credentials as professionals working in physical health — which in turn contributes to shortages of qualified workers. 

Another complication, according to Jefferis, is how insurers in Oregon and nationally divide their billing into “separate silos with separate processes” for mental health, substance use and physical health. 

The study noted that mental health and substance use treatment services “are typically provided in different settings, by different providers, using different billing codes, without options for billing for both” even if a client is seen by a provider with dual credentials. 

Jefferis wrote that the overall shortage of services means those that are in place “are spread thinly across a very wide set of specialty needs, making the shortage more acute.”

State should expand efforts, report says

The study notes that Oregon lawmakers in 2023 allocated $153 million to add more behavioral health services and treatment beds. 

The researchers wrote that a new program called Certified Community Behavioral Health Clinics, consisting of a dozen facilities that provide mental health or substance use treatment to patients regardless of their ability to pay, is improving access. Oregon lawmakers approved $3.2 million to support the clinics earlier this year. 

Meanwhile another new program to promote “assertive community treatment” for people with severe mental illness also shows signs of helping address the problem, the study found. 

The study cites promising new methods to streamline payments to integrated providers, as well as assess clients, and recommends state officials do more to address the gaps identified by the authors

Asked about the report, Kevin Fitts, executive director of the Oregon Mental Health Consumers Association, told The Lund Report that the study ignores larger questions over whether the mental health system relies too much on the short-term medication of people in crisis without tracking long-term recovery. 

Fitts, who is also a volunteer member of The Lund Report’s Community Advisory Board, said the report reflected a disturbing lack of progress since ten years ago, when the state didn’t have so many people in such a high state of acuity.

“We’re not healing our dual-diagnosis client any better today than we were 10 years ago,” said Fitts.

You can reach Jake Thomas at [email protected] or via Twitter @jthomasreports