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Proposed Overhaul Of Oregon’s Mental Health Care System Starts With Phone Number

Oregonians may get a 9-8-8 emergency phone line to take behavioral health calls, and a new network of behavioral health teams and centers.
April 21, 2021

Oregonians may see a day when 9-1-1 is not the emergency number to call for a behavioral health crisis or need. 

Lawmakers are considering a bill that would provide a statewide phone line for people to call when they need help with behavioral health needs -- whether it’s an immediate crisis or a simmering problem. The phone number would be 9-8-8. Instead of police arriving, a crisis response team would show up to talk to the person and assess the situation. 

The caller could get transportation to a treatment center for care, either overnight or just a few hours. They could also get an appointment to see a community mental health provider. Or the 9-8-8 dispatcher could send a response team to help a family and children with behavioral health needs.

But for the plan to unfold, Oregon would need to set up not only the phone line infrastructure, but also add crisis response teams and open new treatment centers. 

The concept is to get people treated sooner and avoid a full-blown crisis with police. Supporters say it would save money by keeping people out of jails, hospital emergency rooms and Oregon State Hospital.

Under the new program Oregon is pushing, the state would work with local agencies to set up crisis response teams for emergency calls and set up a statewide system of crisis stabilization centers where people could go for treatment in facilities from eastern Oregon to the coast. The herculean effort would require start-up costs estimated at up to $165 million for the infrastructure, including new and remodeled buildings to treat people, plus setting up the teams and equipment. The state would fund this effort from a variety of sources, including a new tax on telephone customers, as well as federal grants and state funding.

State officials are urging lawmakers not to delay getting the infrastructure in place, as opening up a 9-8-8 line without more state services would be like running a 9-1-1 dispatch center without having ambulances available to send to emergencies.

At the same time, some worry that Oregon is moving forward too quickly and that it needs to better coordinate the existing behavioral health system that is increasingly complex and fragmented. Some lawmakers also worry about imposing a new tax as the state struggles during the pandemic.

Policymakers and advocates agree that Oregon’s behavioral health system needs an overhaul. Some surveys rank Oregon among the worst in the nation for access to quality care. At the same time, experts recognize that a new program alone is not the cure. Multnomah County Commissioner Sharon Meieran, also an emergency room physician, urged lawmakers to better coordinate all the disjointed parts of the behavioral health system so the new  9-8-8 program succeeds. 

The price tag for the 9-8-8 program -- House Bill 3069 -- is $92 million to $163 million for start-up costs.That includes not just phone lines but a statewide network of crisis stabilization centers to treat people, plus mobile crisis response teams. Those estimates are preliminary. The price difference depends largely on whether the crisis stabilization centers would be in remodeled facilities or require new construction. Operating costs are estimated at $55.5 million for mobile crisis teams and crisis stabilization centers for a two-year budget cycle.

The undertaking has federal backing: Congress last September passed the National Suicide Hotline Designation Act, which designates 988 as the national number for mental and behavioral health crises. The federal action allows states to levy taxes on phone providers to run the program.

Oregon’s bill allows the state to put a tax in place, which means Oregonians could see their phone bills go up if phone providers pass it along to customers. It’s unclear how much that tax might be. The House Behavioral Health Committee sent the bill last week to the Joint Ways and Means Committee. The budget committee will review the financial details and do more analysis. 

There are other sources of money that could cover the project too. State officials plan to seek federal aid for the project, especially start-up costs, through the American Rescue Plan, the $1.9 trillion economic stimulus package Congress passed for COVID-19 relief. 

How 9-8-8 Would Work 

The bill’s goal is to help people access behavioral health services before they are in a crisis. People wouldn’t need to be in dire straits to call 9-8-8. But they would need help with a behavioral health issue or need treatment to stop their mental state from worsening.

The aim is to change Oregon’s current pattern of spending behavioral health money on “downriver responses,”  said the bill’s sponsor, Rep. Tawna D. Sanchez, D-North and Northeast Portland.

“{People} need to be able to know that there’s one easy place to start and say: ‘Help me, I need help,’” Sanchez, also chair of the House Behavioral Health Committee, said in a hearing last week.

Oregon Health Authority Behavioral Health Director Steve Allen agrees. 

“We don’t want families to feel that they have to be in a crisis in order to receive care,” Allen said.

The call center itself would be a small part of the start-up costs: just $1.8 million. Lines for Life, an Oregon nonprofit that already runs crisis lines in the state, would work with the state to set up the system. Dwight Holton, CEO of Lines for Life, said the line could help de-escalate situations and funnel calls away from 9-1-1 operators.

But the new system would also need teams to go out when people call 9-8-8, and places people could go to when they need immediate help. 

“If we don’t have the corresponding infrastructure to go with it, when you call 9-8-8, you won’t have the kind of response that we need,” Allen said. 

More Mobile Crisis Teams Needed 

For example, the state wants more mobile crisis response teams. Such teams have workers trained to assess a situation and direct a person to the appropriate service, whether it’s housing, a treatment facility or community program. The hotline staff would have access to information about available mental and behavioral health services, including crisis stabilization programs, providers, outpatient and inpatient services for needs such as psychiatric care, addiction treatment, sobering centers and voluntary and involuntary residential treatment programs.

Some of the programs and services already exist. But Allen told lawmakers that the 9-8-8 line -- and Oregon’s broader behavioral health system -- need more.

Oregon currently has 36 teams -- one in each county. Allen said Oregon needs 47 total statewide. That would cost an estimated $14 million every two-year budget cycle and $600,000 in start-up costs. The teams are widely viewed as a key piece of the puzzle because they would that work off the shoulders of law enforcement. Under the bill, the Oregon Health Authority would work with community mental health programs and local agencies to set up the teams, which would include mental and behavioral health providers. 

The teams would collaborate with law enforcement on how to handle worst-case scenarios, but law enforcement would only join the calls as a last resort during dangerous situations.

New Stabilization Centers Needed

The 9-8-8 system would also need a network of crisis stabilization centers. These could come in different forms, including beds for people and chairs, such as the recliners at Unity Center for Behavioral Health in Portland, where people can stay short-term during treatment. For those new centers, the state would need to add 176 beds and 146 more chairs to the system. 

Locations would stretch from rural eastern Oregon to the coast.

The costs for remodeling and construction is estimated at $66 million to $139 million. Allen said the state expects a mix of remodeling and new construction.

The state’s timeline is tight. The bill requires the 9-8-8 system to become operational in July 2022.

Allen urged lawmakers to act now, saying it would take at least a year to get everything in place.

Officials acknowledged that technical details still need to be worked out. For example, the 9-8-8 line would need to connect to traditional 9-1-1 operators if someone called with a life-threatening emergency. Plus, 9-1-1 dispatchers would need a way to transfer calls to the 9-8-8 center.

Support for the overall concept is strong. Advocates, lawmakers and health care professionals want to improve Oregon’s poor quality of behavioral health care.But some worry that the state is moving too quickly without knowing how the  funding will work -- or how the program will fit into the state’s broader behavioral health system.

Better Coordination Urged

Meieran, the Multnomah County commissioner, asked lawmakers to look for ways to better coordinate the state’s behavioral health work. The state has multiple projects underway now without a unified approach. For example, the state will set up addiction recovery centers because of Ballot Measure 110, which voters passed in November and which decriminalizes low-level drug possession. There also are efforts to address the state’s “aid and assist” population of people who need mental health care before they can aid in the defense of their criminal case.

“No one entity is corralling all of the parallel efforts, and people are falling through the cracks in our systems and suffering and dying as a result,” Meieran said.

She asked lawmakers to focus on coordination so the state is “not moving backward or treading water.” She also asked the state to talk with key players like emergency room providers, emergency medical service providers and community mental health providers, as well as people with firsthand experience using the existing system.

In an interview, Meieran said she supports the principle of the bill but is concerned about the state’s lack of coordination.

“Now it seems it’s going at warp speed to implement as quickly as possible, and I have concerns when we do that that there will be unintended consequences and some significant challenges,” Meieran said.

Some lawmakers are skittish about a new tax on phones. 

Rep. Boomer Wright, R-Coos Bay, one of three committee members who voted against it, said he would support the bill if the state could pay for it without another tax.

Sanchez said it would be worth it to her to pay a few extra dollars a month on her cell phone bill for someone to get the help they need.

Peer Respite Centers Proposed

Other legislation could move the work along too.

Allen said peer respite centers are also a piece of the needed infrastructure. Lawmakers have a separate pair of bills for peer respite treatment centers. These centers are run by peers -- people who have experienced behavioral health issues firsthand in the past. 

House Bill 2980 could establish three peer respite centers in different parts of the state. The House Behavioral Health Committee last week sent it to the Joint Ways and Means Committee with a 6-3 vote.

Peer-run respite centers are designed as a low-key alternative to an acute care hospital. Under the bill, the Oregon Health Authority would hire peer-run organizations to operate the three peer respite centers. The centers would be in the Portland metro area, southern Oregon and eastern or central Oregon. 

The centers would be small. Each could serve six or fewer people. Each person could voluntarily check in and stay at the center for up to two weeks. The centers would provide a homelike environment where they could decompress and get help. The environment is intended to provide a place for people to get help, before their condition worses and they need to check into a psychiatric hospital.

The bill would give the authority $4.5 million in general fund dollars for the 2021-2023 biennium. That comes to $750,000 annually for each peer respite center.

Kevin Fitts, an advocate and executive director of the Oregon Mental Health Consumers Association, is a strong supporter of the bill, sponsored by Rep. Cedric Hayden, R-Roseburg, and Rep. Rob Nosse, D-Portland.

In an interview, Fitts likened the program to vehicle maintenance. Peer respite is like getting an oil change on a car instead of waiting until the transmission falls out on the highway, Fitts said.

The peer respite centers would fill a critical need, Fitts said, as people are turned away at hospitals if providers deem that they are not a threat to themselves or others.

“If  you ask that question where is there a short-term stay in a homelike place -- that doesn't exist,” Fitts said.

Peer respite centers are part of a growing national trend. The first opened in New Hampshire in 1995, and there are now 32 nationwide, said Dr. Daniel Fisher, CEO at the National Empowerment Center, a Massachusetts-based non-profit that provides technical help and training to behavioral health patients, providers and advocacy organizations.

“They’re run by people who have been through similar experiences,” he said in an interview. “They can say ‘I’ve been through this too.’ That confidence is central to beginning the recovery process.” 

They also save money, he said, avoiding the ambulance, police involvement and emergency room costs of a night in a psychiatric hospital. It’s about $300 a night in a peer-run facility instead of $1,200 for a one-night hospital stay, he said.

While in the facility, people can work on their recovery plan and continue to see their psychiatrist. That’s different from a hospital, Fisher said, because a psychiatrist can lose contact with a patient who is admitted into a hospital.

Other states with peer respite centers include Georgia, New York, Wisconsin and California.

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