TLR: So I’ve read that Oregon is one of only nine states that haven’t yet banned e-cigarettes for minors.
DK: I don’t know how Oregon’s so behind the times but we’re going to change that. I feel confident the Legislature is going to do something. There’s a lot of energy for that.
TLR: There were a couple of bills in the 2014 session that would have done that, and Republicans as well as Democrats supported a ban on sales to minors, but I’m not sure exactly why neither of those passed.
DK: It got tied up somehow in how to tax the products.
TLR: Ah, I see, which would have required a supermajority.
DK: Plus, people have visceral feelings about any tax. Restricting youth access to e-cigarettes is definitely an issue that has strong, bipartisan support.
TLR: Are you doing anything at the county level to cut off sales to minors?
DK: We just started to educate people on the relatively new challenge of e-cigarettes. We had a public forum here [at the County Commission] and in Gresham. I’ll be working with the cities of Multnomah County to make sure we have a strong, cohesive agenda. In order to have a successful initiative, we need the support of the cities.
TLR: Could there be a county ordinance?
DK: We’re still into the information gathering and discussing phase. Definitely the best way to go with this is to get something passed at the state level.
Legislation is important but educating our citizens is equally important. We’ve got a lot to do with education. Kids can buy these in the stores and they fill them up with marijuana. They’re smoking drugs in school and nobody knows it.
TLR: What else needs to be done with tobacco?
DK: There’s a large proliferation of tobacco products, not just e-cigarettes, that are really aimed at our youth. If you haven’t been to a convenience store lately, you will be shocked at what you see.
Keeping cigarettes out of the hands of people till their 18 is important. Pricing them high with a tax isn’t just for revenue, it’s proven to be a deterrent for teenagers to start using tobacco.
Because of the high prices of cigarettes, they have responded with a whole line of products that can be sold much more cheaply. They have little cigars that are 69¢, and they’re grape-flavored or bubble-gum flavored.
TLR: What do you think of Sen. Steiner Hayward’s proposal to bring tobacco sales under the authority of the OLCC?
DK: We’re going to hear from her on that. Oregon is the easiest place to buy tobacco of any state because we don’t have any enforcement. Youth can buy tobacco here pretty easily. We’re on the verge of losing federal money because we have such lax enforcement. Another idea floating around is to have counties license businesses that sell tobacco.
TLR: Would a program like that be self-sustaining and fee-driven?
DK: Yes.
TLR: Will there be another push to increase the cigarette tax?
DK: I haven’t heard of any new push on that. We’re pre-empted to doing anything at the local level. Right now people are focusing on getting a law passed keeping e-cigarettes out of the hands of kids.
TLR: Shifting gears, do you have any proposals for new policies with the public health system?
DK: We’re looking at merging the Mental Health division under the Health department. Right now, it’s separated out in Human Services. We’re looking at putting them all under the same roof. I think it’s odd that mental health is over there and physical services are here and oral health services are here as if it’s not all part of the same body.
I’m really committed to the well-being of the residents of Multnomah County. Mental health is a big deal to me.
TLR: Will there be more county funding for mental health services?
DK: Not really. Having better integration will put a better focus on mental health services. I’ve got some initiatives that I’ll be rolling out to keeping people healthy. Our last budget cycle had a couple initiatives that were pilots. We’ll be focusing on these and putting money into what works.
TLR: What are a few examples?
DK: We have a mental health program training the public on signs of mental illness and where to call to get help. It’s similar to what we do in training people for CPR or when someone’s choking. If you see someone in a mental health crisis this is what to do. It’s especially important for teachers, healthcare practitioners and law enforcement.
TLR: Any others?
DK: Another thing is that we hired a suicide prevention coordinator, and we’re working closely with Washington County and Clackamas County. It’s a regional effort which I think is really important as well.
TLR: Are you coordinating any other work with the other counties?
DK: Not as much.
TLR: What do you plan to take to the Legislature on mental health?
DK: One thing we’ll be advancing with the Legislature is supportive housing for people with mental illness. We have a such a lack of housing in our county. People get that it’s not effective to give people treatment and then they have no place to go. How are you going to live on the streets and kick heroin or deal with that chaos?
We have a strong system right now but there’s these gaps and one of them is lack of housing. At CATC, [Crisis Assessment and Treatment Center] you can stay for two weeks and receive treatment. If you discharge people onto the street, how much of a chance do they have for recovery? So that’s why we’ll be lobbying the Legislature on that.
TLR: How do people drop in to receive treatment?
DK: It’s not a drop-off center. You’re referred by the hospital. The jail diversion program has two beds.
TLR: Is there a long wait to get into CATC?
DK: The center has been full consistently but we’ve been doing a good job of getting people in and out. It’s not long-term housing. It’s a place where people can get stable.
There’s a lot of enthusiasm in addressing these issues. The community realizes the need for having robust mental health services.
TLR: What else is going on to close the gaps?
DK: Legacy Health has been planning to open a psychiatric center [in the Portland Oregon State Hospital building]. The county has been included in those conversations.
TLR: From a business standpoint for hospitals, they’re always eager to open up cancer treatment centers or cardiac units, something that could bring in money from wealthier people trying to extend their lives, but psychiatric wards are seen as a money loser, and in Washington state a number of hospitals have stopped offering such services. These hospitals ended up being forced by the courts to stop boarding people in emergency rooms, which weren’t really equipped to treat them.
DK: I think that’s why they’re looking at this psychiatric emergency ward. You can consolidate this among the hospitals that want to participate. The regular ER is really not a good place for a person in crisis. But with this new model, people with a mental health crisis are able to see a mental health professional.
Comments
Thanks for attention to this issue of such importance
I also want to express my appreciation for a discussion of this. Providing an open forum is giving attention to the need for brainstorming among all cohorts that are affected by the mess we now have in service for tough-to-serve populations.
I think there is an opportunity to make the POSH site into a lab for ways around the world that have worked better for emotional crisis than the U.S. broken mental-health ghetto. I would love to see a social-cooperative model there, based on the Trieste, Italy, model that has been so thoroughly praised by visitors from elsewhere over the years. Mixed with the western Lapland Open Dialogue model, I see so much opportunity to do something that would finally produce a U.S. model that looks at strengths in people rather than the tired, endless examination of diagnostic nonsense.