The World

Disconnect remains between mental health issues and treatment

The Coos County Jail is staffed two days a week with a licensed mental health professional to provide services and evaluation through Correct Care Solutions, which maintains and provides the jail's medical services.

COOS BAY — Treatment for mental health issues is not a simple process.

There is no vaccine, no magic pill and no one right way to provide the right kind of treatment.

Throughout the state, police officers mainly utilize a local hospital or jail for people with mental health issues, who they suspect may either pose a danger to self or others or who have committed a crime.

But in order to enforce any form of treatment, medical providers are either having a difficult time proving danger or there are not enough resources to provide it.

Kera Hood, nurse manager for the Bay Area Hospital's acute psychiatric unit, said one of the biggest misconceptions about involuntary treatment are the requirements.

"It has to be an actual acute danger to self or others, not what they did 20 hours ago," Hood said. "You could have a person living in a rat-infested trailer with no water, but it's their right to live that way."

In past years, Hood said licensed professionals could put patients on a hold if they felt the patient couldn't provide care for themselves, but current standards now require both imminent and serious risk of danger.

With a greater impetus being put on patients' civil rights, Lisa Rojas, clinical social worker at Bay Area Hospital, said placing a hold is becoming increasingly difficult.

"Trying to prove someone is dangerous is not that easy, and it's getting harder and harder because a lot of those cases where we put people on hold are getting reversed," Rojas said. "There are a lot of people on the street who are psychotic, and they have the right to be that way and that's the choice they've made. We can't force them to take their meds because if they're not harming anybody or themselves, they're meeting their basic needs, like having enough food to eat and a place to stay, we can't just hold them."

With the narrow interpretation of the law, Rojas said many are voluntarily discharged from the hospital and the tragedy of the system is cyclical in nature as the process of evaluation and release repeats itself.

"I care for the people who come through our doors, but it's frustrating when we can't even get it to go to a hearing, and we know they need help, but they don't want to stay, and we have to let them out the door," Rojas said. "Maybe not even a week or two later, they're back, and it's sad." Overwhelming demand for services

For patients who are not held, during the daytime hours, Rojas said the hospital tries to get individuals with mental health issues connected with Coos County Health, but given the demand, getting help can often take time.

"Right now, everybody's so overwhelmed that sometimes with wait times, if they're not already established, it can be awhile," Rojas said.

With its hands tied, the hospital tries to do its best with continuing care for the individuals, but ultimately it comes back to the patient to see it through.

"We do set up follow-up appointments for all patients, but it's whether or not they keep them because we can't force them to go," Hood said.

With the Affordable Care Act providing more access to insure, it has complicated matters for health professionals as it has spread service thin.

Between July 1, 2013 and March 31, 2014, the Department of Justice reported Coos County's Medicaid-eligible severe and persistent mental illness population increased from 492 to 520.

"We've also had an increase in numbers, and this is statewide, coming to the emergency room, an increase to the outpatient and everyone is just overwhelmed," Rojas said. "We have a lack of providers because it's difficult to get people to come to rural areas, but there's also a shortage of people going into psychiatry."

Bay Area Hospital has been particularly bombarded with the need for emergency mental health services.

In 2011, 546 consults were through the ED, as well as 27 child and 159 hospital house consults.

Last year, the hospital had 743 consults through the emergency department, as well as 101 child and 271 hospital house consults.

Along with a greater need for service, Rojas said the degree of mental heath issues has changed, as well.

From July 1, 2013 to March 31, 2014, Coos County reported 176 suicide-related hospitalizations.

"I've been here 10 years, and we've seen more people coming to our ED for psychiatric reasons," Rojas said. "It seems like an increase in suicidal ideations and suicide attempts, and I don't know why it's happening, but it seems to be everywhere. We see sicker people in our unit since I started, when it used to be depressed people, but now the majority of the people we see are psychotic and used to be in the state hospital."

While the number of mental health admissions dropped from 371 to 345 at Bay Area Hospital in 2014, Hood said the number is misleading because the average length of stay has increased.

"They are staying longer, which means their conditions are becoming more intense," Hood said. "That's a huge concern on so many levels." Limitations of care in jails

Aside from the hospital, the next closest resource for officers is the Coos County Jail, where medical services are provided and maintained by Correct Care Solutions.

Jim Cheney, spokesman for Correct Care Solutions, said in the past several months, the number of patients exhibiting mental heath issues was eight, but the jail is only staffed two days a week with a licensed mental health professional to provide services and evaluation.

With the limited amount of care available at the jail, Sheriff Craig Zanni said the department is trying to rectify the problem through partnerships with outside organizations.

"I would say that's accurate, but that's not to say there aren't more people with emotional issues," Zanni said. "We're working on that right now, and we're trying to establish a program with the county."

While there are areas within the jail where patients can be isolated and observed, Cheney said the sheriff's department does not specifically maintain beds for people with mental health issues.

For patients the jail is unable to care for, the next step is transferring the patient to the state hospital, but not before a judge appoints an attorney to secure funding for a state psychiatric evaluation and the subsequent availability of a bed in a state facility. A rare, but vital resource

Bay Area Hospital, which houses 11 beds in its acute psychiatric unit and is staffed 24 hours a day with qualified mental health professionals, is one of the few hospitals remaining with in-patient crisis care.

"It's not lucrative, it's not an easy service to provide, but we do it because it's good for our community," chief development officer Barbara Bauder said.

With the cost of in-patient care so high, many hospitals within the state have closed their behavioral health units.

In the American College of Emergency Physicians' 2014 state-by-state report card, Oregon had the fourth-fewest number of psychiatric beds per 100,000 population. Since 2009, the number of beds has decreased from 28.8 to 8.7 psychiatric care beds per 100,000 people.

But while the number of beds in the state has plummeted, the Department of Justice reported in-patient mental crisis admissions rose from 13 to 14.8 per 100,000 adults between July 1, 2013 and March 31, 2014.

Limiting the number of available psychiatric beds at Oregon State Hospital, the Department of Addictions and Mental Health reported 20 percent of beds are occupied by court-ordered admissions.

ORS 161.370 allows patients to be admitted to the hospital for evaluation and restore a person's "fitness to proceed" with the legal process if a person is unable to aid or assist in his or her defense due to symptoms of mental illness.

In 2013, the average length of stay for ORS 161.370 admissions was 108 days.

Rojas said the reduction in the number of beds, including Roseburg's Mercy Hospital closing its behavioral health unit because of the budget constraints, has impacted the demand for services not only at Bay Area Hospital, but others in the state.

"It really hurt us when Mercy closed down its adolescent and adult unit because when we were full, that's where we would send the majority," Rojas said. "I'd say five years ago I never had a problem finding a bed."

With fewer in-patient psychiatric resources in the state, Coos County Mental Health director David Geels said the hospital has become more of a state resource as he estimated at one point one-third to half of the beds at the hospital were taken up by outside counties.

But with the hospital seeing an increase in the number of patients, Rojas said the hospital has its hands full caring for people in the county.

"A year or two ago when we weren't so busy, we would take patients from other counties to fill up our beds because they need treatment," Rojas said. "Right now, we're staying pretty much busy with our own county that we're not able to do that."

While other hospitals in the county, like Coquille Valley Hospital, may encounter patients with mental health issues, they do not offer mental health services and only stabilize patients for transfer.

Given that the hospital is a major resource in the area for crises, Rojas said while the facility can be overwhelmed due to the dire availability of beds, it will do what it can to help everyone in need.

"Acute psych is the last step before the state hospital," Rojas said. "If all 11 beds are full, we're supposed to call around the state to the other hospitals to see if there is a bed. Everybody is full, their EDs are backed up, nobody has beds, so we do what we have to do to treat them and don't just send them out the door."

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Complexity of mental health issues adding further strain to city services in Oregon

Amanda Loman, The World

The more and more she talks about it, the higher Jodi Fritts-Matthey’s voice gets.

"I just get so frustrated,” Fritts-Matthey said.

The Gold Beach city manager was echoing the frustration and desperation that many of the state's rural officials are struggling with because of the tremendous void of services available for people with mental health issues.

"Neither the city nor the county offer mental health services, so there has been a significant impact on my police department," Fritts-Matthey said. "We spend a horrific amount of time responding to the mentally ill and not doing the law enforcement side of the job, but we deal with it because we have to.

"But they need mental health services — not a cop."

Across the South Coast and throughout all of Oregon's rural counties, mental health care has slowly eroded and is near to non-existent.

Between July 1, 2013 and March 31, 2014, the Department of Justice reported Oregon's severe and persistent mental illness population rose 24 percent from 26,741 to 33,252.

With more insured as of Jan. 1, 2014, increased access has put further strain on the health care system as the current number of providers is unable to meet the demand.

"With the expansion of the Affordable Care Act and the Oregon Health Plan, 8,000 more people have insurance in Coos and Curry County," Coos County Mental Health Director David Geels said. "The number of providers did not change so there's no way the system can respond to the growth."

That dramatic rise in the number of people needing care has local and state leaders struggling to find answers. In the meantime, local first responders have had to bear a burden they are least prepared to address.

Law enforcement is so tied up with responding to calls that Fritts-Matthey estimated her police department spends more than 50 percent of its time contacting people with mental health issues.

"I feel the citizens are not getting what they pay for in law enforcement," Fritts-Matthey said. "It falls on the city because no one will deal with it, and the people who should be responding are not responding appropriately."

Unless a person is an imminent danger to him or herself or others, there isn’t much law enforcement can do, Bay Area Hospital clinical social worker Lisa Rojas said.

"The biggest stressors for the police are the ones who get into trouble, but not enough to get committed," Rojas said. "So if we can't commit them, they're just back on the street again, and that's just the revolving door that's just so frustrating for everyone."

Even when law enforcement utilizes its two treatment options, the local hospital or jail, there remains a difficulty providing a continuum of care, which leads to the cyclical nature of responding to people with mental health issues.

In one of the most extreme cases reported throughout Oregon, Fritts-Matthey said her police department had to respond to one person 10 times over a 12-hour period.

Compounding the increased need for service is the lack of training in dealing with these situations, as well as being able to provide an effective solution for the person's needs.

"We're not trained to deal with it, and when there's a one- or two-day workshop, we'll try and send our guys, but we have a small police force," Fritts-Matthey said.

Fritts-Matthey credited Police Chief Dixon Andrews for applying his wealth of experience with training and mitigating some of the difficult incidents, but there still remains an overall lack of training for mental crises.

"A lot of what he does is counseling, so he knows a lot of the ways to talk someone off the ledge, so to speak," Fritts-Matthey said. "He's been a huge asset, but he's not going to be here forever.”

For those who need involuntary treatment, the lack of availability of beds has put further stress on local law enforcement.

While attending a local public safety coordinating council meeting, Fritts-Matthey discovered the lack of resources extended to the state as officers had to escort a person with mental health issues nine hours one-way just to find a bed.

"When they have to take a mentally ill person, they take them to John Day," Fritts-Matthey said. "I just can't believe there is no other facility in the state, whether it be in Ashland or Medford, and they have to take the person to eastern Oregon. That's insanity to me."

With the city already dealing with limited financial resources, Fritts-Matthey said it can't provide the proper treatment and care without outside assistance.

"In our smaller town, we bring in roughly $500,000 in tax revenue, but between the police and fire department, public safety accounts for $800,000," Fritts-Matthey said. "Taxes don't cover public safety, so we have to get a portion from things like the municipal court and franchise fees, but at some point, it's going to get where law enforcement exceeds all revenue. These people deserve the right type of treatment, and the state needs to figure out something to help them." County seats feeling residual effect of jails

Much like the Curry County seat of Gold Beach, the presence of the jail has buoyed the number of contacts for people with mental health issues in Coquille.

"We can definitely see an increase in the number of contacts," Coquille Police Chief Janice Blue said. "We have the jail in the town so we have the residual effect from all the individuals from other cities (in the county)."

With the police more often than not having to contact or re-arrest the same individuals, Blue said the cyclical nature of the events is indicative of the state of mental health services and the lack of resources.

"It's hard because it reflects on us as an agency that we are continually having to arrest the same individual over and over again," Blue said. "Usually, it is due because they need services that just aren't available. Mental health issues don't belong in jail, but there aren't many services available locally that can help them."

More often than not, the site of the county jail, in county seats around the state, have seen the same increase in contacts and effect on city services.

Nolan Young, city manager for The Dalles, said the rise in mental health calls has impacted police responsiveness because of the diversion of manpower, in addition to placing additional costs on the department.

"There's probably a time when there are high call loads and where it becomes a challenge to respond to everything," Young said. "It costs us money because we have to pay overtime, and there's also the cost of transport. We have to hold a person at the hospital until a bed comes available and sometimes it will take hours and hours until we can find a bed." Nuisance calls affecting city services in Bay Area

Scouring the daily North Bend and Coos Bay police logs, the number of “mental subject” calls is rising at an alarming rate, with names of the same individuals appearing at all hours of the night and throughout town.

As the site of the county’s mental health services and Bay Area Hospital, Mayor Crystal Shoji said it was no coincidence the growing number of people with mental health issues has affected the area.

"The Bay Area has become the area of interest for people who need help because the government has put those services here," Shoji said. "Coos Bay has had to play the part of the inner city and assume responsibility for Coos County. It's hard to absorb because these things keep on coming back and they affect things like police, tourism and, really, all of our city services."

North Bend is no different. Police Chief Robert Kappelman said the department is often inundated with calls to which they are required to respond.

"Those people are frequent users of the police system so that if they generate calls to police, we can't choose not to respond," Kappelman said.

Three weeks ago, Kappelman said the issues with responding to mental health calls were especially visible due to repeated calls from one individual.

"We've been dealing with a person advancing in the stages of Alzheimer's disease, and we received over 60 911 calls," Kappelman said. "It ties up the 911 system and diverts officers from a necessary 911 call."

On Jan. 19, the same woman called the Albany Police Department more than 30 times before North Bend police could respond and warn the subject for misusing 911.

The calls to respond to mental health issues have even seeped into North Bend's parks.

Despite community members' attempts to clean up and make local parks more appealing, there has been an increase in the number of calls for patrol.

As a result of the safety concerns at Simpson and Ferry Road Parks, Kappelman said the department has planned to increase presence in the parks with the Police and Residents Cooperating with Compassion program.

The program, which begins in the late spring, will train reserve officers in crisis intervention, dealing with people with mental health issues and bike patrol operations.

"We've had some issues with homeless and mentally ill in our parks and as a result, people don't feel the park is safe to use," Kappelman said. "At the same time, it's not fair to homeless or mentally ill, who feel that is the safe place for them to be."

But even as North Bend tries to bridge the gap between the community and people with mental health issues, the question of how to provide and maintain the continuum of care remains, with treatment a voluntary process.

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The pulse of Kruse's donors

The Lund Report
State senator accepts health care cash for Nov.

Republished courtesy of The World (Coos Bay)

September 29, 2012 -- Democrat Eldon Rollins is blasting his incumbent rival for accepting donations from the pharmaceutical lobby.

Jeff Kruse (R-Roseburg) has accepted $22,000 from health care companies and advocacy groups in the lead-up to this year's election. Election records show that pharmaceutical companies have been consistent backers during his political career.

Kruse says he cares little about the source of his campaign donations. He does not handle those transactions directly.

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