A concession made in this last special legislative session could expand into a real possibility for Columbia County to start looking after its own when it comes to some mentally ill populations.
For the first time, the county is receiving state funds, albeit a small amount at only $61,000 over the next two years, to start building a system for managing acute indigent care patients. Such patients have immediate care needs, such as people suffering from schizophrenia or who are suicidal, and who are unable to afford their own health care costs.
'What you're seeing is a system that is particularly underfunded in the community,' said Gina Nikkel, executive director for the Association of Oregon Counties Community Mental Health Program.
Historically the county has received zero dollars to care for those people when a crisis erupts. Through an agreement between the state and some participating hospitals in Portland, the state through the Department of Human Services pays the hospitals directly for any patients from Columbia County admitted to the hospital.
The county does relatively well in other mental health funding areas, an improvement over prior years when Columbia County received dismal funding levels. Those levels were based on a formula and historical pattern that weighted the county for an unequal share of state dollars.
Columbia County is part of a five-county deal for acute indigent care at the hospitals. The deal also includes Clackamas, Clatsop, Multnomah and Washington counties. Unlike the other counties, which received some money to develop their own systems, Columbia County has received nothing.
'This is the first time I'm receiving something,' said Roland Migchielsen, executive director for Columbia Community Mental Health. 'It's still not sufficient, but it's a start.'
Migchielsen is a firm believer that the impoverished and mentally ill people in the county should have a destination inside the county where their immediate needs can be met.
Because the state-to-hospital funding system cuts the county and CCMH out of the loop, it's difficult to nail down how many people need acute indigent care, placing CCMH in a reactive rather than a proactive stance when it comes to meeting those patients' longer-term mental health needs.
Also, many mentally ill people at that level of care often build antagonistic relationships with the very idea of going to a hospital, Migchielsen said, and are frequently transported to the hospital following a confrontation with police.
One example is last year's involvement with Glenn Shipman Jr., the 50-year-old Scappoose man who suffered from a schizoaffective disorder. In November, police responded to a summons that Shipman was out of control, ultimately using Taser guns to suppress him. Shipman's mother, Elaine, said he had an intense dislike of hospitals, which in part likely led to his resistance to the police. Three days later, Shipman died at Legacy Emanuel Hospital after being improperly restrained.
Building a less oppressive environment within the community, and keeping patients close to family and friends, is a better alternative, Migchielsen said.
'This is a better way. It's cheaper than a hospital, and it's better,' he said.
Now the question is whether the state will renegotiate its contracts with the hospitals to allow more localized care of those patients, something Migchielsen said DHS has indicated it is responsive to.
Nikkel said having the right community support systems in place is a key component for making the overall state mental health system more effective, adding, however, that funding statewide is inadequate to address current need.
'We can go down the rabbit trails for why Columbia County doesn't get enough money, but the whole state doesn't get enough money,' she said.
In 2002, funding cuts resulted in a statewide loss of around 2,000 addiction and mental health workers statewide, she said, with little recovery since then.