Need for subacute center is a given; who will fund it is not

A mayor’s mental health task force early this year said it was something the community direly needs — a place where potentially dangerous mentally ill people could be taken and treated, rather than to jails and emergency rooms, where they often don’t belong. A county public safety task force is set next month to cite the same need as dire. But almost a year after the mayor’s task force recommendations — and almost seven years after the last such mentally ill “triage” center in Portland was closed — community leaders seem to have made little progress on figuring out how to create or pay for such a center. Multnomah County Chairman Ted Wheeler says he’s ready to take yet another run at it. Wheeler says he’s appointing a small work group to begin meeting early next month that will move beyond the settled question of whether such a center is needed — and “hammer out a plan to get this done.” But while the group may have a hammer, it won’t have a cash register. And that may be a problem. The mayor’s task force and county officials have said such a center could cost $500,000 to $1 million to set up — and $2.9 million a year to operate. Those numbers would be for a 16-bed center, where people could be treated for four to eight days or so and released. And no one has identified which governmental entity, or combination of entities, might come up with those operational costs every year. Police often put in middle While most local governmental mental health services are paid for by or through the county, it’s unlikely that the budget-challenged county would be able to pay for the yearly costs alone, Wheeler said. Commissioners cut millions from last year’s budget. Wheeler said county officials are considering forwarding a public safety levy inext fall, “and it’s very possible we could include programs like this in that levy.” But beyond that possibility, Wheeler said, “I think at the end of the day, you’re going to see a partnership between the state, the city and the county — and that’s part of the work that needs to be done.” City officials have not been exactly forthcoming about offering help, however. Maria Rubio, the public safety adviser to Mayor Tom Potter, said that while “it’s very important to the city that this happen,” both the City Council and the county board of commissioners are beginning their budget processes — “which will determine where it is in terms of priorities, for both.” What no one disputes is the need for what city and county leaders are calling a mental health “subacute” center. The problems caused by mentally ill people in medical crises — people who aren’t getting or taking the medicine they need — are seen every day by people on the street, county officials say. And police officers, especially, are being put in an “untenable position … to double as mental health service providers,” Wheeler said. Often, police officers take the people to jail or hospital emergency rooms — places that seldom can really help them. And sometimes, in specific cases, the underlying issue explodes into public tragedy. The city’s mental health task force was created late in 2006 by Potter after the controversial death of James Chasse Jr., in September 2006. Police thought they saw the 42-year-old Chasse, who had schizophrenia, urinating in public. When Chasse ran from them, they gave chase, tackled and subdued him — which some observers said they did too aggressively. Chasse died within hours. An autopsy report attributed his death to massive internal trauma, including the fracturing of almost all of his ribs. Chasse’s family has filed a lawsuit, asserting that police aggressiveness and later neglect led to his “inhumane and tortured death.” More recently, in August this year, a Scappoose man who had schizophrenia died of suffocation after workers at Legacy Emanuel Hospital restrained him by forcing him onto the floor of the hospital, and held him there for at least 10 minutes. The circumstances surrounding the man’s death were reported in the Portland Tribune earlier this month. Center part of ‘safety net’ Mental health experts say that many potentially violent or confrontational situations could be alleviated by mentally ill people in crisis being taken to an appropriate place — such as a subacute center, where they could be given needed treatment for a few days and then released. The county helped pay for a somewhat similar facility — the Providence Crisis Triage Center, attached to the Providence Portland Medical Center in Northeast — that closed in 2001 after the county diverted its funding elsewhere. “Every community really needs a mental health safety net, and we have some parts of that safety net,” said Joanne Fuller, head of Multnomah County’s Department of County Human Services. “But the subacute is the part of that safety net that’s missing.” The subacute center might not be a new or stand-alone center. Wheeler said one idea would be to attach it to an existing alcohol or drug detox center. Fuller suggested people can be made to feel more comfortable in subacute centers than they often are in hospitals. “A subacute center can feel a lot more homey than a hospital,” she said. “It can feel less threatening.” County Commissioner Lisa Naito has advocated for a subacute center for years, and she said she believes the center could pay for itself — because the county would save the sometimes $700 per day per patient payments it must make to hospitals when some people get mental health treatment there. But, Naito acknowledged, “money is definitely an issue, and I’m concerned about that.” Money issues could mean the opening of the center won’t be any time very soon. County officials said it could be mid-2009 or later before a financing plan for the center could be complete. This email address is being protected from spambots. You need JavaScript enabled to view it.

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