Opinion: Oregon lawmakers rethink funding approach to behavioral health
Oregon is experiencing a behavioral health crisis that is touching the lives of nearly every resident. Many of us have directly experienced the difficulty of finding treatment for ourselves or a loved one. Others have witnessed the growing frequency and severity of individuals experiencing crises on our streets, and parents, teachers and students have seen the rising levels of behavioral challenges in our schools. We have all seen the problem, but our communities have not been equipped with the tools and the funding to respond adequately.
In 1995, Oregon closed Dammasch State Hospital with the promise that this was the start of a movement away from institutionalization, and towards community-based care for vulnerable Oregonians with mental health challenges. Unfortunately, over the last 25 years we have not made good on this promise. We have not invested in a holistic system for behavioral health that can meet the needs of people in their own communities. People with behavioral health needs are "stuck" throughout the system — waiting for beds at the State Hospital, stuck in the State Hospital because they cannot be discharged due to a lack of community placements, stuck in jail, or homeless and thus with no way to recover.
Our state struggles with high rates of substance use disorder, overdose deaths and suicide. Mental Health America ranks Oregon 48th in the country due to our higher prevalence of mental illness and lower rates of access to care. Oregon has the 11th highest youth suicide rate in the United States, and from January to June 2020, at least 339 people died of a drug overdose in Oregon.
None of this is good. Oregonians need and deserve better access to quality, culturally, linguistically and developmentally appropriate services. Throughout the legislative session, advocates for patients, health care providers, hospitals and health systems all came to legislators with the same message: we need transformational change and significant investment to deliver adequate behavioral health care for Oregonians.
Here is how we begin to deliver. Voters approved Ballot Measure 110 in the fall of 2020, which moved $200 million in funding to substance use disorder treatment, transforming the way we deal with addiction in this state. To properly confront the crises Oregonians face, we need to treat addiction and mental illness like medical conditions and not crimes — these investments are a big step towards that goal. The Legislature is fully committed to implementing this ballot measure.
Improved budget forecasts and federal aid also opened the door to finally think in a transformational way about behavioral health as a whole. With the help of advocates across the state, we were able to pass a $350 million behavioral health package for Oregonians. The investment package broadly targets four main priority areas.
First, it will fill some of the gaps and support the community needs we already know exist, like expanding access to crisis services.
Second, it will fund a surge in our workforce, helping improve conditions for those already doing the work and attracting new workers from more diverse backgrounds. This will lead to improved cultural and linguistically appropriate services, and help Oregonians find the behavioral health care they need — wherever they are.
Third, it establishes a fund for community innovation, where local stakeholders can determine the most pressing needs in their community. Too often we have approached behavioral health with a "one size fits all" approach — these investments will allow local stakeholders to collaborate with others in their region and propose projects that will better serve patients and reduce the strain on the entire system.
Fourth, the package creates a transformation fund to align and transform the behavioral health system to ensure greater system accountability, outcomes and funding alignment, clear roles and responsibilities, and ultimately sustainable funding for appropriate and quality services.
The goal of these investments is to create a system in behavioral health that works for patients across Oregon. One that is seamlessly integrated with physical health care, with multiple entry points, "no wrong doors," and as few gaps as possible. We will know we have succeeded when patients have timely access to services at all levels, and when we see reductions in houselessness, ER visits, hospitalizations and overdoses. The transformation we need will not be achieved with these investments alone, as we expect more investments will be needed in future budgets, but this package will put Oregon on a path towards patient-centered care that is simple, responsive, equitable and meaningful. With this approach we hope to look back on 2021 as the year we began true transformation of our behavioral health system. Over the next several years as these investments take shape, we hope every Oregonian will begin to see the difference.
Sen. Kate Lieber and Rep. Rob Nosse co-chaired the budget-writing Ways & Means Subcommittee on Human Services during the 2021 legislative session, which ended in June. Lieber is a Democrat who represents Senate District 14, which includes Beaverton and Aloha, and portions of Washington and Multnomah counties. Nosse is a Democrat who represents House District 42, which includes Portland's inner east side, from Interstate 84 to Woodstock.
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