Multnomah mental health system at risk, audit says
As Portlanders call out for better care for people facing homelessness, including those struggling with mental illness, a new audit has found that even with its funding shortages, Multnomah County could be doing more to connect mentally ill people with needed services.
The report is the latest in a long line of reports highlighting poor mental health care in Oregon's most populous county. Multnomah is not enrolling all of the people eligible for state or county programs as it could or should be, and the county is not publicly discussing some of the choices being made, said the audit released by Multnomah County Auditor Jennifer McGuirk on Wednesday, Nov. 20. The report recommends county managers more aggressively and publicly advocate for needed services.
"What was concerning is just that ... we were not seeing all those people being referred for enrollment" into programs that could help them, McGuirk said.
The audit notes that the state is under pressure to move people out of the Oregon State Hospital into county care thanks to a 2016 agreement to resolve a U.S. Department of Justice civil rights investigation into the state's treatment of mentally ill people. But counties don't have the resources available to cope with all of the people transferred.
The audit also comes eight months after the county fired David Hidalgo, the director of the county Mental Health and Addiction Services, as well as another top manager, Joan Rice. The county had placed the two on leave in August 2018 in connection with an investigation into how abuse complaints of patients at the Unity Center for Behavioral Health, a facility operated by Legacy Health that was set up with county and state funds, were handled or ignored.
That investigation, overseen by the Multnomah County District Attorney's office, did not result in charges.
The new audit does not delve into Unity. But it does look at the county's administration of the programs funded or mandated by the state. It found that "Currently, over half of people who are involved with the civil commitment system are not receiving the most intensive services the county offers."
One program, called Choice Model, is supposed to coordinate care for people with serious or persistent mental illness, especially those who have been civilly committed because they are a danger to themselves or others. The audit found that more than half of those who'd been civilly committed in Multnomah were not enrolled in the program, in ways that appear to violate the state's agreement with the county.
Another problem with Choice was the lack of "supported" housing, meaning connected with intensive treatment services. Marion County has 40% more supportive housing units, about 70 compared to 51, for a Choice program that is a third of the size of Multnomah's.
The report adds that the county lost $1 million between 2016 and 2017 due to questionable management decisions that were not publicly discussed with the board even while seeking money to fill the resulting gap.
The county had been reserving Choice funds to use in future housing projects rather than on programs. Learning this, the state in 2016 cut funding, causing county mental health officials to go to the county's elected Board of Commissioners for $280,000 in emergency funding in 2017. County officials told the board the need stemmed from cuts in the 2018 budget, rather than what actually happened. "The modification paperwork and presentation did not accurately describe the circumstances leading to the request," the audit said.
"We would like to see greater transparency around the policy choices that are being made," McGuirk said.
The county is reviewing the matter, according to Julie Sullivan-Springhetti, the county's communications director.
The audit also looked at a second intensive treatment program, called Assertive Community Treatment, finding that it largely goes unmonitored by county staff. The county appears to not be placing eligible people in the program as aggressively as they could be.
County officials praised the report and said they will work on implementing its recommendations.
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