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Overflow is forcing patients to other hospitals in region due to a lack of space at the facility created to accommodate people in mental crisis.

PMG FILE PHOTO - The Unity Center for Behavioral Health in Northeast Portland is in 'crisis,' new emails show.Since asking the state in December for more money to operate Unity Center for Behavioral Health, Legacy Health has stepped up the urgency of its message, saying the facility is in "crisis" and facing "a public health emergency," according to emails obtained by the Portland Tribune.

"We currently have 25 patients awaiting transfer to (the Oregon State Hospital)," wrote Unity's Chief Medical Officer, Greg Miller, on Jan. 9. "We have 15 patients today waiting in (Unity) to come to an inpatient unit, one of them who has been in a recliner chair for over six days."

A coalition of local hospital systems led by Legacy opened Unity in January 2017 with county and state approval. Its goal: to accommodate people in mental crisis — often homeless — who had been flowing into local hospital emergency rooms. Its most prominent feature is a main area stocked with dozens of recliner chairs where patients are supposed to be stabilized before being connected with services.

Previously, hospitals had often been "warehousing" people in crisis, with levels of care that were described as inhumane, according to advocates of Unity. They had argued in winning millions of dollars in support from local and state agencies.

Now, however, overcrowding at the state hospital means that conditions at Unity — which in 2018 sparked complaints of inhumane and unsafe conditions for patients before Unity made state-required improvements — have gotten even worse, Miller said, describing the potential for ripple effects across Multnomah, Washington and Clackamas counties.

"We are on almost constant divert," Miller wrote, meaning patients are being diverted from Unity to local hospitals for want of space. The situation is, "causing patients to be mounting in area medical beds."

Miller's letter, sent to state and local officials, went on: "This situation is approaching a public health emergency. What can we do to address this issue as fast as possible(?) This is a real state of crisis for (emergency) psychiatric cases in Portland."

On Jan. 13, Miller followed up with another email, bearing the subject line, "Update on crisis at Unity."

He wrote that there were then 42 patients sitting in the main room at Unity, and almost all new patients were being diverted to hospital emergency rooms.

"There are no more recliners," he wrote. "There are 12 patients waiting to be admitted, some close to five days. ... There are 30 patients waiting in the community who cannot be transferred over."

Unity officials in December had asked for the state to increase its reimbursement rates, as the Portland Business Journal first reported. It blamed its losses on a lack of financial support from government as well as increased state-mandated costs, some due to improvements the state required after releasing scathing reports on conditions at Unity in 2018.

State reacting

In light of Miller's most recent emails, state officials are mobilizing to examine the problem

"This is very serious," wrote state Behavioral Health Director Steve Allen in a Jan. 9 email.

In asking for more money, Unity representatives said the facility had lost $35 million in two years.

Some local behavioral health insiders say it's not surprising that collecting some of local hospitals' most expensive patients at Unity and accounting for them separately would result in large losses.

But Unity says its losses have dwarfed expectations, and the situation has gotten worse as crowding at the state hospital has spilled over into the local facility.

"At Unity Center for Behavioral Health, we care for some of the most severely mentally ill Oregonians in our state. In our first 2.5 years of operations, we discharged over 5,000 people from our inpatient units, and we managed over 10,800 visits in the psychiatric emergency service (PES) in 2019," said Legacy Public Relations Director Brian Terrett in a statement. "Unity Center is a critical component to providing better care and better access to behavioral health services for all Oregonians, but it is not the complete answer to a mental health crisis that is years in the making for the State of Oregon. Together with our partners from Multnomah County, the City of Portland, and the Oregon Health Authority, we are working diligently to find solutions that will enable Unity Center to remain financially sustainable."

State officials are preparing a meeting with Unity and local officials next month.

Earlier this month, The Lund Report reported that the Oregon Health Authority has requested $81.6 million in increased funding for the Oregon State Hospital.

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