A new state audit says the state's mental health system is broken and underfunded and suffers from gap-ridden laws, bad data, lack of oversight and monitoring, and an absence of leadership and a strategic plan.
Released by the Secretary of State's audit division, the report includes some new analysis as well as a lengthy recap of what amounts to a 20-year record of similarly scathing reports on the system.
At the heart of the problem: frequent turnover in leadership at the Oregon Health Authority as well as a confusing web of dysfunction and failure that seems to only morph and grow rather than get fixed, judging by the report.
The victims: people grappling with mental health issues, especially children. That's an area where the system is particularly in crisis, auditors found. They provided real-life examples of two children caught in the system:
• A 9-year-old boy spent more than 100 days in a hotel room without systematic care or support due to bureaucratic failures and was forced to go to an emergency room for treatment several times.
• A 16-year-old girl with a history of sexual exploitation and drug use went back into drugs due to care delays and denials, triggering psychotic symptoms. She was treated at five different facilities, including emergency rooms, without continuity or coordination.
The system's failures are aggravated by staff turnover, lack of funding and programs and laws that are inconsistent, the audit said.
In a response to the audit, Steve Allen, appointed last year to head the OHA's behavioral health division, wrote that "We agree with the audit's findings — there are no surprises here."
In an interview, Allen added that "we think that their report card is a fair one ... We also think that it's helpful to have an outside entity with fresh eyes come in and take a look around."
Nearly 1 million people in Oregon access state-funded mental health services, according to the audit. The OHA will spend $3.2 billion on behavioral health services in the current two-year budget.
Allen said that his focus since coming to the agency has shifted to deal with the pandemic and the new inequities that have come to light.
As far as the problems highlighted in the audit, Allen said, they are complex and the changes necessary "are not going to be made in a year or two, or even five. This is a decade's worth of work."
Still, he expressed hope that clients of the system will start to see changes in service quality within a few years as his agency does a better job of engaging with them to hear what can be improved. "
Some of those changes don't cost anything," he said. "It's an orientation shift."
The report recommends OHA develop a strategic plan, hammer out inconsistences and break down silos within the agency, improve reporting and oversight as well as input from groups and individuals involved in the mental health system.
It also singled out New Jersey and Washington state as having developed programs with successes that Oregon should look to emulate.
Multnomah Commissioner Sharon Meieran has been one of the most vocal critics of the state's mental health system, retaining consultants in 2018 to look at the situation locally. The consulting firm reported that the situation is so fragmented and confusing that their investigation was unable to complete a core task assigned to it: tracking how money flows through the system.
After reading the audit, Meieran told the Tribune, "Hopefully this is a wake-up call to state leaders that the situation is beyond the tipping point. We don't need another token committee or task force to tell us things we already know. We need to get down to business and do things differently. Ironically, the cost of our ineffective and in fact harmful approach far exceeds the cost of doing things right."
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