Advocacy Update 07/17/2019

Advocacy Update
July 17, 2019

We’re a few weeks removed from the end of the 2019 legislative session and finally able to take stock of what happened. As the session progressed toward adjournment, the worry was that behavioral health would take a back seat to other issues.

And as predicted, the session ended without any major new reforms or investments in the behavioral health system, with the exception of Senate Bills 1/221 companion legislation that infused about $40 million into the children’s system to address kids with the most complex needs. Given the interest in behavioral health, and the pervasive perception that our mental health system is “broken,” it truly feels as if the Legislature missed a golden opportunity.

We’ll spend the next month or two digesting the reasons the Legislature failed to act. It wasn’t because proposals were lacking. The leadership just wasn’t there. Add to that the theatrics of two walk-outs by Senate Republicans and the heavy focus on the K-12 tax package, and there just wasn’t enough oxygen to fuel the fire for true mental health reform.

Among the major disappointments — we didn’t get any lottery bonding for our housing incentive fund, despite demonstrating its effectiveness. What this likely means is that there won’t be any new crisis respite, step-down treatment housing, or housing outside of the “permanent supportive housing” that was in the governor’s budget.

That’s not meant to diminish the governor’s proposal. Some 500 new units of affordable housing will be developed with some supports. But the primary beneficiaries are individuals who are chronically homeless living with serious mental illness. Not chronically homeless? Stepping down from residential or hospital treatment? Need an alternative to hospitalization? Good luck.

It reminds me of a phrase I heard when I first started in this position: “If all we fund are crisis services, all we will ever have are crises.” Oregon did not make concurrent investments to prevent people living with mental illness from becoming chronically homeless. As history confirms, we cannot solve this problem by focusing solely on those with the highest needs. Yet, that’s what we’re trying to do.

Our advocacy will continue full-throated, nonetheless. I hope to have a good idea by fall how we will pursue our goals entering 2020. For a refresher on our priorities, surf to:

Some positives from the 2019 session:

* SB 1 & SB 221: These companion bills create a System of Care Advisory Council for statewide system of care policy development and planning and invest about $40 million into new services for kids, particularly those children who are currently sent out-of-state for services.

* SB 138: Reauthorizes and makes permanent the Mental Health Clinical Advisory Group that is developing treatment algorithms and treatment guides for the most common mental health disorders. This is our alternative to the Oregon Health Authority’s routine efforts to restrict access to medications as a method to save money.

* SB 973: Creates a behavioral health justice reinvestment program ($10 million appropriation) to fund pilot programs that will attempt to address individuals with complex needs who cycle in and out of jail. Again, it’s an investment in individuals with complex, hard-to-treat needs without a concurrent investment that prevents people from ever entering the criminal justice system.

* SB 24: This legislation makes some tweaks to aid and assist treatment in an attempt to divert individuals from the Oregon State Hospital to some nebulous and non-existent alternative community treatment. The goal is that more people receive community treatment rather than default to the Oregon State Hospital, which is essentially full. Again, nothing was done to prevent people from becoming so acute that they encounter the criminal justice system.

* Some funding for mental health for schools was included in the massive K-12 tax package. I anticipate that any added staff and services will be short-lived given the public pension crisis and the inevitable recession that will hit at some point after a long period of economic expansion.

As I wrote earlier, we didn’t get money for our housing fund. Among our other priorities that fell short:

* SB 137: Our NAMI Brain Trust bill that required more of the state’s Coordinated Care Organizations in addressing the behavioral health needs of Oregon Health Plan members when they most need assistance in recuperating from an initial crisis.

* SB 763: This bill added definitions to Oregon’s civil commitment statutes in the hopes that people currently being arrested and entering aid and assist treatment would instead enter through the civil system, thus avoiding a criminal record. The only pathway to acute treatment remains the criminal justice system.

There is other legislation that may produce some positives. For example, SB 52 requires school districts to adopt policies around student suicide prevention. And HB 3289 directs the Oregon Criminal Justice Commission to collect data on the provision of health care — including mental health care — in jails and prisons in Oregon. But any positives will be changes on the margins, unlikely to lead to major system changes. Truly a missed opportunity.