Think Out Loud

Oregon’s mental and behavioral health system is on brink of collapse, say providers

By Allison Frost (OPB)
Nov. 1, 2021 4:33 p.m. Updated: Nov. 15, 2021 9:43 p.m.

Broadcast: Monday, Nov. 1

The Oregon Council for Behavioral Health represents providers of treatment for mental health and substance use disorders all over the state. Industry leaders say the availability of services before the pandemic was already becoming critically low, and now the system is on the brink of collapse. Services for youth and treatment for substance use disorders are the most tenuous, says Heather Jefferis, executive director of the OCBH. She joins us to provide more details and outline the immediate help from the state she says is critically needed.


This transcript was created by a computer and edited by a volunteer.

Dave Miller: The Oregon Council for Behavioral Health represents providers of mental health care and substance abuse treatment all over the state. Industry leaders say that even before the pandemic, availability of services was already becoming critically low. Now they’re warning that the system is on the brink of collapse, especially services for youth and treatment for substance use disorders. Heather Jefferis is the executive director of the Council. She joins us with more details. Welcome to Think Out Loud.

Heather Jefferis: Hi Dave. Thanks for having me.

Miller: Thanks for joining us. Before we turn to broader questions about the pandemic and funding, I’m just curious how you react to the idea as we just heard from Sam Quinones. In case people are just tuning in now, he essentially is arguing that new formulations of meth are creating a wave of severe mental illness and exacerbating homelessness. Is that what you see?

Jefferis: Well, David, that was a really great interview. Thank you for having that today and everything very timely to be right before me. And what I would say is Rachel Solotaroff from Central City Concern and many other folks who are members of our organization anecdotally  comment on the increase of emergency room visits and in our field we call it acuity when people are showing very severe symptoms from their substance use or mental health concerns across the state. This has been a growing phenomenon over the years and we do find that many substances such as Fentanyl, methamphetamine and other substances have increased in potency during these times. So yes, it definitely has through an on-the-ground level. We don’t have big studies, as he mentioned, but we feel that we see some impacts for sure.

Miller: Let’s turn to the overall issues facing behavioral and mental health systems as a whole.

What were the issues your providers were dealing with or talking about or warning about before the pandemic?

Jefferis: Well, actually I love to answer this question. I was going to start off by reacting to something that Sam said earlier and I liked it when you were talking about wrapping it up with hope. A lot of the things that I’m going to talk about today and the questions you’re going to ask me really come out of this long standing history that behavioral health, both substance use disorder and mental health systems were created decades ago under severe stigma.  And stigma--I think he spoke so eloquently about it--really had a huge impact on where we are today and how services were supported or not supported and carved out of the larger health care system and really led us to the system that we have today, for better or worse. And what’s exciting and maybe we’ll wrap up with is just thinking about how hope and reduction of stigma are giving us a really unique opportunity during a really stressful time where we are entering into system-wide system loss across the state of Oregon.

Miller: System-wide system loss. What do you mean?


Jefferis: So I think a really good example of that--a lot of your listeners have probably heard pretty frequently over the last year--that Oregon tends to be in the bottom 10 of states for access to substance use disorder and mental health care. I’ve been in the field for 25 years and we’ve always been somewhere in the bottom 10 for access in the top 10 for need based on SAMHSA, which is the Substance Abuse and Mental Health Services Administration. They do studies and projections and that’s where that data really comes from. And what we found when we entered COVID-19-- a real concrete example in our sud residential system for single adults….

Miller: “Sud” is substance use disorder?

Jefferis: Yes, substance use disorder. So if you’re a person who’s using daily and has very serious substance use, you could qualify to go into a residential program. And so it’s not for folks with mild use, it’s for folks who are really having a lot of barriers and a lot of substance use. Before COVID-19, our membership--not everybody in the state--had about 639 beds. That means there’s like 639 placements being used or available on any given day before COVID-19. But now due to the workforce crisis, having to reduce the amount of beds available in a facility for social distancing and lots of different impacts, we’re down to about 399 for the entire state of Oregon. So as you can see, that’s not a lot of placements for folks who are really, really in serious need.

Miller:  This was a drop of more than one third for beds for the most serious treatment for drug abuse. I imagine at the same time, though, that the need for that treatment hasn’t gone down by a third?

Jefferis: No, no, sadly we have seen lots of studies across the United States, including in Oregon that the increased report by just the average citizen, through surveys, through increased visits to the emergency room, and I think the most recent overdose data was just released about a month ago that we have more need than ever before. And that is expected. There’s lots of excellent research out there about disasters and COVID-19 is a disaster. It’s one of the biggest crises we’ve faced as a world 150 years since influenza. Predictably after disasters, the need for mental health and substance use disorder care predictably increases along with trauma response. We knew that this was going to happen. We didn’t know what the breath of it was going to happen and we also couldn’t project that this would have such an impact on workforce in behavioral health just like physical health. This is very emotional, supportive work. And being 20 plus months into COVID-19 has been very hard on our caregiving and professional behavioral health care staff.

Miller: What do you see as a lasting long term solution to staffing shortages and high turnover and burnout?

Jefferis: I think the thing that’s interesting, that was brought up in your previous interview, is really the reduction of stigma. I think that behavioral health care work has not been really well understood by the general population because folks don’t always think about what it takes to actually be a behavioral health care worker. A lot of folks think you have to have a master’s degree or psychiatry degree and that actually isn’t how 21st century care is delivered. Twenty-first century research quality care includes a team, which means that there are peer services. It means that there are folks with bachelor’s degrees, it means there are folks with master’s degrees. It means actually everyone who can be part of changing and saving lives in a behavioral health sector, whether that’s substance use disorder or mental health, there are lots of different ways to participate in that activity.  I don’t think in that sector that we’ve done the best job we could because we’re used to keeping everything confidential and also because of stigma, we don’t always talk about the sector in a really open way, but there are really exciting ways for folks to get involved in the behavioral health sector. So I think one is us doing a better job of communicating than engaging folks and showing them the rewards of working in the career. And the other piece is with the reduction of stigma, which is also surveyed and documented, that we take advantage of that opportunity to really re-tool how the system is supported through payment and operation requirements because all of those requirements were made during a time when stigma really informed how we decided to deliver care and how to pay for care. And I think we’re in a really interesting time where we’ve seen more investments in the last legislature, which we know will take time. It usually takes a good 10 to 12 months for those kinds of investments to manifest out in the field to really apply those in a way that supports modern whole person mental health, sud and physical health care. And so that is exciting, but it will take time and, and in that time we’re in a very serious situation. So we need to deal with the crisis and to take advantage of the operation to really modernize care and make sure that we can create programs that will serve the mental health and substance use disorder needs of folks that Sam really mentioned when he was talking to you earlier.

Miller: We just have about two minutes left. What exactly do you want to see from the state in terms of changing the way regulations work or building works or the system works? What would you like to see lawmakers do?

Jefferis: Your first interview really hit the nail on the head. We know in the 21st century that those practices we’ve learned over the last few decades are improving behavioral health because behavioral health is just like physical health, it’s constantly improving. Thank goodness. We need to remove the walls between those three different types of health care. We need to allow behavioral health folks to serve both mental health and sud and also have teams of folks in their agencies that are medical folks. We have that in some really amazing models like the community behavioral health home model, which in Oregon and federally they call the CCBHC.  It allows you to treat the whole person and to really meet them where they’re at and to address--especially as we see things that were discussed earlier-- that closer line between mental health and substance with these kinds of interventions that are researched and practiced. When we support them, they work

Miller: Heather Jefferis, thanks for your time today.

Jefferis: Thank you so much for having me. I really appreciate it.

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