From the August 7 edition of Street Roots.
On July 2 the Multnomah County Commission voted to fund and build a new facility to help persons who are acutely mentally ill.
In 2001, during a generational redesign of Multnomah County’s mental health system, a variety of providers, former patients, referring agencies, community members, and independent clinicians decided to close a similar facility — the Crisis Triage Center, or CTC.
The CTC was a 24-hour psychiatric clinic attached to Providence Hospital, which planned to provide immediate treatment for anyone. It specialized in being a third choice for police, the first two being doing nothing or making an arrest. The CTC started unpredictably and badly with the tragic death of Emily Comeaux, a person with needs beyond the comprehension of the CTC staff.
Prospective patients, sick and in crisis, who were coached to seek services at the CTC regularly waited hours before seeing a clinician. Sick children were kept in the same waiting room as adult patients. The cost of care was high and rising. Some patients and clinicians chronically overused the CTC, clogging the service for others. Patients were put on psychiatric holds unnecessarily, given the wrong medicine, or complained their concerns were dismissed.
After some public debate and critical events, such as the death of Jose Mejia Poot, Providence Hospital and Multnomah County, both pointing fingers at each other, quit the contract and closed the CTC.
A re-design was proposed. The newly formed Cascadia would operate five walk in clinics which would be open 24 hours, staffed with able-bodied clinicians, and located in all five quadrants of the city. Anyone could walk in and get help in a few minutes. The costs would be lower because the clinics were uncoupled from a hospital.
The clinics opened with much media fanfare, but within a few weeks, bureaucrats were thinking of how to save money. If services could be reduced, costs could be cut. Cascadia closed one clinic after another, leaving eventually only one that was not open 24 hours, and services were only available to certain people.
The closure of the CTC added a hard-to-measure burden on a variety of services and individuals which had no coordinated way of comparing experience and recognizing an additional set of responsibilities. We’d estimate the cost of not having this service is in the tens of millions of dollars per year.
So we applaud that the county leadership recognizes this new facility is an important component of the continuum of county services. Continue reading