Mental health services starved for funds

Mental health services in this region have always been strapped for cash. With a statewide budget crunch, that situation is getting worse.

The Deschutes County Mental Health Department receives only about $900,000 a year from property taxes and other local sources, according to Director Gary Smith. The bulk of its $14 million budget comes from the state and federal governments. That's why the state revenue shortage hurts locally.

Smith explained that the funding problem is aggravated by the fact that in modern times Deschutes County's mental health operation has been underfunded by the state (see adjoining story).

Smith says a year-long study confirmed that the county was 27th in per capita funding among the state's 32 mental health programs and at the bottom for alcohol and drug treatment money.

That means locally that "Sisters doesn't get a whole lot of mental health coverage other than in the schools," Smith said.

"We don't have an office there. We have one in Redmond, La Pine and Bend... Our primary onsite service in Sisters is in the schools, where we have provided a minimum of six hours a week. I don't know whether they will lose that."

The state budget crisis, worsened by the defeat of State Measure 28 last month, is taking a bite out of the county's mental health budget this fiscal year and promises to take a bigger one in 2003-2004, which starts July 1.

Smith's office has gone to a four-day work week, the staff effectively taking a 10 percent pay cut.

In a memo to the county commissioners before the Measure 28 election the director estimated that if the measure failed, three major outpatient services budgeted for a total of $566,l16 at the beginning of the year would be cut by $155,370, or 27 percent.

These include outpatient adult mental health, child and adolescent mental health and community crisis operations.

Reductions in mental health services for Deschutes County residents who lack insurance or other means to buy private service will grow worse with the beginning of the next fiscal year. In the meantime, a related cut will come earlier: a March 1 cutoff of Oregon Health Plan support for mental health and alcohol and drug treatment. That will affect an estimated 270 residents of Deschutes County.

Smith says his department is working hard to help the most severely ill retain access to needed medication.

"We don't want folks not taking their meds because that's the standard formula for getting sicker or going into crisis and ending up in the hospital," he said.

There have been informal reports of several suicides around the state among people who were notified by letter of pending Oregon Health Plan cutoffs, but Smith says he knows of no such incidents here.

In the meantime, Smith says his department is trying to adjust to shrinking budgets by making changes in the way it delivers service.

"I call it redesigning the airplane at 40,000 feet," he noted wryly.

"To reduce the impact on client services," he said, "we're moving to significantly more group treatment as opposed to individual treatment... In order to move more people through the system we're moving to the group model. There is some reason to believe that it will be, if not more effective, at least more efficient. But it's going to require adjustment on the part of the staff and of clients, who are used to being treated individually."

The change is not universally popular. Bob Marble of Bend, co-president of the local chapter of NAMI (National Alliance for the Mentally Ill), likened the strategy to giving group treatment to "a bunch of people with cancer."

There are many different types of cancer, he noted, requiring different treatments.

Nonetheless, the mental health department's budget problems are likely to get worse before they get better.

Smith's most immediate concern is what will happen if the February 28 quarterly state revenue forecast shows the need for even deeper cuts in the current state budget. The Salem rumor mill is predicting an additional $90 million shortfall.

"The problem is we have four months left in the biennium, four months to make up $90 million," Smith said. "I don't know how we're going to do that. If they take it out of mental health basically I don't think there's anything left except to essentially close it down. There isn't enough left."

East side gets short shrift in funding

By Don Robinson

Short funding is nothing new to Gary Smith. The 54-year-old Deschutes County Director of Mental Health Services says the east side has traditionally gotten short-shrift in funding for such services.

He attributes it to several factors. First, "counties east of the mountains are generally ignored by Salem," he said. "We're ignored in a number of areas, not the least of which is human services."

Second, the Legislature has traditionally given more money to areas closer to state hospitals to try to "get hospital costs down."

A third factor has been the local population explosion.

"We shot up to the seventh largest county all of a sudden and the funding didn't follow."

Finally, Smith says, "there is no formula in Oregon that decides how the money will be allocated. It's all based on political whim and who's got the most juice..."

He notes that the state has formulas for funding schools, community corrections, community colleges and many other local functions. "But you've got no formula for mental health, so it's a total crapshoot."

Smith and others have been working to rectify the problem, or at least relieve it. In the last Legislature they pushed a bill to set up an "equity formula."

It won support, but not enough to pass.

They'll make a similar effort in this session, but legislators are likely to be preoccupied with the budget crisis.