by Ben Botkin, Oregon Capital Chronicle
September 30, 2024
Oregonians can face waits as long as six months to enter the residential facilities they need for mental health or addiction care.
During that time, they might overdose or lose their desire to get help and end up deteriorating on the streets.
It will take Oregon years to fully address this problem, according to a legislative hearing last week.
“We know how critical facility-based care is,” Ebony Clarke, behavioral health director for the Oregon Health Authority, told lawmakers in the Senate Health Care Committee last Monday. “We are navigating and trying to climb out of the hole that was created during the pandemic and even pre-pandemic.”
Across the whole system, Oregon needs to almost double its number of staffed beds to treat people in residential care. The current capacity is 4,033 beds, which includes inpatient psychiatric facilities like Oregon State Hospital, mental health residential treatment facilities, secure treatment facilities and residential facilities for alcohol and drug addiction treatment.
Another 356 beds are expected to come online by the end of 2025. But even with those factored in, a state-commissioned report shows that Oregon still needs 3,714 more beds – or slightly more than 8,100 total.
That means the private sector needs to get involved.
The Oregon Health Authority is not responsible for building or operating the facilities, with the exception of the Oregon State Hospital. Residential facilities are usually operated by nonprofits, health care providers and others. But the agency is responsible for awarding state funding to projects, approving applications and prioritizing projects.
In the past year, the agency has come under fire for not getting money out the door in a timely fashion, even after lawmakers approved the funding for so-called shovel-ready projects. Even then, it can take a year or longer for projects to come online.
Oregon Health Authority’s slowness to respond to drug crisis stymies expansion of care
Five-year plan
The health authority has a five-year plan to add the needed residential beds for addiction and mental health treatment. The plan would cost $850 million total, or about $170 million a year, Jon Collins, the authority’s deputy director of operations and strategy, told lawmakers.
He said there is a lot of interest in launching new facilities. In response to a recent request about projects that need money, the health authority received 63 submissions from across 19 counties that, if funded, would total about $400 million.
Collins said the authority will use that information while working with Gov. Tina Kotek’s office on budget proposals for the upcoming session.
After the presentation, Clarke said she’s optimistic that the issue will remain a priority.
“This seems like it’s a priority for everyone from the governor’s office to the Legislature to OHA,” Clarke said. “So I feel like we’re aligned and looking forward to the long session so we can continue to bring forward resources and policy to better meet the needs of everyone.”
Needs vary across sectors
The challenges and needs vary across different parts of the behavioral health system.
The number of mental health residential facility beds, for example, needs to increase by 10% or 100 beds. But secure treatment facilities need to increase by 34%, or nearly 200 beds.
The needs are much higher for residential drug addiction treatment centers. The state needs 2,357 more beds, on top of the 1,418 already in the system or in the pipeline to open.
That means the state has less than half the beds it needs for residential drug addiction treatment. About 1,400 people died of fentanyl overdoses in 2023 in Oregon, state data show.
With deaths continuing to add up, counties statewide are changing their approach to drug possession, with a new misdemeanor penalty going into effect Sept. 1. From eastern Oregon to the south and coast, counties are launching deflection programs to steer people toward treatment instead of the criminal justice system.
But advocates and critics have warned that without an adequate addiction treatment system in place, the new programs will fall short of the desired outcome.
Lawmakers allocated nearly $21 million million for the deflection programs, which county officials say isn’t enough. This year, legislators also approved $121 million for beds in addiction treatment centers, recovery housing, crisis stabilization centers and primary care clinics.
But that money won’t solve the big challenge that providers face: finding enough workers to run facilities and treat patients.
“It’s more than just building,” Clarke said. “We equally have to consider the workforce.”
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