Mental health challenges abound in Oregon – from children to unemployed workers to older adults. The number of people dealing with mental illness is growing, yet funding to support the delivery of behavioral health services remains scarce.
The Integrated Behavioral Health Alliance began in 2014 to coordinate primary care and behavioral health services. The Older Adult Oregon Behavioral Initiative was launched in 2015. Oregon joined seven other states in a pilot program to set up community behavioral health care clinics in 2017. All have suffered from a lack of resources and qualified staff. They also have faced an uptick in demand, in part because of the pressures posed by the coronavirus pandemic.
In a report delivered last week, the Portland State Institute on Aging said 11 percent of older adults in Oregon experience some form of mental illness. Nearly half of them have received no treatment. Heavy drinking and substance abuse can go undetected for older adults living alone.
Community behavioral care clinics afford an opportunity for patients to receive holistic care, including primary care, without shuttling between providers and often falling through the cracks. According to a story published by The Lund Report, many of the clinics participating in the pilot program are on shaky financial ground, with inadequate funding to retain and expand staff to address growing demand. Three providers halted services. LifeWorks NW, which operates for community clinic sites in the Portland area, reports its client load grew from 4,400 new patients in 2017 to 6,540 patients in 2019 – before the pandemic struck.
Barriers remain to coordinated physical and behavioral health care. Needs vary widely among adolescents, college students, homeless adults, families under financial stress and older adults. Care is complicated by lack of transportation, inadequate housing and a shortage of trained professionals. Events like devastating wildfires and changes in the seasons can cause or aggravate stress. Mental illness cuts across gender, racial and religious affiliation lines. In general, mental health services are underfunded and often underappreciated.
The cost of behavioral health care services can exceed the financial ability of many families and individuals, including households with health insurance coverage. And then there is the fear of the stigma of suffering from a mental illness, which can discourage people from seeking help they need.
The Legislative Emergency Board has released $6 million in coronavirus-linked funding that will provide a temporary patch to behavioral health services between now and mid-year. The latest congressionally approved financial relief package and the $1.9 trillion relief package proposed by the incoming Biden administration should offer even more assistance. But delivering mental health services is not something that can be accomplished with a flick of a switch.
Intrinsically, people suffering from mental illnesses are skeptical and don’t trust health care providers. Some of the men, women and children most in need aren’t easily discoverable, especially if they also are substance abusers or in abusive households. The cost of behavioral health care services can exceed the financial ability of many families and individuals, including households with health insurance coverage. And then there is the fear of the stigma of suffering from a mental illness, which can discourage people from seeking help they need.
The biggest hurdle behavioral health faces is the low rung it holds in the pecking order of budget priorities. Health care overall is a priority in Oregon, as Governor Brown seeks to sustain the state’s Medicaid program, which has surging enrollment, squeezing out more funding for other programs including behavioral health services. Brown’s behavioral health advisory council recommended $33 million in the 2021-2023 biennium, leveraging more than $130 million in additional federal funds, but the recommendation didn’t make the cut in her proposed budget.
Mental health advocates will push state lawmakers for increased funding. As always, they will have lots of competition from K-12 schools, community colleges, public universities and state agencies, many of which have a higher public profile and wider support.
