Oregon Spends on Mental Health, with Few Results

Every two years, Oregon spends $3.7 billion for a mental health system that is one of the worst in the nation; state lawmakers say this is because of a lack of coordination. 

At an Oregon Health Forum event on April 19, lawmakers spoke about issues in the system that include treating people in a crisis for the first time, leaving the system too soon, and the possibility of becoming homeless just months after treatment. They also talked about bills that could assist in solving these problems. 

Dr. Bruce Goldberg, a professor at Oregon Health &Science University’s School of Public Health and a former director of the Oregon Health Authority, moderated the event. 

“Our jails and prisons are populated by those with mental illnesses,” said Goldberg. “Some states are doing better than other states. Sadly, Oregon is currently not one of them.” 

Goldberg went on to say that proportionately, Oregon spends more money on behavioral health than 75% of the other states.  

Rep. Rob Nosse, D-Portland, said that the current two-year budget for behavioral and mental health care is $3.7 billion. This includes Medicaid services for behavioral health ($2.5 billion), Oregon State Hospital ($670 million), and community services ($555 million).  

Sen. Kate Lieber, D-Beaverton, said a large problem was disconnect between different parts of the system. 

“We have to look at it as a system as a whole,” Lieber said. 

Oregonians need to be able to receive care before they reach the point of needing Oregon State Hospital, the state-funded psychiatric facility. 

“We have put a lot of money into behavioral health systems and structures without enough to show for it,” said Rep. Lisa Reynolds, D-Portland, who is also a pediatrician. Reynolds said some up and coming bills could help change that.  

House Bill 3069 would create a suicide prevention and behavioral health hotline that would work similar to 9-1-1. People could call 9-8-8 and talk to a social worker and/or be assisted by a mobile health crisis unit. It would also field calls about people needing housing and those having a mental health or substance abuse crisis. 

Nosse is sponsoring a bill that would help existing access. House Bill 3046 would make it so insurers and coordinated care organizations must set reimbursement rates for behavioral health providers like they already do for behavioral health providers. Mental health care providers frequently face low imbursement rates for patients. 

HB3046 would also direct OHA to make a list of behavioral health services that would not need previous authorization from the insurance, something that slows and potentially effects care. Nosse said the goal of the bill is to better the patient’s standard of care. 

Additionally, the five-year Medicaid waiver is up for renewal next year, giving the state more room from the federal government with how Medicaid funds are spent. 

Lawmakers want OHA to have flexibility in spending so it can put funds towards other things that may affect health, such as housing. Lieber said the system needs to help move people to different levels of care, like when they leave the hospital. The state will go on discharging people before they are ready “until we make the whole system accountable,” Leiber said. 

The Oregon Health Forum is a branch of The Lund Report. 

By: Hannah Ramsey