Oregon’s mental health system is not broken; It doesn’t exist

Despite sufficient funding, we have highest mental illness rate in nation

By Sharon Meieran

Since Bruce Whitman drove a car packed with explosives into the Multnomah Athletic Club, public attention has once again turned to mental illness, treatment gaps and the people who fall through the cracks in our system.

Once again, clinicians, law enforcement and advocates have reflected on what might have prevented the tragedy. Elected leaders continue to proclaim mental health a top priority, spending hundreds of millions of dollars trying to prove how committed they are, yet they have repeatedly failed to identify—let alone fix—the underlying problems.

Whitman’s death was not an isolated tragedy in a broken system. In Oregon, the cracks are the system. After hovering around the bottom for more than a decade, Oregon now ranks dead last in the nation for prevalence of mental illness, according to an annual report issued by Mental Health America.

Instead of a functioning continuum of mental healthcare, Oregon has two utterly dysfunctional revolving doors, activated only after people fall into crisis.

The first is jail. People deemed unable to aid and assist in their own criminal defense due to mental illness are sent to the Oregon State Hospital—not for meaningful treatment, but to be stabilized enough to understand there is a criminal case against them. They then return to court and are almost always released back onto the streets. Cost: roughly $2,000 per day for stays that can last months.

The second is the emergency room. People posing danger to themselves or others can be held involuntarily for treatment—but because the state hospital is filled with people facing criminal charges, those on civil commitment instead languish in local hospital rooms, sometimes for years, never receiving the care they need before being discharged back to instability.

In both systems, intervention comes too late, proves ineffective, drains public coffers and changes little.

When the next tragedy inevitably occurs, debate cycles back to the usual suspects: civil commitment laws, treatment beds, workforce shortages and funding. All of these matter. But not in isolation. Fragmented solutions within failed systems mean little in the absence of a true continuum of care.

Oregon needs a functioning mental health system. But the state alone is not to blame.

Counties are Oregon’s Local Mental Health Authorities, responsible for ensuring residents have access to behavioral health services. Multnomah County’s size—and degree of dysfunction—make it a major driver of the state’s last-place ranking.

Right now, no single entity in Multnomah County is responsible for coordinating behavioral healthcare. Mental health and addiction funding is not tied to outcomes. People bounce between streets, shelters, emergency rooms, jail, treatment programs and housing with no one accountable for whether they ever reach stability.

The consequences are visible in the human suffering and threats to public safety we see on our streets.

As a county commissioner, I worked with community leaders, experts and people with lived experience to develop a blueprint for transforming mental health and addiction care. But under Multnomah County’s structure, only the county chair directs departments, writes the budget and has the authority to fundamentally redesign systems. Tragically, comprehensive behavioral health reform has not been prioritized.

Bev Stein was the last chair to pursue major behavioral health reform nearly 25 years ago. Since then, the county has largely abandoned its role as local mental health authority. Reversing that failure will require new leadership.

Still, the county can begin building the foundation of a functioning system even now, through targeted investments in the current budget cycle such as:

• A centralized behavioral health coordination system—akin to an “air traffic control” center—to manage transitions, track outcomes and ensure people do not disappear between disconnected agencies. Counties and states across the country have accomplished this (see Alameda County’s Care Connect program or Arizona’s Regional Behavioral Health Centers).

• Intensive multidisciplinary care teams dedicated to moving people from streets to treatment to stability and making sure they remain supported.

• Expanded recovery-oriented housing, with services that actually support recovery.

And with all of these investments, the county must budget in a way that measures outcomes (stability, recovery, reduced cycling through ERs and jails) rather than processes (beds, referrals, spending).

Budget constraints are real. But the more the state and county have spent, the worse outcomes have become. The problem is not money. It is leadership unwilling to build a system that prevents crises, matches needs with effective management, supports long-term stability … and ultimately would cost less than we’re currently spending.

Ten years ago, Karen Batts died of hypothermia in a parking garage after leaving affordable housing and refusing treatment for severe mental illness. Last year, Vashon Locust, a homeless man with a history of mental illness, lit a warming fire that spread to a Portland city councilor’s home. Bruce Whitman is dead after driving explosives into the Multnomah Athletic Club.

These are not tragic exceptions in a battle-weary system. They represent thousands of people—patients, victims, and families—completely abandoned by the systems meant to support them.

This recurring tragedy is only inevitable if our leaders continue to allow it. It’s time to stop being last in the nation, stop the revolving doors and stop the suffering.