Behavioral Health Project Chris Farentinos, MD, MPH, CADC II

Director Behavioral Health Legacy

If someone in your life was having a behavioral health emergency, who would YOU call?

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• Best for physical emergencies • Overcrowded • ED Boarding • Best case: stabilization

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Oregon has a Behavioral Health Access Issue

600,000+ Oregonians are in need of mental health services.

32,000 Oregon

youth suffer a major

depressive episode

each year on average.

145,000 Oregon adults

experience a serious

mental health crisis

annually.

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3X higher rates of suspension and expulsion.

50% of students with mental illness drop out of high school.

65-75% of youth in juvenile detention have at least one mental illness.

of youth who die by suicide had one or more mental health conditions.

90%

(Source: The National Alliance on Mental Illness)

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Inadequate Access to Treatment

Loss of Dignity

Undiagnosed

• Homelessness • Suffering • Suicide • Incarceration • Loss of Productivity

Without a place to go when you are in crisis…

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“Untreated mental illness presents a tough challenge for the Portland Police Bureau. Good people can end up in the criminal justice system as a result of their illness and lack of appropriate care and treatment.

We work hard to address community concerns and simultaneously find effective resolutions, but often see persons with mental illness cycle through the system.

This is certainly a resource issue for the PPB but, more importantly, a tragedy for those individuals.”

40% of the Multnomah County jail population have a diagnosed mental illness.

8 – Captain Michael Marshman

Portland’s   suicide rate

is

the national average

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Portland’s   suicide rate is

3X the national

average

Traffic fatalities Homicide

Suicides

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Between April 2011 and June 2013,

there were nearly

2X AS MANY

completed suicides in Portland as there were

homicides or traffic fatalities combined.

01 Harborview Medical Center (Seattle)

02 Marin General (Greenbrae)

03 San Francisco General (SF)

04 John George Psychiatric Hospital (San Leandro)

05 Santa Clara Valley Medical Center (Santa Clara)

01

03

04

05

02

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John George Hospital has 69 beds, 3 units and a Psychiatric Emergency Service

o 7500 square feet o Open milieu o Serves 40-60 patients/ day o 1200 to 1500 patients/ month o Under 5 Restraints & Seclusions per 1000 patients

(they  consider  R&S  as  “treatment  failures”) o 75% of the patients are treated in an average of 20 hours

and discharged o 25% are hospitalized o Early assessment and adequate treatment initiated

immediately o Reimbursed by a facility-based Medicaid code for crisis

stabilization o All patients are evaluated and initially treated at the PES.

Only admits patients who truly meet medical necessity criteria.

Psychiatric Emergency Service

o 60% patients come from the field o Police pick up patient and call EMT o EMT has a protocol for medical clearance o Any patient over 65 goes first to nearest ED for medical

clearance o EMT transports to PES or ED o Ambulance turnaround time @ PES is 18 min o 35% from 11 other local EDs o Were able to reduce the boarding time from 10.5 hours

to 1 hour and 20 minutes o 5% walk in o Mostly Medicaid and Medicare 13

Psychiatric Emergency Service

o PES has 30 recliners and 8 rooms that can be assigned to calming patients, seclusions and restraints

o Environment is designed to reduce agitation by giving patients control

o Snacks and sugar-free drinks available o Phones available o Calming murals o Interaction with staff o Milieu is kept safe through relationships that are caring

and respectful

What is needed before Oregon can sustain a PES?

Crisis Stabilization Medicaid Code: is a service lasting less than 24 hours provided to a beneficiary for a condition that requires a more timely response than a regularly scheduled visit. Service activities include (but are not limited to) Psychiatric Assessment, Treatment Planning, and Therapy. S9484 Crisis Stabilization

A Broad Base of Support

• Addictions and Mental Health Services - OHA (Oregon Health Authority)

• Mental Health and Addictions Services Division of Multnomah County, Clackamas County and Washington County

• Multnomah County Health Department • Portland Police Bureau • Oregon Citizen Crime Commission • Local Public Safety Coordinating Council – Mental Health

Subcommittee • Health Share of Oregon • Family Care • Commissioner Jules Bailey • Congressman Earl Blumenauer

Thank You