Clatsop Behavioral Healthcare, sheriff address limits on crisis services

Mar. 3—Amy Baker, the executive director of Clatsop Behavioral Healthcare, and Sheriff Matt Phillips on Tuesday outlined the limitations of getting people in mental health crisis the help they need.

The Astorian has reported on several incidents over the past year that played out in public view, including two deaths after interactions with police.

Some people in the community have called for directing more resources to a mobile crisis team, like the CAHOOTS model in Lane County, where mental health professionals respond to crisis calls.

Clatsop Behavioral Healthcare, the county's mental health provider, has a mobile crisis team available to advise law enforcement, help diffuse situations, connect people to treatment and avoid unnecessary hospitalization or arrest.

Baker said the mobile crisis team is only one piece in creating an effective system of care.

"We're very proud of it, but we're also aware of the limitations that the state currently only funds us to the level to have one person working across the county at any given time," Baker told county commissioners at a work session.

"There's a lot of discussion statewide around is it better to do co-response, which means having behavioral health experts or clinicians go out with law enforcement, or the CAHOOTS model, which is a diversion from law enforcement altogether, requiring 911 to carefully screen and send the CAHOOTS van out. I think there is a case that can be made for either. In this particular county, given the fact that we have multiple 911 centers, co-response might be easier.

"But having mobile response in and of itself is not going to help address all the behavioral health needs that we're seeing," she said. "We also have to have a place for folks to go. And that looks a lot like a crisis stabilization center.

"I know there had been discussion about the North Coast Crisis Respite Center being that crisis stabilization center. And what we have found over the years operating it is that it's really hard to put people who are in psychiatric crisis into a treatment environment where people are living there full time at the same time. It's sort of like what would happen to your household if you brought somebody in who was really struggling and you're trying to maintain the stability of everybody else."

Baker thinks the rapid access center planned for the agency's Bond Street site in Astoria can serve more of that function and be a place for police to drop people off when they are in crisis. The opening of the center is dependent on when the agency can hire staff, which Baker said has been a challenge, in part due to housing.

"That crisis stabilization center, I think certainly is a need," said Mark Kujala, the chairman of the Board of Commissioners, who represents Warrenton, where the crisis respite center is located . "And many of us, I think naively so, thought that the respite center was going to address that and become the bridge between the hospital and jail. And I know that it hasn't done that — and never probably was intended to be that — but it certainly is a glaring need within the community."

Baker said she would love the rapid access center to be open 24/7, "but we don't have the funding or the staffing capacity for that."

She said some of the biggest barriers to providing care continue to be a lack of funding and affordable and transitional housing.

"I think one of Clatsop's unique challenges is that we're like a rural county, except that we have urban problems — in part due to our proximity to Portland — except that we have rural funding," she said. "So it's kind of a double whammy there."

Baker and Phillips also addressed the state's high threshold for civil commitment, which, in many cases, ties the hands of law enforcement, mental health providers and hospitals from being able to properly assist people in crisis because they cannot force people to accept help.

"The Oregon Court of Appeals certainly values liberty much above an individual's well-being, unless the threat to well-being is imminent and very serious," Phillips said. "And the primary concern has always been preserving someone's liberty and avoiding stigma. But I think most people would agree that someone who is suffering a serious mental illness is probably not wholly at liberty or free from stigma. The consequence, certainly, of having a very limited civil commitment process is that it then diverts people to the criminal justice system, which certainly has greater stigma and potentially greater loss of liberty."

The sheriff said he would like to see the mobile crisis team expanded but acknowledged the limits of outreach.

"We can reach out, and certainly repetition is sometimes helpful — being consistent in reaching out to people. But sometimes we can't legally compel someone to engage in services or to get treatment," Phillips said. "And the hospitals have the same thresholds to work within, so it's difficult."