It's usually good to talk through your mental health problems rather than keeping them bottled up inside of you. Today the Salem City Club did just that, albeit from a policy perspective, in a program called Oregon's Many Mental Health Crises.
The not-so-cheery news is that Oregon ranks 49th out of the 50 states in the prevalence of mental illness and access to care. So for sure, we've got a mental health crisis.
He's chair of the House Joint Committee on Behavioral Health. Until now somehow I didn't understand what "behavioral health" meant. It's mental health plus substance abuse, since you can engage in the behavior of substance abuse without having a mental health problem.
Nosse said that due to the largesse of the federal government, Oregon got $1.3 billion for mental health in the last two years. He said that probably Oregon now ranks as the 46th or 47th worst state for mental health problems and access.
Up from 49, perhaps, but still decidedly pitiful -- especially since we're a blue state with supposedly progressive policies, not one of those backward conservative southern states.
Nosse explained the three levels of mental health care the legislature is trying to improve. The first level is community mental health programs where people are treated on an outpatient basis, often by nonprofits.
The second level is secure residential facilities for those whose care needs are in-between being in the community and in the state hospital. The hope, he said, is that fixing problems with the first two levels will relieve pressure on the third level, the state hospital here in Salem.
Measure 110, which decriminalized drugs like heroin and meth, was needed, Nosse said, since treating drug use as a criminal problem obviously hasn't worked. But he would have preferred to see Measure 110 money for treatment programs ramp up in a first year, with decriminalization happening in the second year, instead of both things occurring at once, as actually happened.
Now that the federal money that was plentiful in 2021 and 2022 has dried up, the legislature is focusing on implementing the programs already started rather than initiating new mental health programs. Nosse said that he's a tax and spend liberal who believes that Oregon needs more investment in mental health.
The next speaker was Ann-Marie Bandfield, a Marion County Health and Human Services Program Manager for many behavioral and mental health areas. She said Marion County has a 24/7 walk-in crisis center. Here's an excerpt from the center's web page.
At least one Qualified Mental Health Professional (QMHP) is on duty at all times to provide face-to-face assessments and crisis counseling. We also provide telephone triage, support, and referral. This service is provided on a first come-first served basis. Most of this work is done at the crisis center itself, but a large number of assessments also occur at the emergency room of Salem Hospital.
The last speaker was Heather Jefferis, Executive Director for the Council for Behavioral Health which helps support behavioral health workers in Oregon. She said it was great that health insurance now has to pay for mental health care.
However, Medicare rates haven't increased in 18 years. And Jefferis said that Oregon is far below the number of substance abuse and inpatient supportive housing beds that are needed.
In the Q&A part of the program, someone asked the speakers if a universal single payer health care system would help with Oregon's mental health crisis. Each of them said that it would, though Rep. Nosse was skeptical that such a plan is politically feasible in our state.
I got to ask a question.
I said that when I was diagnosed with a major depressive episode -- meaning I was super depressed, which is much worse than merely being deeply sad -- I contacted every psychiatrist in Salem. None were taking new patients. Some didn't even have a waiting list. I was told that I'd have to wait months to see someone. And I had Medicare Advantage insurance.
But I noted that people in my situation weren't talked about by the speakers today.
I said that people with insurance still have big problems getting mental health care due to a shortage of providers. (Eventually I learned that my Salem Health primary care physician's office had a psychiatric nurse practitioner on the staff, who saw me fairly quickly, prescribed an antidepressant, and saw me every week or two for several months until my depression had lifted.)
Rep. Nosse said my comments were right on, and that the legislature wasn't focused on the plight of insured people like me.
When the program was over I spoke with several people. The program chair told me that in getting background info for his introductory remarks, he learned that half the counties in the United States don't have a psychiatrist. And most psychiatrists don't take Medicare patients because Medicare pays so little for mental health care.
I also spoke with a psychiatric nurse practitioner who said that any doctor can prescribe antidepressants. True. But my wife, a retired psychotherapist, tells me that primary care doctors aren't as knowledgeable about managing psychiatric drugs, which is why she urged me to try to find a psychiatrist when I was depressed.