Lawmakers in control of the state budget are eyeing multimillion-dollar cuts to county mental health care programs, reductions that advocates and other legislators say are hypocritical and harmful — and based upon flawed assumptions.
The proposal – to slash $15.4 million from a portion of the Oregon Health Authority budget – would deal a “devastating” blow to county mental health programs, said Sharon Meieran, a Multnomah County commissioner.
That money pays for preventative health care programs, such as Multnomah County’s walk-in clinics and crisis outreach teams, helping people avoid costly stays in jails and psychiatric hospitals, Meieran said in an interview.
The commissioner, who is also an emergency room physician, said cutting the program budgets would cause more people to spill into the county’s jails and hospitals. “It’s going to make things worse,” she said.
Sarah Radcliffe, an attorney with advocacy group Disability Rights Oregon, said county mental health care programs are an essential safety net for Oregonians on the brink of crisis. The programs, she said, “are really designed to prevent people from entering higher levels of care that are more expensive and more restrictive.”
The cuts proposed in Salem have observers like Meieran, Radcliffe and others wondering: Why diminish supports for Oregon’s mentally ill people when the need is greater than ever?
“For the life of me I can’t figure it out,” Meieran said. “It really deeply concerns me.”
Rep. Cedric Hayden, a Republican lawmaker who is vice-chairman of the House health care committee, said he, too, is perplexed by the cuts proposal, adding that the trim backs “shouldn’t happen.”
“Why would we do that?” Hayden said. “We’re cutting an area I think is vital.”
Both policymakers have pushed for bolstering mental health programs in light of problems spotlighted by The Oregonian/OregonLive’s investigations. One examined the expensive and at times cruel system by which homeless people who have mental illnesses are jailed for low-level offenses because they are disabled. Another investigation showed how more than 200 mentally ill people had their rights violated by very long jail stays – a situation that drove a judge to hold the state in contempt of court.
Beyond questioning the wisdom of cutting mental health programs, Hayden and Meieran have voiced skepticism about the methods used by state officials to predict program usage – forecasts which state budgets are built upon.
In this case, the Oregon Health Authority predicts there will be a steep drop over two years in the number of people thought by doctors or judges to be a danger to themselves or others due to mental illness.
That assumption led a fiscal analyst to recommend the $15.4 million cut to community mental health care programs.
Meieran said the forecast appears based on a “flawed” formula. She pointed to a paragraph tucked into the Health Authority’s 2013 budget that notes the caseload forecasting method is “not adequate” because it is based on program usage – which can be limited by low budgets – rather than the true need.
A note in this year’s forecast states the caseload predictions may be “artificially low” and are at “major risk” from being based on outdated information.
Hayden said he has requested more information on the funding formulas from government bureaucrats but received no response.
Sen. Elizabeth Steiner Hayward and Rep. Rob Nosse, Democratic lawmakers who play a key role in writing state health care budgets, declined to comment Thursday.
Gregory Tooman, administrator of the state Office of Forecasting Research and Analysis, said in an email that the accuracy of forecasts is “of critical importance.” He said the mental health program forecasts had been refined since 2013 with identification of new data points and added that the underlying methods are “sound,” but did not reply to a request for information on the updated forecasts’ accuracy.
Cherryl Ramirez, who directs a trade group of community mental health providers, said the updated formula still measures programs poorly by emphasizing institutionalized care over less intensive programs.
“It’s something we’ve believed needed to be updated for a long time,” Ramirez said.
Oregon Health Authority spokeswoman Saerom England said the agency’s leadership “recognizes the growing overall needs of the community mental health system” and has committed to maintaining funding for at least 18 months in part through use of unspent federal grants.
In the meantime, Health Authority leaders “will critically assess the funding formula” to ensure it aligns with the agency’s priorities, England said.
-- Gordon R. Friedman