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Eugene Weekly : Viewpoint : 10.29.09




Mental Health Disaster

Lane County shuts down a cost-effective service

by R DRAKE EWBANK

Lane County Health and Human Services’ recent surprise massacre of all programs of Oregon’s oldest and most successful peer-run mental health agency, SAFE, has caused little stir save for maybe those several hundred mental health “consumers” and trauma survivors who were helped by the services. Many of these consumers were people served by Valia, a modest SAFE-owned Medicaid program that kept clients well supported in the community. These outreach services were designed by peers from adapted clinical principles. Valia’s services were also shaped by values the system is supposed to promote, though seldom achieve: individual choice and recovery.

However, talking about those few hundred consumers doesn’t acknowledge the national attention. Advocates and consumers everywhere still want to know how Valia’s choice-based and creative use of resources stack up against an antiquated Medicaid system. More particularly, many wonder why the county never even asked about the outreach service innovations and measurable outcomes, talked to the current clients or even so much as visited the Valia facility while it existed.

How public funds are now used. Medicaid mental health funding is still at the mercy of an often costly and recovery resistant pharmaceutical regimen. Mostly it wants to pay for exotically expensive drugs, hospitalizations at $1,000 a day or office therapy at up to $287 an hour. Valia’s outreach alternative costs 25 percent of that current county office rate. “Peer” providers everywhere are interested in competing for those funds in a system that truly values outcomes and recovery instead of learned helplessness.

Recent research shows community-based mental health care, as opposed to the institutional care favored by Medicaid, significantly reduces the risk of suicide. SAFE’s statistics validate this and are much higher than the county average — it has only lost one client with whom it had worked intesively in its entire history, and this happened after the county closure notice forced termination of the client’s counselor. Sadly, the county hasn’t even bothered to collect Valia’s data.

Public and private agendas. Some of Valia’s affected “clients” were also some of the same people who showed up at an April town hall forum covering the planned closure. In a series of dramatic presentations, they asked Rob Rockstroh, county Health and Human Services director, to explain why he felt Valia’s Medicaid services absolutely must go. Backpedaling from the obvious popularity of the program which both Kitty Piercy and Bill Morrisette at the same meeting called exemplary and a “service that had to be saved,” Rockstroh, who has final authority on any closure, promised in front of 80 people and CTV cameras that no other SAFE programs would be affected. Because it was just a matter of “paperwork compliance,” just the fee-for-service program Valia would be retired.

The backdrop to all of this is that Valia, two weeks later, had to file suit to stop its closure mostly because the county refused an independent examination of the errors in the site review used for closure.

So, frustrated since April by slow negotiations and with a looming court examination of any county misdeeds, Rockstroh did an “end around” of the court case. On Sept. 14, without any apparent concern for the clients, Rockstroh cut off all funding and destroyed SAFE even before its day in court. The county’s “weapons of mass destruction” approach withheld thousands of dollars already owed and all future payments, citing contract “emergency clauses.” The county justified its actions by suddenly alleging $50,000 Valia spent of its own money on client needs, i.e. housing, medications, transportation, emergencies and food, somehow now constituted a “misuse of public funds.” Paperwork previously reviewed was suddenly so out of compliance that the county immediately must act. Facing a large payroll, the cash-flow impact collapsed SAFE instantly, immediately eliminating outreach services to about 30 high-risk clients as well as others. An unjustifiable disaster.

Public accountability. Rockstroh’s reckless decisions in creating this situation shouldn’t go unaddressed. Calmer voices at county administration were overridden when he pulled the trigger that destroyed forever an entire organization which had simply asked for an impartial hearing.

Rockstroh, by some estimates, by diverting staff and other resources, has now spent more than $200,000 of taxpayer dollars to force the closure. And all 27 persons now unemployed at SAFE’s drop-in center and Valia evidently paid an extreme price for standing on principle for their constituents and work. Perhaps its time for county HHS to show what principles they are promoting here.

R Drake Ewbank is the former operations coordinator of Valia Health Resources. He is on the board of Disability Rights Oregon and is a mental health advocate and service provider with 11 years of experience providing peer-delivered mental health services. He can be contacted at op.valia@gmail.com