On June 5, her first day as Multno-mah County Chair, Diane Linn made a bold promise: Within 45 days, she'd deliver a plan to lift the county mental-health system out of crisis.
Last Thursday, Linn made good on her vow--but not without being ensnared by the complexity of the very system she pledged to fix.
Almost as soon as Linn took office, Providence Portland Medical Center decided to shut its Crisis Triage Center on July 31. The center has been the starting point for acute needs in mental-health care in the county for the last four years. Its closure is akin to closing the trauma unit at Legacy-Emanuel.
But news of the closure was only the latest crisis. The county's mental-health system has been falling apart for years, a poorly functioning system pressed by 10,000 patients a year, exploding healthcare costs, and state lawmakers unwilling to fully reimburse the county.
The fix, known as "the redesign," was left to two holdovers from Beverly Stein's days as county chair, Jim Gaynor and Peter Davidson. Their charge was to develop a system that, in essence, could do a $50 job on $20; in the end, they also had to address a $7 million shortfall in funding for hospital stays.
There was no formal vote on the plan last week (that will come Aug. 9); rather, Linn was looking for buy-in. But county commissioners Serena Cruz and Maria Rojo de Steffey almost cashed out. While Commissioner Lonnie Roberts watched events unfold (Lisa Naito was out of town), his colleagues complained that Linn's plan was vague, seemed to tie the county to long-term contracts without formal bidding and was dropped on them only one hour before the meeting.
"I'm kind of pissed off that I'm going to be held responsible for this...and I don't yet have a clue as to what I'm looking at," Rojo de Steffey told WW. "How could I just nod at this thing I hadn't read?"
While Cruz was willing to give a tentative go-ahead to the plan covering the service gaps left by the CTC's closing, she was also miffed. "Since December, every commissioner has said the devil is in the details, and we were not given any direction until today," she told WW.
Linn admits that the rollout was far from perfect. Still, faced with a public-health crisis, she chose to move forward. "I'm ready to make some tough decisions and take the heat for them, because the people I work for are the most vulnerable in the community," Linn says.
Both Cruz and Rojo de Steffey worry that the crisis will deepen without a careful, detailed analysis of Linn's plan. Still, both stress that Linn took over a task that had lost momentum during the final days of Stein's administration and the maelstrom surrounding the county's budget crisis this spring.
"Diane is inheriting a nightmare," says Rojo de Steffey. "It's too bad she had to take this on at the beginning of her term, but she did."
Mental-health advocates, often critical of the county, give Linn credit for making the redesign job one. "That's either really courageous or crazy," says Jason Renaud, executive director of the National Alliance for the Mentally Ill of Multnomah County, "but she's managed it well."
A public hearing on the mental-health redesign will be held at 6 pm Monday, Aug. 6, at the Multnomah Building, 501 SE Hawthorne Blvd.
Since the closing of the Crisis Triage Center was announced, Oregon Health and Science University reports its emergency room is seeing an average of six psychiatric cases a day--twice its normal rate.