The City Club of Portland today issued a study blasting Multnomah County's management of public mental-health services.

The 42-page report (PDF), titled Improving the Delivery of Mental Health Services in Multnomah County, hammers county managers for operating under an opaque budget, failing to assess treatment outcomes and allowing needy patients to fall through the cracks.

"'Blow up the system and start over!' More than one witness speculated that this might be the best way to improve mental health care in Multnomah County," begins the report's executive summary. "Testimony from state administrators, patient advocates and the providers of care produced overwhelming agreement that the system is in need of a dramatic and comprehensive overhaul."

Further, the report accuses the county of withholding crucial budget information from the public and "a tendency for conducting business away from public view."

County spokesman Dave Austin gave a veiled shot back:

"We appreciate the City Club committee's attempt at analyzing the mental health care system, despite some inaccuracies in the report, and we welcome any opportunity to look at how we can improve things," Austin says by email.

"Our Mental Health and Addictions Services Division staff and others in human services spent [more than a year] providing detailed information—including budgets, program offer details, fiscal information and other data—to the City Club committee," Austin's email continues. "As a public agency, information about our services is always readily available and transparency about our systems is a priority. Having provided this information to the committee, we are perplexed about the tone of the report."

The report alleges serious faults in the system:

• "Needy individuals fall through the cracks, sometimes receiving no care or care at inappropriate levels and locales."

• "Coordination among departments within Multnomah County that serve the mentally ill is poor."

• "It is impossible to distinguish direct costs for patient care from indirect costs for administration."

• "Even worse, assessment of treatment outcomes is inadequate, so that the effectiveness of treatment cannot be ascertained."

The report—which was researched by a group of nine community volunteers—goes on to list a series of recommendations for improving budgets, contracts, systems and outcome measurements. The full City Club membership is set to vote on whether to approve the report on April 8.