A Mental Health Facility in Irvington Can’t Keep Enough Nurses

Earlier this month, WW profiled Joshua McCurry, a schizophrenic man whom Oregon’s mental health system has proved incapable of helping (“World of Hurt,” March 8). Every treatment facility where he arrived kicked him out shortly thereafter.

One of those places, Oregon State Hospital, is the source of the state’s problems. It is inundated with patient referrals, and a history of well-documented failings has left lawmakers loath to expand it.

Instead, they want to build dozens of new, smaller mental health facilities across the state.

But that too would prove challenging, as McCurry’s saga illustrates. He didn’t last long at a smaller facility either. And the struggles of that facility show why lawmakers’ plans might be easier said than done.

THE FACILITY

Within months of being admitted to Arbor Place, a 16-bed “secure residential treatment facility” in Northeast Portland’s posh Irvington neighborhood, McCurry was kicked out after allegedly groping a staff member and putting another patient in a chokehold.

McCurry is certainly a difficult patient—his doctors now believe his behavior stems from a personality disorder, not his previously diagnosed schizophrenia—but Arbor Place was dealing with its own problems.

The facility, owned by Cascadia Health, provides nursing care for high-acuity patients like McCurry. It also locks its doors, offering an alternative place for judges to send people with serious mental illness, deemed too dangerous to live on their own.

Unlike Oregon State Hospital, however, smaller facilities like Arbor Place offer placements closer to the communities where patients will eventually return. It has a community garden, hosts “skills-building groups,” and runs “staff-escorted community outings,” according to its website.

THE SHORTFALL

The entire health care industry faced a shortage of nurses during the pandemic. Arbor Place was no exception. By October, the facility couldn’t keep a nurse on call around the clock and had to relinquish a special state classification that allowed it to involuntarily medicate patients.

At the time, it was one of seven such “Class 1″ facilities across the state, including Oregon State Hospital. And it was one of four to lose the special classification since 2019, according to records provided to WW by the Oregon Health Authority.

A spokeswoman says Arbor Place’s staffing issues are the result, among other things, of a “high acuity of need contributing to burnout [and] years if not decades of pay rates in behavioral health inadequate to maintain competitive salaries.”

The nonprofit has won state grants to open three new facilities in Multnomah County. But it still has 180 unfilled positions, according to chief strategy officer Eric Sévos, and has had to close several facilities in Lane County in recent years. “It’s such a tight labor market,” he explains. “It’s just very competitive.”

It’s not clear whether Arbor Place’s staffing struggles contributed to McCurry’s assaults. Cascadia Health could not comment on his case, but said the change in classification had no impact on safety.

But later that winter, one of its employees, Erin Mercer, went to Salem to tell legislators how bad the situation had gotten.

A COVID outbreak had thrust the facility below “staffing minimums,” she said in February 2022. She was being forced to work overtime, and a dire lack of nurses was taking time away from her typical duties of training patients basic skills to help them transition out of the facility, she explained.

“With the pandemic throwing us deeper into crisis, Cascadia and other residential treatment providers need more help to keep staffing minimums to stay open,” Mercer told lawmakers.

THE SOLUTION

If policymakers want to build dozens of new residential treatment facilities like Arbor Place across the state, industry executives say, they need to figure out how to staff them.

“The key is to solve the workforce problem,” says Julie Ibrahim, chief executive officer of the nonprofit New Narrative, which runs more than a dozen residential treatment facilities across the Portland area. “The pay is low, and the work is hard.”

The state has recently increased the amount of money it pays New Narrative, Cascadia Health and similar organizations for each patient they serve, which Ibraham says has translated into higher wages for staff. Now, she’s lobbying lawmakers to continue those increases every year to keep pace with inflation—and offer loan forgiveness to encourage more people to enter the field.

Ibrahim is competing with Amazon and Starbucks, which can offer similar pay and a less stressful work environment. “If you were to look at all my exit interviews, they’d say we just really need more money,” she says.