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Oregon’s state government and its main association of counties announced a major agreement Monday, settling on a plan that would empower the Oregon Health Authority to more closely monitor and shape mental health and addiction services at the local level.
The fruit of more than a year of often-contentious negotiations, officials say the deal reflects a broader push by Gov. Tina Kotek and the OHA to direct scarce taxpayer resources toward the treatment of people with the most severe mental illness and addictions—such as those who have been civilly committed to psychiatric care, or charged with a crime but found temporarily unable to aid and assist in their own defense.
Historically, it has been the expectation that county health departments “would be all things to all people,” says Amy Baker, who oversees behavioral health care in the governor’s office. But she says Oregon’s needs have changed. The state has “tried to get more focused on what it is that we’re trying to accomplish, and to really specify who the people are that we’re trying to serve.”
The effort has faced serious resistance. To some local officials, it seemed like the state was trying to offload legal liability—it’s under a longstanding court order to process “aid and assist” patients into treatment faster—and strong-arm counties into swapping broad-based preventative mental health work for reactive crisis care.
Baker says the new agreements could still fund preventative work, so long as local health agencies are also meeting the basic commitment to treat the most acutely ill populations. She says the deal will give county health agencies more flexibility to tailor their work to localized needs while giving the OHA more data and information about the effectiveness of various programs—and more teeth to make sure counties meet their contractual obligations.
County boards of commissioners must still individually approve the agreements. It’s not clear if all of them will. For those that don’t broader issues will loom, as current contracts are set to expire Dec. 31, after which point much state funding could lapse.
Multnomah County did not respond by deadline to questions about its intentions. But after months of talks, the statewide Association of Oregon Counties was on board. In a statement Monday, AOC Executive Director Gina Nikkel cited a recent Dec. 17 negotiation that “yielded compromise language that the county counsels leading the negotiation felt was sufficient for each county jurisdiction to consider signing.”
Noting that the first new contract term would last just 18 months, Nikkel added that county directors and attorneys would “closely monitor implementation of the new contract to ensure that it does in fact preserve counties’ ability to provide services that are responsive to community needs and does not shift the state’s liability to counties and their community mental health programs.”
Known as County Financial Assistance Agreements, the contracts in question have long been a key mechanism for funding and delivering behavioral health care in a state that, according to one recent assessment, has the highest prevalence of mental illness in the nation.
Oregon has been pouring money into its treatment system in recent years, seeking to build out capacity—in the form of new residential treatment facilities, for example—and to encourage more people to join the health care workforce. But officials also said the CFAA system needed a significant update.
For 30 years, Baker tells WW, that system has remained mostly constant, even as the state behavioral health system changed as more people seemed to be going through mental health crises on the streets. She cites various forces at play, including a housing crisis, chronic underfunding of the behavioral health system and the proliferation of potent drugs like meth and fentanyl.
State leaders say the new deal will ensure more accountability, and ensure taxpayer dollars are getting results. The deal, Kotek says in a written statement, “puts people first, sets clear expectations, and ensures accountability for public dollars, while recognizing counties as essential partners in delivering care for their local communities.”
