Transcript
Automatically generated transcript. It may contain errors and includes testimony in languages other than English that is not individually marked up for assistive technology.
Jamie Dunphy
Good afternoon.
It feels like we've been gone for so long.
I am calling to order this work session of the Portland City Council.
This is intended to help us in development of our state.
Legislative agenda for the 2027 session.
This work on a behavioral health advocacy strategy started during the agenda development process last year.
So during the transition between council presidents, I asked Councilor Pirtle-Guiney to continue to help shepherd this work moving forward.
So for this work session, I'd like to hand the gavel over to Councilor Pirtle-Guiney.
I'll pass it to her to make some opening remarks.
Elana Pirtle-Guiney
Thank you, Council President, and thank you for prioritizing the continuation of this Thank you.
Thank you, Council President Jamie Dunphy, and good afternoon, everyone.
I'm very pleased to welcome our guests today to help us dig into the regional behavioral health landscape and what we would need as a community to have a functional continuum of care.
Health Share will be a major part of the presentation today.
They are our local coordinated care organization, making sure that everyone in our community receives the care that they need.
They will be joined by a number of other partners who we will introduce in just a few minutes.
I named them though here because they have been gracious enough to help engage in the planning for this work session and to share some of the work that they have been doing more broadly to provide context for us.
My hope is that this discussion will help council to clarify where we think the city's efforts are most needed as we prepare for our state legislative priority-setting work.
I want to thank everybody who has joined us today and recognize that our guest speakers represent only a handful of the people who have contributed to the work that we're going to hear about and the work that's done in community.
I'll also note that as you are listening to the presentation, if you have questions for groups that are not at the table, please ask them.
We have representatives from our own city services, from the state, from community providers in the county who are all in the room with us to answer questions, even if they are not part of giving the specific presentation.
I'll note that we're taking on this topic separately from the rest of our discussion about our legislative agenda— our state legislative agenda, I should say.
Because it is a somewhat new topic for this council to discuss together.
We as a city don't provide behavioral health services, and we don't generally weigh in at this dais about what these systems should look like in our community.
But we know collectively that the greatest challenges before us as a city are intricately tied to the shortcomings in our behavioral health system and the desperate need for investment in layers of care that don't functionally exist in our community today.
We're doing this separately so that we can dig into these conversations a little bit more, but these conversations will then roll into the rest of our agenda-setting process and the broader conversations we'll be having with the Office of Government Relations over the next month.
Last year, after we heard from a number of members of this body that you were interested in weighing in on this topic, I asked a few providers in our community to sit down with a few counselors who had been a part of expressing that interest, part of wanting to learn more.
Providers who are often on different pages about what we need to prioritize moving forward.
And I asked them to come up with a proposal for the city of what they think collectively would allow our behavioral health system to better provide services to members of our community.
Something that this council could take on as a proposal to move forward in our state agenda.
I want to thank the councilors who joined me in some of those conversations last year.
I know not everybody was able to make each meeting, but the feedback that you provided helped to shape the proposals that we will be hearing.
I hope this will be a useful presentation and beneficial conversation that helps give our folks at OGR, at the Office of Government Relations, a good sense of where and this council is interested in engaging in the work and how we might be able to come up with a city agenda to improve our behavioral health system across the region.
With that, I want to turn it over to OGR Director Sam Chase, who will give us a full overview of the agenda, introduce our presenters, and help lead us through this conversation.
Thank you for being here, Director Chase.
Sam Chase
Thank you so much.
My name is Sam Chase, Director for the Office of Government Relations, and thank you, Council President, Councilor And thank you, Deputy City Attorney Priya Dhanapal, for your presentation.
I'd also like to thank Deputy City Attorney Nancy Thorington.
Thank you, Deputy City Attorney Priya Dhanapal, for your presentation.
Thank you, Deputy City Attorney Nancy Thorington.
Thank you, Mayor Keith Wilson.
Thank you, Councilor Dan Ryan.
Thank you, Deputy City Attorney Nancy Thorington.
Thank you, Deputy City Attorney Nancy Thorington.
And thank you, Councilor Dan Ryan.
Thank you, Deputy City Administrator Priya Dhanapal.
Thank you.
I want to thank the city staff and staff of the city for really leaning in on the process.
As you know, OJR is not a policymaker or decision maker.
We're really process people.
And the city as a body has really leaned into doing the hard work internally before we're going and doing our advocacy externally with state government, federal government, tribes, local government, and more.
That effort of really leaning in, doing that hard work, finding collective action, finding common ground, finding, getting as close to consensus as we can, and having a unified voice pays off in many dividends when we do that work.
So really, we're sort of here on a new frontier now, which is to do this work and also do it in coordination and coalition with the county, behavioral health partners, coordinated care organizations, and many others that are working in this space.
Thank you.
Behavioral health is an area where the city has limited expertise and limited operational involvement, but yet we've heard from many of you that the issues profoundly affect our core responsibilities.
And as we are reluctant to engage in issues that aren't directly associated with city services, this is one where you've said, hey, there are so many services affected by this work that we have to take some bold action.
Thank you.
Today we seek to build a foundation for partnership, collaboration, and coordinated— and a coordinated state-level advocacy.
We're bringing forward leading behavioral health experts so that together the city can help shape and join a focused coalition delivering urgent, unified, and actionable recommendations.
Before we transition to council discussion, our guest speakers will provide background on the behavioral health landscape, describe key system challenges, share findings from their recent work and outline their proposed direction for state advocacy.
And again, I want to share that this is a foundational point for us to engage in this work going forward.
And so as you're hearing those recommendations, those are the point in time that we are in right now as we're preparing for the 2027 legislation.
And there will be more work to do, more work to work out.
We'll be coming back at the end of September for our first agenda-setting work session with you where we'll build on this work.
And then we'll have yet another work session and hopefully an adopted legislative agenda in December.
So with that, I will invite our panelists up to the dais.
Dr. Joe Hardman, Health Share of Oregon.
They will do more introductions of themselves.
Julie Ibrahim.
New Narrative, James Schroeder, Cascadia Behavioral Healthcare, Director Rachel Banks, Multnomah County Health Department, and Stephanie Howard, Public Safety Service Area.
Dr. Hardman, please take it away.
Joe Hardman
Thanks, Director Chase.
Good afternoon, everybody.
We have some slides to show here.
All right, there we go.
Hi everybody, my name is Joe Hardman.
I'm an internal medicine physician and the Chief Medical Officer at Health Share of Oregon, which is the coordinated care organization that serves the majority of OHP members in our community here.
I'm very excited to be here.
Because today's discussion is focused on state policy and advocacy, I wanted to start off with a quick reminder of how responsibility is shared across the behavioral health system.
So that's demonstrated in this somewhat busy slide here.
The point of this busy slide is that behavioral health is not a single system run by a Obviously, federal and state governments set important codes and rules.
CCOs like ours administer the behavioral health benefits.
Counties, of course, deliver very important care in terms of crisis care and additional services.
And then there's this, like, entire network of providers, hospitals, and community organizations who all play an important role in delivering behavioral healthcare to our community.
And because we all play a role, no single partner can solve these challenges alone.
We really need to come together around a shared vision for how to improve on a shared understanding of what the problem is and then advocate collectively for how we think we need to address it.
So the state does have a particularly important role here, right?
State policy, state funding, state capacity decisions all directly impact us and where the care, how we can accomplish the care locally.
But that really is the point of today's conversation, to align around what we are seeing in the region and what we need to ask of the state.
Um, Rachel, did you want to add something about—.
Rachel Banks
Sure, happy to.
Um, on that last slide, you'll also see the, the role for the county.
So I wanted to talk— for the record, my name is Rachel Banks.
Um, I'm the Health Department Director for Multnomah County.
Um, and I wanted to just talk about a couple of the unique and distinct county roles in that you'll see in this diagram.
So one is, under Oregon law, the counties are designated as the local mental health authorities.
So our Board of County Commissioners fulfills that role, and their role is for planning and oversight for behavioral health services that are offered in the region.
The region, of course, including Portland as well as Gresham and, and our other eastern cities.
And then the Community Mental Health Program, that's the role that the department plays, and our role is to fulfill statutory requirements, obviously under the direction of our Board of County Commissioners as the local mental health authority.
Some of those statutory requirements include things like aid and assist, safety net services, oversight planning, those sorts of things.
And then we work with the board as a local mental health authority who's responsible for policy adoption, for funding for statewide advocacy, for policy and funding for statewide advocacy, and adopting a local plan that we submit to Oregon Health Authority, which basically talks about how we fulfill the statutory requirements.
Thank you.
So thank you, Joe, for allowing me to provide that background on the local mental health authority and the community mental health program.
Unidentified speaker
Yeah, that's great.
I mean, with that context in mind, I think we should look at the behavioral health spectrum that people are trying to work through, because that'll provide some additional helpful context, I think.
So this slide is also busy, and I think that's because the adult behavioral health system is very busy.
As an internist, I can tell you that this is far more complicated than the medical side of the equation, and patients and family members experience that complexity every day.
So the continuum here runs from prevention, outpatient treatment, and housing on the right-hand side of this slide, all the way up through residential treatment, crisis care, inpatient psychiatry, all the way to the Oregon State Hospital on the left-hand side for the most complex patients.
The point with this slide is that this is a continuum.
These aren't separate systems.
They're all connected.
And because they're connected, When one part backs up, the rest of the continuum feels it.
So for example, if a patient is admitted to an inpatient facility, they get stabilized, they don't meet inpatient care needs anymore, they then could step down to another level of care.
But if that level of care doesn't exist, they end up staying in the inpatient setting and then taking up a bed from somebody who is having a crisis and needs that bed.
Similarly, if community services aren't available, people end up cycling through the emergency department or our shelters or even jail.
Yeah.
While they're waiting for access.
So the point is that this is a full continuum.
There are challenges throughout it, of course, but we're really focused today on the yellow circles there because those, according to our data, really represent the major bottlenecks in the system and opportunities therefore to improve flow throughout it.
So our focus today is pretty practical.
What capacity and coordination are needed so people can reach the right level of care when they need it at the right time?
They don't have to wait till it becomes a crisis.
To understand the bottleneck on the left-hand side of the slide, the Oregon State Hospital, I think it helps to understand the legal framework in which we're operating here.
So on the next slide, I should point out that I'm not a lawyer, I'm a doctor, but I'm going to try my best to share the legal landscape.
This legal framework is something that we did not set and we don't really control.
Back in 2003, the Mink case established requirements for how quickly aid and assist patients should be admitted to the Oregon State Hospital.
Continued noncompliance then led to increased federal oversight, some tighter requirements, and then significant financial penalties.
So the practical result of all this is that currently the Oregon State Hospital is now largely focused on the aid and assist patients.
I would say almost exclusively focused on the aid and assist patients.
That is not a criticism.
That's just what's happening today.
That's what we're working within.
So while the state hospital serves a really important role for our state and a very important role—.
Eric Zimmerman
Please describe aid and assist.
Aid and assist, please, one more time.
Olivia Clark
Aid and assist?
Yep.
Joe Hardman
These are folks who have mental health challenges who can't aid and assist in their own case.
So state hospital, very important part of the continuum on the left side for the most complex patients.
It doesn't solve all of our problems, right?
We need a range of options for people who have different levels of need.
And no single bed, especially the most expensive type, can meet every need of every patient.
Dan Ryan
Right?
Unidentified speaker
So we really need kind of that spectrum within the middle and some additional capacity, particularly in the middle of the continuum.
And I will say that the legislature has actually made some pretty significant investments in that middle part, particularly for residential care.
On the next slide, we share what those state investments have been.
So through 2021 and 2025, the state has made some pretty significant investments across residential treatment, withdrawal management, Supportive housing, as well as community-based behavioral health services.
Many of these beds and programs are actually still coming online, so we actually haven't seen the full impact of their, you know, the potential benefit.
It's also important to remember that these are statewide investments, so not all of this capacity is actually built in the Portland metro region.
But even if it were, bed types are not interchangeable.
So a residential bed, a withdrawal management bed, a subacute bed, an inpatient psychiatric bed, That serves a very specific purpose for a very specific type of patient with a specific problem.
So yes, the state has made some very meaningful investments, but really we haven't overcome decades of underinvestment, I would say, in behavioral health.
And I'd also say that like, you know, we need some more in the middle to help.
To make that challenge a little bit more concrete, I want to share with you some of the populations at the center of these pressures.
And the next slide I think will be familiar to several of you, hopefully.
At Health Share, over the last couple of years, we've really worked hard to identify a particularly complex group of patients whose behavioral health needs are really not being met by our current system.
We call this our high acuity behavioral health cohort.
It includes adult members of Health Share who have a stimulant use disorder, an opioid use disorder, a diagnosis of psychosis, Or an unintentional substance-associated overdose.
And you can see with those overlapping circles that a lot of these conditions overlap for patients.
This is meant to be an analytical definition, not a label for an individual.
It really just helps us kind of identify where the system is struggling and where we really need to lean in.
So this cohort represents 9% of our adult members, and yet it accounts for 29% of our total costs.
Thank you.
And that's mainly through use of our emergency departments, admissions for medical conditions, admissions for psychiatric conditions, as well as behavioral health costs.
So the point is not that this population is expensive.
They tend to be, yes.
But we think that these costs are high because there are too few appropriate alternatives for them to meet their care needs, right?
So their care ends up needing to be in a crisis setting because either that's all that we have Or because their behavioral health condition hasn't been treated well enough, so it becomes a crisis.
And I'd point out that these aren't just healthcare challenges, by the way.
These challenges also impact our housing and homelessness systems as well.
And that overlap has become increasingly obvious now that we're integrating our data.
On the next slide, you can see when we link that health and housing data, the overlap here is very striking.
More than half of the people served through shelter Supportive housing and street outreach have a high acuity behavioral health condition.
So the takeaway here is also simple.
Housing and behavioral health are not separate, right?
They're not separate challenges.
These are the same populations.
We're serving the same people.
So, and you know, we all know this, housing is foundational to good health, right?
But housing alone can't replace psychiatric stabilization, medical management, Effective treatments, care coordination, and those sorts of things.
So it's at the same time, behavioral health treatment is really difficult to sustain without a safe place to go or a safe place to live.
So we need folks housed in the places that are safe in order to address their healthcare needs, right?
It's, it's both.
And when those systems are not coordinated and working together seamlessly, people do end up kind of falling through the cracks, cycling through crisis settings, coming to the emergency department, ultimately struggling to remain housed.
So fortunately, I'm joined here by a couple individuals with deep experience in this space.
So I'm going to turn it over to Julie Ibrahim to describe how these gaps and system constraints show up in real life.
Julie Ibrahim
Good afternoon, Mayor and councilors.
For the record, my name is Julie Ibrahim, and I'm the CEO for New Narrative.
We are a nonprofit, 50-year-old agency that provides comprehensive mental health treatment, psychiatric care, residential treatment, supported housing, transitional housing, and peer support.
And we serve 2,000 folks in Multnomah and Washington County.
So the key takeaways from the data that Joe shared earlier are that the lack of capacity for the high acuity behavioral health cohort drives poor health outcomes, disproportionate healthcare spending, With limited outcomes, gaps in the continuum, and gaps in coordination, challenges in the downstream supported and affordable housing system, and community livability challenges.
What this data describes is something we see every day as providers: people getting stuck and getting worse because the level of care they need isn't available when they need it.
Someone may be ready to leave inpatient psychiatric setting, as Joe said, But there is an appropriate place for them to go.
They may no longer need hospital-level care at all, but will still need more support than traditional housing or outpatient services can provide.
To me, that points to 2 challenges: capacity and coordination.
We need a behavioral health continuum with capacity and coordination that centers on the client's recovery journey to ensure they're not falling through the gaps.
Thank you.
That means we need multiple options for this complex population, including inpatient care, subacute and respite care, which we'll talk about later, residential treatment, transitional housing with behavioral health supports, tiered supported housing, outpatient treatment, peer services, and other community-based supports.
But having those services isn't enough.
People also need to be able to move between them as their needs change.
And it's not always linear movement, believe me.
They need coordination that helps them stay connected to appropriate levels of aftercare and housing, supporting them through their entire recovery journey, whether they're moving forward or taking a step back.
For this population, success doesn't necessarily mean they no longer need support.
In fact, some people may need significant support for most of their lives.
A new narrative.
We have clients that have been with us for years, stable, housed in the community because we have supported their recovery journey.
Success can mean fewer crises and hospitalizations, fewer incarcerations, stable housing, trusting relationships, and living safely in the community where they have dignity and choice.
So the question is, do we have a supportive continuum?
And continuum is the key word here.
The right level of care at the right time, and can people actually get to it?
When the answer is no, people get stuck and they fall through the gaps, and the pressure shows up throughout the system with significant human and economic impacts.
Now, one of the places we see this most clearly is actually in the downstream part of the continuum, affordable and supportive housing.
Thank you.
So with that, I'm going to turn it over to James to talk about Cascadia's experience with this population in their housing portfolio.
Unidentified speaker
Great, thanks, Julie.
Hi, good afternoon.
I'm James Schroeder, CEO of Cascadia Health.
Similar to Julie and New Narrative, we kind of have the spectrum of services at Cascadia.
So we do street and housing outreach.
We operate Project Respond, which is a crisis response in Multnomah County, all the way through with outpatient, lots of residential, and then housing, including affordable and supportive housing.
And my job today is to really highlight the challenges in the housing system.
What Joe mentioned is that a lot of folks are not getting the treatment that they need at the level that they need.
And then what happens is we end up putting them in settings that aren't right for them.
Thank you.
And oftentimes that's what's happening in housing.
So we are getting folks in our housing services who have untreated need and high acuity.
That's not a great match.
In those settings, that's not where— they're not set up to support those things and stabilize.
So what we end up seeing is that 3.5 times more likely return to homelessness.
I'm gonna talk about that a little bit, but the other thing I wanted to highlight is, Just in the last month, just to make it really real, at Cascadia, we've had one murder at one of our affordable housing units from someone getting shot and killed.
We've had 3 staff assaulted.
And this is all because of that acuity mismatch, because we're putting people into a setting that isn't right for them.
They may not be ready for housing yet.
And that's kind of the key takeaway is that we need to address that.
Stabilize that and make sure that they're getting the treatment that they need along with their housing and not just housing alone.
So I'm gonna give a couple of stories, but before I do that, I wanted to share, 'cause I took the time in preparing for this to meet with our housing outreach team.
We have a lot of peer support providers on that team.
What they shared with me, I actually hadn't thought about before, and that's being housed can actually be a traumatizing experience.
Yeah.
If you've been on the streets for a while.
If you think about it, it kind of makes sense.
You've been living on the streets in a communal setting.
You have a society, you've got people around you, and all of a sudden we put you into a single-room apartment by yourself.
So just that move on its own is enough to try to work through and get to a better place so that you can stay.
Thank you.
But if you're coming in with untreated behavioral health and untreated substance use, that makes it almost impossible to then deal with those things that are going to allow you to stay housed and not have that 3.5 times more likely to return to homelessness.
Most of that return to homelessness is because of evictions.
Evictions are a failure, right?
If we're in a housing system, our goal is to keep people in housing for the rest of their lives.
Candace Avalos
Yes.
Unidentified speaker
It doesn't mean that we're going to pay for their housing for the rest of their lives, but we're going to try to give them the support they need to not get evicted.
And not dealing with that acuity and that untreated behavioral health and substance use is just setting us up to do that.
The other thing that it does that I didn't think about a lot either until I really started spending more time at Cascadia is it impacts everyone else around them as well.
So think about it.
We've all lived in an apartment at some point, right?
We all hate the noisy neighbor upstairs, right?
If you're dealing with untreated mental health, you are more likely to be just— you disturb people, right?
You're going to cause noise.
You're going to cause damage in your apartment.
And those are all then reasons that you end up not being able to stay housed, not because you're a bad person, but because we haven't treated the things that are setting you up to then fail in that new system, and we're expecting you to socialize yourself to that while trying to deal with your substance use and behavioral health disorder.
Candace Avalos
So that's just a—.
Unidentified speaker
It's not a great setup, right, for doing that.
So you can see why we're getting the outcome that we are without pairing those things together.
And like Julie mentioned, we'll talk a little bit later about a part of our continuum that is really under capacity.
Which is around the subacute and respite, which is really a readiness piece for them getting people ready for treatment, housing, et cetera.
But 2 stories.
So I asked the team for stories.
I probably got like 25, so I had to try to find some.
But one is Alex.
So it's a 47-year-old male who has been housed, let's see, I think 8 times.
Elana Pirtle-Guiney
Wow.
Unidentified speaker
They have been evicted 8 times, and the primary reason that that keeps happening is because they're not getting the treatment for their behavioral health disorder.
They have a lot of paranoia, which tends to make them not trusting and more violent.
And so they tend to react when they're in that paranoid state by being aggressive to other residents or to staff, which then sets them up for being evicted.
Unfortunately, you know, this is one of the folks that just recently punched one of our staff, did some other things, and is now being evicted and is going to go back on the streets, which is again a failure.
Tracy is a 36-year-old female with severe substance use disorder.
She's also been evicted 6 times because of her drug use.
Her addiction just makes it very difficult for her to be a good neighbor.
Thank you.
She tends to disrupt people.
She can be violent.
She's really destructive.
She unfortunately chose to intentionally flood her apartment, which then not only impacted her, but it impacted the people below her as well as us at the organization, because then we have to repair all of that and we've got units offline and all those things.
I wanted to include a good story though, is that We finally were able to get her into treatment, and she now has been housed for a period of time and is doing really well.
And it just demonstrates that when we take the time to address that, we're going to get better outcomes and better use of our resources.
Because right now, funneling people through housing with that mismatch of acuity isn't a great use of our resources.
And So that was the, you know, my primary, you know, goal was to kind of highlight that and that eviction isn't the outcome that we're after.
But if we do a better job with some of the continuum pieces, but also just matching housing and services and treatment, we can do better and do better for our clients as well as the community.
Thank you so much.
Now we're going to hear a little more about from the county and city around how some of this plays out locally?
Yeah, thank you.
So this plays out, as I mentioned earlier about the county's role as the community mental health program, the underfunding of the behavioral health system plays out across the continuum, particularly because we operate the crisis service, because we provide services to the uninsured and underinsured, and really work across that system.
And because the entire behavioral health system is underfunded, And was not designed or has not been re-envisioned to serve the sort of acuity and complexity of needs that we're seeing at this particular moment.
So, and I appreciate that for today we're focusing in on a part of particular— of this, of the continuum with specific needs that my colleagues here have outlined really well.
Ultimately, we want to ensure that we're able to be providing preventative services and the right interventions at the the lowest level of acuity that we can.
And as folks have said, the right care for the right people in the right time in the right place.
Um, and ultimately, the underfunding of this part of the system has, has created a situation where, as we've, we've heard, that is not happening.
Uh, some of the outcomes and impacts that we see, as we've heard, obviously, um, evictions, folks not being able to stay in their housing because of the unmanaged symptoms, We see it in people not being able to gain or keep employment, and then all of the basic and social needs that that contributes to.
We know that when people cannot reasonably access the higher level of care that they need or the lower level of care that they need when they need it, that there are real impacts to themselves, their health outcomes, and those around them, their families.
Their neighbors, um, as, uh, we've heard.
And I think, you know, there's real impacts for the folks that are struggling, that, um, with a really challenging issue and are not getting the supports that they need.
I think that's, uh, especially important because we know that 50% of, um, people will not seek behavioral health services perhaps at the time that they need it, at a lower acuity, because of stigma or negative impressions, societal impressions, beliefs, or stereotypes about them.
And while they're experiencing one of the most complex health issues, then if you add to that the kind of internalized shame and blame that, that then people experience on top of all of the other pieces, and we see that that can lead people to hide their struggles until they become a crisis, until they can no longer hide them.
And so I really just wanted to bring that piece in as well as part of our role is to be thinking about how do we both have the services that we need and ensure that those services are destigmatized and that folks want to access them, particularly where we can prevent crisis from escalating.
So in short, as we've heard, both totally agree with the impacts that my colleagues have shared and the impacts throughout the system for the county.
Thank you.
Which basically is we see poor health outcomes, we see interventions at higher costs, we see people worsen, and ultimately we see more service delivery at the crisis or a higher acuity end, which is often less effective and, and more expensive and demeaning for folks.
So with that, I'll turn it over to Stephanie.
Stephanie Howard
Thank you.
Good afternoon, councilors.
My name is Stephanie Howard, she/her pronouns, and I'm the Director of Community Safety Programs for the City of Portland.
I'm here to represent a little bit about the impacts to city programs and services that these gaps have represented, and I'm very happy to be here today with our partners from the CHAT program.
You can see here partners from Portland Street Response, from PPB's Behavioral Health Unit, And other partners here that can answer more specific questions that you might have going forward.
Oregon's behavioral health system gaps directly affect the city's core services.
We'll put that in the category of Captain Obvious, right?
Staff across bureaus, including public works teams and public safety teams, have increasingly encountered individuals in crisis.
City public safety systems are designed to address a moment of crisis.
Thank you.
Currently, we can only offer temporary stability without transitional and longer-term behavioral health support capacity, which is deeply needed.
These system gaps are visible in our public safety programs, and yet we all are working very hard to strive for more options.
The Police Bureau's Behavioral Health Unit was established because so many calls for service involved a mental health component.
The BHU pairs officers with licensed clinicians who work proactively with individuals who've repeated or high-risk contacts with police to try to break that cycle of crisis response.
In 2025 alone, the BHU received 775 referrals, and of those referrals, 37% were people who had been previously on a caseload.
Meanwhile, the demands for Portland Street Response services continue to grow.
As of August, uh, this year, PSR has received nearly 14 calls for service, which is an increase of approximately 4,000 more calls this year than the same time last year.
Since the program began, Portland Street Response has received nearly 60,000 calls for service in just a few years.
And over the last couple of years especially, PSR has been working to expand its staffing and its presence throughout Portland, all with the goals of providing care to Portlanders experiencing behavioral health crises and significantly reducing the call load on police, fire, and emergency rooms.
The CHAT program continues also to absorb medical and behavioral health-related impacts.
Since 2021, CHAT has responded to more than 17,000 medical and overdose-related calls, including nearly 3,000 repeat callers, with about 1,100 individuals calling 4 or more times due to unmet behavioral health needs.
Health Share data shows that 65% of the known community members CHAT serves are in the high-acuity behavioral health cohort, underscoring the intensity of that need.
CHAT's overdose response units regularly encounter individuals cycling through crisis without access to sustained care, requiring repeated emergency responses from fire, BOEC, police, Portland Street Response, and others.
Since the 2024 fentanyl emergency declaration, CHAT's buprenorphine program has reduced emergency department use by 80% among participants while connecting as many as possible to same-day care and shelter and long-term treatment.
And these efforts can demonstrate that both the scale of the repeat caller impact and also how targeted interventions can reduce strain on city systems.
The city's sheltering work has also evolved, and while not every unsheltered Portlander has behavioral health needs, a significant portion of guests in city shelters do.
And our providers report rising behavioral health acuity, driven in part by substances like fentanyl and P2P meth.
To meet these needs, the city has established recovery-oriented shelter sites and wellness centers at alternative shelter sites.
That bring behavioral health services to the site alongside, excuse me, medical and dental care and case management.
Options to move people with severe and persistent mental illness out of shelter into appropriate care and housing is extremely challenging.
There are too few available options, which greatly inhibits the city's ability to provide more people with shelter and wraparound services.
City bureaus are doing everything they can to respond to the need, but without accessible and sustainable varieties of treatment pathways, we all face the same challenge: people repeatedly cycle through emergency response systems, get short-term stabilization, and without longer-term supports, quickly decompensate, leading to yet another crisis call.
The strain on city resources really cannot be overstated.
We've worked hard to create programs with partners and to fill system gaps, often with only one-time funding.
But these really are just Band-Aids.
Additional capacity and stabilization options are critically important to alleviating the pressure on Portland's core services and achieving better outcomes for the people that desperately need our help, as you'll hear from everyone today.
With that, I will pass it back to Julie.
Unidentified speaker
Thank you.
So the challenge is this: individuals with complex, high-acuity behavioral health conditions need some combination of what you see on this continuum, particularly in the step-down psychiatric care box.
They need, yes, diversion and early prevention, sometimes inpatient psychiatric care, almost always though step-down psychiatric care.
And that can include things like traditional behavioral health housing, Or I'm sorry, transitional behavioral health housing, psychiatric respite, and/or subacute care.
It will always include outpatient care, I guarantee it, and case management, and ultimately supported housing with some higher-tier supports.
And I'm gonna talk about that in a minute.
Without access to this continuum, this population, as you've heard, enters the system in crisis, landing in emergency rooms, jails, or straight to affordable housing without supports.
Which risks their housing retention and doesn't give them the recovery support they need.
So as Joe said, when one part of the behavioral health continuum doesn't have enough capacity, the impact ripples throughout the continuum.
If someone can't move out of inpatient psychiatric care because the appropriate next level is not available, the bed remains occupied.
This backs up inpatient care.
Inpatient shortages put pressure on emergency departments.
And without appropriate community-based options, people cycle right back into crisis.
That's why we need a supported flow through the continuum.
The answer isn't simply more of the expensive and restrictive levels of care.
We need the right capacity and a variety of capacity throughout the continuum, and that includes subacute care, psychiatric respite, residential treatment, Transitional behavioral health housing, high acuity tiered supporting housing, tier supportive housing, and strong community-based services.
Now, these options can often stabilize people in community with a significantly lower cost.
And let me tell you a story to illustrate that.
New Narrative operates a supported housing building on 13th and Clay.
It's 47 units.
Mayor, you toured it the other day.
It's considered supportive housing, but it's, it's a much higher tier of support.
It's 24/7 staffing, usually at least double staffing.
We provide clinical support there, case management.
We provide some meals and some medical support.
We've had folks that have lived there for years stably.
But the other day there was a young man He was— he's diagnosed with schizophrenia.
He got very agitated.
He got very angry.
He was threatening staff, threatening other residents.
He claimed he had a gun.
The staff de-escalated him.
Normally, in a traditional permanent supportive housing situation, crisis response would've been called, the police would've been called.
But that staff is very experienced and knows this participant very well and speaks and works with him every day.
So they were able to de-escalate them.
Thank you.
With their clinical skills, they were able to determine that he didn't have a weapon.
They got him a meal and got him back into his room.
And there was, there was not another incident after that.
Bridgeview operates at about $50,000 per bed per year.
That is a bargain compared to hospitalization.
But capacity alone isn't enough.
We also have to ask who is helping the person move through the continuum.
There is good care coordination happening today.
The gap is that the coordination doesn't always follow the individual from one setting to another through their entire recovery journey.
That's something we're exploring with the psychiatric hospital-to-housing pilot that's being run by Metro in Multnomah County right now, and I'm, I'm co-chair of that along with Andy Mendenhall.
How do we make sure that the person, rather than the program, remains at the center of the transition and doesn't drop through the cracks.
So I think the path forward is this.
Yes, we build the capacity we're missing, but we also improve the connections between what we already have and invest where the data tells us that we'll have the greatest impact.
Health Share commissioned this capacity modeling, and providers across the region have supported it.
There is broad agreement that it points us in the right direction.
Thank you.
Especially when public resources are constrained, I'm sure you will agree that we should be very strategic about where that next dollar goes to fill in the continuum gaps with the most cost-effective options.
The goal is the right care at the right time in the right setting.
I'll turn it back to Joe to walk through what the modeling says.
All right, we're now at the proposal that we're hoping to gain your support.
I think it's important that you know that this proposal, by the way, is data-driven.
It isn't just our opinions.
Health Share worked with the analysts from OHSU's Business Intelligence Unit.
These were the folks under Peter Graven that did the predictive COVID modeling for the state.
So it's a very smart group of folks at OHSU who helped us create a computer simulation of that continuum in our region.
And the really cool thing about this simulation, by the way, is it's dynamic.
Reflecting the changes in our current environment.
So for example, those beds that are coming online as a result of the state's investments, those are built into this simulation.
The unfortunate recent closure of 55 inpatient psychiatric beds in our communities, that's also built into the simulation.
So we are able to take this computer simulation and start testing things like if we add this number of beds, what happens to ED boarding and inpatient boarding?
If we add this type of bed, if we make this policy change, what actually will be the most helpful?
So we tested various scenarios and arrived at several priorities, which we then, as Julie said, reviewed with dozens of local providers and system partners to just really get aligned around what we think will be helpful.
So the model points to 4 priorities, and these are all linked.
One, preserve inpatient psychiatric capacity and backfill the recent closures, those 55 beds that are coming offline.
2, Add approximately 50 psychiatric respite beds and 50 subacute beds.
3, Create sustainable reimbursement rate for inpatient psychiatry.
And that's given some of the financial challenges in the recent closures that we've seen.
And 4, remove barriers that make capacity building harder to, you know, to actually operate.
So I wanna point out here that this is not a menu of options that we're suggesting we pick and choose from.
These pieces all work together.
Thank you.
We need the right mix of capacity as well as the system changes in order to help people move through the system and receive the care that they need at the appropriate level.
You might have some questions.
We've talked a lot about subacute and respite beds, and I think James can give a little bit definition, some context to what those actually mean.
Yeah, thanks, Joe.
So Cascadia has been operating 2 respite sites for a number of years for a total of 16 beds.
16 Beds.
Traditionally, respite is a low, you know, like low-care model.
It's more peer engagement, engaging people and getting them ready for where they're going to be going next.
So we might do some med management, case management, things like that, but it's a fairly lower-touch model.
Okay.
Subacute, however, is a higher-touch model, but it's lower than hospitalization.
So the best example I have is sadly a physical health one, because that's— I'm a physical health provider.
But if you imagine that you're getting IV antibiotics for an infection, like a bone infection, that drags on for a really long time, but your kind of risk area is only for a few days.
Once that risk area is done, you don't need to be in the hospital anymore.
Candace Avalos
Right.
Unidentified speaker
You could be managed at a lower setting to have those IV antibiotics if that setting exists.
This is the same for behavioral health.
There's a lot that needs to happen in the inpatient psych setting, but once you've gotten to that point, we can move them into a subacute setting, which is lower cost and then opens up care, you know, for those beds to be utilized for someone who needs that level of care.
So This recommendation is because we need something that's lower cost, but also it's missing in our continuum.
So the uses for these, if you think about it, is, as Stephanie was saying earlier, if you have somebody in crisis, these could be a setting where that could actually work to stabilize them, right, and get them ready.
This could be somewhere that people go when they're done with their hospital stay and can go to a lower care.
But it's also a place where Like Julie's example, we could send someone who's in our housing to one of these sites to go for a week, stabilize, and go back, which then prevents the eviction and further violence and other things happening.
So they have a really important role in our continuum, and we just haven't built it out as much here in Portland.
There's a lot of other cities and states that have.
All right, so I think we'll close by coming back to our goal here.
Goal is, as we all know, we want our region to have a behavioral health continuum where people can get to the right level of care at the right time when they need it and not fall through the cracks and not waiting until it becomes a crisis.
I was also thinking of a sort of medical example as an internist.
You know, if I see a patient in my clinic who's got chest pain, I get him or her right in for a cardiac catheterization, diagnose the lesion, Stent it.
I don't wait until there's a heart attack, right?
That just doesn't make any sense.
And we want to apply that same kind of logic to the behavioral health network, right?
Like, we don't want to wait until these become crises.
We need this kind of middle part of the continuum.
Yes, crisis care is important because it will happen and it will continue to happen.
So you will see part of our recommendation is building out our inpatient capacity that's sorely needed and supporting it with additional funding.
But it's that kind of middle part that we're really focused on here today because we just don't have that in our current system.
We know that no single investment's going to solve all the problems, but we do feel like this recommendation does address a lot of the critical gaps that we're all experiencing daily.
So I think I'll turn it back to Director Chase.
Thank you.
And I think, so I'll just briefly share legislative landscape.
You've heard me on this.
You're probably going to hear us on this again.
There are really significant challenges with this legislative session.
There are impacts from the federal legislation in HR 1.
There are growing wildfire costs, drought costs, transportation issues of significance, a number of preemptive issues we're concerned about.
This is just to say that even in that scenario, we see this as— and we're going to be pushing to be disciplined and focused and defensive and not losing Keeping our eye off that ball.
And this will help us with that at a minimum.
But there are a significant number of investments and resources that are part of this that, you know, we may not have the ability to get that all in one session, but we want to put forward the best feet we can and continue to build on that over time.
And so this is a long-term strategy to get this fundamental system change.
Demonstrating to legislators, the governor's office, and OHA that we understand how these systems affect our communities.
So with that, I want to open it up for questions and discussion.
And I want to have this question on the table, which is also for you.
Does the approach presented today align with the direction you intended for our behavioral health advocacy moving forward?
Elana Pirtle-Guiney
Thank you, Sam, and thank you all for bringing together not just the 5 of you but your colleagues, especially the other organizations who are providing services on the ground daily in our community.
I know there are a lot of other groups that were a part of this.
Uh, colleagues, I think the question that Director Chase just asked is the right question.
Before we jump into that, I do want to note that I had a few people Ping me during the presentation to say, can we get the numbers that weren't on the slides?
So Director Howard, I think you had a fair amount of data.
And then the specific bed counts in the proposal that you have before us, I just want to make sure I have those down correctly.
This is a proposal to backfill 55 beds that came offline this year, add 50 subacute beds, 50 respite beds, and then address the reimbursement rates and a few policy pieces, both at the city and the state that you did detail in the slide.
But those 55, 50, and 50 numbers, is that correct?
Unidentified speaker
That's correct.
Candace Avalos
Okay.
Keith Wilson
I would—.
Sam Chase
We can share that and we'll work to try to compile some of that information, more detailed information, and share.
And we'll have some opportunity to bring back more thinking at the end of the month at the next work session.
Elana Pirtle-Guiney
Great.
And I think what we're aiming for today is to provide feedback on the proposal before us and to the question Director Chase asked, whether this is right direction or not.
And then if it is, we can ask the folks at the table to develop a little more specifics for us.
I'd note that we heard that this is a data-driven approach.
This is about where we can spend dollars to get the the greatest impact.
And that was part of what I heard from a few councilors as we went into these conversations, is what is actually going to free up the system and give us the greatest impact.
So thank you all for focusing on that.
We have a couple of folks in the queue, and colleagues, I'll note we do have a fair amount of time, but probably a lot to say, and we'll probably have some longer answers to some of our questions.
So I'll keep an eye on the time, but for now, let's jump into a discussion.
Councilor Zimmerman, go right ahead.
Eric Zimmerman
Thank you.
I was gonna say chair, not really sure what your role is here, but okay.
Elana Pirtle-Guiney
Just councilor.
Eric Zimmerman
Thank you.
So, you know, it was some year and a half ago when I kind of dramatically, when we had our joint county and city meeting, said I think the county and the city should go get every TV news camera, take our legislative agenda, get in front of them and rip it up and say we need a mental health hospital north campus that is not accessible to the judicial system.
Um, part of that was bombastic to get attention, but part of it was also— I think it's still the most critical thing that is facing the community.
Every topic, frankly, to an extent, that we've discussed in this city where it's been a challenge in this dais is actually related to this.
Everything we're spending money on, every argument we've had about right choice, wrong choice, right amount, lot— it's related to This.
And so, um, I recognize that a new state hospital north campus is not perhaps the solution, but I am so grateful that the ball has been rolling now.
This is my at least 4th engagement with a few of you at the dais on this.
And so my invitation to councilors is— I spent 10 years at Multnomah County.
I know Director Banks fairly well.
I know some other folks in the audience fairly well, and yet I still each time learn something new.
So I'm glad that we ended on some definitions, because if you don't know what psych respite, aid and assist, subacute—.
Candace Avalos
If you—.
Eric Zimmerman
Do you know what boarding is?
If you don't know what boarding is, please ask, because that helps us.
You will get pissed when you understand how the system is not something moving through a snake right now.
It is the rat sitting at the back of the snake's throat, just chilling, not paying rent, and it's never going to move.
Not in our current system.
We have the most broken system in the country.
Other states aren't this bad.
It doesn't have to be this bad.
We are not the mental health authority, but we have a bigger microphone than anybody else, and that is why I'm so happy that we are having this briefing and this plan.
Unidentified speaker
With that—.
Candace Avalos
Thank you.
Eric Zimmerman
There was a presentation, and we have one of the directors from the Homeless Services, or the HRAAP director here, but there was a presentation at the SOC a few months ago that had some pretty different numbers.
And I think the reason they were quite different is maybe they were statewide numbers in terms of secure residential treatment, secure acute respite, et cetera, but it was not 50/50.
Sameer Kanal
Right.
Eric Zimmerman
We were into the hundreds.
And so I'm really encouraging that if there's an annex to this, that we get that annex, because I actually think we got to go big.
I'm not interested in any mediocrity, frankly, on this topic.
I think it should be the most important topic for the governor all the way down to the freshman legislator in this next session.
So I'd like to ask for 285, which I think that was the number of the most severe beds.
And if we got 100, Okay, but we got to ask big.
So I'd like to see where we can get that presentation.
Um, I'm not on the Housing Committee anymore, colleagues, so I don't get to report back on the SOC meeting often, but I'll just tell you, in the last year of experience and the data that has been presented to us, I've come to a conclusion at this point that I'm comfortable sharing in a lot of venues at this point.
Your SHS dollars are obscuring the state's responsibility for mental health care and addictions to an extent.
We are spending what I think are poverty dollars on medical issues and not people who are in poverty because they have medical issues.
Candace Avalos
Not—.
Eric Zimmerman
I'm not— I'm just— just be basic about it.
We don't have to what-if this.
We are pretty good with rent assistance, evictions prevention, things like that, but we are using a lot of our SHS money on people who If the state had been doing its job, the feds and state and the county have been doing its job all the way through, our, our mission with SHS I think would be better.
And I say that collectively, our— I'm not really pinning this on any one place.
I just think that this is really important, is that the SOC and experience and data in the last year and a half of serving on that, it's very clear to me that, um, we're spending dollars in areas I think are actually directly related to the state's mental health and addictions responsibility.
I really want to uplift— James, right?
Unidentified speaker
Yes.
Eric Zimmerman
The story about some people who aren't ready for housing.
We've turned the corner a couple years ago where providers, housing providers, are now willing to say, yes, we've been taking some clients, and what's going on now is actually really harmful to the other residents in that building.
The example that one of the providers who you all know has told me is like, when John floods his unit because he doesn't know how to live independently, and John lives on floor 12, I got 12 new homeless people because all of them are now homeless.
That's what we're talking about.
And so I'm so glad we're saying that because I think 10 years ago, if you'd said not everybody's ready for housing, your nonprofit would have been canceled, you would have been fired from your thing, and Multnomah County would have taken you out in the back and beat you.
But that's over.
That phase is over, and it's over because it got So bad.
And that is a really important opportunity for us that I'm excited about.
And I want us to go big here because when I said the billion dollars for a mental health hospital north, it was because in my head, my calculation is if I went to every Oregonian and said, I need you to hang on one extra year on the pothole that you're pissed about, let's not put a billion dollars in the transportation fund.
Because we can guarantee that we're going to take care of the folks you encounter who are just not able to take care of themselves?
I actually think every Oregonian would have said yes if they had faith in the system.
That's the calculation that I'm talking about in terms of what do we give up.
But I invite you all to please ask specific questions in this.
Councilor Pirtle-Guiney and the president and I and others have been trying to put something together that is a reasonable— and Sam, a reasonable ask going forward.
Um, you know, it's— I, I think it's— I think it has been challenging sometimes in a, in a, in a society.
Somebody has to talk about the toughest things that we do because there are a lot of people in our community who cannot or won't be able to take care of themselves.
Like, nobody wants to talk about committing a Right.
It's, it's our worst case.
But actually, the worst case is saying that we shouldn't address them at all, right?
Because what we're talking about is people that can't take care of themselves.
And I don't want this principle of autonomy to allow us to dive further into societal neglect.
And I think we really went that direction for a long time in, in collective Oregon's history right now.
And we see it every single day in Old Town.
We see it every single day in most parts of our city.
And that type of a neglect is killing people.
So if I'm feeling passionate about it, if you're hearing that, it's because I'm inviting— I hope, I hope, I hope that this council can tell Sam and his team, we have a lot of priorities, but actually we need you to go lift up anybody else who wants to do mental health work.
We want to go hard.
We want to go heavy.
And we're not And, and please notice who's not here today.
These folks showed up, right?
Not everybody's in this.
There are a hell of a lot of people in this, in this community who are in this work, and they only want to participate if it balances their budget or if they make money on it.
That's not the case for everybody.
So appreciate you all taking the time.
I know you put a lot of work into this and appreciate it.
And I really hope we can get those numbers from the SOC because I think that rounds it out for the actual number that we're talking about.
And I'll stop there.
Elana Pirtle-Guiney
Thank you, Councilor.
Council President Dunphy.
Jamie Dunphy
Thank you.
I want to echo a lot of what Councilor Zimmerman said.
I think that this is the challenge of our time.
This is 50 years in the making.
This is, you know, the state of Oregon got in trouble in how we were using the state hospital and how we were assist— you know, what the state's role was in helping with mental health before I was born.
And we have never built the capacity that we were promised in our local community-level mental health system.
And honest to God, if you go back and read some of the transcripts from when they were discussing the bottle bill back in the '70s, there are legitimately testimony that says that this will actually absolve our responsibility for building mental health because this is a funding source for the homeless.
That actually was said on the record.
Thank you.
We never stepped up to the challenge, and the state has never stepped up to the challenge.
And I was in this building about 8 years ago when Councilor— or then Commissioner Nick Fish started the conversation around permanent supportive housing.
It was 2018.
2018 When we started talking about PSH.
And that's kind of crazy to me that like I didn't know what it meant.
And I was working on housing policy for many years before that.
And we're not meaningfully further along.
And actually solving the problem.
I do, however, believe that we have 2 opportunities before us right now that we've never had before.
The first is that this government, the City of Portland's government, has never been in a position to be able to be strategic partners with our partners in Multnomah County in this way.
I think that the old commission form of government meant we had 5 cowboys who were always running in different directions of whatever they had, and we can actually be strategic and recognize who's actually on first.
And the reality is that the county is the seat of public health.
Thank you.
And the city has attempted to recreate many of the processes that have historically been the county's, and I think we all recognize that it's time to stop doing that.
We should stop replicating things.
The other reality is that the state legislature has a lot of bad choices ahead of them.
They are going to have budget cuts, and we're not going to get almost any of the— there's nothing fun that's going to come out of Salem this year.
And I think it is incumbent upon us that if we know that we— if we send a wish list of 100 different items, and they're all going to get rejected, or we have an opportunity to coordinate with our regional governmental partners and speak with the same voice and say, this is the issue.
If you are going to do one thing, state legislature, this is the thing that you do for the Portland metro region.
I'm really eager to see that, and I think we're really on the right track towards informing what that state legislative agenda should look like.
And I look forward to going down to Salem and advocating to get this.
We need our resources.
We need the state to treat this seriously.
This is a crisis.
This is not a casual thing.
And as, as Councilor Zimmerman said, other cities have figured this out.
Other states have figured this out.
No one's solved it, but they're certainly doing better than we're doing.
And, uh, I think this city council is ready to be serious and strategic and go a, a mile wide and an inch deep rather than the opposite.
So, um, thank you for the presentation.
Thank you for the work that you all have been doing for your careers.
Uh, All of this is really hard, and thank you for helping us find what that next step is.
And we will be back to ask what the next step is after that and what the next step is after that.
We need experts.
No one on this dais is an expert.
We need you all, and we will make the decisions.
So thank you all for everything you're doing for our community, and I look forward to being supportive of tackling this as a region.
Unidentified speaker
So thank you.
Elana Pirtle-Guiney
Thank you, Council President.
Vice President Clark.
Olivia Clark
Thank you.
Uh, can you hear me okay?
Elana Pirtle-Guiney
We can.
Unidentified speaker
Yes.
Olivia Clark
Great.
Um, I just want to thank everybody for an excellent presentation, uh, because some of the terminology is new to me.
Um, I probably need to study it and hear it again, maybe a couple more times, but I've been aware of this problem, um, since I ran, uh, for the City Council.
One of the first people I met with was Dr. Andy Mendenhall at Central City Concern.
Who was sharing some of this information for me.
I really didn't have the mental infrastructure to absorb it all, but I knew there was a problem, the acuity level being very high.
And as my colleagues have said, there are so many people who will never be able— maybe never be able to take care of themselves that we have to deal with.
I also learned about this when I was on the board of the Oregon Providence Health System, where the emergency room became the, the place where so many people went, and they would sort of joke about their frequent flyers, that there were people who continually came in and out of the emergency room who really need to be in a facility and have, um, have some sort of support services.
And so I think, um, I agree with everything that my 2 colleagues before me have said, and I know we were I've been joking a lot in some ways about getting an annex of the state hospital in Portland, but I understand that from this presentation today it's much more complex than that.
I don't understand why we're so bad, exactly how we got here, but my real question is, you know, what is the reasonable ask when you, when you take the recommendations that we've just heard and you put a price tag on them?
What, what really are we talking about, and where were those Where will those dollars flow?
Now, I know that's down the line as we refine our legislative proposal, but I agree that we need to go big.
I agree with Councilman Zimmerman, and I agree with Stephanie Howard that this is connected to so many other issues that we wrestle with and that cost us.
But I want— I'm just wondering now, how big is big, and what, what do we go in with?
And maybe this is premature, but—.
Loretta Smith
Councilor Smith.
Olivia Clark
And maybe the committee or the panelists are not ready to answer that question, but that's going to be on my mind is just how much do we ask for and where does it go?
Thank you.
Unidentified speaker
Yeah, thanks so much for your comments and your question.
I mean, I think the purpose of this work session was really to agree on the what and to get alignment around that without going into a lot of the details of the how much it is.
We do know that inpatient beds cost about $1.5 to $2 million each.
On the flip side, we know that subacute and respite beds are probably more on the order of about $500,000 each.
So that gives you a little bit of a sense of scale in terms of like how much the total package would be.
But again, this— we aren't also recommending that we come out and have 248 beds all at once, right?
Like it would be like a gradual buildup and, you know, and we need to obviously get some more This was really an initial conversation and just to kind of get aligned around what we're talking about and whether or not you could support that.
But we're happy to come back and work with Director Chase on further details.
And I might just jump into just a little further on that.
The process here is to start this foundation, identify that these are the— this is the right path forward, and then start to tier some of the The potential areas and levels of support.
What is that ultimate need?
What is that high number, that go-big need?
What is political viability during this legislative session to be strategically smart about what we can achieve and making sure at a very minimum that we are ready to play as much defense and be as ready to be on call and doing our work when questions come up?
Dan Ryan
Thank you.
Sam Chase
Over the next work session, end of September and October and November, and then again another work session in December, we plan to be processing this along with you, as I hope it's come to be understood that we really try to work collaboratively and informatively with all of you as we're going through that process.
So this is sort of a key milestone in that process of getting those specifics down, having some dialogue with our Portland delegation and leadership in the legislature to see how we can position and move this forward in the most effective way.
Olivia Clark
Thank you, Sam, and thank you to Dr. Hartman for actually beginning to put some numbers on things.
That helps with our perspective.
So thank you all.
Elana Pirtle-Guiney
Thank you, Council Vice President.
Councilor Novick.
Steve Novick
Thank you, Councilor.
I really appreciate the presentation.
I agree with Councilor Zimmerman and President Dunphy on how high a priority this is.
I just wanted to state a few things that I've heard that relate, which maybe are obvious, but I think are worth saying and worth getting your confirmation that they're true.
One is— the one thing I've heard is that a major factor in the acuity of our behavioral crisis now is that fentanyl And the new kinds of meth do greater damage to people's minds than heroin did, earlier forms of meth, and that drives up the acuity of the situation that we're dealing with.
Is that true?
Joe Hardman
That is true.
Okay.
Steve Novick
The other thing I wanted to follow up on, the impact on the housing system, James.
And again, maybe these go without saying, but I've heard that the financial cost of destructive behavior by people with The unmet needs, both repair costs, increased insurance costs, are in some cases threatening the financial viability of the housing providers themselves.
Unidentified speaker
That is also true.
The one comment that I would make to that is the key one to hone in on is the insurance piece, because we've all had to go from— we used to have like $10,000 deductibles.
In fact, we still have a contract with the state that requires that we don't have a deductible more than $5,000.
Most of us are now in the $100,000-$150,000 deductible range, and that's per incident.
So we're essentially self-insuring, and affordable housing and how it wasn't set up to self-fund for those types of incidents.
So it is a big thing.
Steve Novick
Thank you.
Another thing I've heard is that we've all heard complaints about vacancies in affordable housing, and I've heard that one factor in the number of vacancies is that when you have people engaging in behavior that's disruptive to their neighbors, there's people who'd simply leave.
Is that really, is that really a factor?
Unidentified speaker
I don't think that we've had people just leave.
I would say the destructive piece is that we then have to spend a lot of time and money repairing after someone leaves, which then creates vacancy, right, during that time period.
Okay, um, so slightly different.
I haven't heard where we've had folks had to leave because they're— I mean, they might ask to go to a different site, etc., but the bigger issue around vacancy is really that turnover because sometimes we have to do the entire unit over again, which is expensive.
Steve Novick
But okay, so you don't think that it's prevalent of there's people in places where they're just dealing with neighbors they can't deal with and they go somewhere else?
Unidentified speaker
Oh sure, I mean, that's an issue.
I don't think that that's causing vacancy, however.
Okay.
Because we have folks waiting to come in.
So I don't think that's a vacancy issue.
That definitely is a, you know, sustainability issue, right?
For those folks having to move around and not be stable.
But it's not driving vacancy.
Okay.
From like units going unfilled.
Steve Novick
Okay.
And it's a churn issue.
Okay.
Unidentified speaker
May I add something to that?
Olivia Clark
Yeah.
Julie Ibrahim
Sometimes the vacancies are because of coordinated entry.
Dan Ryan
For sure.
Julie Ibrahim
Because that process can sometimes take a long time.
They're eventually filled, but I know that some providers, including us, where we have units that are with coordinated entry, we usually are running at about an 80% occupancy, whereas buildings that are not under coordinated entry, I can fill like almost 100% all the time.
Steve Novick
Can you please explain exactly what coordinated entry means?
Julie Ibrahim
So it's a county process, and there's a process like that in Multnomah County and Washington County where if you're homeless, you need to go through the coordinated entry process.
They assess what your needs are, and then they try to pair you with a housing provider.
And then Then you might go on a waiting list.
There's a lot of, you know, there's forms you've got to fill out.
There's a bureaucratic process that you have to go to.
The idea of coordinated entry is wonderful, a clearinghouse for everybody to go to to find someplace to live.
The administration of it can sometimes lead to vacancies.
Steve Novick
The last thing I wanted to say, and this is probably something we can't do anything about, is that The Reverend Sarah Fisher, who some of you know, made a comment to me a couple of weeks ago that it worries her when people use the phrase behavioral health, because when people hear behavior, they think that, well, you have a choice, you can just change your behavior.
And she was saying that people on fentanyl— fentanyl takes away people— in particular, takes away people's choice.
So I don't know if we should just talk always about mental health and addiction, or if there's another phrase, but that kind of stuck with me.
Thank you.
Councilor Dan Ryan.
Elana Pirtle-Guiney
Thank you, Councilor.
Colleagues, I am going to give the mayor an opportunity to ask some questions or provide some remarks.
This is the point in the queue at which he messaged me and said, hey, can I join the queue as well?
And frankly, our state legislative agenda is something that is approved both by the council and by our executives.
So I think it's important to make sure that your voice is a part of this conversation and that all 13 of us are on the same page here.
Keith Wilson
Yeah, thank you.
And that's really what I wanted to talk to is just a commitment from the executive with these council colleagues to work lockstep.
Whatever we choose, I'm going to be following your lead on this very significant issue because, you know, we've been dealing with homelessness in a robust way and then housing.
But at the end of the day, when we drive to work, ride the bus, or take transit, We all see our neighbors suffering, and we see them on the street, we see them at night, we see them in transit, and we haven't been able to come up with a concerted effort.
How are we going to care for our neighbors that we're leaving behind?
And it's anecdotal as well.
So, Julie, thank you for allowing me to view your facility and New Narrative.
It's an extraordinary success in my eyes as far as subacute.
You're able to stabilize and maintain.
Thank you.
And James, you mentioned that, is that when you go to the doctor in a crisis, you stabilize, and then there's oftentimes a long path to that recovery, for whatever it may be.
I went down to the Oregon State Hospital a month ago to tour because that's where our individuals through aid and assist are primarily going right now.
90% Of our state hospital is aid and assist.
10% Are, are civilly committed.
A decade ago, it was reversed.
Unidentified speaker
Yeah.
Keith Wilson
And so you see, we're using our state hospital as a carceral system now.
And when I talked to the director and the deputy, and they state that a significant, a very large significant of the people who are being admitted were already seen, stabilized, were released, and are being readmitted again because we don't have a new narrative to address and stabilize the drugs.
Because fortunately, Thank you.
With behavioral health, a large majority can be stabilized with med management, but then we're losing the med management as we release somebody to the streets.
They go off med, and then they're being seen by Stephanie's team, our public safety support, and/or in our housing, affordable housing.
It's not a proper match.
So been working closely with Evan, been working closely with Sam, and our overall commitment is to work with council.
Thank you.
To come up and speak with one voice as we go down to the legislature to recognize that this is a meaningful and material impact in Portland.
And so with Multnomah County here and such, we're going to really lean in on our side of the table, work with your side of the table to really partner through this, because this is that next big issue we need to do well at, or do less poorly at.
Dan Ryan
Thank you.
Elana Pirtle-Guiney
Councilor Try to aim for do well.
Councilor Green, thank you for letting me take a quick pause there in the order we have on our screens and go right ahead.
Mitch Green
Thank you so much, Councilor Pirtle-Guiney.
Thanks for those words, Mr. Mayor.
When I'm asked about how to deal with this problem from constituents or at town halls or even at campaign events, The response I have to give is it's a scale of a problem that's larger than the City of Portland.
Like, we do not have the resources in the City of Portland to address this with a magic wand, and that's an unsatisfactory answer to give, but it's the truth.
And I usually say to solve this problem, we have to go to the root of the problem, and we have to think in systems.
We have to think about what is broken in our system and recognize that this is a multi-jurisdictional problem that requires multi-jurisdictional resources.
And so I'm always going to be in support of an evidence-based approach that thinks about the system.
What I want to make sure that we're doing when we put together our agenda is we're centering the care of the people being treated in that system.
And I have to say, and I don't suggest that this is what's being proposed here, but Because I do get cornered by a certain type of person to say, you know, we should just lock them up.
You know, let's just, let's just commit everyone.
Because I think some people are desperate and that's what comes out of their mouth.
But because I know that that's an impulse in this community, I want to make sure that we are not saying that's what we want to do too.
I have an interest in making sure that the people that we're trying to serve and treat never see the inside of a jail cell.
I have an interest in making sure that if there is a warrant served or, you know, a contact with the Portland Police Bureau, that they go to diversion and then they move through this system and they get treated for the thing and avoid the criminal justice system.
So that's my interest.
And I'm going to support an approach that finds the resources to build the system that can treat people.
So I just want to make sure that that's what we're doing here.
I think that's what we're doing here.
We've got some policy choices that we'll have to make as a city about where we interact in that, that will come down the road after we've figured out whether or not we can get some support from the state of Oregon to figure this out.
But this is certainly something that costs a lot of money.
But if we solve the problem, we'll take care of some people.
Thank you.
And we'll move forward.
So I'm open to this conversation, but I just needed to lay out my caveats and concerns because, you know, Mr. Schroeder— that's your name, right?
Thank you.
You said something that I keenly am thinking about every single day, which is the connection to the sort of affordable housing system.
And I think one of the terms or phrases I've used in the past is that we're using the affordable housing system as a backstop for other things.
Eric Zimmerman
Right.
Mitch Green
I'm going to be— I like Sarah Fisher a lot, so I'm going to be very careful on the behavioral health piece.
But I think that's true.
And so I'm not an expert in this part of it.
And so I'm placing some faith here.
But knowing that my interest is always to make sure people are housed and have the Possibility of being housed at all hours of the day and treated for what they need to be treated for and not exposed to the criminal justice system.
So that's where I'm at on this.
And I think many of my colleagues would share that approach.
Thanks.
Elana Pirtle-Guiney
Councilor, was that a question you wanted answered by the folks at the table?
I want to make sure we get you in.
Unidentified speaker
Sure.
Mitch Green
But also, I'm also known for pontificating and sort of putting my preferences out.
But if anyone wants to respond to that, I'd appreciate it.
Elana Pirtle-Guiney
I think the proposal we have is in line with what you're saying, but I'd love to have a couple of the providers maybe weigh in on that.
And I don't know if it's worth talking a little bit about what the approach at New Narrative is.
I think, is that a respite care level facility?
Is that technically what level?
Julie Ibrahim
No, it's got quite a history.
Loretta Smith
Okay.
Elana Pirtle-Guiney
And we don't need to get into the full history.
Sameer Kanal
No, I won't.
Elana Pirtle-Guiney
I'll be speaking a little bit to it.
Olivia Clark
I promise.
Elana Pirtle-Guiney
How this fits in with what you heard from the council.
Unidentified speaker
What, what it is, is, um, it's technically permanent supported housing, uh, and people are on a lease.
But what we have done is this particular program, uh, to get in, you have to have been diagnosed with mental health, uh, issue, and you have to have been homeless Or at risk of homelessness.
Those are the 2 criteria, and that's it.
We have cobbled together funding over the years.
It's not SHS funding per se.
We've cobbled together many sources of funding over the years.
But what we've found with this particular population and the population that Joe has described, that those are the folks that live at Bridgeview.
Um, what, what we found they need is they need 24/7 staffing.
They need help with, with food access.
They need medical care.
And I'm not talking about full primary care.
We, we have a nurse that comes in.
We help them with their medications.
We have a counselor that comes in every week.
We have case managers.
And then of course we have our, just our residential staff that are there to interact with them, support them, make sure they're okay, check on them in their rooms, that, that kind of thing.
Um, and what we're calling this is, uh, informally peer sup— uh, permanent supportive housing plus, or what this— what, uh, OHS is now calling tiered supportive housing.
And there is an effort Mm-hmm.
At OHCS to try and actually put a proposal in front of the legislature next year to support capacity building for this higher-tier permanent supportive model.
We are doing that at Bridgeview.
I believe Central City Concern has a program that's very much like it.
But it is very, very effective in reducing hospitalizations and incarcerations and stabilizing people.
And they have community there because the team there interacts with them as community.
Mitch Green
Thank you for that.
I mean, that helps clarify that this is just an enhanced version of permanent supportive housing.
Unidentified speaker
Yeah, very enhanced.
Mitch Green
I think this— I'll wrap by basically saying that for me, it's not the cost.
I don't think the cost is negotiable.
I think that we are already paying the costs by not having the system.
And so I'm just interested in the design, the program design, and whether it's evidence-based or not.
And from what I'm seeing, it feels like it's in line with that, unless there's anything I'm not seeing.
But I agree earlier, I think the case was made that this is the work of our time, and the resources are in our community if we have the political will to get them.
I think that we should be So, Sam, I'm supportive of that.
Candace Avalos
Thank you.
Elana Pirtle-Guiney
Thank you, Councilor.
Councilor Ryan?
Dan Ryan
Yes, thank you.
First, thank you, panel.
There was some very refreshing truth being spoken this afternoon.
I think in this room we've come a long way in being more honest about these issues.
I said a lot of the things that I'm hearing in 2020, and I wasn't very popular in the political arena for that.
Um, and so I just want to acknowledge that, um, denial is the one of the biggest, um, factors, I think, in where— why this state got here.
And I think it's really important that we continue to do like anyone in recovery must do to stay sober, and that's tell the truth.
Um, my experience also is with the language behavioral health is that a lot of people, um, And don't realize that's the big box, and underneath it is mental health and then also substance abuse or addictions.
And then I see people race too quickly to mental health and treat addictions as a lesser issue to discuss.
I think it makes more people uncomfortable for some reason.
So I just want to put that out there.
This, I think, is for you, Rachel.
Thank you for being here, by the way.
6 Years ago when I was first elected, like my first official meeting, because the mayor at that time put me as a dotted line person from the city to work with the joint office, now called the Office of Homeless Services.
And about halfway through the meeting, I put my hand up— everyone was on Zoom there at that time— and I said, where are the behavioral health and mental health specialists at the county?
And the chair at that time looked at me like I was asking a really silly question.
And that said everything to me on why— We were in this situation that we were in.
Where was that integration with what is obviously, through my own lived experience, from friends to a brother to a nephew who ended up chronically homeless, and the biggest factor was their mental health and substance abuse issues?
They both are capable of working and doing, being stable in housing if in fact they weren't an active drug addict medicating their mental health through that means.
So thank you for lifting that and not shaming that, but actually just naming it as a factor.
So I come to this with a lot of lived experience.
I also— so I want to ask you then, Rachel, are they integrated in 2026 as they weren't in 2020 and 2021 and even going into 2022?
Do you feel like the system at the county with behavioral health, mental health, and homeless services are actually integrated in working together as a team?
Unidentified speaker
Yeah, thank you for that question.
I think we've done— we've come a long way, and there's more to do.
So there are, you know, I'm here with my colleagues in the Homelessness Response System.
We have our Homelessness Response Action Plan and some governance around bringing in behavioral health folks.
Also, my colleagues that That work across the housing system, behavioral health colleagues.
And but I— where I think we have more to do is really building a population health approach to behavioral health.
And that population health approach looks at systems, it looks at, you know, data and bringing in assessment and epidemiology as we've seen here, and, and uses levers like policy and whatnot.
So a couple of the things that we're working on, one of the things Uh, that have been added is additional assessment and capacity, kind of those sort of positions that are connectors and conveners.
Because as has been said, this is a complicated system and it's going to take all of us, and it's an issue of our time.
And we're going to be— you may have remembered working— we have in, on the, in the public health system, we have a public health officer that works across systems that brings together hospital systems and all of that.
Uh, and we're going to be hiring a behavioral health officer to do just that, acknowledging that that has been a gap and a missing link in the behavioral health system.
That person's role is going to be obviously working with our behavioral health programs and colleagues, but also connecting across our other areas, whether that's our housing area, our libraries, um, our, uh, you know, various human services, uh, arms, because the folks that we're seeing are interacting also with all those systems.
So That level is really around putting the, the folks at the center, um, us getting kind of more coordinated in the various areas.
And then the third thing that the behavioral health officer will do is be working with decision makers, policymakers, um, and, and having these sort of conversations as well and really bringing that behavioral health science to the system-level conversation.
Tiffany Koyama Lane
Okay.
Dan Ryan
That was helpful to hear.
It does sound like you've been in many meetings trying to help put that together, and I, I, I'll trust you on that.
Um, I also was, um, I also wanted to make sure I lifted what I also heard from you, James.
Um, the whole issue of when someone's in chronic homelessness, suffering from untreated mental health, behavioral health, and taking someone like that in the Housing First model and Putting them into an SRO, single occupancy unit, without any support systems.
I couldn't think of anything that could be worse for an addict that's in early stages of recovery.
And I've seen this with multiple loved ones because you all— we all know it's about going from isolation to connection.
And whether we want to approve of what that connection is like out in the street, they have connection and community.
Thank you.
So that was the main reason I was able to lobby and get a 5-0 vote here to build Safe Rest Villages and get the county to support it.
I was struck that it was odd that after the passage of SHS, we could not use money for that.
I still to this day don't understand that.
I think a lot of people that voted for SHS funding, the taxpayers, the voters, assumed that there would be services for behavioral health and mental health.
But it was really clear to me that that wasn't what the lobby wanted.
And so I hope that we're continuing to wake up to reality and see how the blurriness of all of that.
So when we built the Safe Rest Villages, Mayor, that was a part of that continuum.
And for the first 6 months when we were actually funding it and we had services, that's where we were getting the best results.
We were having people move out of the Safe Rest Villages when 6 to 9 months was— it needed at least that much time to get acclimated, to build your resilience, to to build your agency, to get to a place where you're working a treatment program, where you're getting workforce aligned in your life, that then you would have the possibility of being successful in housing.
And so we've had fits and starts with building a continuum, but then we haven't had the political will to stick with it.
So we've had those fits and starts, and then someone else gets elected and new things start, and that gets blown up.
So it's like we need a clear game plan about what that continuum is.
And when people are running for office, please work with them to understand the complexity of that continuum.
We should all be on the same page here.
No one likes, you know, Googling where Oregon's at in mental health and behavioral health and always seeing us either 1, 2, or 3 on the bottom.
We'd like to be— I never thought I'd like to be more like Utah.
Like, they seem to always be at the Top of the list in some other states.
So where is it that, that we keep getting in our own way?
Like, what is it with the lobby, the different lobbies where they, you know, like rats just eating each other up when we should be on the same page?
If success is to take people from codependence on services, codependence on drugs, codependence on chat services because they're, they're basically in an ER place On the ground.
When are we going to be able to move to a more stabilized continuum?
What's that going to take?
And when is Salem going to be able to have that conversation?
And it doesn't matter what side of the aisle you're on, you should be excited about moving people from that dependence to that independence since this stat of the majority of people who are homeless are men ages 24 to 55 who aren't physically disabled, and they've been taken out of our workforce, and instead they're dependent on our government resources.
This is such an economic deprivation to our state and to our city.
So are there those kind of conversations where you can make the economic argument down in Salem that this is killing us economically?
Sam Chase
Well, I will jump in here because I want to— those comments underscore a lot of important issues around this work.
And so we have this incredibly large, complex system for what we call— are calling behavioral healthcare, but, you know, may appropriately be termed with different nomenclature.
But I think that that issue, and there are many issues to be resolved and refined and developed and put forward to have a comprehensive system.
And we saw the continuum in some of those pieces.
Thank you.
The place where we are feels like a good start, which is to say these are the most fundamental priorities that we can be more narrowly focused on that will have major impacts to having the system work better.
That is also an entree to be bringing forward those other understandings about the economics, the—.
Eric Zimmerman
Mm-hmm.
Sam Chase
The cost issues and all of those that many of the council brought up.
So that, and I think your message here to this group is helpful in that we can continue to develop that messaging, that communication, how we're talking about this work and bringing folks along.
And this is really the furthest I think this region has come along around a unified behavioral health There are challenges.
City and county are working on a lot of different issues.
Here, they're incredibly aligned, right?
And the health providers are incredibly aligned around this in a way that has not been seen, I don't think, on these issues in the region.
Dan Ryan
And I think that's a real entree strategically to being able to inspire and bring other electeds along and other communities along to I hope so, because if we really care about the people suffering on the street and not being right about our plans from 10 to 20 years ago, but actually dealing with the reality of today, I think we could get there.
And I do think the economic equation hasn't been used enough.
To answer your question, so that would be one.
The other one, to make that case, and also I think it's all about on-ramps to stability, which is why I'm deeply disappointed that we didn't continue to fund the Safe Rest Villages that were getting results.
Instead, we've defunded them, and we need more on-ramps.
So when you mentioned the transition housing, that works.
My last thing that I'll do too is bring up 2 more points.
One is, is there anyone on the panel that's in, if you want to admit it, is dealing with a lived experience?
Sameer Kanal
In recovery.
Dan Ryan
Are we going to hear from people today that are in lived experience, meaning they are in treatment, they are stable, they're in recovery, if you will?
Because I think the peer-to-peer services are essential.
I don't know one recovering addict— keyword recovering— who remains in recovery unless they're active daily.
That's why they say one day at a time, connecting with other recovering addicts or helping those that are suffering.
So lifting the peer-to-peer services is authentic, it's inexpensive, and it works.
So are they at the table?
Joe Hardman
I mean, from Health Share's perspective, I would say we have a number of interventions for folks who are in our high-acuity behavioral health cohort.
And most of those programs do have peers who have been dealing with issues themselves, right?
And they do become a really critical piece to engaging patients because they understand where they're coming I think your question around do we have peers actually helping us advise like our next steps, I think is a really good one and a great suggestion.
We definitely have them involved in our interventions at the patient level, but what you're suggesting is kind of a level up, which I think is a really great suggestion.
Dan Ryan
I appreciate you acknowledging that.
I, again, I just haven't seen any results unless there's people with lived experience active in a leadership role in this type of work.
No offense, but like the people that I know that are in recovery, they stay sober, if you will, because of those relationships, not with PhDs and people that are credentialed.
So I think we need to know our level of engagement, and I think we too often in government don't lift what works on the ground.
So I just really hope that you push for more peer-to-peer Work, and also that we really do build more on-ramps.
And I, Mayor, I want to believe you that you think that the city and the county are more aligned than ever.
Maybe, Rachel, you said that.
I look forward to that day because I often say that we should be merged, and it's on both public safety and when it comes to this type of work.
We get in our way and we waste time.
Fits and starts of, oh, shelters are the number one priority 2 years ago, shelters with services, now they're off the And we're starting to already see those impacts on the ground.
And so I think it's really important for us to stop moving the goalposts, but actually be comfortable with how messy and challenging this work is, learn from the mistakes, get back up and do it better.
This isn't linear work.
It's messy.
And you guys know that.
I want to end by acknowledging the first responders.
I have so much respect for you.
The chats here, I think—.
Thank you.
Street responses back there.
When I do the ride-alongs and I experience what you go through— this goes for the police and fire as well— it must be difficult to constantly care for the same people over and over again because you're all they've got.
And where do you take someone?
And so we as a government, the state of Oregon and the city of Portland, the county of Multnomah, we've just failed miserably to find those places that our first responders can take someone to.
And I just hope that we can continue to know that we need to respect their work enough to allow them to actually see it through, because it's pretty demoralizing when you go on a ride-along with fire and they say, yeah, that's the same person we've had to move from the doorstop, um, 5 times this week.
And it doesn't feel that good to go home and say, what did you do today?
I moved the same poor soul from the same doorstop 5 That's not what we want to be.
We want to know that there's somewhere to take them and we can start really being a part of that continuum that you talk about.
So keep hammering on us.
We need obviously to stay focused on reality here.
Thanks.
Elana Pirtle-Guiney
Thank you, Councilor.
Colleagues, right now we have 4 more people left in the queue.
And if we actually truly only have 4 more people left in the queue, we are going to power through and try to give folks a little bit of their afternoon back.
'Cause we've had a lot of dais time.
So consider this an invitation that if you are planning to speak and are not in the queue, get yourself there so I know whether we need to take a break and give everybody a bit of time, or if we can power through because we only have a few people left.
Councilor Smith, go right ahead.
Loretta Smith
Thank you.
Thank you for bringing this forward.
This is very important work.
And I just wanna say I appreciate all the intricacies of You know, offering housing and supportive services with that.
I was there in 2018 at Multnomah County, and that was kind of a novel thing, adding services to housing.
And it was much more expensive, and for sure, but in many ways it was much more effective.
So I just wanted to say that I support this.
You don't get any pushback from me.
Thank you.
I also wanted to find out if you all participated, Sam, in the pre-session this week at Ledge Days.
Were there any bills that you put forward this week?
Sam Chase
We don't have any bills.
Our staff are down there, although Evan had came up for the work session here, but the staff are down there and working, you know, with legislators.
But there's no bills being introduced at this time.
Loretta Smith
And what are we talking to folks about during Ledge Days this week?
Sam Chase
We're really learning to understand what the priorities are that are moving forward and get a sense of where the legislature is intending to go on the majority of our issues.
I mean, certainly learning what we can about what might be in the pipeline around some of these big issues that, you know, we talk about.
Loretta Smith
Transportation.
Sam Chase
Yeah, you know, CEI Hub, you know, automated vehicles, transportation issues, what are the costs associated with the greater than expected wildfire season, drought.
So there's a lot of really learning that is part of that process.
And then sharing generally what the city's overarching priorities are.
Candace Avalos
Right.
Unidentified speaker
That we carry over just as general talking points from our regular agenda that is still So when will we be getting our overall priority list?
Loretta Smith
When will you come forward to us with a list of other things in addition to the supportive housing?
Sam Chase
Thank you.
So we've done the issue sheet kind of collection, and many have participated in that, and that's from folks throughout the city and council.
We are now— this is one step in the process for And then late September we have a work session where my goal is to bring you a draft that is a starting point that says we think there's consensus within the city around these items.
So let's start to, to, you know, make sure we're on the right path.
Loretta Smith
That's going to be September what?
Sam Chase
September 28th.
Loretta Smith
September 28th.
Okay, perfect.
Um, I will cut my comments short.
Uh, thank you.
Uh, you're speaking to the choir with me.
I support this, and, um, certainly, uh, pushing this as a part of the city's, uh, priority is something that I, I don't have a problem with.
Eric Zimmerman
Thank you, Councilor.
Elana Pirtle-Guiney
Councilor Avalos.
Candace Avalos
Thank you, uh, all for being here and sharing your expertise and also just being honest about what we're facing and what, um, things that we need to grab grapple with as policymakers.
I have a couple of thoughts, um, and a couple of questions.
I'm trying to organize them in a cohesive way, but if they're jumbled, then that's, that's what you're getting.
So, um, first I'll say that, um, you know, it's clear that Oregon has tried to make some investments in the infrastructure, but it's obviously not enough.
The investments do matter, but Yes.
We're still not really seeing investments that are completing the continuum of care.
And so that's something that's top of mind for me.
And I'm also particularly interested in the relationship between behavioral health, housing, and the criminal legal system.
You know, as your memo notes, most of the public inpatient psychiatric care in Oregon is largely tied to people who are involved with the criminal legal system.
And I know that our homeless community is experiencing a lot of health issues, not just mental health, health issues.
So that includes behavioral health, but also a lot of them are involved in the criminal legal system.
And it's hard for me to not clearly see those connections, right?
And as a councilor who represents communities that have historically experienced both divestment or disinvestment And overpolicing.
I just don't want us to solve our behavioral health crises with creating another pathway into the criminal legal system.
So that's where I'm coming from.
Um, you know, I also want to make sure that we're talking about housing as a fundamental part of behavioral healthcare.
Last night I was at the Parkrose Heights Association of Neighbors, and they asked me directly, Does this council care about housing first?
Do you care about getting people into housing?
And I hadn't had anyone ask me that directly in a minute.
And so it was good to kind of talk that out and just hear how they were experiencing it.
And their perspective essentially is like, we've got to get people housing so that they can solve these issues.
I also very strongly believe in that.
And so I think we need to continue to have that conversation.
What I told them essentially was like, because they were like, does no one care about Housing First?
I was like, well, I do, right?
And there are definitely people who I know share those values, but it is mixed in our region.
And I think those changes in those policy differences definitely are stalling some of these joint efforts on deciding where to put limited resources.
Thank you.
Right?
Where is going to get the most bang for our buck?
Um, and so yeah, I just want to name that as an ongoing thing that we need to talk about and be honest about.
Um, also wanted to say that I've heard a couple of times— I hear this, and I've also heard today a couple of times— just this concept of like the people who are always going to need help from their government.
And I do understand where those talking points are coming from.
I get that they are, you know, because of gestures at everything, Right.
Plus, you know, as you mentioned, as it relates to the newer drugs on our streets, just their strength and incapacitating nature is just really making it difficult to get people into recovery.
But I just want to pause on that and just say, I think it's really important that we keep in perspective that it is absolutely the job of government to help people and be there, have services for folks.
I have a 21-year-old cousin who has severe behavioral and mental health issues, and she's always going to need her government.
But that's why we pay taxes.
That is what it's for.
And so I just don't want folks that hear those talking points to feel like we're saying that everyone that needs assistance is a burden.
I think that's really unfair.
I think there are a lot of communities that, you know, have disabilities and other barriers that their government is supposed to be there for them.
So I just want to I caution my colleagues when we talk about that, um, that we keep that in perspective because, um, I, I've definitely heard feedback from folks that feel like, well, I, I, I deserve to have care, I deserve to exist and receive resources too.
And I don't want the conversation, the very legitimate conversation about the increased strain on our resources and how more people are needing help, I don't want that to cloud and feel like everyone that needs help is a burden.
And your government is It's supposed to be there for you, actually.
And that's what we're trying to solve for and make sure that it can reach all of the people that it's supposed to serve.
Because part of the issue is that we're not reaching everybody because the resources are just stretched too thin.
So I just wanted to name that because I, I don't want folks to hear our words and, um, think that we mean that, you know, that they don't deserve that care.
Um, I've also done, uh, ride-alongs with CHAT and PSR, and one of the things that really stuck out to me most is that people are relying on these really expensive emergency response systems for basic healthcare needs.
On the CHAT ride-along, we were assisting a man who, um, helping him get his medicines, um, checking in on him, right?
Like calling, following up.
And all of that's great.
I'm glad that that's available to them.
But in a system that is fully functioning, that's a caregiver, right?
That is Medicaid helping to support in those scenarios, especially when we talk about our senior population.
And let's not forget, our growing homeless population is mostly seniors.
And so we have to connect these dots as we're talking about what the solutions are.
And that brings me to, for the state, it's like, If we know that these are solutions, why are we cutting Medicaid?
Why are we cutting healthcare?
Why are we cutting eviction prevention?
There's so many obvious tools that, um, research, you know, shows is the best method, and the state is just slashing it left and right.
We all know that they are under pressure.
We are government officials.
We know that budgets are tight, but it just feels like for us that are having to deal with it downstream Councilor Smith.
I think that's my message to the state.
And as we're shaping, you know, what we're going to go down to Salem and say, here's what we need you to advocate for, I mean, I think everyone agrees with that, right?
But I think it's important to just name and be real clear that the state is gutting these larger systems that are feeding into these smaller systems.
Smaller ones that we're having to deal with on the city level.
And so all of that being said, you know, I guess my— a couple of questions that I have.
You know, if somebody has— if someone can only access the highest level of psychiatric care only after being involved in the criminal legal system, I guess, how are we— what is our thinking about how we're preventing the criminalization of people whose primary need is healthcare?
Like, what are— how are we balancing those needs and seeing that in the system and trying to solve for that?
Sam Chase
Well, I will say one of the things that— in a number of the areas that you kind of flagged is— but, you know, nobody should have— I think what we've heard from this city in a resounding way is nobody should have to go to jail to get mental health care.
And so that's, you know, a driver around really trying to create space that is accessible other than, you know, going back to the legal analysis and why there's this logjam where all the space is getting consumed for folks who have to go that route to get So that is on the minds of this work, and I think part of the driver behind this, and I certainly welcome any added comments to that.
But I also, and I guess I'll also just touch first on your observation around the housing continuum and the importance of making sure that the state, you know, that it is more than just a Portland issue.
The state needs to be part of delivering on that.
And that I think has a lot of important overlaps with this work.
And that is something that I would like to continue to have.
I welcome the discussion and dialogue from you and others on council to help get through kind of how do we message and move that forward in a comprehensive way with our agenda as we're doing that agenda work.
But I do open it up if there's any other comments to some of the— or to the question.
I guess I—.
Candace Avalos
Let me add one more layer to it before you keep answering.
Also would love to know if we have data on how many Portlanders— I guess Oregonians, but Portlanders— um, are cycling between the hospitals and the shelters and the jails and the emergency departments.
Like, are we able to track when people are kind of flowing through these systems and essentially they're kind of going in and out these doors, but they're not going into a permanent door where they're stable?
So do we have Are we collecting data on that?
Go ahead.
Unidentified speaker
Do you want to answer the data question, or, or— well, maybe before that, because I, I do think Health Share has done some, uh, great work in terms of folks who are cycling in, um, between multiple systems.
But I do think the proposal that's in front of you helps in a couple ways, and, and agree from the criminal legal system that that is not the best place that we want folks to be getting any sort of healthcare, um, and behavioral healthcare in particular.
It's one of the things that we do in the Health Department is operate corrections Health, and, you know, that includes mental health and addictions and behavioral health care and all of those things.
But I think we— and, and we do a great job, and I agree with you that people deserve that service from their government.
But I think we'd all agree that's not where we want people to be getting that care.
Um, having more resources in the community, I think, helps, and to address some of the behavioral health needs before they become a criminal Um, sort of piece.
I mean, I'll just share a story.
I have a family member, a parent, who is not in the state but in the— been— it's this exact issue, a trespassing charge based on unmet behavioral health needs.
Waited 3 years to get on the list for housing and then wasn't able to keep it or manage the pieces and didn't have the behavioral health supports.
Ended up in jail, ended up in the state hospital just to get the treatment that basically was like, now you can go back to jail because Now you can aid and assist in your own defense, um, all for something that could have been prevented from having those behavioral health supports in there.
So I think having just in general kind of community-level interventions, um, like this do help to prevent folks from getting to that level.
Um, you know, so those are some thoughts on, on that, and I just, I really appreciate your comments.
Thank you.
Can I speak to that too?
It's also intervening before they commit a crime.
Exactly.
Yeah, so what I've noticed, and I live downtown, so I live among a lot of homeless folks, and but I'm also working on this hospital-to-housing pilot.
So sometimes folks from the street are going to the ER.
That's their first encounter with the system.
Loretta Smith
Mm-hmm.
Unidentified speaker
And so what our pilot is trying to do is work with those discharged folks at the hospital.
We find out what's their issue.
They get stabilized to some extent at the hospital.
Then the transition team, the coordination team figures out, okay, where is the next best place for them to go to match housing and behavioral healthcare?
So they're not going back out onto the street and stealing something or getting in a fight or something like that.
They're being carried into a recovery journey, right?
And it takes coordination, not just capacity.
And, you know, some— yes, we need more capacity throughout the system, But let's utilize the capacity we have even better with better coordination.
That's what this pilot is about.
And we hope to have some recommendations by the later fall.
But so far it's working.
We're holding, supporting those people through that continuum so they're not dropping into system-based behaviors.
Thank you.
I, I came up, if I may just add one thing, because Rachel said something that is really, really important to understand.
The aid and assist population is not getting treatment for mental health or drug treatment.
They are getting stabilized only to the point that they can then return and address their criminal case.
That is not the same thing as getting stabilized so that you could step down into community care or the kind of sustainable care that prevents the next crisis.
And I think it's a really, really important point that not everybody always understands.
And so in my former life as a public defender, that is a really, really critical piece.
So these are not 2 avenues of healthcare.
There's one avenue that is actual healthcare, and that's, I think, the system that we're talking about today.
And then there's the system that just makes sure that you have enough stabilization I really appreciate your comments as well, so thank you.
And I also appreciate that you asked about data because I think we all share a desire to do this in a data-informed way.
Um, and, uh, Councilor Ryan, I really appreciated your question about, um, how separate these systems are, and the data for these systems are also very separate, right?
We have healthcare data on one side and we have HMIS data data on the other side, and we have different systems for on each of those.
Another side, and then there's correction data on a third side.
But we've done, as Health Share, we've worked with our county partners in Multnomah, Washington, and Clackamas County to actually do data sharing agreements so we can start actually looking at the data collectively.
And this, out of this has sprung some of these interesting pilots like the psychiatric hospital housing pilot.
We also are doing this case conferencing pilot where we actually bring housing providers and healthcare providers around a virtual table and discuss difficult cases and how we can help.
And it's actually led to amazing insights.
It's on a case-by-case basis, so we need to figure out a way to scale it and make it a little bit more efficient.
But I mean, these are the things that data can give us.
So we are starting to look— we have a good data set from Multnomah County, and we're looking at PSH in particular, and we're able to start seeing what types of patients are exiting permanent supportive housing to homelessness.
None of us want that.
That's an unsuccessful exit.
Well, what are some features associated with that patient population or that member population?
Stimulant use disorder is high on the list and they're not taking medications.
Okay, I mean, that may be obvious, but now we have the data pointing us in that direction.
Now we can design clinical interventions or collective interventions with our housing and healthcare colleagues to say, okay, how can we address that problem?
So we are just stepping into that space to kind of start doing things in a data-informed way.
But the first step was actually just getting the data and making sure these 2 systems that are actually talking to each other.
And so that's been the first step.
Candace Avalos
Thank you.
I have a comment, but it makes me a little emotional.
Um, you know, I just think about, um, you know, a couple months ago my house caught fire, and I've been thinking a lot about the person who accidentally, uh, burned my house.
And it's all this, you guys.
It's these systems.
I've been going through the process, you know, as like a victim of a fire, and I'm more sad for him because I was working with the DA, and, you know, it's just like, it just breaks my heart because we deserve better systems for our community.
And just watching him bounce back and forth and back and forth, and I have to be informed of all of this as somebody who's dealing with the fire, and it just Just really hurts.
And so it makes me emotional, but I say it because I think it's important that people see the intersection.
It's really nuanced and it's complicated, and people want people to be supported.
And obviously I don't want my house to be on fire, but I just, I just think about him a lot because when we talk about this, like, this is exactly what happened, you know.
He didn't have the ability to take care of himself.
Thank you.
Bounced him around, and he's, he's out there.
He's still out there suffering.
And so I just— it's vulnerable to say that, but I tell you that because I think it's really important that we remember the heart of it here.
We talk about people like they're just numbers.
There's a real impact, and I had to feel that really personally and watch that.
And it just— this is what, this is what I'm striving for, is like, how do I help people like him?
Olivia Clark
Thank you.
Candace Avalos
So I just wanted to share that personal moment because I hope we just keep grounded on how we do better for people like Quashawn.
Thank you.
Thank you.
Elana Pirtle-Guiney
Thanks, Councilor.
Councilor Koyama Lane.
Tiffany Koyama Lane
Thank you.
And thank you, Councilor Avalos, for your questions and comments.
I want to be clear that I believe that everyone deserves housing.
And I think it was Commissioner— Multnomah County Commissioner Shan Singleton who had said housing first, like no one ever said it was housing only.
Like it's housing first and then people also need support.
And since we also kind of touched on this idea of thinking about language, I want to push a little bit for us to think about saying that there are people who are not ready for housing.
Sameer Kanal
Yeah.
Tiffany Koyama Lane
Because while there are people who You know, have been living on the streets and are going to need access to information and support, skill building and support to stay housed, they can still be ready for housing.
We all know people with mental health, substance use challenges who are firmly housed, and I don't think housing is just a privilege to be earned with certain types of behavior.
So I wanted to be clear about that.
And I think it's especially important to think about how we're talking about this and being mindful because we're also talking about an area that we know is also an economic justice issue as well as a racial justice issue with disparate rates based on race and ethnicity.
And I also wanted to thank all of you for being here today, and I wanted to follow up on some of Director Banks's comments related to population health approaches, which I believe is part of a larger public health approach, and I would just love to hear a little bit more about the systems approach that public health brings to these challenges that we're talking about that look holistically at how we solve some of these challenges, especially from a racial justice lens.
And I'm wondering if you can share what the Health Department is working on from this perspective.
Unidentified speaker
Oh, I love that question.
And I also know that you all talked about maybe getting out early and not I know you need a break, so let me try to calibrate.
And then with an offer to talk much more about it.
But I think some of the things that a public health approach brings to any issue is that it starts with the systems.
It fundamentally looks to get upstream.
It looks to prevent issues.
And so, and I think what you see here, that even though folks may not consider themselves public health practitioners, the things that are public health core capabilities, our data assessment and epidemiology, are getting beyond, getting beyond and getting in between systems.
You've heard a lot about we need connections and coordination.
That's inherently a public health approach where you're looking at what are the systems and what's driving people to the systems and how can we better have folks move with it within that to a health outcomes piece.
It's looking at Where are your populations of folks that are having the highest challenges in interacting with multiple systems?
So I think looking at, for example, in this situation, the high acuity behavioral health cohort, as we used to call it a number of years ago, is one of those approaches.
And the additional kind of piece around equity is a fundamental public health capability with many other things.
So we know on that, as you mentioned, there are differences.
Yes.
Thank you.
So there's not only differences by race and ethnicity, there's also differences by life expectancy.
We are seeing years and years and decades of years lost, preventable deaths, um, with this population, for example, with the, the high acuity behavioral health or other, for a variety of reasons, including we've talked a bit about overdose.
So I think the things that the public health or population health approach bring our focus on policy, using those big levers to impact big decisions, getting in between systems.
Elana Pirtle-Guiney
The—.
Rachel Banks
What I've seen is that the behavioral health system is really built around silos, as many are, and we have phenomenal expertise in these kind of— or cylinders of excellence, right?
And what everyone is saying is this continuum that's needed and being able to have more capacity and Um, to— in this case, we're talking about step up or step down from care, but I would also add those are the people.
That's shifting the approach to, as you mentioned, um, we need connectors that follow the people, not just connectors that are in each of the systems.
So it's conveners, it's connectors, it's those sort of things that sometimes, um, are a little bit harder to understand than a direct service practitioner.
Um, but that's what I think is This helps us to get there a bit.
And I think we, as I mentioned, we have more work to do.
Tiffany Koyama Lane
Thank you.
And I look forward to speaking more with you about this and wanna be clear that I support this overall and just want to make sure that I'm also naming that that public health approach, the population health approach, is also important, an important part of the conversation and finding solutions.
Mitch Green
Thank you.
Elana Pirtle-Guiney
Thank you, Councilor.
Councilor Zimmerman.
Eric Zimmerman
Thanks.
Just wanted to commend Councilor Avalos.
I think you brought up some important points about how this weaves together.
And actually toward the end there with Councilor Koyama Lane too, I don't think that, you know, anything about this is anti-Housing First.
I want to be really clear with what we're seeing.
What we're talking about is a group of folks who have the responsibility Who are saying in order to do this well, we need this other tool, and that is these increased beds.
And, and things like Housing First, one of the reasons why we haven't quite gotten it right in our state, in our community, is that we have major aspects of it that people don't have access to.
And so to answer the question of like, how do we get upstream so that somebody doesn't ever engage in the criminal justice system?
It's these beds.
How do we make sure That's making sure that the beds that we do have are treating people at the highest efficiency, if you will.
That's not having the state hospital filled with aid and assist, where, to Stephanie Howard's point, no one's getting actually mental healthcare.
They're getting like a Band-Aid on a gaping chest wound, right?
Just enough to walk somewhere else.
So that— We want our mental health hospital, who has the deep responsibility to deal with the most difficult stuff, To be able to do that and not be truly warehousing, right?
That is what we've kind of moved to since the— is it the Mossman decision?
Am I getting that right?
Unidentified speaker
Right.
Eric Zimmerman
We've kind of moved that direction.
And so we've got that— that needs to happen, but we've got to figure out the rest of the system.
So I'm seeing that happen.
And I think that this— I think these can be complementary to all the values we've seen come up on here.
I want to raise My one greatest area of concern, and most of my time in government, a department will come to me or to the person I worked for when I was at Multnomah County and say, hey, we need this thing to be better at our job, right?
Whether it be planning, zoning, police work, fire work, etc.
The Health Department has done that historically on a lot of topics, but on this topic.
Historically, I have my greatest concern actually with Multnomah County's Health Department and with the Oregon Health Authority from a kind of almost a bureaucratic perspective about moving a little bit more aggressively in.
There are some folks who we need to advocate for a bigger option, uh, a more— well, first off, You know, we've improved the commitment laws in this last session that not everything is always going to be community-based.
Like, there are some folks where— because I agree wholeheartedly with Councilor Avalos— some folks who government, we are supposed to be that backstop.
I'm in it.
I have said that I'm always going to be there.
I worry because in my time at Multnomah County, no public health— excuse me, no health department Director, employee, anybody ever came and said more than, I'll just say, some, a little bit around the edges, right?
And it was a lot more about people who just with a few more supports, they're gonna be successful.
We spent a lot of time in that conversation.
We spent no time in the most severe.
And that's where my worry is at.
And given the—.
Unidentified speaker
I agree.
Eric Zimmerman
15 Or so, 17 years or whatever I've got experience between the two.
I know the revolving door between OHA and MultCo, and in a lot of ways that we've tried things out in MultCo so that OHA can do it when it comes to like public health things like kids and cigarettes and, and tobacco, right?
So I'm raising that because I want to get proven wrong, right?
I am raising that because I also think that we have this opportunity here where I'm I think that OHA and Multco probably weren't going to do this or bring this to us on our own.
And I'm seeing others up here, I'm seeing providers who have been coming out of the woodwork asking for a different perspective at those two, our two largest health agencies in the state government, local government.
So that's my ask.
I want to be wrong as hell in a couple of years, but bureaucracy, what is it?
It's like the stick in the mud thing.
And this is one of those areas I have I have a lot of concern that Multnomah County has got some of the old cobwebs of, um, that aren't— that are not prepared for the moment.
And, and I, and I— we need— I think we could have been further ahead of this years ago, maybe but for some of that bureaucratic cement that existed between the two agencies.
And so, um, I'm asking for, for us to oil it up, get things moving, Accept that we're going to have to make tough decisions.
And if all the different perspectives that got shared— and I, and I've had this conversation with several county commissioners of this type of thing— and if we can be successful with all levels of the higher acuity stuff, makes our community-based system a hell of a lot more successful because right people, right place, and the throughput.
That throughput Maybe a few years ago I didn't understand the importance of it.
I think I'm understanding the importance of it largely because some of your testimonies in our meetings over the last couple years.
But that throughput is important.
So we need, we need OHA and we need Multco Health to be the leaders on this as the largest agencies.
And I think where those 2 agencies go, the state can be— the state broader, other 35 counties can be successful as well.
But please prove me wrong.
Olivia Clark
All right.
Unidentified speaker
So I didn't walk in here today thinking that I was going to say I look forward to coming back and, and, uh, proving you wrong, Councilor Zimmerman.
Uh, but you all heard it.
Uh, no, I appreciate it.
And I think that, um, you know, a couple of thoughts.
One is, is that I would say this is a different conversation.
Us recognizing that we don't have systems built for— I mean, we didn't— they were underfunded, as I mentioned before, but we don't have systems built for the now.
We've got to do new things.
We've got Councilor Smith.
I think we have to be thinking about behavioral health differently and working with partners and convening because there's so many different systems.
And I think then also just acknowledging that folks whose job it is to provide care to people just want to keep doing it, right?
And because they know that that's a value.
And so we'll continue to hold that value.
We'll continue to have folks that want to see people in suffering and wrap other supports around.
And I think we also know that we need system changes and we need to be doing something differently to get the outcomes that we want to seek and, you know, change the trajectory.
So thank you.
Invite me back so I can prove you wrong.
And, uh, no, we're all in it together, right?
I think that's what's really powerful about this.
And hopefully what folks are seeing is different and a mark of kind of a different way of moving forward.
Eric Zimmerman
Thank you.
And last point, Thank you, Mayor.
Unidentified speaker
Councilor Green.
Eric Zimmerman
To the Chair and President, I just, there was a moment about how do we do things cost-effectively, and that was said a while ago, and Councilor Green kind of alluded to like cost isn't maybe the driver for me.
And I would just wanna say I also highlighted that as like, I am okay with the proposal that it's too damn expensive to fund because at least then I know where we need to get to.
And so cost-effective versus I think the word I care more about on this topic is effective, but I don't want to start from only a cost-effective perspective.
I should reframe that somehow.
But I just want to convey that because I recognize that challenge.
That is every nonprofit, every healthcare system, that is always the challenge of what's— but we've gone so far in the other direction of spending money that isn't really intended for certain clients and patients in ways that I almost feel like there's a washing of a reset to know like what is effective and then going into how to then, um, what is achievable in the short term but also what's achievable in the long term.
Because I don't think this is a 1-session, 2-session, or 3-session thing.
I think we are— I hope we are in a decade-plus of building out a system so that we are not 50 out of 50.
That's where, that's where my passion is at here.
Elana Pirtle-Guiney
Thank you, Councilor.
Councilor Kanal, last in the queue.
Sameer Kanal
Thanks.
I have a question for Director Chase.
Do you feel like you have what you need from us coming out of this?
Unidentified speaker
I feel like I've been able to capture a lot of the kind of perspective and feel of council for this.
A lot of the issues around how we're communicating it, messaging it, integrating it with the housing agenda and that work.
I feel like I've got a really great sort of addition, a foundation to be able to come back and continue this dialogue with you in work session and beyond.
And I welcome and expect to have dialogue and conversation with you in various ways.
You know, you'll see us having our typical kind of briefing availabilities.
You're going to see more of us than I always say than you did during budget season.
Yes.
You know, it's going to start picking up where you see us a lot again.
And so, so yes, I feel like this has been a very insightful, enlightening discussion.
I really appreciate the way Council has leaned in over the last year really on this issue to help sort of give us some guidance around where to land.
It feels to me like we're landing in a place that Council is collectively saying, Yes, we want to continue and do this work.
And there are a lot of nuances and ways that we want to make sure we get it right and that we're big and bold and looking at long-term problem solving and also recognizing short-term challenges.
But I feel like this has been a very welcome conversation.
I have so much appreciation for the alignment that is here with this body that is not fully representative of all of the folks that are united on this issue.
So the short answer is yes.
Great.
Sameer Kanal
You know, sometimes in executive sessions, it's like people count how many times, how many different people are saying they agree.
So I wanted to make sure I said I agree.
I also wanted to really just highlight and uplift I have a couple things that are related to this Medicaid reimbursement for the behavioral health work.
I notice we have folks from PSR in chat here.
That's really vital.
And I know you don't just advocate to the legislature but to the government.
And so the, the OHA could do a lot more there.
Um, I really appreciate what Councilor Green was saying, uh, and, and as this relates to data collection, that we are paying the costs when we don't pay the costs up front.
We pay them in other ways.
Unidentified speaker
Yeah.
Sameer Kanal
So I appreciate that as well.
And I have very similar experiences on my ride-alongs, obviously same district, to Councilor Ryan.
And when I was with fire and went out on an overdose call and was told by the folks I was with that this was the 3rd time they'd seen this guy that day, 24-hour shift, and I'm near the end of it, but still, right?
That's a particularly egregious type of situation.
So I, I look forward to, to getting to a place where we're giving people what they need when they need it and not the bare minimum necessary after the fact.
And, um, thank you.
Loretta Smith
Thanks.
Dan Ryan
Thank you.
Elana Pirtle-Guiney
Thank you, Councilor.
Um, colleagues, that exhausts the queue.
I want to thank everybody who participated in the conversation and our guests who are here today and who brought this proposal forward for us, and everybody who you worked with to put together these ideas and get to a place of agreement amongst providers— perhaps not all, but many providers— that allows us to have an entry point into this conversation in a place where we might be able to advocate together as a community.
I also want to give a big thank you to our government relations Director Chase, your team has spent a lot of time behind the scenes helping to corral this group and get us a proposal that we could consider today.
And that work that is not the, the direct lobbying but is the behind the scenes helping to coordinate and plan and get us the proposal often goes unnoticed.
So thank you to your team for putting this together for us.
Thank you.
I heard a lot of agreement today, and so I just want to Councilor Smith.
I just want to restate a few things that I hope you're taking from this conversation, all of you.
We want to go bigger and go bolder if there is a need to do that, and perhaps have an ask that we know we can't achieve just in one year.
We want to make sure that we are building toward a system where you don't have to go to jail to get care.
And the proposal that we have before us We hope helps to move us in that direction.
And if not, we want to make sure we have something that does.
There were questions about clarities on the level of care and making sure that this isn't just institutionalization by another name.
So a little bit of clarity there as we move forward to make sure folks have confidence in the proposal will be helpful.
Similarly, we want you to be clear about costs, not just the cost of these beds, but the cost of not having these beds.
Dan Ryan
Yes.
Elana Pirtle-Guiney
The costs to our housing system, our healthcare system, insurance costs in our affordable— for our affordable housing providers, evictions, and the way that that throws people into instability, and make sure that as we bring this forward to advocate on, we're armed with that data and that information.
And we need you to be in alignment with us if we are going to take this leap and say this service that we don't provide is a high priority.
We need to make sure we have you all asking for the same thing and not a bifurcated group of asks from providers across the system.
And colleagues, as we move forward, let's keep in mind that we are not seeking to open a new book of business for the city.
We're not seeking to direct the system or be a pass-through for funds, but we heard loud and clear today that we can ensure that this system is meeting the needs we see in our community every day if we're advocating for funding for the specific parts of the system which are desperately underfunded and underserviced right now.
We can only do that, though, if we stay committed and focused to this being a high priority in our legislative agenda.
So as we meet later this month to talk about the rest of our agenda, I hope that we continue to be as all-in as I've heard folks being today.
I think our conversation today has given OGR a sense of what we could collectively support.
Sam, I heard your overview there.
Thank you.
And as we continue to meet, we'll be able to talk about what role this plays in our legislative agenda.
Just as a note there, OGR will be back in late September to talk about the broader state legislative agenda.
Council President, I look forward to you getting to run that meeting and not me.
Thank you.
But at that point, we'll get to revisit how this is a part of our broader work.
In the meantime, if you have questions, I know, Director Chase, you have said you are open to more discussion around this topic if folks have thoughts or ideas after we leave here today.
And I hope that everyone gets their questions answered if they haven't been yet.
I'll look forward to seeing that data from Director Howard to make sure that we all have the background on what the city is doing right now.
Thank you.
With that, I am going to turn it back over to Director Chase for a brief closing and then to the Council President to close us out today.
Thank you all for being a part of this work and walking this journey together.
Sam Chase
Yeah, I just thank again the panel and Council.
I think we've, we've, we've got a game plan to sort of keep moving on this.
And so I'm enthusiastic about it and feeling very hopeful.
Jamie Dunphy
Ditto.
We're adjourned.
Thank you.
Loretta Smith
Nice.
Unidentified speaker
All righty.