Policy Analysis 1

Policy Analysis on the Improvement of Access to Mental Health Services in Oregon

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Health Policy and Politics

POLICY ANALYSIS 2

Policy Analysis on the Improvement of Access to Mental Health Services in Oregon

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Problem Statement

How can the state of Oregon improve access to mental health services?

Background

In 1880, the first mental hospital was opened in Oregon, Oregon State Hospital, however,

due to an influx of patients and need for psychiatric services, Eastern Oregon State Hospital

opened in 1913 to provide mental health services to the eastern region. As with most states in the

United States in the early to mid-1900’s, reports in Oregon identified that an unreasonable

amount of individuals were being committed to the state asylums, which eventually led to the

implementation and usage of community-based services over the more controversial use of state

run hospitals (Unger, 1999).

By 1946, the federal government passed the Mental Health Act which provided grants to

states for community-based services, and the expansion of such services. Eventually, Oregon

legislature authorized that the development of comprehensive community-based mental health

services be the responsibility of local governments in 1971. At this time, alternatives to

hospitalization were integrated into care such as day treatment, group homes, and local hospital

care. Due to overcrowding and a perceived excessive use of mental health services though, in

1981 Oregon legislature mandated that mental health treatment resources should be given to the

most severe and to the “greatest possible extent (Unger, 1999).” The mandate established three

levels of priority. Priority 1 identified those with the most severe mental illness, while Priority 3

was for those with the least severe mental illness. During the 1980’s and 1990’s, the usage of

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community-based services increased, which can be partially attributed to Medicaid funding,

however, the priorities established in 1981 still greatly determined who had access to hospital

and community care. In order to receive benefits from the Oregon Health Plan and Medicaid,

patients needed to have Priority 1 status (Unger, 1999).

Currently, Oregon’s mental health statistics and trends seem to counteract any successes

or progress made in the past. According to “Prevention and Early Intervention B4 Stage 4: The

State of Mental Health in American 2016,” Oregon has scored the overall lowest ranking on

mental health needs, access to care, and outcomes (Mental Health America, 2016). Oregon is

considered the least effective state in the US with addressing issues that involve mental illness.

Other statistics and facts include: “one in 18.5 adult Oregonians suffers from mental illness

(Lifeline Connections, 2016),” one in nine children from Oregon are suffering from severe

emotional disturbance, suicide rates in Portland are three times the national average, and heroin

use, likely as a means to cope with mental illness, has led to consistently increasing overdose

deaths (Lifeline Connections, 2016). Although there is an obvious need for mental health

services in Oregon, current trends and statistics suggest challenges with access.

Landscape. The landscape of mental health in Oregon is made up of various stakeholders

who all have unique perspectives and agendas. The primary stakeholder is the population of

mentally ill who are at risk to suffer if proper access is not provided, but stand to prosper if able

to obtain the care they need. Oregon’s mentally ill, just like any other individual seeking medical

care, want a wide range of services, affordability, and options with providers. The insurance

industry is another key stakeholder because of the companies’ abilities to choose which services

and medications will be covered. The more benefits covered under an insurance plan, the more

money the company is spending, which impacts revenue. For this reason, it is justifiable to

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assume that the insurance industry will want to cover less mental health services in order to pay

out less reimbursements. Behavioral health providers are a third key stakeholder in the mental

health landscape. These providers want to assist those with mental illness in getting the care they

need, however, because of shortages in the workforce and the inability of many mentally ill to

afford such treatment, assistance may be limited. The state and federal governments are another

stakeholder because of their interest to better serve the population on one side, and efficiently

allocate financial resources on the other. The health and wellness of society are significant, but

the government is also responsible for providing financial resources through grants to many state

and local agencies within the health care sector beyond mental health, which leads to a lack of

funding.

Options. Although there are many ways to improve access to mental health services in

the state of Oregon, this analysis proposes three distinct options.

Option 1: Integrating Mental and Primary Care Services. When an individual

receives primary care, she/he will also be seen by a behavioral health provider who will conduct

a general mental health assessment. Those who are identified as needing further care will then be

referred to a mental health specialist. In analyzing this option’s cost, there would be none to the

government because this integration will be solely managed by health care facilities and

providers. The option is politically feasible because it does not call for policy changes, however,

requiring insurance companies to cover these services as preventative in nature could pose a

challenge. Integrating mental and primary care services is effective in the sense that this option

exposes more individuals to mental health assessments and refers those in need of more services

to specialist. On the other hand, this option will have no impact on the uninsured population.

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Option 2: Increase Federal Block Grants. From 2011-2013, Oregon received CMHS

block grants for adults with severe mental illness totaling $4,029,030 and $104,550 for children

with serious emotional disturbance (Oregon.gov, 2015). This option calls for an increase to those

block grants, which will be allocated to various community-based centers, hospitals, and state

mental health agencies such as NAMI. The purpose of the increase in block grants will be to

lower costs for services, and extend available services. Increasing grants will cost the federal

government, which may be a challenging aspect of implementing this option. Political feasibility

is moderate because although this option does not propose the creation of a law, the allocation of

funds is determined by the Secretary of the Treasury who is currently a Republican, and thus less

likely to increase funding for mental health services. Effectiveness, on the other hand, is high

because providing additional grants to mental health facilities and agencies for the purpose of

lowering costs and increasing services will allow more of the mental health population to receive

such services.

Option 3: Provide Incentives to Increase Mental Health Workforce. This option

proposes a reduction in tuition costs for those students enrolled in graduate studies for the

pursuance of becoming a mental health specialist. The purpose of the option is to lessen the

current behavioral health workforce shortage by providing financial incentive to enter the field.

Funding for this incentive will be provided at the state level. This option will cost the state

government, which will have the challenge of determining where to cut funding in order to

allocate enough funding for the incentive. As with option two, political feasibility is moderate

because although no laws need to be established, the difficulty that Oregon will face is attributed

to the dominant political party of the state. Effectiveness of providing incentives to increase the

mental health workforce is high for its ability to ensure more specialists in a field experiencing

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shortage, however, it will not have any impact of those individuals who are unable to access care