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A Progressive Approach to Health 

An inside look at Deschutes County Behavioral Health

Last week, the Source Weekly published a piece about the county’s efforts to decriminalize mental illness. Local crisis experts told stories of working within jails and police departments to identify and assist people coping with chronic mental health disorders.

This week, Deputy Director Janice Garceau of Deschutes County Behavioral Health provides an inside look at the organization’s progressive approach to mind/body health, its ability to win competitive national grants and its team of peer support specialists who bring hope to those suffering in the community.

CHRIS MILLER
  • Chris Miller
DCBH is the government-funded agency that serves people struggling with mental illness who are enrolled in the Oregon Health Plan, and those who have no insurance at all. (A small fraction of its funding comes from people with private insurance.) It is the Community Mental Health Program for Deschutes County, a designation assigned to different providers in every region.

“In other places—like Multnomah County—there might be 20 or more nonprofits providing the services of a CMHP,” Garceau explained. “We provide services targeted towards higher needs individuals who may not need inpatient care, but need more than just general supportive counseling.”

Fluctuating funding

DCBH is largely funded by Medicaid dollars which filter through PacificSource Community Solutions—the nonprofit arm of the private insurance company that helps people with OHP coordinate their physical and mental health care.

Next, DCBH gets money from the State to make sure there are services for people who are uninsured or underinsured, and for specific programs like decriminalization initiatives for people with mental health disorders. DCBH also competes for federal and state grants.

“In our county, we are fortunate to have a board that has seen fit to provide some county general fund dollars to cover the costs that we can’t cover any other way,” Garceau said. “For grants that require a match, those county general funds really make it possible for us to triple down or quadruple down on the county investment.”   
One of DCBH’s biggest wins was the federal Certified Community Behavioral Health Clinic Grant from Substance Abuse and Mental Health Services Administration in 2017. The pilot program focused on high-risk, high-need populations like veterans, older adults and people without homes at risk for ending up in jails and hospitals. As one of only 66 counties across the country that won the grant, DCBH was able to hire 29 additional employees.

“There’s a lot of different funding sources and every single one of them has rules, reports, parameters, requirements, expectations and performance metrics,” Garceau said.

“The downside of getting grants is that they have requirements, but the upside of getting grants is they have requirements,” she said. “The beauty of these grant funds is that they drive change, and big organizations can have some inertia. We’ve wanted to integrate physical and mental health for a long time, for example, and now we’re following through with that because there is specific funding that rewards this kind of innovation.’”

Integrating Physical & Mental Health
click to enlarge Janice Garceau is Deputy Director of Deschutes County Health Services - Behavioral Health Divison - DESCHUTES COUNTY
  • Deschutes County
  • Janice Garceau is Deputy Director of Deschutes County Health Services - Behavioral Health Divison

Garceau believes that the Oregon Health Authority has become more visionary in recent years, with the roll-out of a new set of contracts for PacificSource Community Solutions—which prioritize mental health and addiction recovery for its members.

“What we now know is that when people have poorly managed mental health conditions, their physical health conditions are also poorly managed… so they suffer more from those conditions and they cost more in the system,” Garceau explained.

DCBH has the ability to address the physical needs of its clients in every one of its five sites around the county and in seven of its school-based centers. The Deschutes County Health Services building on NE Courtney Dr. and the Harriman Health Care clinic in downtown have physical and mental health staff that meet regularly, coordinate care and even walk their clients over to primary care appointments. Garceau calls this a “warm handoff,” an extra step that helps clients who are sometimes overwhelmed by noise or confusing environments.

“The Harriman Health Care model—in partnership with Mosaic Medical—has been around for eight or nine years,” Garceau said. “Over the course of that time period, we went from 13% of our clients coming to medical appoints to now 72%. This really is a profound change, especially when you consider that people with a serious mental illness die on average 25 years sooner than their ‘not-ill’ cohort.”

The World Health Organization estimates that people with severe mental disorders have a 10-25 year life-expectancy reduction due to chronic medical conditions such as cardiovascular, respiratory and infectious diseases. Diabetes, hypertension and suicide are other notable causes of death for this population, according to the WHO.

Peer Supports

For over a decade, DCBH has been employing dozens of peer support specialists. Instead of a counseling license, they bring lived-life experience with recovery from addictions and mental health disorders.

The intention is to engage in non-hierarchical relationships with people in the community who are struggling: people who are reluctant to engage in group therapy, psychiatric care and one-on-one counseling provided at DCBH.

“They offer the message of hope, a model of recovery,” Garceau said. “A lot of people out there don’t believe they are ever going to be well. If you have someone who has recovered from an OD five times before they ever got treatment, and is now a functioning adult who has good relationships, and a job and health—that’s a powerful message. It’s one that I as a clinician without that experience can’t provide. We’re really grateful for our peers, they’re inspired, amazing individuals.”
Addiction Response

Peer supports have been a big part of the DCBH’s response to the opioid crisis, but Garceau doesn't believe opioid and fentanyl events have been as devastating by the numbers in Central Oregon as they have in other parts of the country.

“I’m glad there is a focus on the opioid crisis because it's infused communities with dollars to address it,” Garceau said. “But we’ve got to keep reminding people that alcoholism is probably the deadliest addiction out there—in terms of just the sheer numbers of people that are impacted—and the mortality rates associated with it.”

Between 2014 and 2017, an average of 77 people per year died in alcohol-related deaths in Deschutes County, while approximately 11 people died per year of opioid overdose during the same period.

DCBH has been challenged by a growing population and shifting accountability measures from a variety of grants over the past three years, and Garceau believes there are probably more people out there that need services than it has the capacity to assist. In just two years, the number of individuals served by DCBH increased by 70% from 3,433 in 2016 to 5,856 in 2018.

Through this expansion, DCBH was recognized many times over with pilot funding and grants that rewarded the organization’s innovation and willingness to change and grow.

“Our public sector employees (that work here) are the hardest working, most dedicated, most mission driven, most talented people I’ve ever worked with,” she said. “They are doing their best to meet an enormous need.”
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