Collaboration Key to Solving Behavioral Health Problems

It takes coordination and engagement on many levels when addressing behavioral health issues, and more so when delivering mental health services to persons who have the potential for violence. A recent example was when an Alzheimer patient “headbutted” Columbia County Sheriff Rocky Miller after he responded to a call for help at the patient’s home in February.

An interesting conversation took place last week in the Columbia County Commissioners’ chambers between Sheriff Miller, Deputy Prosecuting Attorney Dale Slack, Columbia County Health System CEO Shane McGuire, Blue Mountain Counseling Executive Director Damita Warren, Chrisann Christensen, BMC’s Clinical Director, and local Attorney Mike Hubbard.

The county contracts with Blue Mountain Counseling to provide behavioral health services, including 24-hour crisis response. A major problem for the staff at BMC is finding beds in facilities for the long-term assessment and treatment of patients with substance abuse and mental health issues.

And a major frustration for Sheriff Miller is when an individual is sent to the emergency room to be evaluated by the crisis response team, and then is released, after a determination is made that the individual does not meet the criteria for “hazard to self or others,” when it seems they clearly do, he said.

McGuire said there is only one space for voluntary respite care at the hospital, and it is for a very specific type of patient. “If they need to be involuntarily detained there is no place for them at the hospital,” said McGuire. It is not ideal to discharge people back to the street, or to a motel, either, he said.

And jail isn’t the place, either, said Miller.

Slack said a crime has to be committed to place a person in jail, and that placing a potentially violent person in jail with the general population is a recipe for disaster.

Damita Warren said, “There is a procedure for involuntary commitment, if a bed can be found. She said there is an acute shortage of beds in the state, including at the two state-run mental hospitals. Individuals might qualify for a short term stay in a facility in Walla Walla, but again, only if beds are available, she said.

Hubbard commended the job done by the Blue Mountain Counseling staff, noting they clocked 119 crisis hours in February alone.

“We got lucky in February,” said Christiansen. “There were three beds (available) in one week.”

McGuire agreed with Hubbard. “The crisis team is responsive. We think, ‘they’re going to fix it,’ but nobody is willing to take these patients.”

McGuire went on to say that substance abuse is a significant problem in Columbia County, and better support for addiction treatment is needed. He noted that two doctors with CCHS have received training in dispensing Suboxone, which is a medication used to treat opioid addiction.

Warren said half of BMC’s patients being treated for substance abuse have an underlying mental health illness.

And Miller said the percentage of those jailed in the county who have substance abuse issues is 95%, or higher.

“We’ve all been frustrated by the harm to others we have seen,” said McGuire. “[The Department of Social and Health Services] has more or less said, “These are your community members and you figure that out.” He added, “We need beds.”

“Having local beds would be huge,” said Miller, who believes this would be a good short-term solution. Miller said he thinks that in the long-term, a concerted nation-wide effort should be made to commit more resources to behavioral health.

Commissioner Norm Passmore described the whole situation as “limbo-land,” and asked the group to identify concrete steps to solve the situation.

“Proactive collaborative management is needed to stop the crisis,” said McGuire.

Slack said his office, and the greater community, would be better served by receiving regular updates on the progress of individuals who are undergoing court-ordered substance abuse treatment.

More and better communication between the Sheriff’s Department and Blue Mountain Counseling would be helpful, Warren added.

McGuire said he thought the Hospital District can begin taking steps to create six units at the hospital for assessment and treatment, and he will be looking into grant funding for that.

“We’re starting to learn how to navigate the waters,” he said.