The Oregon governor’s race: Candidates have different views on how to improve mental health care

 

By HOLLY DILLEMUTH/Ashland.news

With a recent national report putting Oregon 50th in the nation for mental health care, major candidates for governor advocate divergent ways to improve the situation: Tina Kotek sees implementing Measure 110 as part of the solution, Betsy Johnson wants local agencies to find fixes the state can back, and Christine Drazan is ready to suspend regulations she sees as getting in the way of delivering care.

Oregon ranks only above Kansas in the recently released Mental Health America national nonprofit organization’s State of Mental Health in America report for 2023, which includes the District of Columbia in the state rankings, largely based on measurements of the need for mental health care compared to the supply of mental health workforce availability.

That’s a stark divergence from another recent national report that ranks Oregon in the top third in its delivery of health care overall. The Commonwealth Fund’s 2022 report places Oregon 14th, buoyed by its ability to avoid preventable hospitalizations and its handling of the COVID-19 crisis — it puts Oregon fifth nationally for both — but marks Oregon down for the number of individuals with mental illness who did not receive treatment, for which it ranked the state 30th nationally.

Tina Kotek, Democrat

Implementing Measure 110, increasing capacity for residential care and improving access to treatment are Tina Kotek’s top mental health priorities, the Democrat said in a phone interview in mid-September.

“I think we all agree that we shouldn’t be last in the country for providing care,” Kotek, a former Speaker of the House, said.

Kotek stressed that COVID-19 pandemic trauma has elevated the need to ensure access to mental health care.

“It affects every community,” she said. “I think most families in the state will, I think, know someone or know someone who knows someone dealing with a mental health issue. We have to make sure that health care is available and this is part of health care.”

In passing Measure 110, the 2020 measure decriminalizing many drug possession charges and directing cost savings to drug addiction treatment, Kotek said, voters indicated they wanted less jail time and more treatment time.

“We have an obligation to put into place what voters have asked,” Kotek said. “That means making sure Measure 110 can work and I’m very focused on that. … Both Christine Drazan and Betsy Johnson want to disregard what the voters have said. They are both advocating for repealing the measure and kicking the can down the road. Look, people’s lives are on the line here. … Let’s dig in and get it to work.”

Kotek said the Legislature has already approved $500 million on top of the existing two-year budget to expand access to mental health and addiction care. “So, my first goal as governor is to make sure those resources are getting out to communities in a way that is improving health care access for Oregonians …. As governor, we’re going to do an immediate review of the Oregon Health Authority management.”

Kotek strongly supports funding mobile crisis teams.

“In 2021,” she said, “I was supportive of the state for the first time setting up a grant program … to make sure that when someone’s in a mental health crisis, they can call and have a trained mental health professional come out, instead of someone with a  gun who’s a police officer who might not be trained to deal with that situation.”

“I will be working on a top-to-bottom review of what our workforce shortage is in our behavioral healthcare workforce,” Kotek said. “My wife is a social worker, so I’ve had an inside view of what it is like to be in this field.

“There should be good provider networks. …People say they have networks and places you can go, but everybody’s filled. So that’s not a network, that’s just people on a list.”

Kotek said she also wants to increase diversity so that those providing services can “become more culturally competent and diverse.

“It helps to have someone who looks like you, who has a similar lived experience being your healthcare provider — we know that is beneficial,” Kotek said. “Same thing in mental health and addiction care.”

“It’s about the money being spent well,” Kotek said. “It’s about looking at the workforce shortage, ultimately just holding everyone accountable to improving the system that we have. Right now, it’s not serving people well and that’s not OK.”

Betsy Johnson, nonaffiliated 

Betsy Johnson sees mental health as a driver for many other issues facing Oregonians, and her approach is to encourage local communities to come up with solutions and help them with funding. 

 Under a Johnson administration, the nonaffiliated candidate would support looking at ideas such as providing government subsidies for housing for mental health professionals if a region is struggling to keep them, she said from Portland in a September phone interview.

“We can locally define the problem, locally define the solution, and then it is in the state’s interest to fix the mental health and homeless crisis wherever it exists,” Johnson said, “so the state ought to be a full partner in delivering money to implement the solution that local places come up with because every places’ problem statement and solution are not going to be the same.”

“To me, it is a profound problem that is driving crime, homelessness — a variety of what I’m going to characterize as sort of social problems — and we have to be able to address it comprehensively and systematically.”

Johnson said she believes mental health transcends just healthcare. 

“It is being exacerbated by our very laissez-faire attitude towards drugs, where with ballot Measure 110, we functionally legalized certain drug possessions and, even though we promised more money for treatment, we don’t know a baseline against which to judge whether or not we’ve made any inroads,” Johnson said.

“You’ve got to know where you’re starting to know if you’ve moved the dial,” she said. “We have a state hospital that is not functioning optimally. I don’t know after the COVID problem whether or not the state’s relationships with all of our county mental health county health departments are intact or they need to be revitalized. When you recognize that Oregon ranks at or near the bottom … we need leadership to fix that.

She believes that illegal substances on the streets exacerbate people’s mental health issues. Add social isolation due to COVID-19 closures on top of that, and the impacts compound.

“We’ve gone through two years of forced isolation with COVID and have no real baseline on how detrimental that was, especially for our kids, who’ve been deprived of mental health, social interaction, academic health,” Johnson said. “We don’t know how badly damaged they are as a result of enforced COVID isolation and so, we’ve got tremendous problems across the system.,” 

Johnson said the issue of housing, especially in rural areas of the state, is also connected with mental health.

“It’s virtually impossible to attract mental health professionals to places where there’s either no housing stock or the housing is so expensive that they can’t find a place to live,” she said. “The fact that we don’t have psychiatric services in many of our counties is enormously problematic … Above and beyond it being a health question, it permeates homelessness, it permeates so much of what we do or don’t do in this state.”

Christine Drazan, Republican 

(Editor’s note: Tina Kotek and Betsy Johnson readily agreed to be interviewed separately by the six reporters who contributed to this project. Christine Drazan, however, declined. This section is based on her statements and her record.)

When it comes to improving health care for Oregonians, former Republican Minority Leader Christine Drazan prefers to focus on serving Oregonians, as opposed to focusing on systems, she told The Lund Report in an interview in April.

“Lawmakers have spent so much time obsessing over how to further regulate the industry that many mom-and-pop doctors’ offices are feeling pressure to sell their practice or get out of the business altogether,” Drazan said, according to the report from the nonprofit, non-partisan news site focusing on the Oregon health care industry. “In the end, it’s the patients that lose in that situation. I will lead by putting the focus back on patients and on how to provide them with care that is affordable and accessible. That should always be our first priority.”

With addiction and behavioral health often going hand-in-hand, Drazan commented on the overlap.

“Oregon ranks among the worst states in the nation for access to addiction and behavioral health supports,” Drazan told The Lund Report. “We’re talking about a crisis that is destroying lives and greatly contributing to the number of Oregonians we see living in our streets. It has to end. In the short term, we need to recruit providers from out of state to join our ranks on an emergency and temporary basis. If that means suspending some of the licensing and red tape that can delay their ability to provide care, as governor, I would be prepared to do that. In the long term, we need to make sure our addiction and mental health professionals have the funding they need to meet the demand for services and that we value and compensate these professionals for the important work they do on behalf of our state.”

Drazan also addressed what Oregon needs to do to rebuild and strengthen its public health system to address disparities and improve equity in care.

“Too often, access to health care is dependent on what zip code you live in,” Drazan said. “The quality, affordability and availability of care is not the same in Klamath County, where I grew up, as it is in the metro area. It’s not uncommon for rural residents to drive more than 100 miles round trip just to access care — and to add to it, they often pay more for it. That does not sit well with me. I will lead by investing in rural health care so that people living in these communities are not stuck continuing to pay more for less.

“Additionally, I think we need more accountability for outcomes in our health care system as a whole. We are spending more money than ever before, yet nobody is asking what our return on investment is. I’m not all convinced that our record investments are leading to improved outcomes. As governor, I will demand transparency, assess existing policies based on their effectiveness, and reform the system where appropriate to better serve patients.”

• This story is part of a newsroom collaboration for the governor’s race, with eight newsrooms each tackling where Republican Christine Drazan, nonaffiliated candidate Betsy Johnson and Democrat  Tina Kotek, stand on a key topic. The Albany Herald-Democrat wrote about wildfires and drought; Ashland News covered health care, including mental health; the Mail Tribune wrote about abortion, the Oregon Capital Chronicle covered housing, the Salem Reporter covered education and Yachats News wrote about the economy.

 

• Votes on health care

• (Alexis Weisend from the Catalyst Journalism Project at the University of Oregon)

• • SB 770 (2019 regular session) passed
    • Established a task force on Universal Health Care charged with recommending a universal health care system for Oregon residents.
      • Drazan —  No
      • Johnson — Yes
      • Kotek — Yes
  • SB 1606 (2020 f
  • irst special session) passed
    • Required hospitals to allow patients with disabilities to have a support person with them and prohibited hospitals from withholding treatment on a patient until they have signed forms about end-of-life care.
      • Drazan —  Yes
      • Johnson — Yes
      • Kotek — Yes
  • HB 3063 (2019 regular session) passed the House but died in the Senate
    • Prohibited parents from declining immunizations for their children for non-medical reasons, including religion.
      • Drazan —  No
      • Johnson — (did not make it to a Senate vote)
      • Kotek — Yes
  • HB 3352 (2021 regular session) passed
    • Expands the insurance eligibility to undocumented immigrants who would be eligible for Medicaid.
      • Drazan —  No
      • Johnson — Yes
      • Kotek — Yes
  • SB 910 (2019 regular session) passed
    • Allows health care professionals and pharmacies to distribute naloxone kits to reverse opioid overdoses to people and social service agencies who work with people who have experienced overdoses.
      • Drazan —  No
      • Johnson — Yes
      • Kotek — Excused