In spite of Oregon’s long, progressive social and health policy tradition, our mental health system has fallen far and fast in recent years. Economics and indifference have reversed substantial achievements.

With more than 33 years in the public mental health system, I am acutely aware — at both personal and system levels — of the destruction. Patients, families, psychiatric providers and the general public have witnessed repeated tragedies related to an under-resourced, over-stressed system.

Too often I see patients who desperately want care denied it because of funding limits, people jailed who need to be in mental health facilities, families torn up over their powerlessness to help psychotic adult relatives who refuse treatment then die from suicide or illness — but with their civil rights preserved. Recent Oregonian articles by Michelle Roberts and Don Colburn highlighted some of the worst problems.

However, increased public attention, an improving economy and renewed political will can make our system more effective, efficient and responsive. That transformation — being discussed and promoted throughout the public mental health system — is reflected in a vision of a revamped service system that is recovery-oriented, evidence-based and culturally competent.

Offer recovery options

With appropriate treatment, people with mental illnesses or substance-use disorders can improve and live productive and meaningful lives in the community. These individuals and their families, though, must find more choices, autonomy and dignity within the treatment system.

Recovery requires active consumer involvement on the direction and manner of their care and, when they are healthier, on the care of others and the development and oversight of policies and programs. Recovery includes educating patients about their illnesses and providing them skills and encouragement.

Treatment settings, especially hospital and residential programs, must be safer. Those facilities need staff sensitive to the traumatic experiences of many patients, from involuntary or coercive prior treatment to crossing paths with the criminal justice system. And within treatment facilities, there needs to be less use of force, especially seclusion or physical restraint.

Proven methods work

By basing treatment on proven methods, not only do people with mental illness improve but overall costs decrease — health care costs and societal costs such as incarceration, social service interventions and lost productivity. Already there are many established evidence-based, condition-specific treatments (such as medications, psychotherapy and skills training) and broader service system approaches (such as prevention methods, early disease identification, case management and patient education).

Oregon’s 2003 Legislature passed a landmark bill requiring most public funding for mental health and addiction services to be evidence based. The state Addiction and Mental Health Division (AMH) and its community, residential and hospital partners are expanding evidence-based care (for details: www.oregon.gov/DHS/mentalhealth/ebp/main.shtml).

A transformed system will integrate behavioral health into primary care, use proven screening and treatment guidelines, and share information to better monitor clinical activities and outcomes.

This initiative provides more rational and effective treatment for a wide variety of conditions, ranging from psychotic disorders, drug dependence and the effects of child abuse.

Hiring the right staff

Health care services must incorporate the ethnic, religious, racial, gender and other characteristics that create a person’s self — and world — view. Understanding these cultural factors is critical to successfully improving the system, and can be achieved, in part, by recruiting, training and retaining diverse workers.

To promote and accomplish these goals, the state needs to dramatically expand and improve its behavioral health workforce as it grows. The state hospital system expansion alone will require more than 400 new psychiatric nurses.

Likewise, community and residential settings need to enlarge and improve services. Where will such competent and culturally aware staff come from? How will they be trained? Participants from all parts of the system, including academic training programs, the business community, consumers and advocates, and policy experts must work together to increase the numbers of motivated, diverse and well-trained staff.

Clearly, the governor, the Legislature and the people of Oregon need to resuscitate the mental health budget — and manage it wisely and fairly. The most intelligent and responsible way to do this is by creating a recovery-oriented, evidence-based and culturally competent system.

Dr. David A. Pollack, a psychiatrist and professor of psychiatry and public health and preventive medicine at Oregon Health & Science University, was medical director for the Oregon Office of Mental Health and Addiction Services from 2002 to 2006, when budget cuts led to the elimination of his position.