SENATE COMMITTEE ON HEALTH POLICY

 

 

January 19, 2005                                                                                                     Hearing Room B

1:00 PM                                                                                                                            Tapes 2 - 3

 

MEMBERS PRESENT:         Sen. Laurie Monnes Anderson, Chair

Sen. Peter Courtney

Sen. Bill Morrisette

 

MEMBER EXCUSED:          Sen. Jeff Kruse, Vice-Chair

Sen. Gary George

 

STAFF PRESENT:                 Rick Berkobien, Committee Administrator

Brittany Kenison, Committee Assistant

 

MEASURES/ISSUES HEARD & WITNESSES:      

Report on Governor’s Mental Health Task Force

Oregon State Hospital Master Plan

      Bob Nikkel, Department of Human Services, Office of Mental Health and Addiction Service

      Gina Firman, Association of Oregon Community Mental Health Programs

 

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

TAPE 2, A

003

Chair Monnes Anderson

Calls the committee to order at 1:02 PM. Chairs opens informational meeting.

GOVERNOR’S MENTAL HEALTH TASK FORCE, INFORMATIONAL MEETING

005

Chair Monnes Anderson

Gives overview of Agenda. Announces that Barry Kast, Department of Human Services, Health Services, will not be available for the meeting.  Invites Bob Nikkel, Department of Human Services, Office of Mental Health and Addition Service.

015

Bob Nikkel

Introduces himself and presents overview of speech. Submits written testimony (EXHIBIT A).

030

Chair Monnes Anderson

Invites Gina Firman, Association of Oregon Community Mental Health Programs to witness table to join Nikkel

035

Chair Monnes Anderson

Excuses Sen. George and Sen. Kruse.

040

Nikkel

Presents overview of mental health history in Oregon.

090

Sen. Morrisette

Requests information for background (history) information.

100

Nikkel

Agrees to request.  Reviews graph of Psychiatric Hospitalization Rate.

110

Sen. Courtney

Asks Nikkel to clarify if the graph is based on forensic, civil or both.

115

Nikkel

Advises that graph contains both forensic and civil hospitals

130

Nikkel

Continues to review graph for Psychiatric Hospitalization. Presents pie graph of Funds for Department of Humans Services, Office of Mental Health and Addiction Services.

145

Chair Monnes Anderson

Asks Nikkel for number of mental health patients are being served in state hospital and how many are in community mental health.

150

Nikkel

Estimates that in 2003-2005, a total of 120,000 people were served in the mental health system. Of that 1,500 have been served in the state hospital.

160

Chair Monnes Anderson

Asks of 1500 in hospital, how many could be served in the community.

165

Nikkel

Believes that most people could be served in the community.

170

Sen. Courtney

Clarifies that the 120,000 does not include the number of mentally ill people who are in the prison system.

180

Nikkel

Affirms and refers to graph in exhibit.

195

Sen. Morrisette

Asks Nikkel to clarify that there are mentally ill people in jail and if they are there purposely.

200

Nikkel

Affirms and believes that it is a policy question to be asked.

210

Nikkel

Summarizes history for community mental health programs.

240

Nikkel

Reports on services and facilities in today’s current condition and comments on services alternative and refers to General Adult Beds Before and After Restructuring.

265

Nikkel

Comments on medications and effects since the 1960’s.

285

Nikkel

Summarizes background of people with mental illness and the connection of drug and alcohol use.

300

Sen. Morrisette

Comments on Alcohol Recovery fee bill in the process and hopes that it could be used for mental health programs using statistics.

315

Nikkel

Adds that 60 to 70 percent of the acute care psychiatric admissions have drug and alcohol involved in addition to the mental illness symptoms. Also shares other studies performed in other states.

335

Nikkel

Describes cost of housing trends in 1980’s and 1990’s. Explains areas that the mentally ill struggle with.

355

Sen. Morrisette

Asks for the number foster homes for the mentally ill in the state of Oregon.

360

Nikkel

Affirms that there are several hundred.

370

Gina Firman

Association of Oregon Community Mental Health Programs. Explains that there are Adult Foster homes and that insurance is a problem area and it is expensive.

380

Sen. Morrisette

Clarifies that he was talking about liability insurance for the homeowners.

383

Firman

Remarks that it is a problem and that it is expensive.

385

Sen. Morrisette

Comments that something needs to be done to keep the homes open.

387

Nikkel

Adds that it is an issue that it is being addressed, but no solution yet.

390

Chair Monnes Anderson

Remarks that there will be a bill regarding the homeowners insurance going to Sen. Morrisette’s human service committee.

400

Firman

Adds that during 2003 session about a bill addressing the homeowners issue did not pass.

405

Rick Berkobien

Committee Administrator.  Ask if Nikkel if forensic type cases be served in a more localized program and what kind of funding would be involved.

425

Nikkel

Believes that they could, but cost would rise considerably.

450

Nikkel

Comments on SB 267 passed in 2003 and positive effects. Training issues and workforce issues need to be addressed. Believes in evidence based practice movement.

475

Nikkel

Comments on reliance on Medicaid federal money from the community mental health system. Remarks on how little the state hospital uses this money.  The Oregon Health Plan has been a step forward in the reduction of stigma of mental health treatments.

TAPE 3, A

045

Nikkel

Gives overview of issues that need to be addressed:

·         Struggle with increased number of mentally ill people in the prison system.

·         Continue with evidence based practice and train toward this.

·         Balance needs with budget realities.

·         Balance public safety and civil rights.

·         Be more prepared to respond to changing demographics.

070

Nikkel

Reviews chart for Mental Health Funding.

145

Nikkel

Summarizes and concludes.

147

Sen. Morrisette

Comments on Scar Jasper Mountain facility for children and its background.

155

Chair Monnes Anderson

Refers to the Mental Health Funding chart and if it includes all fund dollars.

165

Nikkel

Confirms that it includes all fund monies.

180

Sen. Morrisette

Requests list of child treatment centers within Oregon. Requests clarification about classification and the concerns.

190

Nikkel

Responds that most people feel that they are right level.

195

Berkobien

Wants to know what percentage of OHP program funding includes Medicaid monies.

205

Nikkel

Defers to Firman.

215

Firman

Answers that many patients are OHP eligible and rely on Medicaid to fund program.

225

Sen. Morrisette

Asks if there is anyway to track everyone who falls out of the system and what happens to them.

235

Nikkel

Comments that they could track now with today’s technology. Says that it is harder to find them once they drop out of the system.

250

Chair Monnes Anderson

Remarks that Medicaid doesn’t match money to the state hospital like it does to the community mental health, so could they contract with the other hospitals to add small units of psychiatric housing so Medicaid could match the sixty cents to each of the states thirty cents.

260

Nikkel

Explains that it has been done for the last 10 years. Adds that there are 23 beds in Salem hospital and are eligible for Medicaid. Presents the issue of number of patients in the state hospital who are ready to be discharged and go to smaller facilities within the community.

285

Chair Monnes Anderson

Wants to know if there has been progress.

290

Nikkel

Responds that there has been progress, but new facilities are needed as people are waiting in the state hospital.

295

Chair Monnes Anderson

Asks Nikkel if he has access to the number of patients that have been placed into the communities and the new siding that have happened in the last two years.

397

Nikkel

Offers to return information to the committee.

300

Sen. Morrisette

Asks about model in Josephine County.

305

Firman

Addresses Chair Monnes Andersons question, and believes that 278 new community placements.  Describes resolution centers open which help state hospitals.

325

Sen. Morrisette

Asks for name of county representative.

327

Firman

Responds that his name is Bob Beckett, who is now working for non profit organization.

330

Sen. Morrisette

Asks if there were any forensic patients in Josephine County facility.

335

Nikkel

Answers yes.

345

Nikkel

Moves on to the overview of the systemic problems in the public mental health system.

TAPE 2, B

010

Nikkel

Continues discussing the systemic problems in the public mental health system.

020

Chair Monnes Anderson

Stands at ease due to fire drill.

035

Nikkel

Continues discussing the systemic problems in the public mental health system.

050

Chair Monnes Anderson

Clarifies statement on exhibit that states far less money is spent on children than adults.

055

Nikkel

Explains that more adults are hospitalized under the state hospital than children. Begins to discuss parity.

060

Chair Monnes Anderson

Comments that discussions will be held next week on mental health parity.

061

Sen. Morrisette

Comments on problem in identifying mental illness in children and asks if it is still a problem.

070

Nikkel

Confirms that it is and identifies reasons and solutions.

075

Nikkel

Continues to summarize the systemic problems in the public mental health system.

090

Firman

Comments on evidence based practices.

105

Firman

Introduces budget comparison chart for written testimony (EXHIBIT B) and reviews.

165

Sen. Morrisette

Wants to know if county funding issue has been corrected.

125

Nikkel

Says that the issue is in the process of being corrected

130

Sen. Morrisette

Wants to know if equity with Washington, Multnomah and Clackamas counties have been solved.

135

Nikkel

Comments on making progress in the counties.

145

Sen. Morrisette

Asks if Washington county is happy.

150

Firman

Explains counties have had a discussion about equity and pleased with progress.

157

Sen. Morrisette

Asks if Clackamas county has dropped out.

160

Firman

Responds no.

165

Sen. Morrisette

Comments on background of issue and the current progress.

177

Chair Monnes Anderson

Asks to confirm that Multnomah county is not participating.

179

Firman

Affirms.

170

Sen. Morrisette

Asks if Multnomah county has the ability to serve people who move to the area as they are required to.

172

Firman

Explains that urban drift wasn’t as significant as they thought. Suggests that Multnomah be invited for testimony.

180

Chair Monnes Anderson

Agrees and will invite the county for testimony.

 190

Nikkel

Comments on center for mental health services formula to determine the number of people moving to urban area.

195

Sen. Courtney

Ask how much a mental health parity in Oregon would play into the funding issue.

215

Nikkel

Does not think that it will have an effect on funding in his opinion. Would help elevate on some stress on public mental health system.

225

Sen. Courtney

Comments on attention for children versus adult health care. Asks if there is an “attitude” in the ways children are treated versus adults in the mental health system.

240

Nikkel

Replies that he found where in some counties, some of the money for children services has been spent on adult care.  In process of working with these counties.

257

Sen. Courtney

Asks if audit will be performed.

260

Nikkel

Answers that he has reviewed data, but has not called for an audit.

268

Sen. Courtney

Asks Nikkel what he calls the procedure if it is not called an audit.

270

Nikkel

Explains that it is not a requirement that children’s funding be spent on children services, but working to change that.

275

Chair Monnes Anderson

Recognizes need for audit.

280

Firman

Comments on successfulness on county and state working together on accountability.

OREGON STATE HOSPITAL MASTER PLAN

300

Nikkel

Refers to OSH Master Plan and reviews (EXHIBIT C).

·         Reviews statement of work and process.

355

Sen. Morrisette

Asks Nikkel what PSRB stand for.

360

Nikkel

Psychiatric Security Review Board (PSRB).

370

Chair Monnes Anderson

Asks if adjudications increase is from alcohol and drug involvement.

375

Nikkel

Speculates that increase in mental health is from drugs. Discusses approaches.

390

Sen. Morrisette

Asks what the PSRB does.

400

Nikkel

Explains that it was enacted in 1977 to help in sending people with mental illness to treatment centers instead of sending to correctional system.

405

Nikkel

Gives background on Oregon State Hospital (OSH) Master Plan and dates for contract review process.

430

Nikkel

Continues to review OSH Master Plan

  • Scope of services on page 5 under section 2.1
  • Reviews existing studies
  • Discusses land and building reuse.

TAPE 3, B

005

Nikkel

Continues to review OSH Master Plan

025

Chair Monnes Anderson

In reference to Measure 11, asks whether funds for building a prison could instead be used to build a prison/mental health center.

030

Nikkel

Defers question to Department of Corrections.

035

Sen. Courtney

Refers to page 4. Comments on task and the huge effort involved and the report.

055

Nikkel

Comments that it will be part of the stake holders process during phase one.

065

Nikkel

Gives overview of improvements.

115

Nikkel

Summarizes and concludes.

130

Chair Monnes Anderson

Comments on issues and concludes.  Closes informational meeting.  Adjourns meeting at 2:50 PM.

 

EXHIBIT SUMMARY

 

A.     Governor’s Mental Health Task Force, written testimony, Bob Nikkel, 7 pp

B.     Governor’s Mental Health Task Force, chart, Gina Firman, 1 p

C.     Oregon State Hospital Master Plan Project, staff, 15 pp