Thanks to the miracle of WIFI, I am sitting in the gallery of a state legislative hearing that is discussing whether the state mental health delivery system needs some fundamental changes.  The Oregon system has been criticized for being "fragmented" and "inefficient."  Senator Bates and Representative Kotek have raised the question of whether the state system should be "regionalized" and "integrated" with physical health services. 

For over a century, publicly-funded mental health services in Oregon have been county-based.  By state law, each of the 36 counties must have a mental health authority that provides an array of services.  In recent years, many small rural counties have combined forces to provide services regionally.  During the 1990s, the Oregon Health Plan (OHP) spurred the creation of regional managed care organizations that administer OHP money for mental health services.  Non-OHP money from the state continues to go directly to counties.

The state Department of Human Services has weighed in, suggesting that three major pilot projects be established to test whether regionally-administered and funded services would save administrative costs and deliver better services.  It also wants to test whether health outcomes for individuals needed public mental health services can be improved.

Having heard some of the testimony, it seems that folks that run community mental health services are supportive of the goals but skeptical about the approach of regionalization.  Hospitals and managed care entities seem to welcome carefully-implemented change.  Advocates seem to be eager for change.  Counties are feeling threatened.

There can be no doubt that in this time of fiscal austerity, efficiencies are welcome.  Treatment approaches that keep people in their homes and support healthier lifestyles are welcome.  But people involved with mental health services have good reason to be wary.  Years of chronic underfunding have been punctuated by periods of serious racheting back of support.  Will efficiencies merely result in loss of local control and a loss of financial support that is never returned?  Or will changes result in more uniform access to quality services across the state and elimination of the 25 year life-expectency gap for people with mental illness?  The conversation ensues.

In this Friday’s Oregon AFSCME e-lert, union spokespeople claimed that DRO was disrespectful to Oregon State Hospital workers.  Our offense was arguing that the voting members of a proposed oversight committee for the hospital should not include those with a direct financial interest in hospital operations. 

 The publication went on to state:  “No decisions have been made, but one possible compromise would be for any committee member who has any sort of financial tie to OSH to be an ad hoc, non-voting member. That would include employees, but would also include Joondeph and his ilk, who make money from OSH client families.”

 Hmm.  DRO does, from time to time, get crosswise with public employee unions who sometimes view our advocacy for patients to be anti-worker.  We rarely get credit for advocating for improved conditions in the hospital that make life better for patients and staff alike. 

 Consider this: despite deep cuts in the state budget, construction of a new hospital is still on track.  The budget for the existing hospital has not only been held exempt from cuts, but OSH continues to hire hundreds of new staff.  Is the advocacy that brought this about disrespectful to staff?  I don’t think so.

 The state hospital is not a place to work if you want fame or fortune.  But it is a place where people with good hearts and unique skills can bring healing and recovery to Oregonians whose lives have been devastated by mental illness.  These professionals deserve the tools and resources to do the job right.  That includes an oversight board that can keep the condition of the hospital in the public eye and not be dismissed as a tool for one interest or another. 

The national network of Protection and Advocacy (P&A) organizations (like DRO) is represented in Washington DC by the National Disability Rights Network (NDRN).  Recently, NDRN urged legislators, on our behalf, to support hate crime prevention legislation.  The proposed bill would grant agencies the authority to investigate and prosecute federal crimes based on the victim’s disability, whether real or perceived, and would authorize funding to states to help with the prosecution of hate crimes.

In a letter signed by almost all P&As, we reminded legislators that through much of our country’s history, people with disabilities -- including those with developmental delays, epilepsy, cerebral palsy and other physical and mental impairments -- were seen as useless and dependent, hidden and excluded from society, either in their own homes or in institutions.  Now, this history of isolation is gradually giving way to inclusion in all aspects of society, and people with disabilities everywhere are living and working in communities alongside family and friends.

But this has not been a painless process.  People with disabilities often seem “different” to people without disabilities.  They may look different or talk differently.  They may require the assistance of a wheelchair, a cane, or other assistive technologies.  They may have seizures or have difficulty understanding seemingly simple directions.

Unfortunately, disability bias can manifest itself in the form of violence.  Federal hate crimes legislation would broaden the definition of hate crimes to include disability, sexual orientation, gender and gender identity.  It would make grants available to states and local communities to combat violent crimes committed by juveniles, train law enforcement officers, or assist in state and local investigations and prosecutions of bias-motivated crimes.

 Violence against individuals with disabilities is not limited to adults.  On Monday, March 9, the Oregon House Education Committee will hold a hearing on House Bill 2599.  This bill would strengthen Oregon law that is designed to lessen the bullying of students in our schools.  It would make school districts adopt policies to train staff and students about avoiding and reporting bullying and designate a staff person to accept complaints of bullying.  DRO supports this bill that will provide a reasonable way to address the harassment of all students, including students with disabilities.