Leaders from the County’s Behavioral Health Division briefed the Board of County Commissioners on the Mobile Crisis Program Tuesday, April 20, outlining the full scope of crisis services available to Multnomah County residents.
Mobile crisis services play a key role in emergency situations that don’t require law enforcement, fire or ambulance services. The COVID-19 pandemic, the racial justice movement, criminal justice reform, and other crises have underscored the need for easy access to mental health services, experts told the Board Tuesday.
The death last Friday of Robert Delgado underscores that need. Delgado, a resident experiencing homelessness who lived with mental illness, was shot during an encounter with Portland Police. His death has amplified calls for a new approach to responding to 9-1-1 calls that may have a mental health component.
“Robert Douglas Delgado, age 46, lost his life after an encounter with law enforcement that tragically ended in his death,” Chair Deborah Kafoury said. “While I recognize that an investigation is underway to gather all the details, we can’t simply have an open, honest or productive discussion about behavioral health crisis services without recognizing what unfolded in Lents Park just a few days ago.”
The Mobile Crisis Program can be the difference between life and death, Chair Kafoury said. Reaching someone in crisis at the right time with trained mental health professionals reduces the likelihood of a fatal police encounter.
The outcomes can be promising. Behavioral Health experts estimate more than 80 percent of individuals served by Mobile Crisis can be served with a lower level of care in the community. In the last three years, less than one percent of incidents have resulted in the client being transported to jail.
“Our commitment is, what good will it do? How will it matter in the lives of the people we serve?” said Julie Dodge, interim Behavioral Health director. “We are one of the first mobile response teams in the country. And I think one of the challenges is that a whole lot of people don’t even know we exist.”
Under Oregon law, Multnomah County acts as the Local Mental Health Authority, and the County’s Behavioral Health Division is charged with providing a range of mental health services that meet every level of need. The County operates a 24-hour, 365-day-a-year crisis program including the Behavioral Health Call Center, mobile outreach team, and walk-in clinic available to every resident. Last year, the Call Center alone logged more than 70,000 contacts.
Every time the Behavioral Health Call Center receives a call, mental health experts triage the situation and determine the appropriate response. Depending on the situation, Portland Police Bureau may need to be involved. For example, if there is an involuntary hold, police help transport the individual to the hospital.
Whenever appropriate, the Call Center dispatches Project Respond, a Cascadia Behavioral Health program, to deliver mobile crisis services. Project Respond also receives referrals from 9-1-1 when operators determine a call is more of a mental health situation. A team of expert crisis clinicians will make contact with the person, help stabilize them, and link them to community-based resources. About seven percent of calls to the Behavioral Health Call Center get referred to Mobile Crisis.
“In the event someone is having a behavioral health emergency, we can deploy resources,” said Frederick Staten, who manages the County’s Behavioral Health Call Center.
At the beginning of the COVID-19 pandemic, the Behavioral Health Call Center went entirely remote. Call volume also declined in the early months of the pandemic as there were fewer people in the community to report people in crisis. As the county moves into a new phase in the pandemic, call volume is beginning to pick up again.
“To say that we went remote during the pandemic is amazing,” said Health Department Director Ebony Clarke. “And that had to take a lot of thought, intention, and strategy to make sure we were mitigating any issues. Because we know the consequence if that service is not available.”
One success story involves a 37-year-old experiencing homelessness with a history of schizophrenia whose friends became concerned after he began appearing more agitated. They called the Behavioral Health Call Center, who activated Project Respond to assess the man’s condition.
After determining the man was experiencing a behavioral health crisis, Project Respond transported him to the emergency room where he was stabilized. After his release, he didn’t have a safe place to go home to. Project Respond stayed with him and helped him create a discharge plan. They connected him to community-based services and supports and helped him access shelter. Now he has a whole community of people around him helping him regain stability.
“This is the kind of thing that we hope for,” Dodge said. “From the beginning, we connect our Call Center to the appropriate behavioral health response, give someone the level of support that they need so that they can be supported and go back to some level of normalcy.”
Between July 2017 and June of 2020, Project Respond saw more than 7,000 people and responded to more than 9,500 episodes. Last year, COVID-19 caused a reduction in referrals with fewer face-to-face contacts between callers and people in crisis.
Mobile crisis services are gaining recognition as a possible alternative to 9-1-1. Multnomah County’s Mobile Crisis Program is one of several such programs. Multnomah County also partners with other services, including Portland Street Response, a City of Portland pilot project. In February 2021, Portland Street Response began taking calls in the Lents neighborhood. The program assists people experiencing homelessness who may also be experiencing behavioral health issues.
Portland Street Response typically serves patients with a lower level of distress, while Project Respond handles high-acuity situations with greater volatility. Additionally, Portland Street Response cannot place people under a “custody hold”, which allows people in crisis to legally be transported to the emergency room.
“We truly believe that the best intervention to behavioral health crisis is the behavioral health intervention,” said Barbara Snow, clinical director for Crisis Services at Cascadia. “We also are going out on calls that span a variety of situations and symptoms and behaviors. So we do respond to calls in which weapons are present. We do respond to calls in which someone is making viable threats of harm to themselves or someone else. So we have to make a decision in those calls about whether or not we think law enforcement needs to be there for safety”
Whenever law enforcement needs to be involved, Mobile Crisis talks with them first about what type of assistance they’re seeking. For example, behavioral health clinicians may try to make first contact with an individual but may need law enforcement there to make sure the scene is safe. Between July and December 2020, the team requested law enforcement 47 percent of the time.
The team has identified several areas that need improvement. First, they aim to improve their capacity to serve culturally-specific populations. They also are looking to strengthen their resources for young people and older adults. And they need to enhance their data collection so they have a clearer picture of the people they’re serving.
Response times can also be improved. The state contract with Cascadia requires mobile response to arrive within an hour. They meet that target 94 percent of the time. But for the person in crisis, every minute counts. They aim to bring that number down as much as possible.
“What about the cities of Gresham, Fairview, Troutdale, and Wood village?” asked Commissioner Lori Stegmann, who represents East County on the Board.
“Our response is the same no matter where someone is in the county,” said Snow. “We go out to East County. We, in fact, are working on having an office more out in the Rockwood area for staff to utilize so our response time out there improves.”
Looking ahead, the program wants to continue promoting crisis services that reduce law enforcement response while encouraging law enforcement to use their service whenever possible.
“I think there’s some opportunities to continue to build that relationship so that they, even not just 9-1-1, but a street officer, feels comfortable saying, ‘You know what? I think we should be calling in behavioral health,’” Dodge said.
Mobile Crisis also has a plan to strengthen its relationship with Portland Street Response. Thirty-two percent of Mobile Crisis calls involve someone experiencing homelessness. That’s one area where Mobile Crisis and Portland Street Response have a lot of crossover.
“This collaborative relationship between Portland Street Response and Project Response will be most significant in working with this population,” said Christa Jones, who manages the Community Mental Health Program. “Project Respond can refer clients to Portland Street Response and also provide community support to them. Additionally Portland Street Response can refer to the Call Center and Project Respond where the client is in increased distress or has a higher level of symptoms.”
Commissioner Jessica Vega Pederson said more people need to be aware of Mobile Crisis Services as an alternative to law enforcement. After the shooting of Delgado last week, she said, many are asking what could have been done to prevent his death.
“How do we change the dynamic of that situation where we’re recognizing the severity of it before something lethal happens?” Vega Pederson said. “I think this is incredibly timely and incredibly important.”
There’s an incredible number of people doing exceptional work, but the system is so complex that it’s hard to evaluate how services are coordinated, Commissioner Sharon Meieran added. She suggested the system needs to be streamlined.
“How can we all be ensuring that we are having a functional system in responding to crisis?” said Commissioner Meieran. “How do we look at individual programs and whether we are using our resources in the most effective way to meet the goals of the program? And how is that fitting within this larger, very complex system as a whole?”