Mental health crisis affects Old Town Portland

Some organizations situated in Portland’s Old Town district say the numbers of unsheltered people in the neighborhood is dire. And help for people who experience a mental health crisis is scarce. We hear from Scott Kerman, the executive director of Blanchet House, and Jennifer Coon, a peer support specialist, about what they’re seeing.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud, I’m Dave Miller. For months now, business leaders, cultural organizations, and social service providers have been speaking out about the situation in Portland’s Old Town Chinatown. They say a humanitarian crisis is unfolding on a daily basis on the streets, with violence and vandalism and unchecked behavioral health emergencies. Scott Kerman runs Blanchet House, which provides meals, clothing, and shelter to people in need. He told Willamette Week recently he has heard the area referred to as “an open air psychiatric ward.” Kerman is calling for more behavioral health specialists in Old Town. He joins us now, along with Jennifer Coon, the one peer support specialist who is currently doing that work for Blanchet House. Scott Kerman and Jennifer Coon, welcome to Think Out Loud.

Jennifer Coon: Thank you for having us.

Scott Kerman: Thank you Dave.

Miller: So Scott Kerman first, as I noted there’s this phrase, “open air psychiatric ward,” which really caught folks attention, and you’ve said that it’s not necessarily an inaccurate description of what’s going on. What do you mean?

Kerman: Well, I think what it does is it really paints a portrait of what is an unethical, and I’d say even inhumane way that we’re caring for people with mental illness. What we have right now on our streets is people who are suffering tremendously. People who have experienced trauma in their lives, perhaps trauma that led to their houselessness to begin with. And being houseless itself is a traumatic experience. And think of everything that we’ve had to endure as a community over the past 19 months, it’s trauma compounding upon trauma, which is exacerbating the mental health situation for the people that we serve. And what we need to do is figure out, as a community, how we can provide better, compassionate, trauma-informed behavioral health services to people at the level of the street.

Miller: Jennifer Coon, I mentioned that you’re a peer support specialist at Blanchet House, working most afternoons and evenings there. Can you give us a sense for what your job is like on any given day now?

Coon: Yeah. I’ve been at Blanchet House since December, and I worked with the folks outside, mostly the homeless community. We serve meals three times a day. We have regulars, people that come every day, breakfast, lunch and dinner. And a lot of the people, that’s their only thing that they can accomplish in the day is to come here for food. Oftentimes I provide them with clothing. Sometimes I’ll direct them to a shelter, and oftentimes they’ll just want to talk to me. But just the connection I think is really what is important. And some of the people, it’s hard to connect with them because they’re so mentally unstable. But I just feel that us being consistent and being here on a daily basis is something that they can rely upon. And that’s valuable.

Miller: How often have you felt physically unsafe yourself in the last few months?

Coon: Well, it is dangerous. It’s dangerous on our streets in downtown Portland and pretty much anywhere. I guess because I have lived experience and I can relate with the folks outside, I feel as though I have a connection with them. Maybe one would say I’m on their team if you will. But I’m more of a friend than a foe, I think, with the folks outside, I have a good communication with them and a level of respect that, again, I’m gonna say is very valuable.

Miller: Scott Kerman, what kinds of changes have you seen in the last 18 months, specifically because of the pandemic? I guess I’m wondering, from your perspective, where you see the effects of the pandemic for people who are coming to you for services?

Kerman: So we’re seeing exacerbated levels of mental health signs and symptoms. We’re seeing greater levels of delusion. We’re seeing greater levels of hallucinations, greater levels of disassociation, and even catatonia among the people that we serve. And some of the people that we serve today, we served prior to the pandemic. And so we can see firsthand how the last 19 months have affected their state of being. And we’re seeing a lot of new people as well, mostly new people since the shutdown began in March of 2020.

And I think it’s reasonable to understand why we’re seeing this exacerbated mental health. I mean, it has been a humanitarian crisis, and I hope we’re not taking the meaning out of that word by using it so often, but the conditions are deplorable. People are living without proper access to sanitation, without proper access to hygiene, maybe have not slept indoors in 19 months. They can’t launder their clothes, they can’t really get ready access to showers. So, imagine how that would affect somebody who is already suffering from trauma and mental illness and perhaps substance abuse use. I think it’s common sense for all of us, we can understand that, for the people that we’re serving in Old Town and throughout the district here, that the deplorable conditions and the stress and the anxiety of the past 19 months has obviously taken a terrible toll on their mental health.

Miller: You know, one of the maybe incorrect aspects of that phrase, “open air psychiatric ward,” is that it implies that psychiatric care is being delivered in this place, just out in the open. And I’m wondering how accurate that is? Jennifer Coon, from your perspective, because we’ve been hearing about people coming in with delusions or in a catatonic state or other very visible evidence of serious mental health problems, but how much treatment are the people that you’re seeing and trying to help, how much treatment are they getting?

Coon: Well I have a couple of resources that I’m able to reach out to. But the person has to be willing to go, and to want to accept help. And unfortunately, they’re just kind of used to self medicating and just walking the streets of downtown Portland and barely surviving until their next meal. But I reach out to some resources every week for people, in hopes that they’ll get some mental care that they need. But there’s a long way to go.

Miller: Scott Kerman, what options do you all have available to you right now? If, say, somebody who comes in for a lunch is having an acute psychotic episode, where do you turn?

Kerman: To be honest, there’s not a lot of places to turn to. We’re really left to ourselves to resolve that crisis in a way so that the person in crisis can receive necessary services, and that really is food and beverages. And hopefully in a way that doesn’t disrupt the services for everybody, and that everybody can receive services safely. And it’s not just us, it’s many of the agencies in this district. We’re dealing with the same issues and we’re dealing with them in isolation from one another, But there really is no one to call, except when the situation becomes so extreme or becomes violent where it necessitates a 911 call. Even if we can get Portland Street Response in Old Town, which I hope we can, that’s still a situation where the crisis is already fairly extreme and you have to call for help.

We’re looking for additional support because we think that there’s a lot that we can do to de-escalate crises before they ever get out of hand. We have seen that work with Jennifer’s work at lunch and dinner at our service. The fact that she could develop relationships with people and get to know them, create scenarios where she can anticipate their needs and resolve any crisis that they may be experiencing before it interferes with their ability to receive services or our ability to provide services.

Miller: Scott Kerman, I want to hear more about what you’re proposing and how it would work. But, Jennifer Coon, to go back to you, as Scott mentioned, if things get really bad, that’s when you might have to call 911. I’m curious, what it would take for you to call 911, and how you feel about police officers responding to somebody in, say, a mental health crisis on the streets of downtown Portland?

Coon: Yeah, I avoid calling 911. That’s the extreme. I think any police officer showing up with a gun is going to add to the situation. I’m fairly good at de-escalating the situation, dissolving the situation, redirecting it if needed. That lived experience is very valuable. It’s not something you can learn in the classroom, and I have the lived experience, I was homeless. I’ve been in their shoes. It’s kind of that unspoken connection that’s very valuable. So again, calling 911 is my last resort. It has to be someone being violent to themselves or others. And quite honestly, we haven’t got to that point very often, and I hope we never do.

Miller: So, Scott Kerman, let’s hear specifically what your pitch is, given everything we’ve been talking about. Can you describe the near term solution you’re calling for?

Kerman: Well, one of the, one of the bright spots of the, of the past 19 months, there’s a lot more communication and collaboration going on among the social services agencies throughout the entire Portland metro area, but certainly in the Old Town/Pearl District/Downtown district. And from these conversations, we can see that we’re experiencing a lot of the same issues, and often with the same clients, or as we call them at Blanchet House, meal guests. So the idea is that, if we could share peer support and behavioral health personnel, we can provide this service much more efficiently than if each of us independently try to ramp up to provide this service. But we can also provide greater continuity of care for the people that we serve.

So what I’m proposing is teams of personnel, two people each, who would be scheduled and stationed at the different agencies in our district, at the times that we need them most. At Blanchet house, that’s when we serve breakfast, lunch and dinner. It may be different times for other agencies when they’re providing their services. And what I think can be a terrific outcome of this program is that people who come to Blanchet House for breakfast will then encounter the same team of specialists when they receive care, let’s say at Rose Haven, or William Temple House, or Sisters of the Road, or TPI. And so here we now have over the course of a day, over the course of a week, over the course of many weeks, continuity of care, and the opportunity to develop the kind of trusting relationships that we’ve seen work so well for people when it comes to the relationships that they’ve been forming with Jennifer. It’s these kinds of trusting relationships that can eventually lead to better outcomes for the people that we’re serving.

Miller: Last week, Portland Mayor Ted Wheeler told us he is in favor of expanding Portland Street Response. He didn’t give us an exact geographic map or timeline, but based on the PSU Study, he is in favor of expanding it, potentially citywide. But, he said, it’s going to take time to do that, because of staffing challenges. Is it fair to say that you would face some of those same exact challenges to get your proposal staffed up?

Kerman: That’s certainly true. And it may be the biggest challenge of all, because we are deep in the hole when it comes to mental health care services in the state of Oregon for the people that we need to effectively deliver those services. We are working with the Mayor’s office on a workforce component to this proposal that would allow people in training to be peer support specialists, to work with mentors as they are working towards their certification and getting the hours that they need in direct service. So that may be a way forward in terms of the staffing challenges.

But I think ultimately, we have to understand that this is something that we are going to have to do. Houselessness is, in large part, a mental health issue. The data in terms of what’s coming down the road, the American Academy of Pediatrics just issued a report that said ER mental health visits for children ages 12 to 17 are up 31%. What has concerned me throughout this pandemic is that we are grooming the next generation of houseless and food insecure people who are going to need our services 5, 10, 15, 20 years from now.

So it really isn’t a question of should we do this? We have to do this. And we have to invest in it, and we have to do what it takes to make sure that we have people willing to do this work, which means we have to pay them and train them well. And we have to put the full force of our community effort behind it.

Miller: As you noted, this is a statewide issue, probably a nationwide one. But just recently, we talked about national guardspeople being sent to the Oregon State Hospital because they don’t have enough staff there right now. How do you justify putting more people on the street in this one particular part of Portland, when we’re facing a truly statewide shortage of qualified mental health workers?

Kerman: You know, that’s an excellent question. And I’m not trying to be selfish about what we need here at Blanchet House or in the district, but this is the district in which I work, and the one that I’m most familiar with. I’m hopeful if we can get this going, that it can be a pilot for other communities in Portland, and perhaps throughout the state, much in the same way that the CAHOOTS program in Eugene was a pilot program perhaps for Portland Street Response here in our community.

Yes, this is a situation that we have to address, not just in Old Town, but throughout Portland, throughout Oregon and indeed across the country. I can only speak for the neighborhood that I’m in, but by no means am I intending to exclude other regions.

Miller: Before we go, I just want to go back to something you said earlier, Scott Kerman, that when you mentioned the phrase humanitarian crisis, you paused and and said something like you’re afraid people have heard that phrase so much recently that it’s ceased to have the kind of power that it should, because it remains an actual crisis. That gets to a deeper question, since this has been going on for so long now, how worried are you that Portlanders, who may not like at all what they’re seeing, certainly not what they’re experiencing if they are houseless or if they’re living through everything you’ve just been describing, but that it’s been going on for so long that many Portlanders are just starting to think this is the way it’s always going to be?

Kerman: I’m very worried about it and not because Portlanders aren’t compassionate and don’t care. They are highly compassionate, they have been very generous, to Blanchet House in particular and to other agencies, prior to and throughout this crisis. But I think it’s reasonable that there are people in our community who are feeling frustrated and disappointment and impatient. As I said before, this has been a hard experience for everyone. And I think all I can do is emphasize the fact that we can’t ignore this problem and it’s going to go away. It’s only going to worsen. And so we have to stay vigilant, we have to be persistent and, and most of all, I think we have to be patient. Houselessness is an incredibly complex problem. It’s an incredibly nuanced situation, and it’s going to take a very complex and nuanced approach, and it’s going to take time, and ultimately it’s going to take money.

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