Deschutes County Stabilization Center opened in the middle of the pandemic offering care to anyone having a mental health crisis in the area. The center offers medication support, peer counseling and an observation room for those unable to talk through problems and who need more immediate care. A two-year grant from the Oregon Criminal Justice Commission allowed the center to start its operations, but the future of the facility is unknown. We’ll hear from Holly Harris, program manager at Deschutes County Crisis Services, on how the community will be affected if the facility closed.
The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. In June of 2020 a new center opened up in Bend to serve people who are in the middle of a mental health crisis. It’s called the Deschutes County Stabilization Center. A two year grant from the Oregon Criminal Justice Commission allowed the center to start its operations, but as those two years come to a close, the future of the facility is still a little bit unclear. Holly Harris is the Program Manager at Deschutes County Crisis Services. She joins us now to talk about this stabilization center and the way forward. Holly Harris, welcome to Think Out Loud.
Holly Harris: Thank you so much for having me. Good to be here.
Miller: Thanks for joining us. What was the original idea behind this center? Why was it necessary?
Harris: Well, the original idea started with our sheriff, coming to behavioral health, saying how can we partner to do something differently because our jails are quickly filling up with folks with mental health conditions, and what we knew from years and years of doing crisis services in Deschutes County was that we knew after hours, there was very limited options for the people that lived here. There was either the emergency department and then for our law enforcement partners, there was really the emergency Department or jail for some low level offenses and there was just a gap that we all knew existed. So that’s really what inspired the project.
Miller: How different is what you offer from those two other options – from the emergency room or a jail cell? I mean those are two very different options, but I’m just curious how you think about what you’re doing in a different context?
Harris: Oh, that’s a great question. They’re very, very different as you can imagine. I mean hospital’s emergency departments are wonderful for a lot of things, but they’re not really set up to be mental health facilities, There’s a lot of activity happening in there and their priorities are primarily going to be people who are having heart attacks and broken bones and trauma type of physical trauma that they need to attend to. So mental health is not an environment to deal with that situation. Jails are even worse. They are not intended to be mental health facilities nor were they set up to be that way at all. People often get significantly worse in those settings. So our facility was really designed to be trauma informed, a welcoming, homey environment that people actually want to be in that’s calm, relaxing and intended to support their mental health.
Miller: What services do you actually offer there?
Harris: One of the things that makes us unique in that and different from the emergency department is that we offer a wide array of services, and we come from a multidisciplinary approach. So we offer things like case management, getting people set up with food boxes and housing resources and all of those basic needs types of things. We offer peer support. So these are individuals with their own lived experience with mental health that can really walk alongside people that come into our facility and demonstrate to them what recovery looks like. We offer medication management, we have masters’ level clinicians that can do the crisis counseling and evaluation. And even from our front desk we have a behavioral health technician. So that right when you walk through the door of our facility, you have someone who knows what they’re doing when it comes to mental health and can provide that positive experience right from the front door.
Miller: That’s interesting. So, if someone walks in and they’re not dealing with an administrative assistant or secretary, somebody with maybe good clerical skills, but not mental health experience. Even the people at the front desk, what kind of experience do they have?
Harris: Yeah, they just have a skill set in dealing with mental health and some of them have their own lived experience. But some of them really just have worked in a mental health environment for the majority of their career. So it’s wonderful, because they aren’t surprised by what’s walking through the front door when someone’s having a really bad day or really escalated because of their mental health crisis, they know exactly what to do. They can help start the calming the escalation process right from the front door.
Miller: One of the aspects of your center which surprised me, and maybe I was wrong to be surprised about this, but is that you serve adults and children? I think I’ve come to recognize that often there is a split in those populations in terms of service centers. First of all, am I wrong about that? Is it common for a center like yours to serve children and adults?
Harris: No, I wouldn’t say… it may be more common now. When we started this project, I toured the country looking for what else was out there when we were developing this, and I didn’t find a lot of facilities that were taking children. That was an area that we knew as a community we wanted to serve our child population as well. We had been in crisis Monday through Friday up to that point. It is a little bit unique in that we serve anyone of any age that’s having a mental health crisis that happens to be in Deschutes County. They can walk in and receive mental health services regardless of their ability to pay or their age or their residence or anything. We really want to be a low barrier, easy access center to get mental health services. We’ve served somebody as young as five and we’ve served somebody as old as 96 so far.
Miller: Are there challenges in serving such a diverse population?
Harris: Sure. You always wish you had experts in every single age range, and developmental age range. But, what I will say about crisis workers is that they do have a skill set with working with all developmental ages because that’s what they’re used to working with. Because of our multidisciplinary approach, there’s always some type of level of expertise for each population that we serve that we can tap into.
Miller: You noted that you toured more than a dozen similarly set up facilities or at least facilities with the same basic idea in mind around the country before you started yours. Can you give us a sense for, I guess I’m wondering about two different categories of what you saw. First of all, things you saw that you wanted to emulate, that you wanted to bring back to Deschutes County?
Harris: Absolutely; those tours were the most valuable thing I ever did. I toured 14 facilities in five different states, and boy did I see the gamut. There are, if you’ve seen one of these, you’ve kind of seen one of these, is what I learned. So amongst those facilities, some of the things that I saw that I wanted to do was the 23 hour observation, which is a piece that I didn’t mention before. So that’s a really unique service that we offer here, that not many other facilities offer. And so it’s really, it’s an observation unit. It’s pretty simple, it’s five recliners and it’s really intended for people who can’t just walk in, get some appointments, get a mental health counseling session, get some case management and kind of be set up for success in and go on about their day. It’s intended for those individuals who have not had their basic needs met in a period of time, often haven’t eaten or slept or showered in a number of days or just, too escalated to even begin problem solving around their crisis. So they have access to this recliner where they can go get some sleep, where they can get showered, get their clothes laundered, get some food, all in an effort to bring their crisis down to a manageable level where we can then start to problem solve and figure out what the next steps are. They can, technically, stay with us for 23 hours, but most people only stay an average of 10 hours. So that was one of the things I saw at a couple of the facilities that I toured and I was like, we need that.
Miller: What’s specific or magical about 23 hours? It seems like it’s not a randomly chosen number.
Harris: No, it’s not. So once you hit 24 hours, you really become a licensed residential treatment facility. There’s a whole gamut of licensing and requirements to be that and we knew we didn’t need to be that here in Deschutes County. We have a number of licensed residential treatment facilities in our community and that’s not a need that we needed to meet here. So we really know that most crises can be resolved in several hours, anywhere from 4-6 in general. So having the 23 hours is nice for those folks that we’re really needing extra time to work with, but usually the people that stayed 23 hours, if they’ve hit that mark, then we’re probably looking at a higher level of care, but we know we’ve tried a lower level of care and now we need to seek something higher.
Miller: So that was one thing that you saw in other places you want to emulate. Were there things you saw that you thought, ‘I don’t want this in Deschutes County?’
Harris: Yes, there were. There was a lot of those actually, and it was great. It was a process of elimination of like, oh, we either have that, we don’t need that. But one of the things that really struck me from a lot of the places I toured was that many of them didn’t take walk-ins. They took only law enforcement facilitated drop offs or they took only hospital referrals or they only served adults. And those limitations were something that I [saw] in our community really needs more than that. We want to serve our children. We want to serve people that can just walk in and get their crisis needs met, but we also want to help our law enforcement partners and have them have a place where they can voluntarily bring people to us as well. So we kind of do it all.
Miller: How do walk-ins work? I mean, first of all, just numerically, how many people are coming in off the street and referring themselves for your services?
Harris: About 80%. So the vast majority of the people we serve walk in on their own and have heard of us, or have a community partner that referred them to us, and it could be anywhere from your primary care doctor to anyone in the community that’s heard of us that says go to this place. Only about 20% of the people we serve are brought to us by our law enforcement partners.
Miller: Do you see, broadly, differences in the issues that people come to you with if they are brought there by law enforcement and if they walk in on their own?
Harris: Yes and no. I would say generally speaking, anybody who’s brought to us by law enforcement is going to be more acute. If you come to the attention of law enforcement, you’ve been doing something that caused law enforcement to get involved, so there’s sort of a higher acuity right off the bat with those folks, but we do see many, many high acuity folks walk in or brought in by a family member that are equally as acute as the people brought to us by law enforcement. But we also see within the walk-in population, anything from mild depression all the way to suicidality to mania, to psychosis.I mean the whole gamut.
Miller: How would you describe your relationship with law enforcement? You started by saying that one of the reasons that started up in the first place was the Sheriff told the County, ‘We have a crisis and we don’t have appropriate places to take people,’ and that was part of the genesis of this Center. At this point, what would you say your relationship with law enforcement is like?
Harris: I would say in Deschutes County, we have an amazing relationship with our law enforcement partners. We’ve invested a lot of time and energy, all of us. They and us, have invested a lot of time and energy into building those partnerships and relationships and it’s a value we hold dear. So we have a robust crisis intervention team training which is the 40 hour training that is offered to law enforcement to help them understand mental health and respond differently. We’ve been doing that since 2012. So we meet monthly with all of our law enforcement partners, we’re able to talk through cases that maybe didn’t go ideally for either one of us and we still walk away good partners in this work and we’re all committed to keeping people with serious mental illness out of the criminal justice system.
Miller: You got some funding from the Sheriff’s office for the 2022 fiscal year. More broadly, what has your funding picture looked like for your first couple of years of operation?
Harris: Yeah, so we took a pretty strategic approach in that, early on in the project. We looked for partnerships to have funding to start the project, and we quickly realized you can talk about how we’re going to save people money and we’re going to have all these wonderful outcomes, but really, without data to prove it, it’s a very difficult conversation. We didn’t want that to stop us from getting this program off the ground. So we took a different approach and really sought after grants and opportunities like that, and we did have a wonderful partnership with our sheriff. That contribution is our biggest ongoing sustainable contribution for this project at $570,000 a year, annually. And so we have that, but that’s not enough to be 24-7. So we sought a number of grants, both federal, state and local grants and because we had these wonderful partnerships and this momentum, we were set up for success to be awarded those grants, and we were. So we’re in a position now where we sort of knew we’d always be, like grant funding is limited duration, it doesn’t last forever. And so we knew this day was coming when grant funding would end. And we are in active partnership, active conversations with our partners around that.
Miller: What is the data? So this was your plan from the beginning, get started with grant money, prove that we are actually saving money and saving lives and then we will make it so people can’t help but fund us going forward. It seems like that’s, to put it in a couple words, that’s your plan. So, what’s the data that you’re presenting now, to county leaders or to the State, or to whomever, to show that what you’re doing is working?
Harris: Yeah, that’s a great question. And you’re absolutely right that this was our strategy. So that some of the data that’s really important is we’re diverting approximately 30-35% of people that come to this facility from higher levels of care from the emergency department, from jails, and that’s significant when you start to put dollars to that. 20% of the people brought to us by law enforcement, about 29% of the people we’re serving are experiencing homelessness. So we’re a big resource for them. But it’s also a good data point, in that over 70% of the people we serve are housed, so we’re serving everyone in our community that needs mental health help. But I think one of the more startling statistics that I continue to track, that I think is really meaningful, is about 4% of people told us that they would have taken their own life had we not been open. And I think, regardless if that’s 1%, 2% or 4% or any percentage, it’s too much, and it just shows the value and the necessity of us being here 24/7.
Miller: So what does the funding picture look like going forward? Where are you planning to get funding from?
Harris: We’re looking at all of our key stakeholders, all the people that utilize our services, that benefit from our services; where we’re having seen cost savings for those entities, and we’re in active conversations with those partners and it’s not like we just started having these conversations. We’ve been having these conversations, they’ve just become a little bit more real, now that we’re getting closer to the end of our grant funding. But I will also say the grant, the Oregon Criminal Justice Commission Grant that we received, that got us to 24/7 for two years, that ends June 30 of this year. We are eligible to apply for that again, so we will absolutely be going after that funding again. Whether we are funded at the full amount, a partial amount or not at all, is sort of one of those things yet to be seen. So we have contingency planning in place, should that not occur.
Miller: If you were giving advice…just a couple of years ago you were touring the country trying to learn best practices from other places. Now, you have a couple of years of experience, what advice would you give to somebody who is just starting out in terms of what they should think most strongly about to make a program like this work?
Harris: Absolutely, yeah. It’s funny I have been reached out to by a number of states across the country because we are one of the few places doing exactly this model, and even though we’re still new, it’s only a year and a half, we’ve been doing it. What I tell everyone who reaches out to me is if we can do it, you can do it. We were not a county that had an enormous amount of money thrown at this project or had, just funding sitting aside ready to do it. We are not huge by any means. We’re not a Multnomah, we’re not some of these bigger communities, we’re medium sized and we had our own challenges but if we can do it, I know other communities can do it. So if there’s a will, there’s a way.
Miller: Holly Harris, thanks for your time today. I appreciate it.
Harris: Yes. Thanks for having me.
Miller: Holly Harris is the Manager of Crisis Services for Deschutes County.
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