Breaking Stigmas and Creating Solutions

Unity Center experts weigh in on the state of behavioral health care in Oregon during National Mental Health Month.

May 4, 2022

May is National Mental Health Month. The awareness month, established in 1949, was created to further advocate for those experiencing mental illness, help break down stigmas surrounding mental illness and advocate for those in need of care.

At Unity Center for Behavioral Health, a team of doctors, nurses, counselors, clinical social workers, and many others advocate for patients year-round, caring for everyone who walks through Unity Center’s doors. Unity Center works to fill a gap in mental and behavioral emergency services by offering a pioneering model in Oregon that understands behavioral health and how to better serve those experiencing mental health emergencies.

In the United States, millions of people each year are impacted by mental illness, according to the National Alliance on Mental Illness. Statistics only continue to climb – especially for youth – as the country continues to grapple with the COVID-19 pandemic.

Below, several experts at Unity Center weigh in on the state of behavioral health care in Oregon, what they see each day, what’s still needed to advance care in the state, and other critical topics. Click on a question to see their answers.

Questions

Answers

In your expert view, what are the most pressing problems we see now in Portland, and throughout the state, when it comes to access to behavioral health care?

Melissa Eckstein, MSSW, MBA, LCSW-S, President, Unity Center for Behavioral Health

What I see is a community that’s been underserved and underfunded, which has led to the behavioral health crisis we are now experiencing. By crisis, I mean the houselessness, rampant meth addition, and individuals with severe and persistent mental illness who can’t access the right services at the right time. And with the Oregon State Hospital no longer taking civilly committed patients, the problem only continues to grow.

The community is struggling on the behavioral health front due to a lack of a coordinated approach. We are still very siloed, but one effort—the Behavioral Health Emergency Coordination Network (BHECN)—is working to address many of these hurdles. The network, made up of several key community partners, is working to fill a critical gap that currently prevents people who are experiencing mental health or substance abuse crises from getting the help they need, and we expect to see further progress in that area this year and into 2023. I am optimistic but also feel, like everyone in the behavioral health field, time is of the essence. We must make changes now.

Go back to questions.

What resources are lacking? What are some of the solutions?

Melissa Eckstein, MSSW, MBA, LCSW-S, President, Unity Center for Behavioral Health

It’s critical that we focus on the workforce. That’s a significant challenge for everyone in behavioral health. Recently, the University of Oregon began focusing on a new degree program that will focus on children’s mental health through the Ballmer Institute. That is a very an encouraging step. There are other initiatives coming down the pipeline, like BHECN, that will benefit the community. It’s essential we increase training and workforce opportunities. Social work is a big concern. They are essential in connecting people to the resources they need, and yet we are seeing the number of social workers drop at an alarming rate.

It’s the social worker’s role to connect people to resources, and yet oftentimes, the resources just aren’t there, such as timely access to in-person counseling. It’s required by the Centers for Medicare & Medicaid Services that anyone leaving the hospital be seen by a mental health professional within seven days, and yet that’s difficult to fulfill as counselors are overwhelmed with patients in Oregon. Each piece of this puzzle is critical to solving the behavioral health crisis in Oregon.

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What behavioral health care successes are you seeing in Portland?

Melissa Eckstein, MSSW, MBA, LCSW-S, President, Unity Center for Behavioral Health

For the first time in many years, there is a true desire for community partners to come together in a way they haven’t in the past. BHECN is a good example of this.

In addition, Measure 110 will help fund drug addiction recovery and treatment, but we are still unclear how that may benefit patients as of now. We are eager to see where this goes.

I think most of all, what I see as the biggest success are the people who care for those with mental illnesses every day at Unity Center. The Psychiatric Emergency Service (PES)—our emergency department for those in crisis—has seen high utilization days so far this year, with more than 3,200 patients. That speaks to our team pulling together to care for that many people.

In addition, our pharmacy continues to be one of the most innovative in the system and we’ve had some good initial success with medication reconciliation. When a patient is admitted, we must reconcile the medications they were on before admittance, and we must ensure we provide the right medication upon discharge so there is good continuum of care. This is a difficult process. The Unity Center team worked with providers to create this process and it’s working.

We also now have a full-time quality improvement consultant. With that consultant working in tandem with a performance excellence coach and risk coordinator, we’re seeing our team excel at patient and staff safety improvements.

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Mental health wellness is a national crisis for people of all ages. What are some of today’s exacerbating factors for adults? What about for youth?

Dr. Joe Thoits, MD, Medical Director of Child & Adolescent Psychiatry

The past couple of years of living through this pandemic have been a struggle for all of us and it is well known now that kids and adolescents have been hit especially hard during this time.  Disrupted schooling, loss of routine, loss of opportunities for extra-curricular activities and socialization, not to mention heightened collective family stress, have all contributed to soaring trends in outpatient mental health demands and suicide attempts among youth. 

The team here on the child and adolescent unit here at Unity Center have continued to work very hard during this time to try and meet the needs of the children and families in need of this level of care, optimizing our processes and increasing our staffing, and we are now consistently caring for more children and families each month than we did prior to the onset of the pandemic, a testament to the team’s dedication and hard work.

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What can parents do to help their children who may be experiencing depression, anxiety and other behavioral health challenges?

Dr. Joe Thoits, MD, Medical Director of Child & Adolescent Psychiatry

Attention to a child’s mental health and well-being is just as important as attending to their physical health, something most parents excel at. One of the most important aspects of understanding how your child or adolescent is doing is maintaining a healthy relationship with meaningful, regular communication. 

Most kids and adolescents that we treat on the inpatient unit here at Unity Center are struggling with some combination of anxiety and depression, and while most parents/guardians had some sense that things were not going well with their child prior to whatever event(s) may have led to hospitalization, the majority of caregivers had limited appreciation for just how bad things had become. 

Spend time with your child, establish household routines that support communication, family engagement and build trust. If you are concerned that your child is struggling start by talking to them, sharing your concerns and have a low threshold for seeking additional supports. Many parents will start with a visit to their pediatrician and seek additional referrals/professional mental health supports as needed. Parents should be proactive when possible, and they should not feel like they need to wait until things get bad or unmanageable before reaching out for help.

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What are you seeing each day inside Unity Center? What are Oregonians grappling with? How do you help them?

Ron Lagergren, MSW, LCSW, Director of Clinical Operations

Our community is in crisis. The safety net in Oregon for mental health, addictions and social determinant needs is very disjointed and oftentimes non-existent. You can see this with the rapid rise in houseless individuals in our community over the last couple of years. 

We have a lot of individuals with mental health and addictions issues that need long-term support. That long-term support, such as residential or intensive community treatment, is almost non-existent.

It can take months for someone to get into those services, if accepted. Patients can get declined by many of these services because their needs are too high.

Nate Boyett, LCSW, Manager of Inpatient Services

What I see each day inside Unity Center is a group of individuals who come together to support people who are experiencing a moment in their life where, due to the symptoms of their mental illness, they require additional resources and support. There is a truly dedicated team of professionals in all disciplines who collaborate to make this possible, despite their own struggles of working through a pandemic, staffing shortages, a decrease in community resources, and managing their own stressors and mental wellness.

The commitment and willingness to advocate and seek out resources in a time when they are shrinking is both commendable and taxing on staff members. There is a strong dedication to the work, but Unity Center alone can’t support the community’s needs – we are just one piece of a larger puzzle.

At Unity Center, I help patients by continuing to advocate for increased resources, working to build relationships with community partners to strengthen the network of care through the community and encourage coordination and sharing of information.

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What types of hurdles do people face experiencing behavioral health illnesses?

Nate Boyett, LCSW, Manager of Inpatient Services

So many hurdles exist in our community. Staffing shortages are a big concern in our hospitals as well as with our outpatient resources. This has a ripple effect throughout the community regarding timeframes for access to care at all levels. We had a lack of resources before COVID and this gap has continued to widen. With the move to telehealth appointments this has created additional hurdles to members of our community who lack access to technology, a place to charge electronics, and are unable to maintain payments to secure access to internet to attend tele-health appointments.

Hurdles continue to grow, and resources are drying up. As this persists, Oregonians are the ones suffering because they cannot obtain the behavioral health care they need.

At Unity Center, we often see instances where we are unable to schedule with agencies for months for a person to get connected to the resources they need. There are innumerable hurdles day to day that a person living with a mental illness must navigate and our system is not currently in a state that’s able to support them.

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What types of stigmas still surround the conversation around behavioral health? How can we break down those barriers?

Ron Lagergren, MSW, LCSW, Director of Clinical Operations

We have a lot of stigma in our community with mental health and addictions. I believe this is due to a lack of understanding of how disorders impact a person’s functioning in the community. It’s still a “taboo” topic for people to openly talk about. 

Our community has this belief that one can control their symptoms, or that they are made up. There’s a lot of blaming of the patient for what they are experiencing. Our society doesn’t view mental health and addictions disorders as medical conditions. We don’t talk openly about them like we do when talking about heart conditions, diabetes, cancer—and we need to. 

People should not live feeling shame for their mental health and addictions condition as they are medical conditions. And, those conditions are treatable.

Nate Boyett, LCSW, Manager of Inpatient Services

When hearing the question of stigma, the thing that comes most immediately to mind is that of public stigma in the form of stereotypes and prejudice, which lead to discrimination in the public sector. There are other forms of stigma as well, including self and institutional stigma. An example of self-stigma would be that a person believes they are dangerous, incompetent, or to blame for their current circumstance. This in turn may lead to lowered self-esteem and a decrease in self-efficacy—a person not feeling worthy of help.

In institutional stigma, the stereotypes are embodied in laws or other institutions, and this leads to both intended and unintended loss of opportunities for people who experience mental illness.

For ideas of how we can break these barriers and more information on stigma, here is a starting place: Psychiatry.org – Stigma, Prejudice and Discrimination Against People with Mental Illness

Go back to questions.

Ron Lagergren, MSW, LCSW, Director of Clinical Operations

I recommend using 211—it is a great resource to connect people to assistance with their social determinant needs. Learn more about it here.

For mental health and addictions, call a local county crisis line. Each county has them. They will assess the caller’s situation and help connect them to services that best match their needs. For emergent issues, individuals should go to their local hospitals’ emergency departments, such as Unity Center, for assistance. There are also urgent walk-in clinics in each county that can help with non-emergent issues.

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