Medford is a regional hub for mental health services in Southern Oregon. But according to complaints from some patients and therapists, gaps in the mental health system are causing vulnerable people to slip through the cracks.
Earlier this fall, Medford resident Freesia Rowden was trying to get her medication filled. Rowden has a range of mental health diagnoses including schizophrenia, bipolar and dissociative disorders, and PTSD.
The trouble started when she went to Providence Medical Center in Medford. Rowden was having a bad day with her mental health. A social worker at the hospital told her they couldn’t help her and she should go to Jackson County Mental Health instead.
“It was really unclear and I felt like they could have helped me better by having somebody go with me or something,” she says. “Just because I needed my medication, so being in the mental state that I was, I obviously needed assistance.”
Rowden was sent by taxi from Providence to Jackson County Mental Health, the local crisis center.
But things didn’t get much better there. County employees said they couldn’t help her either, she says, and instead they drove her to ColumbiaCare, another nearby mental health provider.
“They had pulled up and said ‘Alright, just go inside and see if you can get an appointment.’ But they didn’t go inside with me or anything and I wasn’t in the mental state to really handle it on my own.”
Rowden says she didn’t get clear instructions or a mental health assessment at any point.
“I don’t even remember the process. I was out of it. I remember my mom picking me up and I don’t even remember getting a prescription that day,” she says.
Nothing bad happened to Rowden, beyond a frustrating experience transiting around town. But, according to Jason Farris, when providers don’t take responsibility for patients, it puts them at risk. Farris is a licensed professional counselor. Until recently he was the clinical operations director for ColumbiaCare Services in Medford.
“Someone gets dropped off on our doorstep, and this has happened more than one time, you would ordinarily expect there to be a plan,” Farris says.
In December, Farris quit his job. He was frustrated over what he describes as a lack of accountability from providers and a lack of assessments for patients who could be in danger of hurting themselves.
“It’s consistent with someone who has those disorders that if they’re off medication, they would be very disorganized,” he says. “They would have a very difficult time focusing. If you have a voice talking to you in your head, it can be very distracting. Someone in that situation is at very high risk.”
Oregon has the second highest prevalence of mental illness of any state in the U.S., according to the advocacy group Mental Health America.
The state’s mental health care system is difficult to navigate for patients and providers alike, says Sarah Radcliffe, managing attorney for the Mental Health Rights Project at Disability Rights Oregon. She says patients often have to jump through hoops to get services.
“The fact that there is no single point of accountability for mental health care within the system, that you’ve got a lot of different players and a lot of confusion over who does what, that seems typical,” Radcliffe says.
A limited number of mental health providers has been a problem in Jackson County. In 2017 both of the local Coordinated Care Organizations – the health care networks tasked with serving Oregonians on Medicaid – ended their contracts with Jackson County Mental Health because of budget disagreements. The county lost millions of dollars in contracts and around 200 mental health workers lost their jobs, though some found work at other local agencies.
Today, the current mix of agencies in Jackson County has contributed to experiences like Rowden’s, according to Stacy Brubaker, the mental health services division manager with Jackson County Mental Health.
“I think it’s unfortunate and unfortunately it is true. Our system is really divided up now [so] that it really has to be quite a feat to get the right people to the right places,” Brubaker says.
Clients often get sent to the county crisis center, when they should instead go to their long-term mental health provider, says Rick Rawlins, clinical operations manager for the county.
“In this situation, again, this is not the gold standard of how it should have worked. But that’s more of the ongoing challenge in the community because things have changed,” Rawlins says. “How do we improve those communication processes?”
Officials from Providence in Medford declined to be interviewed citing patient confidentiality. But a spokesperson said hospital protocol calls for patients to be screened in the emergency department where staff determine their next steps for care, including referrals to another provider.
Jason Farris, formerly of ColumbiaCare, is leaving community mental health. He plans to start his own private practice to work with clients in a setting he can better control.
Farris also says his frustrations are shared by many in the area. He believes the leaders in mental health in Jackson County need to work together to fix the gaps in the system.
“Maybe it’s one point of contact between each person and the county: ‘Hey, this client just landed on my doorstep that came from the hospital. What’s going on?’ Versus, ‘Don’t send them to us,’ That’s what I think we need to do,” Farris says. “That could be done and that could help.”