Mental health crisis?

June 07--After Medford's third police shooting in a year renewed discussion of a mental health crisis in the community, Jackson County health officials say the prevalence of mental illness isn't always depicted accurately -- but they aren't disputing the need for more services.

Police said James Anthony Morris, 40, was reportedly suicidal after a recent breakup when he armed himself with a handgun and confronted a Medford police officer May 30 near his home on Juanipero Way. Police said both Morris and the as-yet unidentified officer exchanged gunfire, although it's still unclear who fired first.

The officer was unharmed, but Morris was transported by ambulance to Asante Rogue Regional Medical Center, where he died from his injuries.

Previously, Medford police shot and killed Andrew Charles ShipleyMarch 17 and Stephen Andrew McMilon Aug. 24, 2014, both of whom were described as suffering from mental illness. McMilon, a U.S. Marine Corps veteran who suffered from post-traumatic stress disorder, was shot in a church parking lot near Stewart Avenue and Cherry Street after he fired on police with a shotgun. Shipley reportedly had suffered a mental breakdown in the days before he barricaded himself inside his girlfriend's home on Argyle Court, a standoff that ended in his death after he fired on MPD SWAT team members from the garage.

In making their case for more urgent-care options for the mentally ill in crisis, Medford police have pointed to their own 17 percent increase in calls for mental health holds and a 35 percent increase in suicides and attempted suicides in the past year. But county officials say those numbers don't tell the whole story and don't necessarily indicate an increased prevalence of mental illness.

Stacy Brubaker, division manager for Jackson County Mental Health, says the apparent increase could be attributed to several factors. For one, she said, many people who are reported to the police as mental health cases may be under the influence of alcohol or drugs, rather than having a purely psychological episode.

"It's really hard when I hear that because I can't see how they're coding it," she says. "Many people do (dangerous or irrational) things who aren't necessarily mentally ill."

Clinical operations manager Rick Rawlins says substance abuse often co-occurs with mental illness, making it difficult to determine the precipitating causes of serious incidents. "A lot of the things that make the news as 'mental health issues' are impacted by drugs or alcohol," he says.

Another factor is increased training for local law enforcement officers that may result in new identifications of conditions that were always there. "We've done a great job of educating our officers, so they're recognizing it more," Brubaker says.

What Brubaker and Jackson County Health and Human Services Director Mark Orndoff don't question is the need for more resources nationwide for treating mental illness. "We're all trying to ramp up services," Orndoff says.

One thing that's often misunderstood about HHS is the agency's responsibilities as a service provider. In Oregon, county health departments primarily are responsible for administering benefits under the Oregon Health Plan, the state's implementation of Medicaid. Orndoff says the agency also receives some funding to provide care for the indigent. "That's probably about 5 percent of the county total (population)," Orndoff says.

But people with Medicare and commercial health insurance aren't covered by the agency's services, and sometimes get upset that they can't receive treatment through HHS departments. Orndoff says it isn't that the agency doesn't want everyone to receive care. "We just really don't get funding for that population," he says.

Orndoff says Health and Human Services as a whole has seen a massive increase in client enrollment as a result of the Affordable Care Act, which expanded the number of people who qualified for OHP when the health care exchanges took effect in October 2013.

"We'd expected (local enrollment to increase to) about 50,000 and a slow, gradual rollout," he says. "Four months in, we'd already exceeded that."

Orndoff says current OHP enrollment in the county is about 65,000 and growing -- up from about 35,000 in December 2013 -- but some of those people likely will be found ineligible for the coverage. "It's kind of a moving target," he says, explaining that the changing numbers makes it difficult for officials to estimate the exact staffing levels needed to keep up.

What is certain, Brubaker says, is that the county desperately needs more licensed clinicians with master's degrees to provide services to the wave of new clients the Affordable Care Act brought with it. But all of the counties in southwestern Oregon are considered geographic "shortage areas" for mental health care professionals by the federal government, and Orndoff says that the relatively low number of licensed clinicians nationwide limits their pool of potential hires.

Still, the county is making an effort to ramp up its staffing in the near future and hopefully expand its number of satellite positions. "We currently have the Rogue Family Center out in White City," he says, explaining that Health and Human Services eventually would like to increase the number of full-time licensed staff at the facility. "We're looking to have something at the south end of the county as well."

There are currently three options if somebody is experiencing a mental health crisis: Call 911, go to the emergency room or call Jackson County Mental Health's 24-hour line at 541-774-8201. "People can walk in (to Jackson County Mental Health) and receive urgent care from therapists," Rawlins says.

People needing longer-term inpatient psychiatric care can sometimes be placed in the Behavioral Health Unit at Asante Rogue Regional Medical Center. Rawlins says that although space at the BHU is limited to 18 beds, mental health workers also regularly find clients placement in other psychiatric facilities throughout the state.

Because first-responders are so often involved in mental health situations, Brubaker has helped oversee the implementation of crisis-intervention training for local law enforcement agencies, training officers from Medford police, the Jackson County Sheriff's Department and other smaller agencies how to recognize and relate to people with mental illnesses.

"We've (also) had conversations with not just the sheriff's office but other law enforcement agencies as well about possibly embedding caseworkers with them," Brubaker says, adding that the concept is still just an idea. "I think it's a renewed area of potential partnership."

Orndoff describes those kinds of community partnerships as key to addressing the often multi-generational and overlapping health issues many residents deal with. Both he and Brubaker say they'd also like to see more local private and nonprofit agencies become certified as mental health care providers.

"We have a really extreme opportunity to really benefit a lot of people," he says.

Reach reporter Thomas Moriarty at 541-776-4471, or by email at tmoriarty@mailtribune.com. Follow him at @ThomasDMoriarty.

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