Mental Health grab bag

An assortment of news and information releases related to the consumer/ survivor movement, broadly:

Mental care – As the nonprofit tries to right itself, critics trace
the crisis to early leadership

by ARTHUR GREGG SULZBERGER

The Oregonian

Even though he moved to France more than two years ago, the chief
information officer at Cascadia Behavioral Healthcare continues to
collect a hefty paycheck as a full-time employee, telecommuting
across many time zones.

Like the other three members of Cascadia’s executive team, Jeff
Poolin worked at the small predecessor organization that aggressively
built itself up into the state’s biggest provider of mental health
services.

Critics say that small team, leading an insular and top-heavy
management, played a big role in steering the massive nonprofit
toward collapse.

The organization has tried to answer its critics and change its
culture with a leadership overhaul that has for the first time
shifted the agency out of the hands of the small group that built it.
Upper managers were cut by 40 percent. Most strikingly, Poolin is the
only longtime executive still there (and he is still in France).

The changing of the guard might help explain why the state and
Multnomah County stepped in this week to ensure that Cascadia could
continue to work with the 23,000 people it serves each year. Their
eleventh-hour $1.5 million cash infusion will keep Cascadia operating
for at least another two weeks.

But how the company will go on after that and in what form are the
complicated questions now facing the governments that send millions
of dollars to the agency to treat their hardest cases.

To explain the current crisis, it makes sense to go back to the
beginning.

How did Cascadia start?

In the 1970s, after years providing mental health services itself,
the county decided to decentralize the local mental health system. It
divided the county into quadrants and contracted with four nonprofit
companies to provide the bulk of care in those areas.

But in the mid- to late 1990s, those agencies and a number of smaller
mental health nonprofits struggled financially. Leslie Ford — the
CEO of Network Behavioral HealthCare in Southeast Portland, one of
the four geographic companies — made a series of aggressive mergers
and acquisitions with the goal of consolidating services under a
single banner.

In 2002, Ford successfully united the companies and called the new
amalgam: Cascadia Behavioral Healthcare.

Cascadia struggled financially from the start, partly because the
merger included the debt-laden nonprofit charged with providing
mental health services for the west side of Portland.

But it has continued to expand. In the five years since its
inception, the company grew an additional 45 percent. It now has an
annual budget of $58 million, with more than 1,000 employees and 90
facilities.

Cascadia provides a full spectrum of mental health care — from
housing to counseling to crisis treatment. The roles include
operating walk-in clinics, crisis response and a network of housing
for low-income people with mental illness. Though the bulk of its
business occurs in Multnomah County, Cascadia also provides services
in Clackamas, Lane, Marion and Washington counties and directly to
the state.

Why is Cascadia struggling?

Cascadia has been constantly shadowed by looming financial crisis.
While management decisions and rapid growth played a significant
role, much of the trouble is linked to the thin margins that come
with working in the mental health field, experts say.

Most of the money in Oregon’s mental health system comes from the
state and federal government in the form of Medicaid reimbursements.
That money is passed to counties, which determine how to spend it.
Some counties provide their own services, but most contract with
private nonprofits to provide service.

Because of the dependence on government funding, mental health
providers have coped for years with budget cuts and, more recently,
with mandated changes to how they conduct business. The most
significant is a switch in how they get paid.

Multnomah County and other counties until recently provided up-front
payments to mental health agencies for each client and allowed broad
spending discretion. In 2006, Multnomah County mandated a change:
Agencies now would be reimbursed for specific services after clients
received them. The move was touted as a way to increase fiscal
transparency and ensure that money was going for services rather than
administration.

But Cascadia managers said that while the new system was good at
caring for people with mild or moderate mental illness, it failed to
provide resources to care for the very sickest clients. That’s
because it provides no money to track down and help people too ill to
enter or stay in the system on their own. Cascadia’s success reaching
out to those individuals before they ended up in expensive hospital
beds or jail beds was core to the company’s mission.

In June, a consultant estimated that Cascadia employees spent about
30 percent of their work days providing billable services and would
have to double that ratio to break even. That same consultant warned
about incorrect record-keeping. Months later the state ordered the
nonprofit to pay back $2.7 million because of improper payment
records. Cascadia still owes the money.

What has happened so far?

In recent months, Cascadia has laid off more than 250 staff, or about
of a fifth of its work force. Last week it replaced Ford as CEO with
Dr. Derald Walker, who has worked at the nonprofit for just two months.

County and state officials still refused to bail out the agency by
backing its loans.

On Wednesday, the Capital Pacific Bank drained most of Cascadia’s
cash accounts, saying the company had defaulted on a $2 million loan.
Cascadia was only able to make payroll because the state and county
accelerated a $1.5 million payment for services Cascadia already has
provided.

The company remains deeply in debt and many of its vendors have
stopped providing services unless paid cash in advance.

Nevertheless, Walker said this week that Cascadia’s focus on cutting
staff and increasing productivity are starting to pay off with
growing revenues.

What happens next?

County officials already have spent weeks working with state and
local mental health leaders planning to shift contracts from Cascadia
to smaller providers and have drafted detailed plans for an emergency
partitioning of the rest of the company’s services and assets should
it be forced to declare bankruptcy.

The county will wait until an independent audit of Cascadia’s
finances is completed later this month before making any big decisions.

Arthur Sulzberger: 503-221-8330; arthursulzberger@news.oregonian.com


News Release – 3 May 2008

United Nations Treaty on Disability and Human Rights Now in
Effect Globally.

Psychiatric Survivors Play Important Role in Creating the
Legally Binding Treaty.

MindFreedom International (MFI) joins with the international
disability rights community in celebrating the entry into force of
the “United Nations Convention on the Rights of Persons with
Disabilities.” The UN Convention — a type of binding international
treaty — enters into force today, 3 May 2008, after 20 countries
ratified it.

Celia Brown led the MFI UN team of psychiatric survivors inside the
United Nations. “It’s been great to be in the United Nations with
survivors of psychiatric abuse and many international disability
groups from around the world,” said Celia. “We’re all fighting
together for human rights, self-determination and freedom.”

For the full news release — text or PDF — click here:

http://www.mindfreedom.org/campaign/global/disability-convention
or here: http://tinyurl.com/5s5j3k

~~~~~~~~~~~~~~~~~

(2) News Report – 3 May 2008

MindFreedom Ireland Holds Successful Protest of Electroshock

Members of MindFreedom Ireland protested in Cork, Ireland on 3 May
2008 against the use of electroshock as a ‘treatment’ both in Irish
psychiatric institutions and worldwide.

For the brief report of the Cork Ireland protest of electroshock from
Mary Maddock, click here:

http://www.mindfreedom.org/as/act/inter/mfire/ireland-electroshock-
protest
or here: http://tinyurl.com/54pnup

For news of other May electroshock protests and events click here:

http://www.mindfreedom.org/events_sf

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