Peace of mind
Kathy Randle was working as a nurse when she was diagnosed with multiple sclerosis, a disease in which the immune system attacks the central nervous system, often leading to disability.
The disease ended her nursing career.
"I was staying at home and got more and more depressed and I tried to kill myself," Randle said.
She swallowed several bottles of pills and spent three days unconscious in the hospital with a breathing tube down her throat. Upon her release, a Jackson County mental health care worker recommended she start attending Medford's Compass House, a new club for people living with mental illness.
Compass House opened in August as part of a push by Jackson County to radically expand mental health care services in response to the federal Affordable Care Act, which requires mental illnesses to be treated on par with physical illnesses.
The club is funded by the county, local foundations and private donors and is continuing to look for more funding sources, according to Matthew Vorderstrasse, executive director.
Although Randle is still weak and recovering from her suicide attempt, she jumped at the chance to shoulder responsibilities at the club, helping others with kitchen, snack bar and computer tasks. Her past nursing experience has even come in handy.
"As a nurse, I worked in long-term care and helped people with strokes who didn't talk clearly. There are some people here at Compass House who don't talk clearly. I can tell everybody what they said," said Randle, who is taking an antidepressant for her chronic depression and pain medication for the multiple sclerosis.
In addition to helping fund Compass House, Jackson County is pouring money — which comes largely from the federal government — into other mental health services.
Also known as Obamacare, the controversial 2010 Affordable Care Act ushered in numerous changes, requiring people to obtain health insurance and vastly increasing the numbers of people on publicly subsidized health care plans such as the Oregon Health Plan.
Insurance companies cannot deny applicants based on preexisting physical or mental health conditions, and young adults can stay on their parents' insurance plans until age 26, under the act's provisions.
The state has tasked newly formed coordinated health care organizations with coordinating both mental and physical health care for OHP patients. Locally, the organizations have turned to Jackson County Health and Human Services to provide mental health care, since the county has long provided such services to OHP patients and others.
The county is receiving $24.8 million from the organizations to treat mental illness this fiscal year. That includes $7.8 million to deal with the surge of new patients seeking mental health services, according to the county.
In 2013, the Oregon Health Authority estimated 8,000 more Jackson County residents would become OHP members in 2014.
Just through August of this year, OHP added 16,000 county residents, said Jackson County Mental Health Services Clinical Operations Manager Rick Rawlins.
Almost 30 percent of county residents are now on the Oregon Health Plan, according to state numbers.
Not all people who have new access to health care because of the Affordable Care Act will seek mental health care, Rawlins noted.
In August 2013, about 200 people sought county mental health services. This August, about 250 people sought care, he said.
They are coming for a range of conditions, including depression, anxiety, schizophrenia, bipolar disorder and post-traumatic stress disorder, Rawlins said.
"People who are able to get services now for years probably needed services," he said. "It's like people who don't go to the dentist. The first trip in will be major — not just a cleaning. A lot of people have significant life challenges. Their problems are more acute."
Jackson County is in the midst of a hiring surge to meet the escalating demand for mental health care.
It expects to hire 45 people this fiscal year, Rawlins said.
He said the county has hired many local mental health care providers and is searching nationwide for candidates. A big challenge has been finding enough master's degree-level mental health therapists.
"That's still our struggle — getting enough people," he said.
Mental Health Division Manager Stacy Brubaker said the county has been able to hire new people who can prescribe psychiatric medications, which was sorely needed. A new psychiatrist hired from Michigan is bilingual and has expertise i head injuries. Another new mental health worker has experience dealing with chronic pain, while another can help mentally ill people who are diabetic. The county also landed a child psychologist from Arkansas, Brubaker said.
"We really have scooped all these people in from around the country. They're drawn in by our innovative programs and our new building. We have an opportunity to make treatment of mental health really different in this county," she said.
In December, Jackson County Health and Human Services workers who are scattered across multiple sites will move into a new building now under construction at 140 S. Holly St. in downtown Medford. Clients will be able to get services for a range of issues in one place.
Using $1.07 million in grants from the Oregon Health Authority, the county is tackling new projects, including expanding its jail diversion program to treat mentally ill people and reduce their incarceration rates, intervening early with teens and young adults showing signs of severe mental illness such as schizophrenia, creating a drop-in center for youths with mental health issues and reaching out to homeless youths and families to provide mental health care. A new worker will help mentally ill individuals pursue higher education at Rogue Community College and Southern Oregon University.
Other community programs include intensive services for people in crisis to prevent costly psychiatric hospitalization and training police officers how to help people with mental illness, developmental disabilities and dementia. An effort is also underway to create a special court for mentally ill defendants, according to county employees.
Treating mentally ill people can reduce costs to society, according to the National Alliance on Mental Illness.
The advocacy group estimates the economic cost of untreated mental illness in the United States is $100 billion per year. Those costs include unnecessary disability, unemployment, substance abuse, homelessness and inappropriate incarceration.
The nationwide costs to the federal government of the Affordable Care Act in 2014 are projected at $36 billion, according to the nonpartisan Congressional Budget Office. Most of the costs stem from spending on insurance subsidies and from increased spending for Medicaid.
According to NAMI, 70 to 90 percent of people with serious mental illnesses can have a significant reduction of symptoms and improved quality of life with treatment. About 6 percent of Americans live with a serious mental illness, although one in four will experience a mental health disorder in any given year.
Mental illnesses are treatable diseases that can affect anyone. They cannot be overcome by willpower and are not related to a person's character, intelligence, upbringing or income, according to NAMI.
Medford Police Department Lt. Curtis Whipple said he hopes increased mental health services in the county can help reverse a trend of escalating numbers of police calls for incidents involving mentally ill people, including threatened, attempted and actual suicides.
Pat Garoutte, president of NAMI of Southern Oregon, said mental health advocates have long battled for mental health care to be covered on par with physical health care.
But while they celebrate that victory, they know the shortage of mental health workers and services cannot be erased overnight, she said.
"It is quite a change. The mental health field has been very short on funds and short on help for the mentally ill. So many of the calls I get are from people trying to find adequate care and not being able to get it," Garoutte said. "I think it will be an improvement, but it will take time."
Garoutte — whose daughter and siblings have suffered from mental illnesses, including schizophrenia — said more transitional houses, respite homes and living quarters are needed. Legislators should encourage more people to enter mental health fields, perhaps by forgiving the student debt of people who commit to working in those fields for three to five years, she suggested.
Randle, the former nurse living with chronic depression and multiple sclerosis, said mental health care has been out of reach for many people until now.
"There are so many people — even regular people — who have mental illness. A lot of people can't afford treatment because they work minimum-wage jobs or they get an illness like mine and can't work," she said.
Randle said the expansion of mental health care in Jackson County is a positive change.
"They need to do something about mental health and I think they're doing that," she said.
Reach reporter Vickie Aldous at 541-776-4486 or firstname.lastname@example.org.