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4A THE DAILY ASTORIAN • TUESDAY, JULY 31, 2018 Center: Offers residential treatment and crisis care Continued from Page 1A or forced medication if they become aggressive. The type of patients who would most likely qualify would be people who are sui- cidal or psychotic and are not safe at home, but are not vio- lent enough to trigger care at a psychiatric hospital. Baker estimates secure beds would cost an extra $200,000 for staff and secu- rity enhancements. “Are there enough of those folks to jus- tify what the increased costs would be?” she asked. Alarm The commitment to have secure beds at the crisis respite center grew out of alarm. Warrenton and Astoria, alerted by law enforcement about the risk of potentially violent patients, demanded the security improvements weeks before the respite cen- ter was expected to open on Marlin Avenue in April 2016. Rich Mays, the interim county manager, brokered the agreement for four secure beds with the Caring for Clat- sop Coalition, the partner- ship between Clatsop County, Greater Oregon Behav- ioral Health Inc., Columbia Memorial Hospital and Provi- dence Seaside Hospital on the respite center. Administrators at Clatsop Behavioral Healthcare, who at the time were under pres- sure over management and quality of care issues, reluc- tantly went along. But top administrators resigned from the county mental health agency before the respite cen- ter eventually opened that July, leaving Baker — the agency’s new director — and Cameron Moore — the new county manager — to fulfill the promise. “Generally, I would say I’m satisfied with where we are with CBH,” Moore said. “I think we’ve come a tre- mendously long way from two years ago.” After heavy losses and a bailout, the county and the other partners in the respite center made finding a sus- tainable financial model the priority. “There is a timeline and a plan for when and how we can get to secure beds, but, again, we want to make sure we don’t do that in a way that cre- ates any financial problems,” Moore said. Broken promise Warrenton Mayor Henry Balensifer said the respite center has had some success in relieving pressure on hospi- tals and the county jail, but he sees the lack of secure beds as a broken promise. The mayor was upset after a young woman walked away from the respite cen- ter in March and a few days later was arrested for killing her dog. Warrenton police had taken the woman to Columbia Memorial Hospital in Asto- ria several times in the days before the dog’s death, and her fiance had also appealed for help. “The county has failed to deliver on a promise,” Bal- ensifer said. “They can dance around the issue and say, well, we did or we didn’t, or we thought we would or what- ever. I don’t care. Everybody was on that page.” District Attorney Josh Marquis, who has been crit- ical of the county’s men- tal health system, has also pressed for quicker action on secure beds. “We certainly had hoped there would be at least a cou- ple of ‘secure’ beds but we are hoping that there will be soon,” he said in an email. “We clearly do not have enough jail space and even less secure housing for people with mental issues involved in criminal behavior that might not be appropriate for a jail but still need to be held until they are medically stabilized. “We had hoped over a year ago that when the respite cen- ter opened we would have that, but I know Clatsop Behavioral Health is doing what they can to meet the cri- sis needs of the community. Without an adequate local jail, this will continue to be a crit- ical need.” Balensifer has suggested the county consider a detox component at the new jail proposed for the former North Coast Youth Correc- tional Facility in Warrenton. The mayor — who has not yet taken a position on the $20 million bond for the jail that voters will decide in Novem- ber — said detox could help with people whose behavioral problems are more rooted in drug and alcohol abuse than mental illness. Astoria Mayor Arline LaMear said she is grateful a new project for the homeless at a former Uniontown board- ing house could have a hand- ful of detox beds. Columbia Memorial, meanwhile, is looking at a larger room to screen patients in mental health crisis as part of a $4 million expansion of the emergency department in 2019. The room could be in a quieter part of the emergency department than the small multipurpose room the hospi- tal uses now, and could have some security. “Even though we don’t pro- vide psychiatric services here, still we know that patients are going to come here needing help,” said Trece Gurrad, the hospital’s vice president of patient care services. Episodes Many of the people Clat- sop Behavioral Healthcare and police encounter have drug or alcohol problems that can influence mental health. The county’s lack of detox and substance-abuse treat- ment options for people on the Oregon Health Plan — the state’s version of Medicaid — can place burdens on the cri- sis respite center, hospitals and the jail. “Alcohol and drugs are a fantastically effective way of dealing with emotional pain and hopelessness, but they also have a horrible impact on one’s mental health,” Baker said. Baker and others under- stand that police often get frustrated when they have to repeatedly respond to emer- gency calls involving a person who appears to be in mental health crisis, yet gets released from the hospital or walks away from the respite center. “If the police were just going to drop somebody off, I can’t hold on to them if there is a possibility that it’s sub- stances that are fueling their crisis,” Baker said. “I can’t take away their civil liberties based on substance use.” The respite center, which is financed by Medicaid, may be preventing some of the epi- sodes that used to routinely play out in hospital emer- gency rooms. At Columbia Memorial, behavioral health visits were down 23 percent last year, according to Gurrad, while the average length of stay fell by 17 percent. The hospital also saw a decline in the number of behavioral health patients who transferred to a higher level of psychiatric care. Baker is lifted by some of the respite center’s individual successes — getting people in crisis back on their medi- cations, into their own apart- ments, or stable enough to hold jobs. “Is it completely serv- ing the needs of the system? I would say there’s a question mark there,” she said. “Are we serving people really well and getting good outcomes with our clients? Yeah, that we’re doing.” Look for participating items throughout the store Card not required in Albertsons Savings worth celebrating clip or CLICK! 10 Valid 7/31/18 thru 8/7/18 ® $ OFF 50 $ or more * Save on your next grocery purchase of $50 or more* with your Club Card & this Savings Award. *Use this Savings Award on any shopping trip you choose at any Oregon Safeway or Albertsons store and S.W. Washington stores serving Clark, Wahkiakum, Cowlitz, Skamania, Walla Walla and Klickitat counties by 8/7/18. 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