Arnold Bennett once said, "Any change, even a change for the better, is always accompanied by drawbacks and discomforts." It is important to keep this in mind when reflecting on all the reports and comments regarding the status of mental health services in our community. When I assumed the helm of Umatilla County Mental Health (UCMH) 17 months ago, the voyage of change embarked upon held many challenges, known and unknown. Coinciding with UCMH's overhaul was the financial turbulence created by the state budgetary crisis. Change can be difficult, especially in the shadow of laying-off 40 percent of an agency's treatment and support staff.

Oftentimes in the helping professions, when resources dwindle, needs increase. As many individuals faced losing their Oregon Health Plan benefits, symptoms of anxiety and depression rose. Several of Oregon "legislatively mandated" services lost their attached funding which necessitated tough choices, such as reduce other program areas in order to continue to fund 24- hour a day, seven day a week Crisis Intervention Services. Those choices were made, but not without creating a ripple affect in UCMH's service delivery system.

Each of the stakeholders and community partners have their own perspective and vested interest in the past, present and future situation regarding mental health services. In spite of differing opinions, I believe all are interested in one thing: Those who need help, get it! Much has been written about the site review conducted in May 2004. In the exit interviews with both the UCMH leadership and the Umatilla County Board of Commissioners, the inspection team commented that "UCMH's hard work and progress were evident throughout the review" and "please pass our compliments along to the entire staff." Having said that, the investigators went on to delineate areas and concerns that still needed to be addressed. For over two and a half months the Board of Commissioners and UCMH received no official correspondence about the site review. Based on that verbal debrief, UCMH began to focus on implementing further improvements. When the silence finally broke, the County found itself in the situation currently under scrutiny.

Many of the site review findings revolve around UCMH's lack of an ongoing Medical Director and the clinical issues radiating from that deficiency. Dr. Russell Ferstandig, M.D. joins the UCMH clinical team with the full knowledge of the current concerns and future challenges that lie ahead. Client care and staff competencies have been the subject of comment and speculation. Respecting the confidentiality and privacy of each individual client makes it impossible to publicly comment on or respond to specific allegations and conclusions about UCMH's client care. I would like to point out, twenty percent of our clinical staff are new since the site review, allowing for fresh perspectives, if you will.

It is also important to note, two months prior to the site review UCMH sent out a Client Satisfaction Survey to all consumers who had received mental health services since July 2003, over 700 surveys. Statistically speaking, a very high number of clients completed and returned the survey, over 23 percent. Out of all respondents, 97 percent indicated they felt UCMH staff listened and 91 percent said they received help for their symptoms. Additionally, 96 percent stated their appointment was set in a timely manner (as defined by their own expectations). Every person who had a concern and had provided their name and address/phone number for follow-up, were personally contacted by the Program Manager for resolution of the concern. Although not perfect, I am encouraged and believe these statistics indicate UCMH's efforts are on the right track.

Overall integrity of a clinical process is often maintained by ensuring a proper balance and equilibrium within a community system. Mental health providers often walk a fine line between advocating for each and every client and partnering with law enforcement and other agencies to ensure personal and public safety concerns are adequately factored into the equation. Aggressively providing resources to consumers and their families, while respecting the civil and basic rights of individuals with mental illness is both fundamental and essential. Assisting each individual in their right for self-determination can be tenuous in times of crisis or when other life situations are overwhelming.

Regardless of the clinical issue, I am not embracing or advocating for clinical mediocrity or encouraging anyone else to do so. Building clinical excellence within the system has to always be a priority. Umatilla County residents have a right to expect quality of care and service delivery with dignity and respect. In the past 17 months as UCMH Director, I have witnessed your county mental health program come such a long way in being the kind of agency your family, friends and community deserve. My team has had the difficult mission of repairing the bicycle while still riding it. As previously mentioned, I believe Dr. Ferstandig's expertise will help us build an even better bicycle.

The County is in the process of appealing the decertification. No worthwhile journey is achieved overnight and this is no exception. On this issue I agree with our critics, our journey is far from over and we have not yet reached our final destination. I encourage and welcome any and all interested parties to partner with us as we continue to make Umatilla County a great place to live and raise a family.

One last request, if you know a mental health counselor or clinic support staff member, regardless of whether they work for UCMH, let them know they are appreciated.

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Charles Carnes of Pendleton is director of the Umatilla County Mental Health program.

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