Community Counseling Services wants to expand acute mental health care in Eastern Oregon. The nonprofit recently purchased the Aspen Springs Psychiatric Hospital, which was previously operated by Lifeways and closed in April 2021. The goal is to have the facility operating again by the end of the summer, but supply chain issues may cause delays. Kimberly Lindsay is the executive director of Community Counseling Solutions. She joins us to share what access to mental health care is like in rural Oregon and the role this facility will play.
Note: The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The Aspen Springs Psychiatric Hospital opened up in Hermiston in September of 2020. Then just seven months later, the nonprofit that ran it had to shut it down because of staffing issues. As a county commissioner told the East Oregonian newspaper recently, “the closure was a huge blow to the region, as if all the oxygen had been sucked out of the room.” Now, another nonprofit, Community Counseling Solutions, wants to reopen the facility. Kimberly Lindsay is the executive director of CCS. She joins us now with the details. Welcome back to Think Out Loud.
Kimberly Lindsay: Thank you very much. Good morning, I’m very excited to be here. Thank you for the invite.
Miller: Thanks very much for joining us. Before we get to the specific story, [the] issue of this hospital that closed. Can you give us the bigger picture of mental health care in your region of Eastern Oregon?
Lindsay: The demand is high. It’s been high for some time but certainly COVID exacerbated it. We have seen, depending upon the county, anywhere between a 20% increase and a 100% increase in requests for services. And that is great. We knew that the need was high before. So we’re glad that people are wanting to come in. Our struggle now is the supply. So with COVID, in our industry as well as many other industries, there has been an exodus from the workforce. There’s also been an increase in funding which has created additional positions. So I guess the combination of the additional funds and requirements for positions, as well as people leaving the field, it’s created a backlog of people who are needing to come in. So we have about 20% to 25% of our clinician positions vacant. And because of that we do have wait lists and some of the counties that we operate in, which is problematic.
I just do want to emphasize that every person who calls to request an appointment, we do have a triage system. So depending upon the acuity, some people are seen immediately. Some people, the wait is longer and that’s unfortunate.
Miller: How long might the wait be? If in the triaging, it’s determined that this is not an acute emergency and so somebody gets put to the back of the standard line, how long might they wait for that first appointment?
Lindsay: Depends upon the county that they are requesting services in. In some counties it could just be two weeks, three weeks, but in one of our counties, and that is in Umatilla County, the wait can be four months to four and a half months.
Miller: What does that mean for people? I mean what have you heard?
Lindsay: That it’s frustrating, for sure. There are some individuals who are okay with it. There are some who have additional resources who are able to look elsewhere, such as in the private sector, they can go see a psychologist or a psychiatrist [or a licensed clinical social worker] outside of CCS. But for others it’s a long time. And if you’re a mom, dad, brother, sister, son or daughter who has a loved one who you are wanting to be seen, or just you, yourself, are wanting to be seen, and you’re ready for the service now and you need to wait, it’s discouraging. It’s really hard on the people who are wanting services.
It’s also hard on the people who are wanting to provide the service. People that go into this field are mission driven. They want to help, they want to be available and knowing that people are needing to wait for weeks or months, it’s a challenge. So as an organization we have to ask ourselves, “Oh, we could pile more people onto the existing clinicians, but those clinicians will leave.”
Miller: Oh, you could increase their caseloads, but then that would lead to burnout.
Lindsay: Yeah, it’d increase burnout and they’ll just leave because they can go elsewhere. Or they could go into business for themselves, set up their own shop. So if we burn them out, we really exacerbate our problem. I think we’re doing better than a lot of programs similar to us, with our vacancy rate for the clinicians. We’ve been able to be creative. We can talk about some of our mitigation strategies if you’d like, but we’ve got to keep our workforce . . .
Miller: I am curious. What are the mitigation strategies which… and I guess mitigating, meaning preventing people from leaving or attracting them in the first place. What are your strategies?
Lindsay: We just talked about one of the mitigation strategies: to limit the size of the caseload so that people don’t leave. That has been helpful. The clinicians will tell you that they still have high caseloads. We just have put a cap on the number of people that they will see. We’ve also created additional positions. Again, that’s a bit of a challenge because it’s hard to fill those, but we are slowly getting those filled. And so that is helpful. As those positions get filled, the caseloads are dropping.
Oregon also [has] the Equal Pay Act. That law has been there for a long time, but the legislature at the beginning of COVID suspended a part of the Equal Pay Act that made it difficult to institute bonuses. So they suspended that. And as a result of that, we were able to offer hiring bonuses. And we offered a substantial hiring bonus, and I do think that that has been very, very helpful for us in filling these positions.
However, that provision sunsetted towards the end of September, so we are now working with our attorney to see whether or not we’re able to continue to offer that. We are hopeful that the legislature will suspend that provision again because the hiring challenges have not [gone] away.
Miller: I’m curious what you see as the added challenges, if that’s the right word for them, in a place like Eastern Oregon where people may be very far from, say, the county seat or or the offices where mental health professionals work. What do the distances themselves mean for the kinds of services you provide?
Lindsay: Distance can definitely be a challenge as you indicated. We have some communities that could be almost two hours away from the closest office, and if they are working, their transportation is less than reliable. Financially, gas is still not cheap. We haven’t benefited from other parts of the US that are down to just over $2 a gallon. The distance, the cost, the time away from work, it definitely can be a challenge. One thing that was good, if you can say this about the pandemic, is that the laws allowed us to provide more flexibility in telehealth services.
Prior to the pandemic, it was just difficult, just leave it at that, to provide tele-health. [Then] the feds relaxed some rules, the state relaxed some rules. So [now] as long as there’s a good internet connection, or a good data connection, people can utilize services via their phone or their laptop. Which is great. However, some of the services that we provide are still required to be delivered in person, or should be delivered in person, and that means we’re having to look at opportunities or ways to bridge those barriers.
I think that CCS has done a fair job, if not a good job, of providing services in the community or in the home, despite the distance. We have clinicians that sometimes will drive for three hours to deliver a service that lasts an hour, and then turn around and drive back three hours.
Miller: That’s an entire day for one client.
Lindsay: An entire day for one client. I’ll say that that’s not super common, but it does happen. Probably one or two times a week with different clinicians where they’re spending all day providing service to one or two people. It’s kind of shocking maybe, but that’s our value: to deliver the service where and when they are needed and whenever we can do that, we will do that. And it keeps people out of the emergency room. You asked earlier about what are some of the challenges that come with these longer wait times. You might call today, we do a triage on you, you’re able to wait for the next appointment a month out or four months. But life happens, things change. And while we might tell you, “Give us a call back if anything changes,” you don’t necessarily do that or you don’t want to bother us and then you end up in the emergency room because things are worse.
So it’s just to highlight that this issue, it’s paramount. It’s significant. We want to address it. We want more clinicians, and there are some consequences. It is really important. I hope I spoke to the distance piece in Eastern Oregon. We’re working on ways to address that. Again, telehealth is helpful. We do bring services to the individuals whenever possible. But the isolation piece and the distance, it is a challenge, especially for seniors. So again, we just try to look for creative ways to bring those services to them.
Miller: The nonprofit [Community Counseling Solutions] is, right now, planning to reopen a now-closed psychiatric hospital in Hermiston. So Lindsay, let’s turn to that. What did it mean for the region when this hospital opened in September of 2020?
Lindsay: So when the hospital opened, it meant that there were additional acute care beds. I would add that there was one facility that was already providing acute care services. So there were more acute beds for the eastern part of the state. Which is great.
Miller: Was it a surprise to you when, just seven months later, this new psychiatric hospital closed down?
Lindsay: In some ways, yes. At the time that they closed, we were in the middle of COVID, maybe not in the middle, but we were into COVID, and staffing issues were really becoming very visible, and so that they closed due to staffing issues, was not a surprise. We were seeing that elsewhere. I would add that, when you ask, “How did it affect the region?”: the increase in beds was good. In 2016 there were about 26 beds per 100,000 people in Oregon. This was a study that was done by Willamette Week in 2019, so this was before the pandemic started. There were eight acute care psychiatric placement beds per 100,000.
A number of things that happened before the pandemic reduced the number of beds, and we could talk about those if you want. But then when the pandemic hit, the number dropped even more and that definitely happened in Eastern Oregon. There were two facilities. With two facilities open and they took it to 26 beds, that was more than Eastern Oregon can support. So one facility closed and then shortly after that Aspen Springs closed and we were left with zero beds and it was devastating. People are sitting in emergency rooms that went from maybe 24 hours to now [to] five or six days, in some cases longer, before an acute care bed could be found. Which is horrible. It’s very difficult on the ER staff, it’s difficult upon law enforcement who needs to do the transport. If you’re not in a good space, and you’re the individual that’s there needing services, waiting for services and you’re sitting there for five or six days, chances are you’re going to get worse. So it really placed a big strain upon the entire system for Eastern Oregon.
Miller: How do you plan to prevent those same staffing issues that doomed the newly opened psychiatric hospital? How do you plan to prevent them from happening again?
Lindsay: Aspen Springs, when it opened, it was staffed for 16 beds. And there’s a certain set of staffing levels or numbers that you need for 16. One thing that we’re going to do is we’re going to reduce the number of beds. It’ll be a 10 bed facility. So we won’t need the same number of staff for 10 beds that we did for 16 beds. The other six beds that are in the facility will be used but they’re for long-term care, so it’s a different level of staffing also that’s needed for the long term care. Just for this conversation, those 10 beds will make it easier for staffing.
CCS has a good reputation on the east side of the state and people want to come work for us. There are some individuals that really like the 24/7 acute care atmosphere. So there are individuals that have already reached out, indicating that when we do get ready to open they would really like to apply. So that is exciting and encouraging. That said, those clinical positions, the ones that require the master’s degree, those are the more difficult ones to staff. So how we roll this out will be different than other residential or acute care facilities that we’ve run. Typically we just would [post] all of these positions at the same time, and people could apply. We’re gonna advertise for the master’s level clinicians first, and get those individuals on-boarded.
And once we have them all hired then we’ll advertise for the rest of the positions. And that way nobody will be waiting for long periods of time. Worst case scenario, I mean, what could happen if you advertise for all the positions at once and you don’t fill those clinical positions, you could have to lay people off, before you even started. So we’re not going to do that.
Miller: What is the timeline right now for opening? If all goes well?
Lindsay: We do have a remodel that needs to occur on the facility and that remodel will be going up to bid for contractors in the next… it may be open right now, I’m trying to think. If it’s not open right now, it’ll be going out for bid in the next couple of weeks. The timeline for opening it, if all goes well, is the end of August 2023.
Miller: Kimberly Lindsay, thanks very much for joining us.
Lindsay: Thank you.
Miller: Kimberly Lindsay is the executive director of Community Counseling Solutions. They are planning to reopen the currently shuttered psychiatric hospital in Hermiston.
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