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State needs to spend $850 million on behavioral health beds over five years, report says

Inpatient psychiatric care gaps fuel racial and geographic disparities, according to an OHA-contracted study
July 1, 2024

Oregon needs to invest about $170 million annually over the next five years to meet the state’s projected behavioral health bed needs, according to a consultant’s study for the Oregon Health Authority.

The funding would add capacity of approximately 650 new beds per year. It would come in addition to more than $1.5 billion allocated by the Oregon Legislature over the last four years to expand behavioral health treatment capacity.

In May, state officials released a separate study showing 37% of people receiving mental health treatment in Oregon also have a diagnosed substance use disorder, compared to a national average of 27%. 

In a press release, State Behavioral Health Director Ebony Clarke echoed the new report’s observation that support services other than beds need additional funding to prevent Oregonians’ behavioral health challenges from getting worse.

“This report provides us with critical data to inform how we prioritize the creation of more treatment beds and it also underscores the broader understanding that we need to continue to invest in solutions that reduce the number of beds needed,” Clarke said. “We do this through investing in protective factors and earlier intervention – additional community-based programming, crisis and outpatient programs, in addition to other supportive services – to prevent people who are experiencing mental illness or substance use from progressing to a level of severity in their illnesses that would require treatment in a more acute setting.”

The report cited input from two focus groups to recommend significant changes to how Oregon tackles racial and inequities in the behavioral heath system. 

Oregon Black Brown Indigenous Advocacy Coalition members interviewed for the report said that mental health treatment facilities tend to adopt a “one size fits all” approach, but differences in cultures and backgrounds need to be recognized. They identified a “severe lack of Black, Brown and Indigenous providers” in behavioral treatment programs and across the care continuum.

The report also noted that Oregon’s system has geographic disparities. Columbia Gorge and Eastern Oregon, with a combined population of 226,458, are home to none of the state’s current 461 inpatient psychiatric beds. 

The report echoed advocates’ longstanding complaint that many facilities won’t accept patients that are most in need. It called for “establishment of ‘no refusal’ facilities, ensuring that critical mental health care services are accessible to all who need them, regardless of their circumstances or background.”

The report also called for the state to continue to raise provider payment rates and invest in beefing up the behavioral health workforce. 

“We don’t get to choose between adding beds and adding workforce. We must do both in order to make real change in our behavioral health system,” Clarke said, according to the release.

The report was produced at the direction of Gov. Tina Kotek. It was issued by Public Consulting Group, a firm that has produced similar studies in Oregon and other states. 

An earlier draft of the report called for a smaller investment to create more than 700 beds less than the new projections. The final report uses updated data, it said.