Data shows that Oregon has higher rates of mental illness than most states but provides fewer services. Chris Boonev says that’s because states have found themselves in a predicament where the cost of mental illness is borne solely by taxpayers, while private insurance companies have historically provided little coverage.
Bunev came to the National Alliance on Mental Illness of Oregon as a volunteer in 2004 and has led the organization since 2009. The nonprofit organization has 17 branches across the state and provides free education and support programs to families living with mental illness. “At NAMI, we are people with lived experience,” he says. “We either live with a mental illness, or it’s a family member, or we’re a parent. Most of us are just like me. We check multiple boxes.”
NAMI serves approximately 14,000 Oregonians annually and advocates for Congress and state and county health officials.In the latest in a series of interviews WW Mr. Bunev, 54, who has conducted research with insightful experts on Oregon’s broken mental health system, stopped by our office last week for an hour-long discussion. The former journalist answered questions about why Oregon has struggled for so long to provide adequate mental health services. His answers have been edited for brevity and clarity.
WW: Data regularly shows that Oregon has the highest prevalence of mental illness in the country. why?
Chris Boonev: Nobody knows. I haven’t seen anything authoritative explaining it in academic literature or comparative data.
What does Nami do every day?
We receive about 2,000 calls and emails a year asking, “How can I help my loved one?” For example, yesterday I received a call from a father in Marion County about her 22-year-old daughter. She is experiencing her first psychotic episode. He experiences what it’s like to take someone to the emergency room and be told, “We can’t do anything.” As an advocate, you will spend most of your day angry.
Dr. George Keepers, chair of the Department of Psychiatry at Oregon Health and Science University, recently said that Oregon’s decentralized mental health services system is expensive and has terrible outcomes. what is your view?
Well, we’ve always had structural misalignment. Before her 2005, when Oregon passed the Health Insurance Parity Act, most people had no insurance for mental health conditions. This is especially true if you are an adult with a severe mental illness and are not eligible for Medicaid.
Like many states, Oregon is organized by county, but who else would consider the population as a whole? But that doesn’t make sense. What other medical field is completely under the jurisdiction of the county government? Oncology? Heart disease? And in 2011, we established the Medicaid Cooperative Care Organization Network. So our state is in turmoil. Who is responsible for mental health? Is it a coordinated care organization? County?
How can the system work better?
We need to start moving behavioral health care out of the government and into the health care system. We need to force private payers to pay more for things that we know work, things that are really only available in the Medicaid system.
Do other states have more effective parity laws?
not now. Not now. With fundamental updates in 2021, I think Oregon can be at the forefront of parity laws. And now that we’re in that position, the question is how aggressive regulators will be. The Medicaid side is the Oregon Health Authority. The commercial side will be the Oregon Department of Insurance. How aggressive are they going to be in enforcing these requirements? Oregon is known for being highly regulated.
Some say Oregon’s insurance regulators are ineffective.
There was a moment when the insurance sector really stepped up. One good example is applied behavioral analysis, which is a treatment for autism. This was incorporated into Oregon’s parity law at the time. But primarily in my experience, Oregon, from the attorney general to the Oregon Health Authority to the health department, is biased toward collegiality and not really bringing down the hammer when they think it’s more appropriate. I don’t.
Where are the examples where you want them to drop the hammer?
Well, there are treatments that were previously not covered by private health insurance. For example, Oregon is at the forefront of early intervention for mental illness. This onset usually occurs when people are young, and effective interventions have been found to be more successful in keeping people on their life path the closer they are to onset. However, if you have private insurance in this state, that service is not available to you. That doesn’t make sense.
Let’s talk about more details. What do you think about ketamine?
Well, evidence shows that it is effective for treatment-resistant depression. But this reveals the perversion of our system. The data we have is on ketamine infusions. However, nasal sprays are still available. Because it’s manufactured by Johnson & Johnson and is FDA approved. There is no benefit to this IV as it is essentially a generic form of ketamine. No one wants to do more research because there is no money to be made.
Has NAMI taken a position on Measure 110, Oregon’s drug decriminalization plan?
No, we remained neutral. We came to the conclusion that if you had defined the goal that Measure 110 was trying to accomplish, it would not have been accomplished the way it did. This demonstrated the dangers of trying to implement these major initiatives through voting.
Some lawmakers want to lower the hurdles for civil participation. what is your view?
We supported that bill in 2021. [It didnât pass.] We set up our own workgroup to talk about lowering the bar a little. At the same time, if you just change the criteria that qualifies someone to commit, but you don’t have a corresponding package of services, you’re not doing anything other than contributing to the logjam we have going on. . I already have it.
Having been an advocate for 20 years, what troubles you the most?
Why are we almost entirely reliant on public funding for behavioral health? Why are we producing a highly qualified workforce that is incapable of even comprehensive mental health assessments? Why aren’t we proactively measuring network adequacy on both the commercial and Medicaid sides?
Are public funds being poured into mental health care because people facing mental health crises are disproportionately low-income?
No. I’ve served families in this city who have streets named after them, and they struggle just like everyone else. They often don’t talk about it.
So why don’t we see hospital wings for mental health funded by big names?
Until 2005, Oregon didn’t care if you had a mental illness. If we do so, we will not pay anything for your care. What hospital would provide a service to anyone or develop a department to provide a service if no one would pay for the service?
It wasn’t until 2021, when large amounts of American Rescue Plan money flowed into the state, that the state Legislature finally committed money to building that capacity. It’s unrealistic to expect to make up for what should have taken 20 years to do in two years.
