By Nicole Hayden
PORTLAND, Ore. — A year ago, Sandi Jernstrom was waiting to die. Living unsheltered in the Lents neighborhood of Southeast Portland, the 45-year-old believed her former partner would kill her, as he repeatedly told her she wouldn’t live until the next day, she said.
But now, Jernstrom is safe from abuse, has moved from a tent to an RV and is on waitlists to obtain more permanent housing and mental health care.
“I feel a lot better now,” Jernstrom said on a recent Wednesday as she doted on her two small dogs. “I have a reason to wake up every day … I threw around the idea of going back to school before, but I thought, ‘I can’t do that.’ But the person I am starting to feel like again, I think she could do it.”
She credits her safety and progress to Heather Middleton, a community health worker on one of Portland’s new non-police street response teams. Operated out of Portland Fire & Rescue, the program, dubbed Portland Street Response, sends trained mental health workers instead of armed officers to intervene with individuals experiencing a mental health crisis.
On March 28, the team will grow three-fold and expand its coverage area from the 36 square miles of Lents, the initial pilot program area, to the city’s full 145 square miles.
Robyn Burek, the program’s manager, said her teams figured out how to earn trust from individuals living on the street over the past year and how they can effectively function as a new arm of the city’s emergency response structure.
“We learned so much and I am excited what an expansion citywide will look like,” Burek said
While the expansion – that will bring the program’s cost to $2.98 million for the budget year — won’t fully meet the demand for behavioral health calls in Portland, Burek said, it is “a good next step.”
This next phase will add 15 workers to increase the program from two response teams to six. Burek plans to ask the City Council in October to approve funds for two additional two-person teams.
any Portland community members and business owners have been demanding such an expansion.
Scott Kerman, director of homeless services organization Blanchet House in Old Town, has been counting down the days, ruing the unaddressed misery and mental health needs of people camping outdoors in cold and rain.
Kerman, along with local business owners, often has been forced to call police for assistance when trying to defuse an individual’s mental health episode.
Even with the much-anticipated growth of patient, trauma-informed care for people living on the street, challenges lie ahead. While Burek worries about having enough capacity to promptly respond to each call, Portland Street Response workers are frustrated by the lack of long-term mental health care services for the people they’re summoned to help. That shortage has made it hard to help clients with more than just immediate needs, they say.
A SUCCESS STORY
Jernstrom first interacted with Portland Street Response workers a year ago. Her former partner was experiencing a panic attack and needed to be calmed down. She remembered a friend told her the crisis team was trustworthy, so she frantically phoned for their help. No one had ever been able to calm her partner down, she said, but Middleton was able to.
From then on, trust between the two women continued to build. Middleton would drop by to bring Jernstrom water or other essentials. They would eat lunch together. Middleton would help troubleshoot challenges like finding Jernstrom a new phone or identification. When the time came that Jernstrom was ready to stop living with her volatile partner, Middleton was the one she trusted to help her through it.
An evaluation of Portland Street Response’s first six months in operation, conducted by Portland State University, found that the team responded to 383 incidents and that the help they provided was fiercely appreciated. Two-thirds of the team’s calls involved individuals experiencing homelessness, while 53% included someone with suspected mental health needs.
As of mid-February, the team has responded to a total of 897 calls, though specifics of those won’t be released until the one-year evaluation is complete.
During the first six months, the most common outcome by far was that the responding firefighter-paramedic and licensed mental health crisis therapist evaluated the person in distress and no further treatment was required. But 11% of clients were connected to ongoing assistance, as Jernstrom was.
In the first year, the team made 87 referrals, mostly connecting individuals to one of Portland Street Response’s community health workers, including Middleton, who work in depth with clients to evaluate their long-term needs and provide case management. These workers advocate for clients to be connected to services and help offered by other organizations. They can also connect clients to the team’s own peer support specialists, who have lived experience with mental health struggles or homelessness and can attend appointments with the client or just be there as another person to talk to.
WATER, SNACKS AND A LISTENING EAR
Britt Urban and Brian Chavez, mental health crisis responders for Portland Street Response, were the initial team members sent to nearly every call in Lents so far. Urban works days while Chavez wrangles the night shift. They described the first year as challenging, with many fulfilling moments along the way.
Most calls came from business owners, neighbors or passersby who called 911 out of concern about an individual lying on the ground or yelling or screaming. Urban said many calls involved people experiencing psychosis, which can include paranoia and delusional thoughts. Psychosis often presents as agitation and confusion. At times, callers have also reported individuals wandering through traffic or women who lack clothes. Many psychosis cases the team has responded to are meth-induced, Urban said.
The crisis team typically responds to these calls within 24 minutes.
“What we do is show up and explain why we are there,” Urban said. “We make sure they know we are not police, we are not enforcement and we will not be forcing them to do anything. We try to deescalate and make sure the individual is out of harm, such as if they are going in and out of traffic, we address that. Our biggest tools are water and snacks, to show people we are there to take care of them. And a lot of times de-escalation can just be allowing the person space and control to vent or be angry and giving them the time to calm down.”
In one instance he recalls well, Chavez responded to an individual who was screaming and visibly upset.
“(The individual) ended up literally saying, ‘I just needed to get that out,’” he said. “And then we got them a bus ticket and they went on their way. But it was a poignant moment because we are oriented in a way that allows us to be able to spend that time with people to get a positive outcome like that.”
This week, Urban also crossed paths with a frequent client who ran up to Urban and wrapped her in a giant hug.
“(This individual) has a significant trauma history and we have seen them in various states of crisis,” Urban said. “When we first met them, they weren’t in a place to get off the street and it is not our role to pressure someone to find housing or stop using substances. But today, they talked about wanting to work with one of our community health workers to find housing. The trust we built over time with them, it means when they are ready to make changes, they know we are a program that can assist.”
HELP – AND A LONG WAIT
While most client calls result in one-time interactions, others become ongoing relationships.
Since Jernstrom often doesn’t have internet access or even a place to charge her cell phone, she isn’t able to easily tackle housing applications. But with help from Middleton, Jernstrom has gotten onto several waitlists for a reduced-cost apartment or a housing voucher that will cover a portion of her rent.
Open to moving, Jernstrom is on lists for housing in four different counties, from Multnomah to Marion, in addition to lists though Cascade Management, Rose Community Development, Human Solutions and Relay Resources. Middleton estimates that Jernstrom could be on those waitlists anywhere from one to three years before any lead to an affordable apartment or a housing voucher.
The list of nonprofit agencies that Middleton has worked to connect Jernstrom to in the meantime is also long. Middleton asked Transition Projects, Cascadia Behavioral Health and Central City Concern – all of which play a role in helping hundreds of Portland residents experiencing homelessness — to help her find housing, rebound from domestic violence and get care for her mental health. Transition Projects has also delivered mail to Jernstrom on multiple occasions.
Jernstrom is also on a Lion’s Club waitlist to get a free eye exam, which could require a wait of up to two years. She’s also on a waitlist for mental health support from Life Works NW, which Middleton estimates will take about two months.
While they wait, Middleton will continue checking on Jernstrom as she responds to other clients and makes rounds in the neighborhood.
And soon, there will be more workers like Middleton reaching all corners of the city. Portland Street Response will scale up from two mental health crisis responders to six, from two community health workers to five, from two peer support specialists to four and will add six community health medics. The medics will provide lower-level medical care than a paramedic, as program officials found extensive medical care was rarely needed on calls the team received.
With the additional workers, the total cost for 2021-22 will be nearly $3 million, coming from both the general fund and fire department budgets. The costs to operate the expanded program year-round will run even higher, so the city has built in $4.8 million a year for future budgets, a program spokeswoman said.
The teams will work from 8 a.m. to 10 p.m., seven days a week. Currently, a 6 p.m. to 2 a.m. shift is staffed but that will be eliminated come March. Burek said most calls after 10 p.m. are for more dangerous emergencies that police respond to instead.
Street Response teams respond to non-emergency calls about mental health crises or intoxication, welfare checks and other low-acuity situations occurring outdoors or in public buildings. They do not respond to threats of suicide or instances that callers indicate involve violence or weapons. They also do not respond to situations inside homes.
While city officials have discussed potentially allowing Portland Street Response workers to be dispatched to suicide calls, that decision is still undecided. However, Burek said that during the city’s recent negotiations with its police union over a new contract, the Portland Police Association showed support for the team’s expansion.
If the City Council approves, a committee including police, fire, dispatch and Portland Street Response leaders will decide how to broaden the categories of calls that Street Response teams are sent to. That change could take effect in 2022, Burek said.
While Portland Street Response can provide some ongoing care to clients, the teams’ leaders have found many of the community resources they need to make the largest, most effective impact are in short supply or lacking altogether. They cite the need for more inpatient mental health care, medical detoxification treatment, drop-in day centers with access to services and mental health clinics with immediate appointments available. And they say the city desperately needs the clearest solution to solve any homelessness-related challenge: affordable housing.
Donald Johnson, interim chair of the Lents Neighborhood Association, said he believes Portland Street Response’s impact on the neighborhood has been positive, but he believes even more resources are needed. He would like to see additional workers walking the streets to connect individuals to housing and supportive resources.
“We’re dealing with all of the encampments … Driving by once in a while doesn’t fix this … There is a sense that (Portland Street Response is) the way forward” but the city’s overall lack of resources for people experiencing homelessness is frustrating, he said.
Street Response workers agree.
“If we had day centers and clinics around the city where people could get more immediate services beyond crisis intervention, that would go a long way,” said Urban, the mental health crisis responder. “The ongoing challenge is wanting to do more for someone but that’s not always possible given the circumstances.”
In Los Angeles, a street response team out of the University of Southern California addresses that city’s lack of long-term mental health care by dispensing medications and providing basic treatment of mental illness and drug and alcohol counseling during regular street rounds.
Portland Street Response doesn’t have authorization to prescribe or distribute medications or provide extensive counseling. However, the program has coordinated with the all-volunteer coalition of health care providers known as Portland Street Medicine to help some individuals get medical care without having to leave their encampment.
Oregon’s senior U.S. senator, Ron Wyden, has led an effort in the past year to allow states to get additional funds through Medicaid to support mobile crisis teams like Portland Street Response. Wyden, a Democrat, said in an emailed statement this week that he is working with the Senate Finance Committee to create bipartisan legislation by this summer to address shortfalls in the mental health care system that he hopes will create more resources.
Portland Commissioner Jo Ann Hardesty, who oversees the fire department, said Portland Street Response officials’ insights have helped identify gaps in the system, such as the need for more detox beds. She said that will help direct how any new federal dollars are spent.
Chavez, one of the mental health crisis responders, said he daydreams about the possibilities to come.
“I look forward to the day when I can say to a client ‘Someone will check on you tomorrow,’” he said. “People need to know someone will follow up.”
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