Behavioral health

In Multnomah County, behavioral health is the umbrella for mental health services, addiction treatment, and crisis response. The county spends roughly $150 million a year on these services, and the demand is growing while funding is under pressure from multiple directions. I've spent more than 20 years working in the county's behavioral health and human services programs and currently manage long-term rehabilitation through Bienestar.

What the county is responsible for

The Behavioral Health Division sits within the Health Department and serves as the county's local mental health authority. It delivers services both directly and through more than 100 contracts with community-based providers. The county pays for treatment and recovery services from its own general fund, not just state and federal dollars. Mental health and addiction services carry separate licensing and separate funding, even though the people who need one often need the other.

In September 2025, CareOregon, the state's largest Medicaid provider, ended its intensive care coordination funding, opening a $4.6 million gap in the county's behavioral health budget. The Board covered $2.4 million. The rest came out of the youth, adult, and jail care coordination teams. The FY 2027 budget proposes further cuts to behavioral health.

What I've seen

With a program I manage at Bienestar, we work with people for 12 to 24 months, combining housing with treatment and employment support. We can assist five to eight people at a time. The funding isn't there for more.

I've worked with a woman who struggled with addiction and had been in and out of the justice system. When she got out, the county placed her in an apartment but didn't connect her with behavioral health services. She was selling the furniture to fund her habits. We brought her into our program, found her permanent housing, and spent the next 14 months getting her into regular treatment and helping her find work. I'm happy to say she's now working, paying her own rent, and self-sufficient for the first time.

We spent 14 months with her. Many people who come through the county's behavioral health system only need short-term counseling, and the system handles that. But for people dealing with addiction, mental illness, and housing instability at the same time, which is a common thread, there's not much in the way of comprehensive rehabilitation services to create a long-term change in behavior.

Opportunities

The county declared a fentanyl state of emergency in March 2026. Its own addiction services staff have made it clear that traditional treatment approaches aren't working for fentanyl. Narcan, which can reverse an opioid overdose, saves lives in the moment but doesn't treat the addiction. You can declare all the emergencies you want. Without the treatment programs and practitioners to back it up, nothing changes.

The county doesn't have enough licensed behavioral health practitioners for counseling or addiction treatment. And the programs they work for should be measuring what they produce. Treatment completion, patient progress, whether diagnoses are improving over time. Most of that isn't being tracked. When it is, it shows the public what their money is buying, and it shows the practitioners and staff what their work is producing. That's how they get the funding and support they need.

At Bienestar, we've shown what long-term rehabilitation can produce. That should be the standard for people with severe and overlapping needs, not an exception that reaches a handful at a time. It takes multi-year funding and committed staff, not one-time grants that end before the work is done.

Commissioners vote on the budget every year. That's where these changes start.