⁄Tactics⁄ What is your agency seeing right now that it was not seeing when you started in 2017? Central City Concern is an agency that’s been around in the region for, now, 43 years. We provide health care, we provide housing and we provide employment services, and we’re serving upwards of 13,000 to 14,000 people annually. We know that about 75% of the folks that start receiving services here at Central City Concern step into our health-services programming through Hooper Detoxi cation Center, which has been around for decades and is located near the Rose Quarter. Hooper is a medically supervised withdrawal-management program where we’re serving more than 2,500 individuals annually. It’s a 24/7 program; we serve a ton of folks year-round. We help those individuals get medically stabilized and detoxi ed from opioids, from methamphetamine, from alcohol, from benzodiazepines and other substances. Half of the folks we serve at Hooper come in with a primary diagnosis of opioid-use disorder, and the vast majority of those individuals over the last two years have shifted from using heroin to using fentanyl. Most of those individuals have been smoking fentanyl, but now we’re starting to see a shift back toward injecting fentanyl. And many people report that they have a history of overdose. We also have thousands of people who we’re providing a housing resource to. We have about 3,500 people who live with us in our housing continuum. Some of those are folks who have permanent housing with us and some of those are folks who have transitional housing with us. We know that substance-use disorder is represented in the community of folks who live with us. We have, over the last 18 months, been very intentional about developing a zero-overdose strategic approach whereby we are providing wide access to naloxone, which is the medicine used to reverse opioid overdose. It doesn’t mean that there aren’t folks still experiencing overdose. But what it does mean is that all of our housing staff are trained to respond, which is a really signi cant investment for us. On the back end, the goal is to provide support and to hope to get folks to a place where they’re open to engaging in withdrawal management and, better yet, engaging in treatment. Talking about that 40% of people who need acute mental health services, what are your thoughts on how the system is both addressing and not addressing the needs of people who are acutely mentally ill but not necessarily substance-affected? We do not currently have a fully resourced or fully functional continuum of psychiatric care within the region, nor do we have a state mental hospital or mental health hospital system at the Oregon State Hospital that can fully meet the needs of the population of the state of Oregon. That is our truth. Our truth is that we know that there is a signi cant gap between the demand and the need and the availability of inpatient and residential beds. That has been exacerbated by the COVID pandemic, which had a signi cant impact in terms of creating isolation; folks with severe mental illness and substance-use disorders need a lot of contact. They need a lot of support and accountability. Many of those regular connections became disrupted. During the same time period, there was a reduction in the behavioral health workforce, both in terms of psychiatric care and also in terms of substance-use disorders care. The Alcohol and Drug Policy Commission report from PSU and OHSU calculated that we were de cient 36,000 behavioral health care workers in the state of Oregon — in a prepandemic estimate. Central City Concern is one of several agencies in the region that is suffering from persistent vacancies among our behavioral health workforce. Then we layer in an inadequate system of care for higher levels of acute psychiatric care that’s been persistent for a long time; all of that is contributing to create the ecosystem that we live in within this region. It’s really dif cult for me as a physician — and for me as a leader of the organization — to know that we’re providing housing to individuals who are challenged to take care of themselves: They lack capacity to make decisions and therefore might be deemed incompetent. Our current state commitment standards have a really high bar. I think it’s really important for us in the region and in the state to evaluate our commitment standards to lower that bar, to do a better job of caring for people who lack the capacity to make decisions in their own best interest. It’s a false ag of freedom to think that somebody who lacks capacity actually is making decisions — because again, they lack capacity to make decisions. Let’s not mistake that lack of capacity with freedom more broadly, especially when we’re talking about treatable psychiatric conditions. Andy Mendenhall Urges ‘Courageous Optimism’ Amid Behavioral Health Crisis Central City Concern’s CEO talks about how his organization has responded to the pandemic, the escalating behavioral health crisis and what’s next. INTERVIEW BY CHRISTEN McCURDY This July Andy Mendenhall celebrates one year as CEO of Central City Concern. Mendenhall, who comes from Phoenix originally, attended college at the University of Portland and medical school at Oregon Health & Science University. Board-certi ed in addiction medicine and family medicine, he co-founded an outpatient integrated substance-abuse treatment program called HealthWorks NW, which was acquired by Hazelden Betty Ford in . Mendenhall joined CCC in as senior medical director for substance-use disorder services and became chief medical o cer in . He succeeded Rachel Solotaroff, who left the organization last summer after ve years as CEO and years total with the organization. CCC was founded in as Burnside Consortium and tasked initially with addressing the prevalence of alcoholism in Portland’s Old Town area. e organization purchased and began managing multiple downtown hotels, and assumed management of Hooper Detoxi cation Stabilization Center in . The organization now manages multiple addiction treatment centers, addiction clinics and a ordable-housing buildings in Portland. is interview has been edited for space and clarity. 14
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