On Monday, July 30, Portland’s main health care provider for people experiencing mental health crises unexpectedly shut its doors to new patients. According to officials at Unity Center for Behavioral Health, the temporary shutdown was due to an unforeseen staff shortage, following a major investigation by the Oregon Health Authority (OHA) into the facility’s staffing deficiencies that called for immediate staff training sessions. Unity Center couldn’t say when that shutdown would end.
While the training sessions are intended to improve the facility for future patients, they also threw a wrench into the region’s mental health care system—leaving many Portlanders stranded in emergency rooms that can’t adequately address their critical needs.
“It was completely out of the blue,” said Chris Bouneff, director of the National Alliance on Mental Illness (NAMI) for Oregon, a program that works closely with Unity Center. “We didn’t get any advance notice. They didn’t allow for the type of planning needed to close a major health asset.”
Unity Center, located across I-5 from the Moda Center, is first and only facility in the region with an emergency room specifically designed for those experiencing psychiatric crises. It’s also home to a whopping 107 psychiatric beds for longer-term patients, the result of four major hospitals deciding to close their psychiatric inpatient departments and consolidate services under one roof. One of those hospitals, Legacy Health, now runs Unity Center.
Since opening in 2017, Unity Center has become a one-stop shop for people seeking urgent mental health care in the metropolitan region. While the OHA’s recent report unveiled a tangle of miscommunication, serious staff errors, and training deficiencies that come with opening a psychiatric center, local leaders still see Unity Center as a solution to an overburdened mental health network.
But that solution ceased to be viable almost immediately after Unity Center announced its temporary ban on new patients who either arrive in an ambulance or are transferred from another hospital. (The facility continued to accept “walk-in patients.”) On Wednesday, two days after the closure, Bouneff said there were already an estimated 50 patients scattered across the region’s emergency rooms waiting to be transferred to Unity Center.
“When you take that many beds offline, the ramifications are magnified throughout the system,” says Bouneff. Bouneff adds he was worried about this problem when he first heard about plans for Unity Center.
“It puts a lot of pressure on one provider,” he said.
According to Brian Terrett, spokesperson for Unity Center, only 80 of the 107 inpatient beds were filled on Wednesday. But, he stressed, the center was not “closed,” and had diverted patients to other emergency care facilities. Terrett says temporary restrictions like these are procedures Unity Center has used in the past, though he doesn’t have records of when or how long those restrictions occurred.
Portland does have two other inpatient options for the kind of acute psychiatric care Unity Center offers: Providence Hospital and Cedar Hills Hospital. But both alternatives offer fewer beds than Unity, and unlike Unity, they don’t accept patients in the same way an emergency room would. That means when an ambulance is diverted from Unity Health, it often ends up not at Providence or Cedar Hills’ acute psychiatric care facilities, but at a standard hospital emergency department.
American Medical Response, the ambulance company that contracts with Multnomah County, reports that 24 percent of all behavioral health patients they transport are sent to Unity Center.
According to Oregon Health and Science University, last week’s closure didn’t impact its emergency department. But other hospitals felt the impact.
Herb Ozer, who oversees Kaiser Permanente’s mental and behavioral health departments, says his department depends on Unity Center to help with patients who have serious psychiatric needs.
When someone who’s experiencing a mental health crisis arrives in the Kaiser emergency room, Ozer says doctors first try to address the issues in-house. While Kaiser does have one inpatient care unit, it’s not suitable for what Ozer calls “high-risk patients.” That’s when his department turns to Unity Center.
Ozer estimates that 25 percent of all people seeking urgent behavioral health care at Kaiser end up being transferred to Unity Center.
“There’s a certain level of need that we can’t manage,” Ozer told the Mercury last week. “And right now, there’s a delay in the access of the level of care we need. We know we have patients waiting on Unity to reopen.”
Unity Center was specifically created to keep patients in crisis from waiting for treatment. Before Unity Center opened last year, mental health patients who entered a local hospital emergency room would regularly wait between 40 and 60 hours before seeing a qualified mental health specialist.
“People... were housed in a chaotic environment at a time when they were most vulnerable, and the experience was often more traumatizing than healing,” wrote Multnomah County Commissioner Sharon Meieran in an email to the Mercury. Meieran is an emergency room physician in Portland and helped introduce the Unity Health model—first executed in Alameda, California—to the region.
Meieran says she stands by the program but acknowledged that Unity Center is hardly an end-all solution to mental health care in Portland.
“It is clear that coordination of services, including outpatient community mental health services, substance abuse services, and, perhaps most importantly, affordable, supportive housing are all essential pieces of the puzzle,” Meieran writes.
A week ago, Unity Center announced it was “ramping up” toward normal operations and “will begin to accept patients brought to the hospital by ambulance.” But there’s been no update since. Unity Center’s media office did not return the Mercury’s Tuesday call requesting comment. (Update: On Wednesday morning, a spokesperson for Unity confirmed that the center is "functioning at normal operations.")
NAMI’s Bouneff said he’s eager to learn why, exactly, Unity Center had to close its key services so urgently, putting patients’ health at risk. In the meantime, he said, the pause has left other mental health providers and advocates “scrambling.”
“This doesn’t just have a ripple effect on us,” Bouneff said. “It’s a burst dam. And we all got flooded.”