Cascadia Op-Ed

(Published in The Oregonian approx. 2008)

As a sporadic client of Cascadia Behavior Healthcare services, it saddens me to read the recent headlines about its problems. For many of us, the mentally ill, Cascadia is a lifeline, a comfortable place to go when we desperately need help. I have found the councilors and staff there uniformly compassionate and helpful, but always weary from the difficult task of caring for our city's vulnerable and sick. I have found more stable care elsewhere, but Cascadia remains a place I can go when my medication access is erratic or I fear that without help I will be headed for emergency services at a local hospital or psychiatric ward.

Aside from the moral question of why our culture will not take better care of the mentally ill, there is a financial aspect. You, the taxpayer, do not save any money by underfunding mental health services. When places like Cascadia go under or are allowed to languish in financial turmoil, where do you thing the mentally ill go? The answer is usually to the streets, into the jails, and in the waiting rooms of local hospitals whose services most of us cannot pay for.

When we are arrested, the public pays far more to house us in jail than to help treat our real problems. When we skip out on hospital bills, everyone else pays higher insurance premiums and hospital costs. When we end up on the streets, we prey and are preyed upon, drink and use drugs to medicate ourselves, sleep in your doorways, bother you for spare change. A survey of the homeless population in Miami, detailed in Pete Earley's book Crazy, found that 100% of that city's chronic homeless were mentally ill. Every single one. Undoubtedly it is the same or similar everywhere in America.

So when you read a headline about the possibility of losing Cascadia or a proposal to help it dig out of its financial hole, please remember it affects you too. If it looks like just a bailout, remember that even a poorly run—I have no insight one way or another into the management of Cascadia—frontline mental health provider is a far better deal for the money than the alternatives. And know that most of the people who care for us, even in the best of times, are poorly paid, overworked, and undervalued. They do what they do out of compassion, the kind that society as whole does not seem to share.

I can tell you, having spent many an afternoon in the Southeast Division Cascadia waiting room, that the line between you and us is not as clear as you might think. It is a continuum and I have met a lot of people trying to hang on to their jobs and families, their place in “normal” society. We are sometimes the easily marginalized schizophrenics mumbling to ourselves on street corners, but we are also people who look just like you.