Michael Reaves, M.D., medical director of Lane County Mental Health in Eugene, Ore., responded to questions from Psychiatric News about the impact of Oregon’s budget crisis on people with mental illness and about how psychiatrists can help.

How are patients responding to the threat of loss of medication and other services?

Reactions range from stunned disbelief to resigned acceptance. For me, it’s most painful to sit with a financially strapped, emotionally distraught individual who has a lifelong history of trauma and have her tell me that she is not surprised because she expects to be forgotten and "left behind."

The loss of resources reinforces a sense of worthlessness for many patients.

What are psychiatrists doing to address this crisis and the likelihood that it will worsen?

We are scrambling to help those most in need through patient assistance programs and marshalling the minimal resources we still have for the most critically ill.

Many of us are trying to envision how we can help a reorganized system rise from the ashes of this major conflagration. We are working directly with primary care colleagues, hospitals, emergency rooms, nonprofit mental health providers, public health, criminal justice, and charitable organizations. We are doing our best to educate fellow psychiatrists who are not involved directly with public psychiatry and encouraging them to advocate for our patients.

What is the worst aspect of the cuts?

The decision to eliminate the mental health benefit for a whole subgroup of enrollees in the Oregon Health Plan is, for me, the most distressing aspect of recent changes.

This cut flies in the face of all the efforts by organized psychiatry and medicine to establish parity for mental health disorders. To have a Medicaid program drop mental health benefits is a move backward for American medicine.

How does the fact that other public services are being cut affect the situation?

Cuts in criminal justice, education, and other human services areas lead to a sense that basic critical services in our state are imploding. It feels like we are in a free fall and are not certain when it will end or what the world will look like.

What would you like to tell other psychiatrists?

The changes that have taken place in Oregon could happen anywhere in the United States. Two years ago I could not have conceived of these changes occurring. Now they are a reality. ▪