Oregon behavioral health director pushes workers to hold agency accountable 

Oregon Health Authority Behavioral Health Director Ebony Clarke told hundreds of peer workers in a Seaside conference that they are a vital link in the state’s response to an ongoing addiction and mental health crisis. 

Clarke spoke Monday at Peerpocalypse, a gathering of people who work in peer support roles. Peer workers draw upon their life experiences to help people, including those struggling with drug and alcohol addiction and other issues. The four-day event, organized by the Portland nonprofit Mental Health & Addiction Association of Oregon, has grown in the past decade from less than 100 people in 2013 to nearly 900 in attendance on Monday. 

“We’re in a crisis,” Clarke said. “First and foremost, to me it’s about safety, trust and belonging. To me, it’s about connection, and we have to have a workforce that truly understands the need.”

The gathering comes as Oregon faces a herculean task of reining in the state’s tide of fentanyl overdoses and addiction, as well as a broader behavioral health crisis and workforce shortage that makes access to services difficult. State lawmakers have allocated millions of dollars in recent years to the problem, including the approval of more than $1.3 billion for behavioral health needs in 2021. This session, lawmakers allocated $211 million as part of House Bill 4002, which aims to encourage people to enter treatment for fentanyl and other addictions and allow counties to set up diversion programs if they wish to do so. 

Clarke, addressing the event for the second time as the state’s behavioral health director, asked the audience what they need to meet the needs of suffering Oregonians. 

People shouted  “money” and “outcomes” and “housing” in the conference room at the Seaside Civic & Convention Center. 

“Peers,” Clarke said, answering the question for the audience. 

Clarke said the state has fallen short at times in addressing the behavioral and addiction crisis and promised to do her best to give peers – and their experiences – a voice. 

“Quite frankly, I recognize that we, as government, I recognize that we as system providers, have continuously done harm,” Clarke said. “And so every day that I stand up, every day that I can come before you all, I’m committed to holding myself accountable and living out the value of what it means to truly integrate lived experience and your voice.”

Clarke also gave a historical overview of the history of the peer worker and consumer rights movement in Oregon, which can be traced to 1970, naming landmarks, such as the health authority formally incorporating peers into agency staff in 2014. In 2022, the health authority opened the Office of Recovery and Resilience, which spearheads peer work in the authority and looks for ways to give people with experiences a voice in the state’s work.

“We’d love for you to hold us accountable,” Clarke said. “We expect for you to ask us questions. We expect for you to push us.”

Peers have specific roles 

Oregon’s behavioral health and addiction system is in a state of transition. Twenty-three of Oregon’s 36 counties have agreed to set up new programs to allow people to start recovery instead of face criminal drug possession charges and go to jail. Through House Bill 4002, counties will have flexibility to set up the programs based on input from community mental health providers, prosecutors, law enforcement and public defenders.

At this stage, counties are still planning the programs before the new law takes effect in September. It includes a new misdemeanor penalty for defendants who don’t participate in the programs. 

Janie Gullickson, the executive director of the  Mental Health & Addiction Association of Oregon, said in an interview that peers, who are certified by the state or the association, can play a role in those programs and their planning. 

But she stressed she doesn’t want to see peer workers put in a position where they are expected to be compliance officers reporting on whether or not someone is participating in a deflection program. 

“The caution I would add and the hill I’m going to die on and advocate on my soapbox for is that peer services remain peer services,” Gullickson said.