At this point, many of us have probably encountered someone in the midst of a drug, alcohol or mental health crisis in a public place. And you may have wondered: What can I do for that person? Where could that person go so as not to be disrupting public space? In Multnomah County for the last four years, the answer has been nowhere. Central City Concern’s Sobering Station closed abruptly in December 2019, and a lengthy effort to reopen a new center fell apart four years later. Now, Multnomah County Commissioner Julia Brim-Edwards has led an effort to propose a new center, which is backed by state funding. Brim-Edwards joins us to explain the final proposal.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. In 2019, the only dedicated sobering center in the city of Portland closed down. The timing couldn’t have been worse. It was only a few years before fentanyl and the deadliest wave of the opioid epidemic hit the west coast and swamped Portland in fatal overdoses. And then there was the pandemic. City and county leaders came together with behavioral health experts and law enforcement agencies to create a new sobering center, a new system. But after three years and millions of dollars, everything fell through. Now, finally, the county says it’s going to move forward with its own center. Commissioner Julia Brim-Edwards is the point person on it. She’ll be giving a presentation about this to the commission tomorrow, and she joins us now. Welcome back to the show.
Julia Brim-Edwards: Thanks for having me here today.
Miller: What happened back in the end of 2019 when the city’s only sobering center closed down? What did that mean for the region?
Brim-Edwards: It meant that we had a huge gap in our emergency system, in that we were gonna have people on the streets, with no place to go. If you were a first responder, and you encountered somebody who was severely intoxicated, whether it was alcohol or drugs, there was no place to take them. So your choices were very limited. You could take them potentially to the ER, which is not necessarily the right place. You could take them to the jail, which we know also is not the right place. Or you could leave them on the street. None of those were really good choices. And so we know that there’s an urgent need from talking to police officers, firefighters, Portland Street Response, have all told me this is an urgent need that needs to be stood up right away, so the people who are on our streets who need services have that ability to get sober or stabilize, and potentially access treatment.
Miller: So leave people where they are, take them to the ER, take them to the jail, as you’re saying none of those are the right option. But in general, which one of those did emergency responders turn to? What would happen most often?
Brim-Edwards: I think it depended upon the circumstances. If somebody could be left on the streets and it wasn’t life threatening, that was an option because there wasn’t a place to take them. We know that emergency rooms often had people who were severely intoxicated. And so they just entered into the crowded ER, and potentially delayed service to other people who had health emergencies. And some of those people also ended up in jail depending on their circumstances.
So, it was a little bit of everything. But really what I heard over and over again from first responders was that sort of heartbreaking “I think they’re okay, we’re gonna leave them on the street,” and the first responders knowing there actually could be a much better place for them to be, which is the sobering center.
Miller: That was more than four years ago. And as I mentioned, city leaders, county leaders, a bunch of other folks came together and they spent years and millions of dollars in consulting and hundreds of hours talking, working through all kinds of issues to create a new system and a new sobering center. And then it all fell through. We don’t have enough time to go through dissecting all of that, but it actually does seem important to just at least ask one question about it: what went wrong? And the reasons that that fell through, how much are those complicating your efforts now?
Brim-Edwards: Well, because I’m new to the commission, and I wasn’t part of the BHECN [Behavioral Health Emergency Coordination Network] process.
Miller: That was eventually the acronym for the second iteration of that failed process.
Brim-Edwards: So one of the things was they tried to do everything at once. And a critical piece is we are taking a very discreet piece of that, and trying to stand it up right away, with a very ambitious timeline. And that’s the 24/7 drop off sobering center. And instead of setting up the whole continuum of care, we’re focusing on this very important piece which we know is important for the person who’s severely intoxicated on the streets. We also know it has a huge impact on community safety and livability, if we don’t take care of that piece.
We also took some lessons learned that came out of that. One of the reasons why, [in] 2019, that sobering center closed is the type of drugs had changed on our streets. The people who are showing up in the sobering center had very different needs. And we’ve tried to build it into this plan how to address those very different needs. And the other thing we know is the safety of staff who work in that Sobering Center is absolutely critical. We will not be able to staff it if we can’t ensure that staff are safe. And that was an issue in 2019.
So we’ve taken some lessons learned, hopefully put them into an actionable plan. It’s been informed by experts, both health care providers, but also our first responders, the Portland and Gresham police chief, the sheriff participated in this process, Judge Nan Waller. I feel like we have a plan that we’re ready to move forward the first piece of it.
Miller: And you’re not starting completely from scratch. You were able to use some of the communal wisdom that was gathered in that process?
Brim-Edwards: Absolutely. We took that, and we had a core project team that had lots of expertise. In addition, we went out and looked at best practices elsewhere in the country. We went to Baltimore, San Francisco, Eugene, to look at what made for a successful sobering center. And when we say success, that means that people have a safe place to sober up, and to access potential services like detox and treatment. The other thing we looked at for the best practices is how do we also establish this community safety and livability for everybody else?
Miller: I’m curious about that tour. You mentioned Baltimore and San Francisco, as well as Eugene. What are some specific things you learned from those tours that you think Multnomah County should either do because it’s a positive lesson, or not do because it was a negative example?
Brim-Edwards: Well, the first thing I learned is if Eugene, Baltimore, and San Francisco can do it, so can we. We shouldn’t not take this very first step.
Miller: Was anybody saying you can’t do this? It seemed like the opposite, why can’t you do this, why can’t the county/Portland region get your act together?
Brim-Edwards: Well, it’s a good question. I don’t know all of what happened in those four years…
Miller: Do you really not know? Or you’re commissioner now, and you have to be careful about not stepping on a lot of toes?
Brim-Edwards: I’ve heard a lot of things. The main thing was they tried to build out the entire system at one time.
Miller: Back to the lessons though, because I do want to hear this. What should you do based on what you saw in those other cities?
Brim-Edwards: First of all, having an in-house transportation capability is really important. Yes, first responders will be able to drop people off at the sobering center. But we also found at Baltimore that they outfitted vans, and when they got a call, they would go pick somebody up and transport them safely there, so it wasn’t a law enforcement transportation. In addition, once the person had sobered up, they were transported to the next step. So they weren’t just disgorged in the neighborhood.
Miller: This is one of the points that stood out to me in what you’ve prepared to talk about with the rest of your commissioners, is setting up a new transportation system. I think I understand the idea of not involving law enforcement if they’re not necessary. You might have people get more triggered and have more sort of escalated risks there. But what’s wrong with having EMTs take people? Why do you need a whole new transportation system set up to make a sobering center work?
Brim-Edwards: Well we could also, as we set it up, look to other resources we have here. For example, in San Francisco, their transport system is actually run by the fire department. And it looks very much like Portland Street Response, frankly. They have vans, they’re outfitted with an EMT, a social worker, and a peer mentor. Again, it’s very similar to Portland Street Response. So I think that we have other capabilities that potentially could be utilized. But we don’t want the lack of transport to be a barrier, which is why we built it in.
And again, the other important piece is the transport away. So in Baltimore, you wouldn’t even know that the crisis center was there, because there’s not a lot of people loitering outside. Basically, when they leave, they have transport to wherever they’re going. And one of the places they’re transported to is right next door. If that person is ready for detox and treatment right next door, they can access that right away, if they’re ready for that.
Also, we also heard very clearly that being near an emergency room, siting it near an emergency room was important for people who might have an escalated health issues while they’re sobering, we have access to that.
Miller: I want to go back to one of the points you made about one of the lessons you learned from the earlier process, which is that the drugs have changed. So how does the potency of fentanyl being, I don’t know, 50 or 100 times stronger as an opioid than what came before, change the way a sobering center has to operate?
Brim-Edwards: Some of the things we heard from individuals who worked at the other sobering centers is it’s really important to set up the environment when somebody enters the sobering center, to understand what they’re sobering from. In all the places we saw, you would see alcohol sobering being in one environment. It’s very quiet, people are essentially sleeping it off. If you are sobering from drug intoxication, more likely to be sitting in recliners, a lot more activity. So it’s not people sleeping something off, they are very active. Also having quiet rooms or places where people can be secluded from others is another thing that we saw in the sobering for drug intoxication versus alcohol intoxication.
Miller: Are we talking about “sleeping it off ,” getting sober over the course of a couple hours? Or are we talking about people saying “I want to seek treatment for this and get clean long-term”? Those seem like maybe overlapping but also potentially very different scenarios.
Brim-Edwards: I mean clearly the overriding goal that we would hope for is that eventually people seek treatment for their addictions. That ultimately is the goal. I think we also realistically know that a sobering center may be a place where somebody is there for six to eight hours, they sober up, they stabilize, they may return to the community. And frankly, they may come back, maybe back the next week, sobering. But we hope that there’s a point in time when people say “I’m sobered up, I’m stabilized, I’ve talked to a peer mentor, I’m ready to go for detox and treatment.” And that then, as a community, we need to make sure that we have beds available, and both detox and treatment.
Miller: We need to make sure we do. So that’s another way of saying that we don’t have them yet. I was wondering when you said that one of the key points here is not just transportation to the center, but transportation away to the next step. Are there enough places where people could get in that van and go to?
Brim-Edwards: Absolutely not. We know that there’s about a 40% gap between the need and what we actually have here. This is an “and” conversation. We need a sobering capability, and we need more detox and treatment. Because one of the most heartbreaking things I’ve heard from people’s mothers, grandmothers, sisters, brothers, daughters is “my relative or my friend needs treatment or detox.” And they were ready to go, they raised their hand, maybe they’d left the sobering center or a place where they’d sobered up, and they were ready for detox and treatment. And there’s not space available.
So there’s an urgency to both standing up the sobering center, and at the same time, to be focusing on expanding our detox and treatment capability.
Miller: But your larger point, your earlier point, is that you don’t want to wait for those inpatient beds to be up and running before you get this emergency sobering center up and running.
Brim-Edwards: Absolutely. Between 2018 and 2021, we saw a 533% increase in fentanyl overdose deaths. We know that every day that we don’t take action, more people are going to die on the streets of Portland. Which is a huge tragedy, obviously for that person, their family and their loved ones. It also has a huge impact on our community livability, and our community safety. So I think with standing up a sobering center, we’re gonna be able to accomplish two very important objectives.
Miller: My understanding is that in the failed process before, one of the sticking points was, people who might be sent to a sobering center because of maybe a drug induced psychosis, how long they could be held involuntarily. Where does that stand right now? And how much is that a part of active discussions?
Brim-Edwards: What we know from other places is that most people go to sobering centers voluntarily. And they could be there from anywhere from six to eight hours if it’s an alcohol sobering, or they could be there for an extended period of time if it’s a drug intoxication. We do know that people may end up needing it for a longer period of time. And that’s why it’s really critical that we also have a partnership with Providence and Unity, that they have sort of stepped up capabilities for people who have more acute sobering needs than we could offer at this particular sobering center.
Miller: Legally, how long can someone stay? The last thing I saw, it was 24 hours if the only issue is sobering. Is that the same? And do you want to up that?
Brim-Edwards: I believe it’s up 72 hours now.
Miller: If it’s simply about sobering, not if there’s some other added psychiatric diagnosis?
Brim-Edwards: So just to be clear, the sobering center is not for mental health issues. It’s for sobering. So if somebody shows up at the sobering center and it appears that they need alcohol sobering, but it turns out 12 hours later that it’s a persistent mental illness that is at the root of it, one of the important things is also the ability for us to transport and having very clear ways to transfer people, if they need a higher level of care that they get access to that.
Miller: I want to turn to funding. The legislature gave the county $25 million that can be used to get this facility up and running. Would we be having this conversation right now, would the county be moving forward if it hadn’t been for that allocation?
Brim-Edwards: I want to thank the governor, Senator Lieber, the others who took the lead on providing resources to counties, and the $25 million to Multnomah County. We originally started this project when I first got on the commission, I said this is the top priority. I’d heard from first responders, I’d heard from the community this is something we needed. So it wasn’t necessarily contemplated that we would get resources from the legislature. I’m very appreciative that we have. From my perspective, if we hadn’t got the resources from the legislature, this absolutely would be a priority in our county budgeting process, which we’re beginning shortly.
Miller: Do you anticipate the votes for the $14 million a year it’ll take to actually run this, to operate this as opposed to capital expenses to get it off the ground?
Brim-Edwards: What I would expect is for county commissioners to look at the trade-offs that we have in place now. Because we’re paying a huge cost with overcrowded emergency departments, people going to jail when they shouldn’t be and taking jail beds, there’s a cost there. I also think obviously there’s a very personal cost for the person that’s being left on the street without an opportunity to sober, without safety, potentially dying. So for me, the $14 million is a very good investment both to keep people safe, and also from a community safety and livability standpoint. Like right now, if you go down downtown to or to Old Town or outer East Portland, where you have people who are severely intoxicated without any sort of supports, we’re seeing people who are dying, who are having huge impacts on neighborhoods, and not good ones. And so to me it’s a cost that we should think is a very good investment. And certainly the trade off is that we’re gonna not have costs in other places.
Miller: Just briefly, do you have a short list of actual sites?
Brim-Edwards: We don’t yet. The plan lays out the specifications. We know it needs to be centrally located so it’s easy for first responders to drop people off. We also know it should be near an emergency room in case we need that stepped up care. As soon as we get the okay from the county chair to start looking, we will take that next step. It could be as early as next week if we get the okay from the county chair.
Miller: Julia Brim-Edwards, thanks very much.
Brim-Edwards: Thank you for having me.
Miller: Julia Brim-Edwards is a member of the Multnomah County Commission.
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