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JULIANA:
Welcome to They Are Us, where you’ll hear stories of resilience and hope from folks in recovery and insights from experts in the field. I’m your host, Juliana.
This is the final episode of this season. Thank you for joining us as we explored housing, healthcare, employment, community, the impact of street drugs, and the power of second chances. Now we’re turning the spotlight on you, our listeners.
Throughout this podcast series, you’ve sent in thoughtful and powerful questions. So, we invited back CCC’s president and CEO, Dr. Andy Mendenhall, to help answer a few. Let’s get started.
We kicked off this season by talking to Dr. Andy Mendenhall, CCC’s president and CEO. Now for our final episode, we’re glad to have him back to help us answer some of the thoughtful questions our listeners have sent in. Welcome back, Dr. Andy.
DR. ANDY MENDENHALL:
Thanks Juliana, it’s great to be here.
JULIANA:
All right, let’s get to some of these questions.
The first one is from someone who works with folks in recovery. They say, when I speak to friends and family about my work, they always ask me, if we offer more services for challenged populations, aren’t we just attracting folks from out of town with a multitude of issues into our community? How would you reply to that?
DR. ANDY MENDENHALL:
So, two things, I mean the first is humanistically, if somebody is actually seeking help and seeking services, why wouldn’t they? Why wouldn’t they come get really great service wherever they could find it, especially recognizing the dearth of services that exist in many communities, both across rural Oregon, rural Washington, and quite frankly, here at home too. There is that supply and demand mismatch in terms of what people need and what they’re seeking. But it’s also important to know that the vast majority, not all, but the vast majority of folks that receive services within this region actually originate and come from this region.
JULIANA:
Okay, that’s a good one. Here’s another one. Explain the various levels of supportive housing and why we can’t just put someone into permanent housing right after they detox.
DR. ANDY MENDENHALL:
Going from detox to permanent housing would assume a couple of things. Right? First, that that person was medically stable and that they had received the support that they need in order to then have successful tenancy. Right? Being a successful tenant in that permanent housing unit. So, there’s a gap between where folks are actually at in terms of getting healthy and what they need in order to benefit the most from that permanent housing placement.
So that’s one layer. Another layer that’s a little bit more important is recognizing that the best spot for folks to land after detox is either in a transitional recovery housing program where they are surrounded by folks who are also on the same recovery journey, they’re in a housing environment that’s alcohol and drug free, and they’re able to then also get behavioral health treatment services, we would call that SUD or substance use disorder treatment services, primary care, all those things.
And then here’s the most compelling piece is a lot of those folks don’t actually need what we would traditionally consider a permanent housing placement. A lot of folks get healthy, they go back to work, and then they start paying their taxes and paying rent and they’re out in the general property market, so to speak, and they might need or benefit from some affordable housing, but affordable housing is very different than a permanent supportive housing program, which might be for somebody who’s disabled, right? And may not have the ability to be gainfully employed, where they’re paying taxes and they’ve got healthcare benefits, and they’re back out on their own. In fact, many people who start off in detox and navigate our systems, they’re homeowners. They’re earning, you know, beyond living wage jobs. They’re earning, you know, solid family wage jobs.
JULIANA:
Well, it’s safe to say on this topic that there are a variety of options for folks and it depends on the person’s own needs, right?
DR. ANDY MENDENHALL:
That’s exactly right. Their needs, their recovery trajectory, and their recovery capacity in terms of how healthy can they truly get. And for the vast majority of folks, boy, they get healthy and then some.
JULIANA:
Okay, great. Our next question is, what is the secret to fixing the behavioral health worker shortage?
DR. ANDY MENDENHALL:
What a great question. So, I’m going to start with the workers themselves, and then I’ll talk more systemically. First and foremost, we need to attract people to this work. And we need to attract them to this work by offering robust scholarship opportunities, loan repayment opportunities, paid internship opportunities. Make the work something that people don’t have to go into extreme amounts of debt and or suffer unnecessarily during the process of actually earning their licensure.
So that’s one part of it. The other part of it is we need to help people who choose a professional journey in the public health space. Choose to stay in the public health space. And if we look at the out migration and people leaving the public health space, the foundation of keeping people in this work is actually a system of care that does a better job of creating the space for people to go and get what they need. One of the things that I hear about folks leaving the public health space all the time is the moral injury of watching people get worse because they can’t get access to the services that they need, and it is exhausting emotionally for folks to work in that space. And everyone has a time limit in terms of their willingness and openness to stay in a space that’s not meeting the needs of the clients they’re serving.
JULIANA:
Yeah, thank you for that. What can we do to increase the amount of second-chance employers?
DR. ANDY MENDENHALL:
It’s wonderful when an employer has a strong desire to help people re-enter society after they have criminal offenses, sometimes not insignificant ones. The thing that we have found that’s most effective at Central City Concern is a supportive employment services. So having an employment case manager, somebody that is an advocate for the employee or the newly returned employee, to create advocacy on behalf of that employee, is really the most effective way to both help that employee be successful, but also help that employer have a clear understanding of what some of the needs and accommodations are for folks that are seeking to re-enter the workforce and need to be employed by a second chance or a third chance employer.
JULIANA:
Yeah. Is Central City Concern a second chance employer?
DR. ANDY MENDENHALL:
Central City Concern is proudly a second chance, and sometimes we say a third or fourth or fifth chance employer, because we do our very best for folks that are on a recovery pathway to help them re-enter the workforce in a meaningful way. And it’s been really remarkable to see both the recovery journeys of individuals, but also what the career development journeys are for many folks who couldn’t necessarily envision that they’d be where they are today.
JULIANA:
Like one of our guests, Sean Fox, who is absolutely incredible at leatherworking and never could have seen that path for himself.
DR. ANDY MENDENHALL:
Exactly. It’s a great, great example. And what a great gift that he’s now doing his best to offer back to the community.
JULIANA:
Dr. Andy, as drugs rapidly change on the street, what are the trends you’re seeing right now that may go beyond fentanyl?
DR. ANDY MENDENHALL:
So first, I’ll say that I’m hopeful that some of the gains nationally in terms of a reduction in overdose death will be preserved. The biggest change that we’ve seen outside of fentanyl, which is in the class of drugs called opioids, is really methamphetamines, which is in the class of drugs called stimulants. And P2P methamphetamine is just a more potent, more pure version of methamphetamine that has now been out in active circulation for the last four to five years. And it’s cheaper, stronger, more potent than ever before, more reinforcing, and I say this actively, more damaging to people. And that does not mean that people don’t heal, people do heal, but the lift that they have to carry in order to get healthy is much harder. The post-acute withdrawal and the withdrawal and the craving is reportedly just way worse because the drug itself is much, stronger. And we typically see the psychiatric impacts of methamphetamine with much shorter durations of use and those psychiatric impacts can be the development of psychosis or drug induced or stimulant induced psychosis, which is a form of behavioral health condition that we would associate with schizophrenia, so it’s drug induced and generally speaking temporary. But what we’re seeing is a need for people to have more extended periods of time drug free and also have ongoing or concurrent rather psychiatric care with medication in order to go back to a healthy baseline.
JULIANA:
So, when you’re out in the community and you see somebody who is very agitated and who is upset and angry, is that person likely somebody who’s used the stimuli you just mentioned?
DR. ANDY MENDENHALL:
Not always. I would say that when we see that it’s one of two things. It’s either somebody with schizophrenia that is simply unmanaged, and schizophrenia alone independent of substance use or stimulant use in particular can present that way. And stimulant use can also present that way. The tragedy is, these are typically folks who need active intervention, and then they need to be actively medicated. And our community right now lacks sufficient resources to ensure that that happens with the level of frequency and at the threshold that it should.
JULIANA:
When you go through all the current data collected regarding housing, healthcare, and employment in Portland, what surprises you the most?
DR. ANDY MENDENHALL:
The truth is that there’s an unacceptable number of people sleeping outside every night. They seem to be more ill than ever before. And the group of folks that are chronically homeless seem to have a higher degree of behavioral health, untreated behavioral health acuity than ever before. So, the amount of money that’s been spent for the amount of impact for our community seems to be out of proportion.
JULIANA:
So, what would you tell a community member who sees the problem getting worse on the streets and is being asked to pay more taxes to support people? What would you say to that person to convince them why it’s important to continue to invest?
DR. ANDY MENDENHALL:
I’ll answer the question directly, and then I’ll tell you what I really think. So, what I really think about this is, because I experienced this, rational, compassion fatigued, progressive people are saying, I don’t want to spend any more money because I don’t believe it’s actually making a difference. And then what I say is, well, what I’d like to ask you to do is hold your elected officials accountable for reports that matter, for data that matters. And hold folks accountable for that reason. And then I would say, and when it comes time to have a resource placed in your neighborhood, that’s where you can actually make a real difference. And that is to say yes to a shelter site or to say yes to an affordable housing site going up in your neighborhood, recognizing that it’s part of the problem that we’ve had for the last decade is the truth of that NIMBY-ism and the delays in getting a lot of these programs, placed, cited, all the things have only contributed as well.
JULIANA:
Yeah, they’re starting to look at data around crime statistics around shelters and finding really impressive data that says crime rates have actually gone down.
DR. ANDY MENDENHALL:
That’s exactly right.
JULIANA:
And so I think more proof of that will make the community a little bit more comfortable with the idea of having a shelter or a facility in their neighborhoods.
DR. ANDY MENDENHALL:
Yes, especially shelters that connect individuals with services. And I think that’s a really important gap that we have to pay close attention to is when folks have access to on-site service connection versus when they don’t.
JULIANA:
So, Andy, what keeps you hopeful?
DR. ANDY MENDENHALL:
Juliana, what keeps me hopeful is the truth that we see folks, and I see folks every single day at Central City Concern working a journey of recovery, maintaining a journey of recovery. And so many folks that work with us, again, up to 40 % of our employees identify as being folks with lived experience, right? Substance use disorder, behavioral health challenges, homelessness, poverty, all the things.
And that 40 % slice of the folks that are of service to our community are living examples of what’s possible with respect to a recovery journey. And so that’s what keeps me in this work and keeps me hopeful. I also take a lot of hope in seeing better alignment than ever before within our health care systems, in our coordinated care organizations, and even among certain parts of government, in a post-charter reform phase where we have a larger group of elected officials, I think there’s better direction and better clarity in terms of what the core outcomes truly need to be for the population that’s suffering.
JULIANA:
Yeah, I see, you know, we can acknowledge that there’s a lot of challenges, especially to funding on a federal level. And I always look for silver linings, and I’m seeing a push for alignment that’s really helpful to me between the city, the county and the state. And I think in the face of headwinds, we’re all going to need to come together and work together to solve for problems that are bigger than we as a state can manage. So that gives me hope that we can do a lot if we can align.
DR. ANDY MENDENHALL:
Well said Juliana. I agree with you.
JULIANA:
Yeah. And then the other thing that gives me hope is very similar to what you said, that we get to hear the stories. And this podcast has had multiple stories that we’ve shared, and all of those folks are just so successful in giving back to the community and helping each other.
So to me, I always think of those stories as priceless, and it is my honor to have been able to share them. So, thank you so much for being here again, Andy. It’s always good to see you.
DR. ANDY MENDENHALL:
Thanks, Juliana. Likewise.
JULIANA:
Thank you so much for listening to They Are Us and for joining us on this journey. We’re so grateful to everyone who’s tuned in, sent in questions, or shared these stories with others. To learn more about the topics covered this season, or to support the work we do at CCC, visit centralcityconcern.org. If you have questions, we’d love to hear from you. Just send us a note at podcast@ccconcern.org.
Until next time, I’m Juliana.
