FILE – Oregon state Capitol building cherry blossoms

The Oregon state Capitol building in Salem

(The Center Square) – Becoming a therapist or a psychiatrist in Oregon is a long, expensive process state lawmakers want to better represent the communities of color who need them.

Gaps in mental health care is one issue the pandemic has highlighted in Oregon where joblessness and school closures have exacerbated racial inequities and social unrest. Studies put Oregon's health care system in the middle of the pack nationwide with regards to cost, care, and available physicians. Its mental health care tops lists of the the nation's worst with 1,186 specialists for the state of 4.2 million. As many as one out of five worked part-time in 2019.

Oregon's health care workers continue to be whiter than the state where one out of four people are minorities. Hispanics, who make up 13% of the state, are most underrepresented, making up just 5.6% or less of state health care providers. In Malheur County, Hispanic residents outnumber Hispanic health care practitioners three to one. The Oregon Health Authority also reports just 20% of Oregon's health care workers reported speaking a language other than English in the months leading up to the pandemic.

For Angela Foster, a native member of Klamath Falls' Warm Springs Tribe, finding meaningful mental health care is a never-ending struggle for her and her family.

The system is so overwhelmed with cases, Foster says, that counselors may drop one at a moment's notice. That caseload leads to more mistakes like writing the wrong prescription or mistreating patients like her daughter.

"Knowing my child tried to commit suicide was one of the worst days of my life," Foster told the House Committee on Behavioral Health on Wednesday. "I was being made to feel like it was my fault because of the lack of resources the state could provide."

Parents like Foster are among thousands of people insured through the Oregon Health Plan, which still leaves out some 248,000 people statewide. The income threshold is narrow at $1,468 a month, one Foster says only makes life harder. 

"I have to make sure I stay in poverty, to protect my daughter's mental health and ensure that we don't have a lapse in the life saving medication that she needs," Foster said. "Having to advocate so aggressively for my family and now even my friends to get them mental health care has gotten me involved in teaching people how to navigate the mental healthcare system, which can be frustrating, exhausting and discouraging. I know from experience."

The bar for becoming a mental health care professional is high in Oregon where earning a master's degree is the bare minimum to work as a licensed therapist. A masters of counseling degree at Oregon State University for an in-state student costs $53,525 alone before scholarships in 2021, according to the university's online tuition calculator. That also comes with two years of post-graduate experience and 2,400 hours of clinical experience. 

House Bill 2949 would see the state offer $15,000 in student loan forgiveness  for mental health care professionals and cuts required clinical experience to 1,600 starting July 1 under one amendment. That would come at the cost of $98 million in general fund money and also fund mental health programs for the formerly incarcerated.

The bill, introduced by state Rep. Janelle Bynum, D-Happy Valley, says slashing those clinical hours is "an issue of equity and economic opportunity" for growing the state's health care workforce. 

Oregon's 2,400 hours of mandatory clinical experience is already hundreds more than California's 1,750 hours and Washington's 1,200 hours. 

For Dr. Anjabeen Ashraf, a Beaverton counselor and one of four physicians who requested the bill, cutting clinical hours overlooks the real problem—Oregon's occupational licensing laws are keeping out of state mental health care workers out of state. 

"The intent of HB 2949 is to center the healing of [Black, Indigenous and people of color] mental health in Oregon and increase the wellness and number of BIPOC mental health professionals," Ashraf said. "Without changing the licensure process, we are passing an incomplete solution."

The bill, Ashraf says, is still one she supports as amended. At the same time, she also believes lowering the required number of clinical hours would be a faster solution than the "pipeline development" that can take years.

"I also feel that a critical way to bridge the gap of the lack of practitioners is an adjustment of the hours, because that is a quicker remedy than pipeline development that can take years," Ashraf said. "I don't believe one issue is more important than the other but rather both need to be solved."

The Oregon Legislature's long session is set to adjourn on June 28.

Staff Reporter

Tim Gruver is a politics and public policy reporter. He is a University of Washington alum and the recipient of the 2017 Pioneer News Award for Reporting. His work has appeared in Politico, the Kitsap Daily News, and the Northwest Asian Weekly.