Multnomah County Mental Health System Analysis

Improving Multnomah County's mental health system

Multnomah County is focused on providing accessible and effective mental health services—connecting people to the right care at the right time. We’re conducting a deep systems analysis for the County, engaging with community stakeholders, reviewing previous studies, examining funding and reimbursement mechanisms, and focusing on touchpoints between systems, where individuals in need might fall through the cracks.


Multnomah County is one of the largest safety net providers of health and mental health care in Oregon.

Over 300 local stakeholders—including service users and their family members—provided input for the study, through interviews, community listening sessions, and online feedback channels. 

  • Data Collection and Analysis
  • Systems Design
  • Stakeholder Engagement

Creating a more connected system

Mental health systems are complex: funding comes from many sources, and organizations and agencies provide different types of services and address different needs, making systems feel fragmented and piecemeal to service users. What’s more, pathways to services are often tricky to navigate—some with stringent requirements that are tough for people with mental health issues to stay on top of. As a result, many people with mental health problems can get lost in the system—or give up on the system—and wind up in crisis.

To support people’s mental health recovery and help them avoid the trauma of a crisis, Multnomah County is looking to promote a mental health system that’s service user–friendly, well-coordinated, and accessible.

Engaging with stakeholders to study the system

To assist Multnomah County, we examined prior studies of mental health and related systems in the county and state; examined aggregated service use and budget data; and conducted and analyzed in-depth interviews with 139 stakeholders representing a range of perspectives, including people with lived experience of the mental health system and their family members. We also incorporated data from two community listening sessions—attended by 159 individuals—as well as additional community feedback gathered online.

Our findings

Multnomah County is ahead of the curve in many respects: It has an array of services and incorporates evidence-based practices and services that address social determinants of health; it incorporates peer support throughout much of the service continuum; it embraces trauma-informed, culturally responsive approaches; and there are strong efforts to ensure that services are provided in community settings whenever possible.

Despite this, stakeholders noted that the system is still complex for service users to navigate, and many perceived that the more progressive, innovative practices are in short supply or more difficult to access. Many with complex needs – including individuals who experience homelessness and individuals with co-occurring mental health and substance use issues – have a particularly difficult time engaging with and accessing services. We also noted room for improvement in terms of integrating physical and mental health systems and providing these in service users’ preferred settings (often their primary care office). And as in many other parts of the country, the local mental health workforce is overburdened, underpaid, and not as diverse as the service user population.


The report includes a range of recommendations to support Multnomah County in its system transformation efforts in the areas of:

  • Enhancing the service array to support system priorities of cultural responsiveness, trauma-informed services, and recovery-oriented care
  • Increasing access and supporting system navigation for individuals and families with complex needs
  • Representing and elevating the lived experience perspective at all levels of the system, including establishing a director-level lived experience leadership position
  • Using data and analytics to support system improvements and monitor ongoing progress toward systems change

Multnomah County, Oregon

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