Portland providers say region lacks psychiatric beds, treatment slots and recovery housing

At a Community and Public Safety Committee meeting Sept. 9, regional providers told Portland elected officials that the area lacks enough acute psychiatric beds, residential treatment options and recovery housing to meet demand from people with severe behavioral-health conditions and substance use disorders.

Central City Concern President and CEO Dr. Andy Mendenhall said population-level Medicaid claims analysis shows a concentrated cohort driving disproportionate health-system use. “We don’t have enough behavioral health services,” Mendenhall said, and he told councilors the region is short roughly 40–50 acute psychiatric hospital beds, 150–200 secure residential treatment beds for step‑down care, about 1,000 outpatient substance‑use‑disorder treatment slots and roughly 500 transitional recovery housing beds.

Those deficits, Mendenhall said, translate into higher hospital utilization and costs. He said the study found that in 2024 about 8% of adult Medicaid members fell into three diagnostic categories (opioid use disorder, stimulant use disorder and psychosis) yet accounted for roughly 24% of total cost of care and represented a large share of hospital stays. “We are paying to treat the complications of untreated behavioral health conditions,” he said.

Providers and county and city staff described efforts meant to link emergency response to ongoing care. Portland Fire Rescue’s Community Health section (CHAT) operates an overdose response and medication‑for‑opioid‑use‑disorder (MOUD) pilot that offers buprenorphine on scene and arranges same‑day clinic handoffs; Deputy Chief Corey Wilson reported the pilot enrolled 36 people in its initial phase, with the CHAT aftercare team arranging same‑day medical appointments for 56% of participants and warm handoffs to a MOUD clinic for 68%. CHAT said 44% of those pilot clients were placed into shelter and the program’s aftercare averaged about 80 days of engagement per enrolled person.

Fora Health CEO DeBarshi Bajpai, whose provider network includes withdrawal‑management and residential treatment, said demand outstripped available beds during the pandemic and that the state and local investments now coming online take time to expand capacity. “People do want treatment,” Bajpai said, but he warned that expanding demand without workforce and bed capacity will limit near‑term impact.

Mendenhall and other speakers urged coordinated, cross‑agency strategies: better front‑door deflection and triage for people in crisis, more acute psychiatric capacity to decompress hospitals, and more transitional recovery housing so people can leave shelters and remain engaged in outpatient care. Mendenhall described existing collaborations—such as a rapid rehousing program run with the Portland Police Bureau’s behavioral health unit—but said program completion rates for people coming directly from the street remain low and that expanding clinical capacity is critical.

Committee members and panelists discussed next steps including data sharing, pilots to expand referral pathways and continued efforts to match street‑level response with housing and treatment capacity. County and city staff said they are testing expanded outreach and partnerships with Portland Street Response and other first responders to increase warm handoffs into care.

Ending: Speakers emphasized that new legislative changes and local investments are a starting point but said it will take additional beds, workforce and housing to change outcomes for the highest‑acuity people seen in Portland’s overdose and homelessness response.