County Commissioner Brings Expert on Millionaire Migration Into Preschool Debate

WW Headline: “County Commissioner Brings Expert on Millionaire Migration Into Preschool Debate”

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I generally appreciate attempts to bring outside experts into government conversations, because it’s generally good for politicians to have someone around who understands the issues at hand. In this instance, however, the effort to bring in a professor from Cornell to talk about real-world problems in Multnomah County was misguided at best and led to dangerously misleading conclusions at worst. Link to article

Commissioner Moyer’s Cornell expert said nothing whatsoever about Multnomah County or Portland, let alone offering “cold, hard data”. He mentioned a nationwide academic study showing little direct correlation between wealth mobility and small fluctuations in tax rates, which isn’t at all surprising. We know people are willing to pay a premium for quality of life. Manhattan is a prime example, with population growth despite some of the highest taxes in the nation. The more relevant question is what happens when taxes are sky high, while the quality of life has eroded?

In Portland, this is not an academic question that requires an opinion based on theory, but a real-life question that has been emphatically answered by, well, “cold, hard data”. ECONorthwest just looked at our local data and found that high-income earners have, in fact, left the region, taking with them over $2 billion in personal income in 2022 and 2023 alone. That’s the equivalent of 1000 millionaires leaving the region per year, if you want to put things in terms of millionaires.

And it’s not just the wealthy who are leaving. As most other urban cores across the country are seeing population growth, Portland is one of only a few major cities showing net out-migration. Although underneath that trend, some people do continue to move in, those coming in are often looking for jobs that yet another study has shown don’t exist, as downtown non-occupancy rates reach 30%, corresponding to a missing 30,000 jobs. Meanwhile, a larger number of people who have lived in the region for years, who have spent their careers and have homes and raised their children here, are leaving. With them go more than their tax dollars – we are losing community members, well-rooted neighbors and a ton of social and creative capital.

This is the story of a community in decline. Commissioner Moyer’s expert and the WW article extolling the expert’s irrelevant presentation, while neglecting the real data, just led people to believe that there isn’t a glaring problem with Multnomah County losing its tax base as it drives long-term residents away. I hope that there is more open and frank conversation about this topic that leads to urgency and action, because this should be deeply troubling to anyone who calls this region home.

Multnomah County Reaches Agreement With Ambulance Provider

WWeek headline: “Multnomah County Reaches Agreement With Ambulance Provider”

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Translation: Multnomah County Chair Reaches Agreement With Ambulance Provider after unnecessarily delaying for 18 months, putting untold numbers of lives at risk.

Link to original Willamette Week article by Anthony Effinger, published August 1, 2024

The Multnomah County Chair finally answered the County’s 911 call almost two years too late. Signing an agreement with the ambulance service provider to do something that could and should have been done 18 months prior is not an accomplishment. Rather, it is a testament to the Chair’s willingness to put lives at stake and allow untold suffering, even when a clear solution with an implementation plan was offered to her on a silver platter.

Whistleblower suit alleges Multnomah County

Oregonian Headline: Whistleblower suit alleges Multnomah County’s mental health system turned into “the wild west”

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This whistleblower action should include the leaders in charge of perpetuating Multnomah County’s failed mental health system.

A year and a half ago, as a Multnomah County Commissioner, I wrote to fellow board members calling out the County’s egregious failure to fulfil its responsibility as the Local Mental Health Authority. I asked Governor Kotek to intervene. I’ve copied my January 2024 communication below.

Some meetings were held, promises were made that the County would do better, and things have only gotten worse. The County’s failed mental health system continues to cause devastating harm to countless individuals and families, plays out in the region’s worsening homelessness crisis, impacts public safety, and wastes hundreds of millions of dollars.

Many experts have been whistleblowing for decades about the failure. Meanwhile, County leadership distracts and deflects by blaming the state and federal governments and calling for more money. Legislators tout their commitment to behavioral health by spending hundreds of millions of dollars. But what they all fail to understand (or admit) is that money isn’t the problem. The problem is a lack of leadership, a lack of a comprehensive plan to coordinate and use existing resources effectively, and a lack of accountability.

Here is the email I sent to the Multnomah County board and Governor Kotek:

Dear Colleagues,

Oregon State law directs counties to act as the Local Mental Health Authority (LMHA) for their regions.  For years, Multnomah County has not fulfilled this obligation on either a statutory or moral basis.

Throughout the past seven years of my term as County Commissioner, I have expressed concern about this both publicly and privately, and have pushed for the County to do more.  At this time, I have lost confidence that the County can fulfil its role as the LMHA.  I believe that this requires intervention at the State level.

At the start of my term, I commissioned an analysis of the Multnomah County Mental Health System.  The final 134-page Report was presented to the Board, the former Chair’s office and the public in August 2018. It spurred the next phase of work – a stakeholder engagement process called Analyse, Align and Act, which led to the development of the Blueprint for Better Behavioral Health, a framework for creating a functional and coordinated behavioral health continuum. I was hopeful that this effort would transform our behavioral health system to serve individuals in our community with the compassion, services and supports they need and deserve to live their best lives.

Unfortunately, the former chair deprioritised this project before its completion.  And since then we have seen many additional failures to fulfil the County’s obligation as LMHA:

  1. Decimation of the original BHECN process
  2. A failure to address the fentanyl crisis
  3. The failed relationship between the Health Department and the jails, condemned in the scathing National Institute of Corrections’s report
  4. The unprecedented number of deaths occurring in our jails over the past year
  5. The turnover of five Behavioral Health directors in six years and seven Health Department directors in seven years
  6. The failure to hire a new permanent Behavioral Health director after almost a year, when mental health and addiction issues have been at the heart of virtually all the major issues facing our community
  7. The failure to have a coherent, coordinated plan around the youth mental health crisis

While the County has some scattered elements of a behavioral health system, our failure as the LMHA has led to terminal dysfunction in coordinating, convening and planning. It has also led to other entities stepping in to compensate for our deficits, for example:

  1. The City of Portland, with Portland Street Response and the Police Bureau’s Behavioural Health Unit
  2. CCOs CareOregon and HealthShare are directing processes and programs to address behavioural health crisis care
  3. Central City Concern and OHSU are investigating systems gaps and making recommendations to fill them

It must, of course, be acknowledged that the COVID pandemic placed additional strain on our system as a whole. But it was troubling that when our behavioral health crisis worsened during the pandemic, and the County, as LMHA, should have been bringing people together like never before, County leadership used the pandemic as an excuse for failing to meet our statutory responsibilities, not a call to action.

Details about the role of an LMHA have never been shared with commissioners by the Behavioral Health Division. I have some unique insight into LMHAs, given my experience as a physician providing behavioral health crisis services, and also as a lawyer who enjoys getting into the nitty-gritty of statutes. I have therefore prepared a summary version of the Oregon Revised Statutes section establishing counties as LMHAs for your convenience, and have linked the actual ORS sections here. I also offer the following ultra-condensed summary:

ORS 430.630 directs counties to establish community mental health programs and substance use disorder treatment continuums and establishes counties as regional LMHAs. The primary responsibility of an LMHA is to establish a Comprehensive Local Plan for mental health and make sure that it is being implemented.

To my knowledge, Multnomah County does not have a current Comprehensive Local Plan (CLP), even though the requirements are outlined quite well in statute.  It certainly does not have a functional continuum of behavioral health care, nor has it coordinated or led efforts to create one.

Our failure in fulfilling our statutory and moral responsibilities as the Local Mental Health Authority has directly led to and/or exacerbated multiple behavioral health crises in our community.  You only need to look at recent headlines to see some of the tragedies that have occurred due to a lack of an effective behavioral health continuum, and these heartbreaking stories are just the tip of the iceberg. As one of the many people working in healthcare and social services, I see the impacts regularly in the ER and as a volunteer caring for people experiencing homelessness.

At this time, I do not believe that the situation is salvageable without external intervention, and the State must step in to ensure that our legal obligations under ORS 430.630 are met for the people we are meant to serve.

I therefore formally request that Governor Kotek intervene to address Multnomah County’s failure to create and implement a comprehensive local behavioral health plan.

I realise this is a very serious request, and I do not make it lightly. But we are facing numerous behavioral health crises, things are getting worse before our eyes, and we have yet to see any critical action being taken by County leadership that has the potential to reverse our trajectory. People residing in our County are suffering and dying. We need to do something NOW.

I have copied Governor Kotek, her Behavioral Health Policy Director, Juliana Wallace, and Oregon Health Authority Behavioral Health Director Ebony Clarke on this message and formal request.

I sincerely hope the seriousness of this situation results in action to help the untold, unaddressed suffering in our community, and I look forward to further engagement with each of you on the subject of the LMHA.

Respectfully,

Sharon Meieran

Multnomah County poised to pay marketing firm $238K to collect feedback on Preschool

Oregonian Headline: “County to pay marketing firm $238K to collect feedback on Preschool for All”

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A reporter should investigate how many consultants Multnomah County (read as JVP) has hired over the past 2.5 years in the core work of the county – homelessness, mental health and addictions, emergency medical services, corrections health, the overarching health department, animal services, and Preschool For All. Not to mention the ridiculous investment of hundreds of thousands on a county “mission, vision and values” statement. I estimate there have been at least 10-15 consultants, but I don’t have access to the information. The County is welcome to provide the details.

Then the reporter should calculate how much money and time have been spent on all of this consulting in fields that are supposed to be the county’s core responsibility. Here’s a hint: The money can be measured in millions, and the time can be measured in years. This is clear from reviewing County budgets.

The reason for all this waste is straightforward and predictable, albeit tragic: The chair has surrounded herself with department leaders who are political allies rather than subject matter experts. Lacking the background and expertise necessary to run departments in an organization as big and critical as the county, they end up having to hire others to do the jobs they were hired to do. Aside from wasting tons of time and money, the situation has resulted in unprecedented turnover of county department directors, further destabilising county systems. For example, in the past eight years, there have been seven health department directors, six behavioral health directors, and five homeless services directors (not counting the three additional “homelessness response system” directors the chair hired in the past two years alone). If this were a business, it would have failed many times over. But Multnomah County keeps getting a pass.

This is what happens when politics is prioritized over policy in a government responsible for crucial human services.

Understanding what’s ailing Multnomah County continues to be a simple matter of connecting the dots and recognizing the patterns of failed leadership. Fixing them requires the current board to acknowledge the tremendous instability and waste this has caused and do something about it.

Officials now have a much better idea of how many homeless

Oregonian headline: Officials now have a much better idea of how many homeless people live in Multnomah County. It’s a lot

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Translation: Officials finally learn how to de-duplicate names in their database and realize they still have no idea how many homeless people live in Multnomah County or what to do about it

Link to original Oregonian article by Lillian Mongeau Hughes, published April 16, 2025

The scope and scale of Multnomah County’s homelessness problem is not a “stunning new reality” that’s just been revealed. What’s stunning is how surprised the County seemed to be by the revelation that there are roughly three times as many homeless people on our streets as they’ve previously talked about.

After de-duplicating names and scrubbing data – apparently a first for the JOHS – the latest numbers reveal more than 14,000 people are homeless in Multnomah County. 14,361, to be unexact. That’s 6,796 unsheltered, 4,260 sheltered, and 3,208 unaccounted for.

And… stop right there. 3,208 human beings that the County is supposed to know “by name” are unaccounted for? How is that not the headline? If it’s a by-name list, no one should be unaccounted for. They’re still fudging the numbers.

This is a far cry from a By-Name List.

A By-Name List (BNL) is supposed to be a comprehensive list of every person in a community experiencing homelessness, proactively obtained and updated in real time. The core idea is that you literally go out and identify everyone experiencing homelessness in your community, including their name, location, and needed support services, and put that into a database.

The beauty of having this reliable, accurate, complete, up-to-date list is that it allows governments to strategically invest in building what’s actually needed to end homelessness on a macro scale in their communities, while focusing on meeting the needs of the real human beings living on their streets.

If you can’t account for actual human beings in your database, it’s not a BNL. No matter how many times you say that it is. And the County has said it a lot since City Councillor Dan Ryan and I got the concept adopted in 2020.

  1. In October 2022, as if by magic, the Joint Office declared it had completed a “quality by-name list” and would soon be releasing numbers.
  2. In April 2023, the JOHS excitedly reported that it would be releasing its first data to come from its “quality by-name list” of people experiencing chronic homelessness in Multnomah County. They claimed it was “foundational” and a “major milestone”.
  3. In May 2023, they claimed that 3000 people were living unsheltered in the County.
  4. In July 2023, the JOHS re-emphasised that the “cornerstone” of their work was building and using a “quality by-name list of individuals experiencing chronic homelessness” and that, thanks to their “quality by-name list”, they could see that “providers funded through the JOHS are rehousing hundreds of people experiencing chronic homelessness.”
  5. In January 2024, the County said that the total number of people experiencing homelessness according to its “quality by-name list” was 11,153. Of those, 5,398 were unsheltered, 3,197 were sheltered, and 2,558 were unaccounted for. (Again – 2,558 unaccounted for?)
  6. Last September, I commented in a social media post that the county still hadn’t produced anything like an actual by-name list that proactively identified and comprehensively covered the homeless population. That apparently hit a nerve, because at our next board meeting, the JOHS director accused me of lying when I’d said that the JOHS had not published the number of people actually living unsheltered in our community. He doubled down that the County knew how many people were living unsheltered and that the County had a BNL. “In fact, we published that number earlier this year,” he said. “It’s 5,398.” I shouldn’t have had to remind the director that a BNL, by definition, contains real-time, up-to-date information about the number of people living outside. And that the 5,398 number, which wasn’t accurate even when first reported, certainly wasn’t accurate eight months later.

Now, back to the latest claims.

The numbers may have come as a shock to everyone who hasn’t been paying attention. But the situation is what it’s always been:

  1. Multnomah County did not have a BNL when it first said it did in 2022, and it still doesn’t.
  2. The situation is worse than the County has been reporting all along, and the numbers will continue to get worse as they arc toward reality (which is the one silver lining: The numbers do seem to be getting more accurate and more complete).

The most disturbing thing about all of this is that Multnomah County just doesn’t seem to get that this isn’t just about a “list” or about chasing random numbers. It’s about the people at the heart of the list.

The unique value of a BNL comes from linking the numbers to a plan for meeting the needs of the human beings those numbers represent. And nowhere does the County talk about the people behind the numbers, or what the plan is to get them and keep them stably housed. In fact, the Chair’s recently released budget ignores this completely.

This is what the County should be focusing on like a laser, instead of issuing more press releases inaccurately reflecting their efforts to count how many people they’re not serving.