This week's Mercury Blogtown question:

"Multnomah County is facing an $18 million budget shortfall, which will make it exceedingly difficult to provide adequate mental health, drug treatment and addiction services. Though social services aren’t under the city’s jurisdiction, the issue impacts our city. How would you, as a city commissioner, find creative ways to fill the gap?"

It was especially challenging to answer this question in under 500 words. The Mercury doesn't set a limit, but I know from reading other candidates' answers that at some uncertain point, a long reply changes from interesting to "OK, on to the next one". After nearly 22 years working in mental health care in Portland, prioritizing the top three actions needed to help fund gaps in social services was both easy (the "Duh!" answers), and challenging (What about this? What about that?). I would love to elected to lead an ongoing, thorough analysis of ways the City and County could work more efficiently to provide necessary services.

Some candidates assert on Blogtown that it doesn't matter which jurisdiction provides and/or pays for services. I believe it does - because the current blurring is wasting money on bureaucracy, and causing gaps and overlaps. See this post on my other blog in May 2007, for details.

An expanded version of my answer on Blogtown:

Every evening I work on the inpatient psychiatry unit at OHSU, I realize again that our current "system" is deeply flawed. Gaps and overlaps between City and County functions result in failure to provide help to human beings desperately in need, and failure to operate in a fiscally efficient structure. Taxpayers foot the bills for crisis-intervention hospital stays for uninsured patients, then people are discharged to live on the streets where they can't afford and don't take their medication, and return to the hospital sicker than before. Some patients are admitted feeling suicidal, when what they need most is a warm bed, a hot meal, and safety.

Too often, people search for "creative" answers while ignoring basic solutions. Portland sometimes suffers from a craving to be "innovative", when what we really need to do is to implement the strategies we already know will work. The City can help the County by prioritizing provision of affordable housing, funding emergency care in the community, and returning more tax revenue to the County by allowing Urban Renewal Areas to end.

When the City has permanent stable funding to meet its responsibility to provide housing, the County will not have to spend so much money on hospitalization. Housing is needed to get a job, housing allows people to spend time in treatment instead of on survival. Housing provides a measure of safety, distance from on-street drug dealers, and insulation from the need to "get drunk to stay warm and fall asleep". I will continue to implement the "Housing First" strategy Commissioner Sten has put in place.

Multnomah County should fund community health care clinics to provide emergency services 24/7/366 (this is a Leap Year, remember). Not only is treatment outside of acute care hospitals much less expensive, but also the clients are known to the practitioners so less time and money is wasted gathering information and performing routine tests that may already have been done multiple times. Although paying for social services and health care is a County responsibility, currently our public safety officers spend huge amounts of time attending to medical and mental health crisis management in Portland. It would be cost-effective for the City to help subsidize emergency services at community clinics on evenings, nights, and weekends.

As stated in my response to the question on Urban Renewal Areas, spending tax money on projects like the Streetcar takes $19 million per year from the Multnomah County budget. The City can support County programs by honoring target dates for returning the County's portion of revenue from revitalized Urban Renewal Areas, so the money is available for County services.

Voters sometimes ask me why electing a psychiatric nurse to the City Council makes sense. "Doesn't the County do social services?", they say.

Nurses listen to problems and help find solutions to promote healthier living. Our current City Council members sometimes forget or ignore the division of responsibilities between the County and the City. Instead of "giving" millions to the County for programs like short-term jail beds for meth addicts or a tax-exempt building in the Gateway Urban Renewal Area, the City should focus on its core mission, including housing and jobs. Doing so will help reduce the need for County services.

Nurses have to be efficient, on task, and goal-directed. We think about how policies and practices affect people. When process problems impact our ability to provide services, we identify the issues and work to fix the system. I have the community experience, background knowledge, practical skills, and demonstrated ability to be a good City Commissioner. My understanding of the gaps and flaws in City and County services, and how to fix them, is one more reason I ask you to elect me in May.