Next Oregon behavioral health director seen as collaborative, ‘truth-teller’

Ebony Clarke, who has family experience with addiction, plans to  take a collaborative approach to a high-profile job: tackling Oregon’s crisis of mental health and substance abuse.

Gov.-elect Tina Kotek on Friday announced the appointment of Clarke, director of the Multnomah County Health Department, to lead the behavioral health division in the Oregon Health Authority.

Clarke has made her mark on behavioral and public health in Oregon’s largest county by shepherding it through the COVID-19 pandemic, focusing on vaccinating minority communities and widening access to mental health services.

As the new behavioral health director, she faces the task of addressing Oregon’s mental health crisis and shaping state policies and programs that will have an impact for years to come. 

Oregon’s behavioral health system faces a crisis that includes a high addiction rate and limited access to treatment and programs that can serve people and aid in their recovery.

Clarke, 45, will leave Multnomah County on Feb. 3 and replace outgoing behavioral health director Steve Allen, who started the job in 2019 and worked alongside OHA Director Patrick Allen, who has taken a similar job in New Mexico. Her appointment was among several other hires announced by Kotek on Friday.

Clarke is the second high-profile health hire for Kotek. James Schroeder, the new interim director of the Oregon Health Authority, is former CEO of Health Share of Oregon, the state’s largest Medicaid insurer.

Clarke was director of Multnomah County’s behavioral health division, formerly called the Mental Health and Addiction Services Division, from 2018 to 2020, when she became interim health department director. She was named permanent county health director in 2021. She’s worked for the county since 2010 as deputy director and manager of the children’s system of mental health care.

Her portfolio of work is varied. She helped set up COVID-19 vaccination clinics for low-income and underserved, including people of color. communities. Clarke persuaded Multnomah County commissioners to declare racism a public health crisis in April 2021. Clarke also helped kickstart Multnomah County’s Behavioral Health Resource Center, which opened in December and serves more than 1,000 people a week in downtown Portland.

“I am honored and humbled to be called to step into the role,” Clarke said in an interview with the Capital Chronicle. “I know that the time is now, and we are in critical times. What I recognize is that we have to succeed. We have to see the outcomes that we’re looking for and we have to be able to move forward with real solutions and meaningful impact. I know that it’s a daunting role.”

She faces a formidable task. Oregon has one of the highest addiction rates in the nation and surveys usually rank the state among the last for access to treatment and services.

Oregon behavioral health providers struggle to retain and recruit workers to meet demands, whether at the state-run Oregon State Hospital or private programs across the state. Hospitals have sued the Oregon Health Authority for leaving patients who are civilly committed in private hospitals for long periods of time instead of the state hospital. The state hospital is under a federal court order to admit people sitting in jails who need treatment more quickly so they can face criminal charges.

Meanwhile, the system is growing. Oregon lawmakers appropriated $1.35 billion in 2021 so the state has more resources, whether through residential facilities or other programs like incentives to encourage people to train and enter the field. Most of that money is allocated,  but the state is still working to set up the programs. Lawmakers say the state needs to do more to help Oregonians, whether through direct treatment or more residential programs.

Clarke said solutions can be found within communities across the state and that the state needs to be flexible.

She stressed Oregon needs a collective approach as it looks to improve the system. 

“There is not a one-size fits all approach,” Clarke said. “The strategies that we create and move forward have to be flexible enough to meet the individual. Humans are unique and complex, and so we can’t take a cookie cutter approach to what we do. There really, truly has to be a collective approach in what we do.”

In a farewell email to staff on Friday, Clarke said community connections are key to health – and equity has to stay in the forefront.

“Every person in our community deserves health,” Clarke wrote. “And that’s what we help our community members reach and sustain, especially those who don’t have access to the tools, connections and services it requires.”

In interviews, people who have worked with Clarke say she takes a collaborative approach and listens to input. 

Deborah Kafoury, former Multnomah County chair, said Clarke makes efforts to include input from people who’ve faced mental health struggles when creating programs and policies.

“She doesn’t just give lip service to it,” Kafoury said. “She actually does it.”

The Behavioral Health Resource Center, Kafoury said, is one such example of that approach.The center provides services to people who are homeless and suffering mental health or addiction crises, offering them a safe place to come off the street for refreshments, a shower or information about programs.

“That’s just one of the many things that she’s been able to do,” Kafoury said. “She walks her talk. She knows the importance of having people with lived experience involved in the creation of programs and policies that affect them.”

In another instance, Clarke set up an Office of Consumer Engagement for the county’s behavioral health work. The office does outreach and works with peers and people who are consumers in the behavioral health system to amplify their input.

That effort, Kafoury said, helps make sure their “voices are not just an afterthought but actually an important part of the conversation.”

Clarke was born premature in Portland, and her mother used narcotics throughout the pregnancy. Clarke had opioids in her blood when she was born and spent part of her early childhood being transferred to foster parents, relatives and hospitals before she was reunited with her mother at a residential treatment center, according to a profile Multnomah County published. She attended her mother’s 12-step meetings as she grew up and eventually headed the county agency that helped her mother.

Kevin Fitts, a longtime mental health advocate in Portland and the statehouse, said Clarke’s work in Multnomah County – and her background and life story – makes her a compelling candidate for the job. 

“Her lived experience is profound, and I think it shapes her conscience,” Fitts said. “She’s a truth-teller and I think she has a noble commitment to being honest and candid and that’s refreshing.”

Clarke said her story is one of her sources of inspiration.

“It drives my commitment towards doing all that I can do to make this a better Oregon for all Oregonians,” she said.