A New Model for Sobering Centers

Wednesday, July 01, 2020

For the past 40 years, CCC has worked hand in hand with the Portland community by providing critical housing, health care, recovery treatment and employment services for people affected by homelessness. In 1985, CCC assumed operational responsibility for the Sobering Station. Over the past decade, we saw an increase of clients acutely intoxicated by methamphetamines and with co-occurring severe mental health challenges.

CCC recognizes that instances of self-harm occurred in the Sobering Station. It became increasingly difficult to manage the needs of clients in crisis in a facility based not on health care design, but on a correctional design, even with timely transfer out to the Emergency Department. As the needs of clients changed and risks of self-harm increased, we took several actions, including: 1) performing a comprehensive safety review of the program; 2) revising admissions criteria; 3) restricting the use of isolation rooms to only stable patients with hygiene needs, and; 4) enhancing de-escalation training for Sobering Staff.

Even with these changes, we knew the current model for the Sobering Station was not meeting Portland’s need for effective behavioral health crisis intervention. Grounded in a correctional model, the design of the program did not meet the emerging standard to provide a safe, comfortable, voluntary space for intoxicated individuals to shelter when they need support. Last September, we had already made the decision to close this program at the end of our contract in June 2020.

Evolving problems call for evolving solutions. Beginning in September 2019, CCC shared a vision, based on the work of the National Sobering Collaborative, for how Portland can meet its need for effective behavioral health crisis intervention. We connected with multiple stakeholders including the City, County, Portland Police Bureau and local area hospitals. We suggested the Sobering Station be replaced by a Voluntary Sobering Center combined with a Crisis Stabilization Unit, independent of the Portland Police Bureau.

Sobering Centers are designed to address the needs of people who are acutely affected by substances and who need a safe space to rest and recuperate. These are not detoxification facilities and do not provide the level of care of a hospital. Sobering Centers utilize trained healthcare, peer support and lay staff in a supportive shelter setting to assess and monitor the wellness of individuals. Most Sobering Centers admit voluntary clients and will take referrals from a variety of community partners. CCC’s Sobering Station was unique, as it utilized a police involuntary hold on clients during admission.

Crisis Stabilization Units (CSUs) are designed to provide specialty behavioral health crisis stabilization requiring a more immediate response than a regularly scheduled behavioral health visit. Often thought of as an alternative to psychiatric emergency services, CSUs provide participants a secure environment, less restrictive than a hospital, but equipped to meet the medical needs of individuals who may be in a mental health or substance induced crisis, or a combination of both. People experiencing this level of crisis can present erratic behavior towards others or themselves. Individuals experiencing a behavioral health crisis require a safe and therapeutic environment ideally supported with highly trained behavioral health professionals and staff skilled at complex care coordination.

It should not take getting arrested to gain access to quality healthcare programs. Just as Portland and our nation are considering changes to interventions for people in need, the closure of the Sobering Station and the review of what replaces it should contemplate both the program model and how people gain access to its services.

There is significant national research and models supporting voluntary Sobering Centers combined with a Crisis Stabilization Unit, focusing on the health needs of the clients. We hope the community can learn from our experience and leave behind what is no longer working for today’s needs, develop services that center people most impacted, and take a healthcare approach to health needs.