Improving mental health care requires rethinking the “front door”

We talk a lot about mental health in Eugene—and rightly so. We debate funding levels, service providers, workforce shortages and crisis response models. But too often, those conversations jump straight to the most complex parts of the system, while ignoring the most important question of all: How do people facing mental health challenges actually get in front of a trained mental health professional, get a clear assessment and begin receiving care? In other words, how do they get in the door?

Right now, for too many people in Lane County, the front door to mental health care is either locked, hidden or only opens during a crisis. By the time someone reaches help, they’re already in acute distress—interacting with emergency rooms, law enforcement or overwhelmed crisis teams. In other words, it’s a system designed for last resorts instead of care.

We can, and must, do better.

As a founding volunteer with the Trauma Intervention Program, I’ve seen how these gaps play out in the most profound way—standing in homes after a suicide, watching the impact ripple outward through families, friends, neighbors, coworkers and entire communities. In those moments, it becomes painfully clear that the consequences of delayed or inaccessible care don’t end with one person, but multiply and leave lasting impacts.

That’s why I’ve come to believe mental health reform has to start upstream. Before policymakers debate expanding inpatient beds or investing in specialized programs, we need to make access simple, predictable and humane at the very first point of contact. 

That means rethinking the front door.

For many people in our community, the front door to mental health care should be primary care, schools, workplaces and community-based settings, not emergency rooms. Care needs to meet people where they already are, through trusted institutions and everyday touchpoints rather than requiring them to navigate a system that is difficult to access in the first place.

It also means acknowledging that mental health is a housing issue, a transportation issue, a land-use issue and a workforce issue, as well as a health care issue. When people can’t find housing they can afford, anxiety and instability follow. When services are spread far apart and transit access is limited, care becomes inaccessible even when it technically exists. When frontline providers can’t afford to live in the communities they serve, turnover rises and continuity of care suffers.

These connections often go unsaid in policy debates. But we need to be honest about what happens when the front door fails. We’re already seeing the consequences locally. With the loss of CAHOOTS, Eugene police and Eugene Springfield Fire are increasingly being asked to respond to non-emergency behavioral health calls, situations that are better addressed earlier, through accessible and coordinated care.

When the front door doesn’t work, people get pushed into parts of the system that were never designed to help them. Law enforcement becomes the default responder. Emergency departments become holding rooms and families are left to manage crises alone—until they can’t anymore. That’s unfair to everyone involved, especially people who are already struggling.

Fixing the front door doesn’t require reinventing everything. It requires focus.

It looks like:

• Low-barrier access points where people can walk in and be seen quickly
• Better coordination between schools, primary care and behavioral health providers
• Stable funding models that prioritize prevention, not just crisis response
• Clear accountability for outcomes, not just spending

Most importantly, it requires political will—and resources—to invest in what works. That means prioritizing early access and coordination, even if it means shifting funding away from more reactive, crisis-driven responses. It means investing in primary care integration, school-based services and community partnerships that meet people where they are. And it means recognizing that upstream investments are not just more humane, but are actually more effective and less costly over time.

We are already paying for this system—we’re just paying for it at the most expensive, least effective point.

In Eugene, we pride ourselves on compassion and innovation. But compassion isn’t measured by how we respond when someone is already in crisis. It’s measured by whether we made it easy to get help before things fell apart.

I’ve seen what happens on both sides of that door—volunteering with Trauma Intervention Program and through my years with NAMI (National Alliance on Mental Illness) Lane County. I’ve sat with families who didn’t know where to turn, and I’ve worked alongside those trying to hold the system together with duct tape and dedication. Fixing the front door isn’t optional. It’s the foundation for everything that comes next.

Because the best crisis is the one that never happens.