Summary

A coalition of elected leaders, health care professionals, crisis responders and community organizations announced they will develop a broad policy approach to improving the state of behavioral health availability and sustainability for King County.

Story

King County Executive Dow Constantine, joined by Mayor Bruce Harrell, King County Councilmember Girmay Zahilay, King County Sheriff Patti Cole-Tindall, Seattle City Councilmember Teresa Mosqueda, Kelli Nomura, Behavioral Health and Recovery Division Director, Representative Nicole Macri, SEIU Healthcare 1199NW, and leaders in behavioral health and crisis response today announced a coalition to develop a response to the degrading state of behavioral health care in King County.

The coalition will develop a broad policy proposal alongside Executive Constantine’s budget this fall that will prioritize behavioral health, increase resources, strengthen the workforce, and call on local agencies, jurisdictions, and service providers to develop solutions in partnership.

“The health of our families and communities - and the well being of valued service providers - depends on creating solutions to meet the rising need for behavioral health care and provide timely support for people in crisis,” said Executive Constantine. “An ongoing pandemic, long-standing racial injustice, increasing levels of fatal drug use, and underfunding of human services have left people to fend for themselves, in homes and on the street, or consigned them to jails and emergency rooms. This newly formed coalition will work with all sectors, in all corners of the county, to confront this crisis with the urgency and scale required.”

“This continued strain on our behavioral health system means those in need don’t receive the essential care they deserve, with communities of color disproportionately impacted," said Seattle Mayor Bruce Harrell. "As their outcomes worsen, neighbors, businesses, and communities feel the impacts on public safety and public health. From diversifying our crisis response to expanding system capacity and supporting providers on the frontlines, we must effect change in our streets, hospitals, and communities. By bringing this group together united toward a common goal, we will better understand the scope of the problem, identify and develop solutions, and take the holistic, urgent, and sustainable actions necessary for progress.”

“The King County Sheriff’s Office has long recognized that our community needs thoughtful and innovative alternatives to meet the acute needs of persons experiencing a behavioral health crisis,” said King County Sheriff Patti Cole-Tindall.  “We continue to hear from communities about concern for public safety and it is clear when people are not able to access the behavioral health care they need, it puts families and communities at risk. I look forward to working with local leaders, behavioral health providers, and Executive Constantine on creating a path forward to address these issues and prioritize the behavioral health system.”

The coalition will work to develop the final proposal, but Executive Constantine is prioritizing three areas to bolster the behavioral health system:

• Building a regional network of care centers so individuals, families and first responders can access same-day care 24/7 for thousands of people annually.
• Restoring and expanding the residential mental health bed capacity. The mid-level care component in behavioral health care that helps people recover for extended periods of time is a core component that ensures care is more effective, more accessible, and more equitable.
• Developing the workforce to staff these services sustainably, for patients and providers. Evaluating compensation models and creating recruitment and retention strategies for credentialed and non-credentialed behavioral health workers.

Currently, King County is without a walk-in behavioral health urgent care facility. Only one 46-bed behavioral health crisis facility is in operation for the entire county. The region’s only voluntary crisis facility resource, the Crisis Solutions Center in Seattle, requires a first responder or hospital referral due to its limited capacity. Residential treatment beds are on a steady decline. In 2018, 355 beds for mental health residential care existed. Today, only 244 beds are available. In 2022, people in King County wait an average of 44 days for a mental health residential bed.

“We have a huge opportunity to create a world class behavioral health system here in King County. We can provide people a network of therapeutic indoor settings where they can go to heal from their addiction or mental illness,” said King County Councilmember Girmay Zahilay. “We can invest in the workforce needed to treat our neighbors. We can create sustainable public safety by investing in the residential and healthcare infrastructure our region desperately needs. Let’s seize this opportunity.”

"The behavioral health crisis that was at critical levels prior to the pandemic and has only continued to worsen due to the compounding stressors during COVID. To serve those with high-acuity needs, we need regional long-term investments to meet the needs of residents, and to help the first responders have a more compassionate place to bring those in need to get behavioral healthcare and prevent revolving doors at hospitals," said Seattle City Councilmember Teresa Mosqueda. "The broad array of elected officials, organizations, and individuals here today represent the cohesion needed to plan and deliver for our community on these issues. The coordinated strategy represented here can improve the health of our community and economy, allowing us to recover more quickly and equitably."

“The pandemic has revealed and exacerbated how many people across the country are grappling with anxiety, depression, and other severe mental health challenges,” said Kelli Nomura, Director of the Behavioral Health and Recovery Division at King County. “As people are breaking their silence, challenges with substance use and mental health are being seen for just how common they are across all in our communities. At the same time, people see that behavioral health care is critical for everyone’s wellbeing, and there’s a growing call to invest in our behavioral health system.”

“Our ability to respond to behavioral health crisis events is itself in crisis,” said Michelle McDaniel, CEO of Crisis Connections. “As one of the primary connectors of people in crisis to services, Crisis Connections sees firsthand how deeply under resourced the behavioral health system is in our region. I am pleased to see our elected leaders and local and state agencies come together to take significant action to bolster our system because there is no time to lose. Without urgent action, people in crisis, the staff and organizations that care for people, and the community at large are at risk.”

In the 2022 legislative session, lawmakers made historic investments in behavioral health, including funding for mobile crisis services, rate increases for community-based Medicaid and non-Medicaid services, and one-time payments for behavioral health providers. The success of these investments and national investment in the 988 crisis line depends upon creating enough coordinated behavioral health crisis care to ensure residents have immediate, voluntary access in all regions of King County.

“In these times especially, it is important to be a part of a community where people help one another. Today's announcement sends a message to people across King County that our community will be there when they need help the most,” said Rep. Nicole Macri, D-Seattle. “It builds on the historic investments the State legislature has made that begin to fix an inadequate behavioral health system, to stabilize the network of services devastated by a pandemic, and to support people doing the vital work of caring for neighbors in crisis. Today we demonstrate that by working together we can create the network of care that helps people in crisis to truly stabilize and to recover.”

“I work in the Program for Assertive Community Treatment, a team designed to support people so they avoid places like hospitals and jails. Our program works, but the system is failing us right now because my colleagues and I are being asked to do the impossible,” said Naomi Morris, a nurse with SEIU Healthcare 1199 NW. “Low wages and high stress have turnover so high that I’m the only nurse on my team when there should be three. I’m also the only person of color on my team. We need more workers, and they need to match the community—but we will only get there if we support workers. This needs to be a profession that people can make a career in, leave their workday with a sense of accomplishment, and be healthy.”

Once the policy proposal is finalized and approved, King County will work with state agencies, state legislators, and behavioral health providers to partner in addressing key priorities within the behavioral health and crisis response system.  The policy proposals will be delivered to the King County Council alongside the Executive’s 2023-2024 Biennial Budget next month.

Relevant links

• Aug. 11 - Announcement Video

Quotes

“The health of our families and communities - and the well being of valued service providers - depends on creating solutions to meet the rising need for behavioral health care and provide timely support for people in crisis. An ongoing pandemic, long-standing racial injustice, increasing levels of fatal drug use, and underfunding of human services have left people to fend for themselves, in homes and on the street, or consigned them to jails and emergency rooms. This newly formed coalition will work with all sectors, in all corners of the county, to confront this crisis with the urgency and scale required.

This continued strain on our behavioral health system means those in need don’t receive the essential care they deserve, with communities of color disproportionately impacted. As their outcomes worsen, neighbors, businesses, and communities feel the impacts on public safety and public health. From diversifying our crisis response to expanding system capacity and supporting providers on the frontlines, we must effect change in our streets, hospitals, and communities. By bringing this group together united toward a common goal, we will better understand the scope of the problem, identify and develop solutions, and take the holistic, urgent, and sustainable actions necessary for progress.

The King County Sheriff’s Office has long recognized that our community needs thoughtful and innovative alternatives to meet the acute needs of persons experiencing a behavioral health crisis. We continue to hear from communities about concern for public safety and it is clear when people are not able to access the behavioral health care they need, it puts families and communities at risk. I look forward to working with local leaders, behavioral health providers, and Executive Constantine on creating a path forward to address these issues and prioritize the behavioral health system.

We have a huge opportunity to create a world class behavioral health system here in King County. We can provide people a network of therapeutic indoor settings where they can go to heal from their addiction or mental illness. We can invest in the workforce needed to treat our neighbors. We can create sustainable public safety by investing in the residential and healthcare infrastructure our region desperately needs. Let’s seize this opportunity.

The behavioral health crisis that was at critical levels prior to the pandemic and has only continued to worsen due to the compounding stressors during COVID. To serve those with high-acuity needs, we need regional long-term investments to meet the needs of residents, and to help the first responders have a more compassionate place to bring those in need to get behavioral healthcare and prevent revolving doors at hospitals. The broad array of elected officials, organizations, and individuals here today represent the cohesion needed to plan and deliver for our community on these issues. The coordinated strategy represented here can improve the health of our community and economy, allowing us to recover more quickly and equitably.

The pandemic has revealed and exacerbated how many people across the country are grappling with anxiety, depression, and other severe mental health challenges. As people are breaking their silence, challenges with substance use and mental health are being seen for just how common they are across all in our communities. At the same time, people see that behavioral health care is critical for everyone’s wellbeing, and there’s a growing call to invest in our behavioral health system.”

Our ability to respond to behavioral health crisis events is itself in crisis. As one of the primary connectors of people in crisis to services, Crisis Connections sees firsthand how deeply under resourced the behavioral health system is in our region. I am pleased to see our elected leaders and local and state agencies come together to take significant action to bolster our system because there is no time to lose. Without urgent action, people in crisis, the staff and organizations that care for people, and the community at large are at risk.

In these times especially, it is important to be a part of a community where people help one another. Today's announcement sends a message to people across King County that our community will be there when they need help the most. It builds on the historic investments the State legislature has made that begin to fix an inadequate behavioral health system, to stabilize the network of services devastated by a pandemic, and to support people doing the vital work of caring for neighbors in crisis. Today we demonstrate that by working together we can create the network of care that helps people in crisis to truly stabilize and to recover.

I work in the Program for Assertive Community Treatment, a team designed to support people so they avoid places like hospitals and jails. Our program works, but the system is failing us right now because my colleagues and I are being asked to do the impossible. Low wages and high stress have turnover so high that I’m the only nurse on my team when there should be three. I’m also the only person of color on my team. We need more workers, and they need to match the community—but we will only get there if we support workers. This needs to be a profession that people can make a career in, leave their workday with a sense of accomplishment, and be healthy.

The emergency medical system has historically been the backstop for behavioral health and crisis response. However, the significant increase in behavioral health emergencies and legislation that has limited law enforcement from engaging in these emergencies have placed a heavy burden on firefighters and paramedics. We are encouraged by today’s announcement and look forward to being a partner in addressing this crisis.

For more information, contact:

Chase Gallagher, Executive Office, 206-263-8537