Mental Illness and Drug Dependency Behavioral Health Sales Tax Fund (MIDD)

Additional Info

King County's MIDD History

2005: The Washington State Legislature created an option for counties to support behavioral health services locally by increasing the local sales tax by 0.1 percent to augment state funding for behavioral health services and therapeutic courts. As required by state law (Revised Code of Washington 82.14.460), revenue raised under the MIDD must be used for new and expanded mental health and substance use disorder services, including King County’s therapeutic courts.

2006: The King County Council began exploring of the possibility of utilizing the tax option in response to shrinking state investment in community-based behavioral health services and corresponding escalation in the use of jails and hospitals for people living with behavioral health conditions.

2007: After significant work in partnership with communities and the Executive, the Council authorized the sales tax levy collection to begin in 2008 and extend through 2016. King County is one of 23 counties (along with one city) in Washington State that have authorized the tax revenue.

2016: King County Council voted unanimously to extend sales tax collection for MIDD through 2025. The nine-year extension of the tax is expected to generate an estimated $134 million per biennium (two-year budget cycle), and is known as MIDD 2. Also, the Service Improvement Plan for MIDD 2 was approved by King County Council, updating policy goals for MIDD 2.

2017: As called for by the Council, the MIDD 2 Implementation Plan and Evaluation Plan were transmitted, building upon and updating the Service Improvement Plan.

2018: Both MIDD 2 Plans were approved by the Council.

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MIDD Accountability and Leadership

King County's MIDD is guided by adopted policy goals (King County Ordinance 18407) and the Service Improvement Plan (Ordinance 18406). The forthcoming Implementation and Evaluation Plans, due to the Council in August 2017, will further detail operations and assessment components for MIDD initiatives. 

As required by the Council annual MIDD reports are provided to the Council. Find MIDD reports

The MIDD Advisory Committee is an advisory body to the County Executive and Council on matters related to King County's MIDD, as described in Ordinance 18452. The MIDD Advisory Committee is a unique partnership of representatives from the health and human services and criminal justice communities, including providers and other stakeholders. MIDD Advisory Committee meetings are open to the public and comments are welcome.

Find a schedule of meetings and meeting notes from past meetings on the MIDD Advisory Committee page.

MIDD Policy Goals

As adopted by King County Council, MIDD’s five policy goals updated for MIDD 2 are as follows:

• Divert individuals with behavioral health needs from costly interventions, such as jail, emergency rooms, and hospitals. 
• Reduce the number, length, and frequency of behavioral health crisis events. 
• Increase culturally appropriate, trauma-informed behavioral health services. 
• Improve health and wellness of individuals living with behavioral health conditions. 
• Explicit linkage with and furthering the work of King County and community initiatives.

The MIDD 2 Framework is an accountability structure driven by the results policymakers and stakeholders want to see in the community as the result of investment of MIDD funds; the indicators that the county will use to signal that it is headed down the right path to get there; and the actions the county and its partners will take to create the change stakeholders want to see. The MIDD 2 Framework organizes the work of MIDD.

The MIDD 2 Framework includes:

• MIDD Result – the overarching purpose of MIDD 2
• Adopted MIDD 2 Policy Goals – King County Council’s direction for MIDD 2 via Ordinance 18407:
  • Divert individuals with behavioral health needs from costly interventions, such as jail, emergency rooms, and hospitals.
  • Reduce the number, length, and frequency of behavioral health crisis events.
  • Increase culturally appropriate, trauma-informed behavioral health services. 
  • Improve health and wellness of individuals living with behavioral health conditions.
  • Explicit linkage with and furthering the work of, King County and community initiatives.
• Theory of Change – what’s going to happen as a result of the application of MIDD 2 funds
• Strategy Areas – five distinct areas that organize MIDD 2’s services and programs into a continuum of services
• Sample Performance Measures*– examples of how service capacity, service quality, and individual outcomes will be measured for MIDD 2 programs.

* “Sample Performance Measures” are not intended to capture an exhaustive list of outcomes. They are a representative example of the types for the strategy areas. It is expected that outcomes will change over time, including during MIDD 2 implementation, based on community and stakeholder feedback.

The MIDD 2 Framework is a living document that will continue to be updated over the life of MIDD 2 to reflect specific programmatic and services or other drivers. The MIDD Advisory Committee reviews and discusses this framework at its meetings, providing input on any revisions.