King County, Seattle form coalition to boost mental health facilities and workforce

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King County has lost nearly a third of its residential mental health beds since 2018, and residents wait an average of 44 days for such treatment, county and city officials announced Thursday.

The data points to the severely under-resourced state of the county’s behavioral health system. It was announced as part of the formation of a new coalition of King County and Seattle government leaders, state representatives and health care workers who plan to rebuild and add more resources to the region’s depleted mental health workforce.

A wide-ranging proposal to address holes in the crisis response system, a lack of beds at residential treatment centers and workforce shortages is expected to head to the Metropolitan King County Council next month alongside Executive Dow Constantine’s 2023-24 biennial budget, officials said at a news conference Thursday morning in downtown Seattle.

Officials didn’t commit to a specific budget, or offer details on how much these big-ticket items might cost or how they would be paid for. But officials suggested that an upfront investment in the mental health and substance use treatment systems could lead to long-term cost savings in other corners of the city and county budgets, such as jails.

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The system caring for people with mental health or substance use challenges is strained from top to bottom. The county has no walk-in urgent care center for people experiencing a mental health crisis, youths and adults wait hours or days in emergency departments before landing an inpatient bed, and several community behavioral health clinics have cut back care or closed altogether.

“All of us are here to work together,” Constantine said, “to form a robust policy proposal to address this crisis with urgency and on the scale that is needed to meet the levels of care required today, and to serve our community tomorrow. ”

Constantine was joined by Seattle Major Bruce Harrell; King County Councilmember Girmay Zahilay; King County Sheriff Patti Cole-Tindall; state Rep. Nicole Macri, D-Seattle; King County Behavioral Health and Recovery Division Director Kelli Nomura; and members of the SEIU Healthcare 1199NW union.

The creation of the coalition acknowledges the urgency of addressing an already disjointed system made worse during the pandemic. The number of people in need of mental health and substance use help skyrocketed just as services began to constrict.

It also comes on the heels of the nationwide launch of the new 988 crisis hotline, which replaces other suicide and mental health hotlines and is the first step in a long process of transforming the nation’s crisis response system.

Officials called for 24/7 walk-in crisis stabilization units, incentives like higher pay to attract more people to the behavioral health workforce and a move away from relying on emergency departments and jails as front-line mental health providers.

Macri said lawmakers and other officials may need to consider regulatory or statutory changes to make some of these proposals possible. For instance, she said, the state hasn’t yet created a specific facility license pathway for mental health crisis care centers. And she said the state’s Medicaid plan, which primarily serves people who have a disability or are low-income or pregnant, doesn’t take full advantage of the ability to draw down federal funds to pay for mental health care.

The county’s ability to expand the number of mental health beds is also constricted by a federal rule that prevents large inpatient psychiatric facilities — those with more than 16 beds — from receiving federal Medicaid dollars. The state has a temporary waiver from this rule, but the waiver expires at the end of 2022.

Building the mental health workforce poses challenges, too. Naomi Morris, a nurse with SEIU Healthcare 1199NW who spoke as part of the coalition, is the only nurse on a team of behavioral health crisis care professionals that should have three. Colleagues are leaving the profession, Morris said, because they experience daily trauma and stress. Pay is so low that some can’t meet their own basic financial needs.

“I’ve done this work for years, and to be real, I’m exhausted,” Morris said. “But I also have a passion for this work.”

People deserve a mental health system that meets them where they are, Morris said.