This spring, King County voters could weigh in on whether to approve a new plan to tackle the region’s burgeoning behavioral health care crises.
The plan would build five new walk-in centers to allow community members to access mental health care and substance abuse disorder treatment regardless of insurance status. These centers would fill a large gap in the region’s health care system, said King County Councilmember Girmay Zahilay.
“Throughout the pandemic, we’ve seen such an alarming rise of people suffering from behavioral health crises, whether they’re indoors in their own homes going through isolation and depression and anxiety and substance use disorders, or people who are on the streets doing the same thing,” Zahilay said. “And, as a councilmember, I hear about these issues all the time. That’s probably the number one issue that I hear about.”
According to a report from Public Health – Seattle & King County, drug overdose deaths increased by 20 percent between 2019 and 2020 and 39 percent between 2020 and 2021. The department also said that fentanyl — a newly popularized and highly effective synthetic opioid — contributed to about 70 percent of overdose deaths in 2022, compared to less than 10 percent in 2018.
Faced with this growing crisis, Zahilay went to local providers and hospitals to try to understand why the county’s health care system was failing to respond adequately.
“Their responses to me were, ‘Well Girmay, everything is over capacity,’” he said. “The hospitals are over capacity, the emergency rooms are over capacity, the shelters are over capacity, the jails are over capacity. The permanent supportive housing is over capacity. All of these things that we would need to respond to this crisis are filled up, and so you are seeing the consequence of that, which is people untreated, uncared for, out in the streets suffering from mental illness or substance use disorders.”
Together with other councilmembers, King County Executive Dow Constantine and the county’s Department of Community and Health Services, Zahilay formulated the crisis care proposal to expand the county’s behavioral health care infrastructure.
Washington state has long been criticized for its inadequate mental and behavioral health infrastructure. In 2022, the nonprofit organization Mental Health America ranked Washington as having the 32nd best mental health care system for adults and the 39th best for youth out of all 50 states and Washington, D.C.
According to an infographic from Constantine’s office, mental health beds have decreased by almost a third since 2018, from 355 to 244. It also claims that the average wait time for a residential mental health care bed is 44 days. Zahilay added that options for walk-in, short-term crisis stabilization were even more scarce, with a single, 46-bed DESC facility that is accessible only with a referral from law enforcement and other first responders.
If the plan passed, the five crisis care centers would be distributed throughout the county and admit people on a walk-in basis, with one of the centers specifically catering to youth. Each center would contain a 24/7 behavioral health emergency center where new patients are received, evaluated and stabilized. Patients will also be able to call in via 988 — the new national suicide and crisis line launched in 2022 — or be referred by a first responder or family member.
A second component of the crisis care centers is what Zahilay calls a “23-hour living room,” which is staffed by trained peers and clinical mental health professionals. The third component is a 16-bed voluntary crisis stabilization unit, in which patients can stay overnight.
The final part in the pipeline would be a new countywide crisis responder assessment office, which would help identify opportunities to transition patients to more long-term options, such as permanent supportive housing or in-hospital treatment.
To fund all of this, the county has proposed a nine-year property tax levy that would raise about $121 a year from a median property valued at $694,000, totalling about $1.25 billion in all. The levy would also support workforce development and retention, improving the working conditions of first responders and mental health professionals. According to Constantine’s office, vacancies at community behavioral health agencies doubled between 2019 and 2021.
The King County Council is set to review the finalized crisis care center proposal in February. If the council passes it, the next step will be to send it to the voters, who would decide in April on whether or not to approve the property tax levy.
However, Zahilay warned, the crisis care center proposal is just one piece of the solution, and it cannot solve the county’s many overlapping crises alone.
“As we’re building out these crisis care centers, it is equally important that we’re simultaneously building our capacity for all the other types of homes that people need, from temporary shelters, to permanent supportive housing, to homeownership, to affordable rentals … and everything is needed in the continuum. We need to be simultaneously working aggressively toward those,” Zahilay said.
Guy Oron is the staff reporter for Real Change. Find them on Twitter, @GuyOron.
Read more of the Dec. 28, 2022-Jan. 3, 2023 issue.