Summary

King County Executive Dow Constantine announced a robust plan to improve the state of behavioral health availability and sustainability in King County alongside a broad coalition of elected officials, behavioral health workers and providers, emergency responders, and businesses.

Story

King County Executive Dow Constantine and a regional coalition of leaders today announced a plan to address the behavioral health crisis by creating a countywide network of five crisis care centers, investing in the recruitment and retention of the community behavioral health workforce, and restoring the number of residential treatment beds in the region. The plan would be funded by a nine-year property tax levy to treat immediate crisis and support long-term recovery and wellbeing, and if approved by the King County Council will be submitted to voters for approval in April 2023.

“We must do more to deliver the behavioral health care people need, when they need it, especially in a moment of crisis. Today, we are telling the thousands of King County residents in behavioral health crisis, their families, and our communities - help is on the way,” said Executive Dow Constantine. “The behavioral health system in this state has long been underfunded and underappreciated. The pandemic added further stress, and need is increasing even as we lose both treatment beds and qualified workers. Now, we can chart a path forward as a region – to create places where people can receive the effective care they need and begin their journey to recovery. This is an opportunity to make the generational investment our region needs.”

The proposal is estimated to cost the owner of a median-value home about $121 in 2024. The levy would continue through 2032, generating a total of $1.25 billion to stabilize and strengthen King County’s behavioral health crisis care system.

Informed by a broad-based coalition of local governments, behavioral health workers and providers, emergency responders, and businesses, the behavioral health crisis response plan developed by Executive Constantine will do four things:

1. Create five new regional crisis care centers: Distributed geographically across the county, the centers will provide walk-in access and the potential for short-term stays to help people stabilize, depending on needs, with one center specifically serving youth.
2. Preserve and restore the dramatic loss of residential treatment beds: In 2018, 355 beds providing community-based residential care for people with mental health residential needs existed in King County. Today, only 244 of these beds are available.
3. Grow the behavioral health workforce pipeline: The proposal will create career pathways through apprenticeship programming and access to higher education, credentialing, training, and wrap-around supports. It will also invest in equitable wages for the workforce at crisis care centers.
4. Provide immediate services while centers are being constructed: The proposal will also use initial proceeds to quickly create mobile or site-based crisis behavioral health services that can operate until the first crisis care centers open. This bridge strategy will complement recent state and federally-funded-mobile crisis teams.

“Building healthy communities requires investing in individualized, comprehensive, and sustained behavioral health care. Our residents in crisis and the most vulnerable deserve nothing less," said Seattle Mayor Bruce Harrell. "The time is now to reestablish proven behavioral health solutions and reverse the trend of negative health outcomes. Together, we can show progress for our communities and provide stability, resources, and expanded access to care for those in need.”

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, DESC’s Crisis Solutions Center in Seattle requires a referral from a first responder, hospital, designated crisis responder, or mobile response team due to its limited capacity.

“For many years now, law enforcement has been the primary responder for people in behavioral health crisis. I’m excited that the proposed behavioral health levy will bring urgently needed resources to work alongside first responders," said King County Sheriff Patti Cole-Tindall. "A well-resourced and well-functioning behavioral health system is a vital component of an effective public safety system. When there are more places for people to go to receive timely, life-saving care from mental health professionals, and we have expanded behavioral health outreach, we will begin to address the unmet behavioral health needs in our communities. At the same time, we can increase the effectiveness of law enforcement, allowing officers to respond to higher priority public safety incidents.”

Many people cycle through a revolving door of emergency rooms, jails, and homelessness because other options do not exist. In King County, case managers identify people who need a behavioral health supportive housing unit or a psychiatric residential treatment bed and find that providers reach capacity by mid-month. As of July 2022, people wait an average of 44 days for a mental health residential bed.

“As I have stated before, our ability to respond to behavioral health crisis events is itself in crisis,” said Michelle McDaniel, CEO of Crisis Connections. “It is imperative that King County invests in the connection of a system where community members have a place to call, there are places for people to go to access care, and someone who can respond no matter the circumstance. King County is acting with the urgency this moment requires, and I look forward to working closely with the Executive and the coalition to ensure people get the care they need when they need it.”

In recent years the number of residential treatment beds is in steady decline. King County recently purchased Cascade Hall in North Seattle, preserving 64 beds or approximately 25 percent of King County’s remaining mental health residential treatment beds.

"Behavioral health care is built upon inadequate wages. People in this field—including people with bachelor’s and Master’s degrees—regularly find themselves working to enroll clients in housing and food subsidy programs that they themselves qualify for. Choosing to do work we care about should not mean sacrificing a living, thriving wage," said Kristen Badin, Crisis Counselor, SEIU 1199NW. "In this proposal King County is making a commitment to begin to change that. By committing that these centers will open with wages that recruit and retain workers, rather than the low wages that exist in the field today, we are righting a wrong."

In North King County, the Cities of Bothell, Kenmore, Kirkland, Shoreline, and Lake Forest Park are in the process of developing a place for more crisis stabilization beds for north King County residents. Executive Constantine’s 2023-2024 Biennial Budget to be announced tomorrow invests up to $11.5 million in the project already underway, including a $10 million state capital grant, for the county’s first crisis care center.

“This proposal expands upon the work we have been doing in North King County and opens doors across the entire region to more compassionate, effective behavioral health care.” said Kirkland Mayor Penny Sweet. “Having somewhere to go is a critical missing piece of the behavioral health continuum of care, and it is a priority of our North King County city coalition to secure funding to build out and operate a future facility.  The health and well-being of our communities are at the center of our region’s safety and security.  I am grateful for the County and our City partners of Bothell, Kenmore, Lake Forest Park, and Shoreline in helping realize these critical investments."

King County will continue to partner with state agencies and state legislators to address key priorities in the behavioral health crisis response system. This partnership at the state and local level is essential to increase foundational Medicaid funding as well as capital and crisis services investments that match the community’s needs. King County’s robust community-based behavioral health provider network will also play a lead role in designing and operating the facilities this levy will make possible.

The County Council is expected to vote by February on whether to put the proposal on the April 2023 ballot.

Additional behavioral health investments will be announced as part of the Executive’s 2023-2024 Biennial Budget, set to be sent to the King County Council on September 27.

Relevant links

• August 2022 - Executive Constantine announces coalition to tackle behavioral health crisis in King County
• September 2022 - King County and State acquire behavioral health treatment center in North Seattle, preserving sixty-four treatment beds
• Crisis Care One-pager (PDF)

Quotes

We must do more to deliver the behavioral health care people need, when they need it, especially in a moment of crisis. Today, we are telling the thousands of King County residents in behavioral health crisis, their families, and our communities - help is on the way. The behavioral health system in this state has long been underfunded and underappreciated. The pandemic added further stress, and need is increasing even as we lose both treatment beds and qualified workers. Now, we can chart a path forward as a region – to create places where people can receive the effective care they need and begin their journey to recovery. This is an opportunity to make the generational investment our region needs.

Building healthy communities requires investing in individualized, comprehensive, and sustained behavioral health care. Our residents in crisis and the most vulnerable deserve nothing less. The time is now to reestablish proven behavioral health solutions and reverse the trend of negative health outcomes. Together, we can show progress for our communities and provide stability, resources, and expanded access to care for those in need.

For many years now, law enforcement has been the primary responder for people in behavioral health crisis. I’m excited that the proposed behavioral health levy will bring urgently needed resources to work alongside first responders. A well-resourced and well-functioning behavioral health system is a vital component of an effective public safety system. When there are more places for people to go to receive timely, life-saving care from mental health professionals, and we have expanded behavioral health outreach, we will begin to address the unmet behavioral health needs in our communities. At the same time, we can increase the effectiveness of law enforcement, allowing officers to respond to higher priority public safety incidents.

As I have stated before, our ability to respond to behavioral health crisis events is itself in crisis. It is imperative that King County invests in the connection of a system where community members have a place to call, there are places for people to go to access care, and someone who can respond no matter the circumstance. King County is acting with the urgency this moment requires, and I look forward to working closely with the Executive and the coalition to ensure people get the care they need when they need it.

Behavioral health care is built upon inadequate wages. People in this field—including people with bachelor’s and Master’s degrees—regularly find themselves working to enroll clients in housing and food subsidy programs that they themselves qualify for. Choosing to do work we care about should not mean sacrificing a living, thriving wage. In this proposal King County is making a commitment to begin to change that. By committing that these centers will open with wages that recruit and retain workers, rather than the low wages that exist in the field today, we are righting a wrong.

This proposal expands upon the work we have been doing in North King County and opens doors across the entire region to more compassionate, effective behavioral health care. Having somewhere to go is a critical missing piece of the behavioral health continuum of care, and it is a priority of our North King County city coalition to secure funding to build out and operate a future facility. The health and well-being of our communities are at the center of our region’s safety and security. I am grateful for the County and our City partners of Bothell, Kenmore, Lake Forest Park, and Shoreline in helping realize these critical investments.

With only one behavioral health crisis facility and no walk-in urgent care behavioral health facility, our region does not have the clinics or care teams to meet the growing behavioral health crisis in our community. Workers, residents, first responders and businesses owners see this crisis playing out daily on our streets. This proposal is good for the health of our community and our local economy. This proposal is our chance to build the care facilities we need, invest in essential workers, get to people in need faster and get them into care - instead of the revolving door at a hospital or jail.

Today we have the opportunity to build on the recent investments the state legislature has made to improve and expand behavioral health services, stabilize our provider network devastated by the pandemic, and support the vital people who care for our neighbors in crisis. It sends an important signal to people across King County that when any of us face challenges with mental health and substance use and most need help, our community will be there to respond and assist.

We are severely underserved in regards to access to behavioral health in our region and even throughout our state. This crisis is well known and has been amplified by the pandemic. If we want to truly have healthy communities we must improve access, improve staffing and training of professionals and meet people where they are. These crisis centers will be a very good start to this effort.

This levy is proactive solution to a longtime hole in our crisis response system. King County’s proposal creates a supportive response for community members who may find themselves experiencing a crisis. It is what we need to address the root of our region’s complicated homelessness issue.

For more information, contact:

Chase Gallagher, Executive Office, 206-263-8537