Fixing the behavioral health crisis response system

From behind we see a woman's arm raised in a gesture of explanation as three men solemnly look on. They are standing outside on a sunny fall day, and there is part of a tall apartment building and a wooden fence across the street behind them.
Director of Clinical Programs Maggie Hostnick talks about the CSC during a tour in September. Listening are King County Director of the Department of Community and Human Services (DCHS) Leo Flor, DESC Associate Director of Mobile Response Freyton Castillo and King County Executive Dow Constantine.

By DESC Executive Director Daniel Malone

You may have missed the article, “Seattle psychiatric nurse reckons with the city’s most vulnerable residents,” on Nov. 25, featuring a psychiatric nurse working at DESC trying to help some of the most vulnerable people in our community. 

It’s two stories in one, showing an intense level of suffering being experienced by people living with serious psychiatric conditions and the heavy toll that can take on the people attempting to relieve that suffering. And it’s vividly told, showing minute-by-minute examples of what inadequate support  from the behavioral health crisis response system can look like.

Service providers have sounded the alarm

More than a year ago I joined with numerous colleagues across the behavioral health treatment continuum to sound the alarm to government leaders about the state of the crisis response system and scarcity of appropriate community supports, using phrases like “people in crisis” and “workforce challenges” and “the under-resourced behavioral health system.”  The stories chronicled in this article are the raw versions of what those phrases mean.

People living with psychiatric conditions are not inherently dangerous, but in all walks of life danger rises with desperation.  If you can’t get the help you need for the symptoms you are experiencing and the pain you are suffering, you can deteriorate in ways that might include diminished ability to regulate your emotions.  When that leads to risks of harm to yourself or other people, you need more intense help, and you need it now, not sometime after waiting weeks for an evaluation as described in the article.  Same-day evaluation with immediate placement into treatment used to be the norm in responding to these severe situations, but now DESC and other community providers are often left without that essential backup support.

So with a picture this bleak, what’s the way out?

Last year we and others proposed essentially the three-legged stool of a greatly enhanced crisis response system including the creation of places for people in crisis to receive immediate support, major support for the behavioral health workforce, and investment in the basic infrastructure everyone needs to have a healthy life, none more important than safe and affordable housing. We applaud King County’s recent announcement of plans to ask voters to approve a proposal to build many more crisis centers and to provide appropriate compensation and training to the behavioral health workforce.  The state and federal governments should also provide resources to bolster this system. While enhancements to our crisis system’s capacity are urgently needed, solely building up the crisis response system is not sufficient to fully address the needs of people experiencing crises and frontline workers who are caring for them.

A whole lot of crisis can and will be prevented when we fully attend to the support systems and housing everyone needs.  Evidence-based practices implemented at DESC and elsewhere, such as Housing First permanent supportive housing, Assertive Community Treatment, specialized outreach and crisis response programs, and routine behavioral healthcare services delivered in community-based settings for people with long histories of trauma, have been under immense strain during the pandemic.  Normal supports have been weakened, and timely interventions not as available. 

The Washington state Legislature has an opportunity to invest in these things

The state Legislature will be convening in January and has an opportunity to invest in behavioral health and affordable housing resources and the essential workforce that prevents people from experiencing a crisis and supports their recovery after a crisis.

There are reasons to be hopeful, at least in the long run.  For one, there is an incredible behavioral health workforce, albeit a fractured and hurting one, to build on.  At often great personal sacrifice, people continue to show up every day to carry out the proposition that people with psychiatric conditions deserve direct, personal care and can thrive when they get it.  Likewise, people with these conditions want that help and care, and make use of it best when it’s consistently available and they aren’t fighting for survival. 

System investments can lead us into a new era of behavioral health

The pandemic exacerbated all of this for sure.  As that recedes there should be some level of natural improvement.  Investments to restore and build the system we all need will get us through the current chaos and into a new era where everyone with psychiatric conditions can resume thriving and healthy lives.

(This piece first appeared in The Seattle Times.)

Northgate emergency housing opens

DESC’s Director of Housing Noah Fay joined King County Executive Dow Constantine and Dept. of Community and Human Services Director Leo Flor to open our second emergency housing site, Health Through Housing Northgate.

In the video, Noah and Mr. Flor answer questions from the media about how HTH is transforming the service model and providing dignity and stability to our guests.

Read more about this facility here.