Crisis care centers are important. But WA needs more to fill behavioral health gaps | Opinion
King County voters will decide whether to fund a network of behavioral health crisis care centers in April. Pierce County is watching the outcome with interest since access to behavioral health care is a significant issue impacting the region.
There are many reasons to embrace crisis care centers. We all know people who have experienced behavioral health emergencies. However, Washington’s entire behavioral health system is in crisis. Narrowly focusing on crisis centers may lead to more crises.
In King County, lawmakers have explained that crisis centers will “provide a safe place… specifically designed, equipped and staffed for behavioral health urgent care. These Centers will provide immediate mental health and substance use treatment and promote long-term recovery.”
If crisis centers receive the most resources, they will be the most robust element of the system. Outpatient clinics providing earlier intervention and prevention services are under-resourced, understaffed and have waitlists for both new and established patients. Excessive waiting for care can precipitate emergencies.
Crisis care centers will accept anyone, with or without insurance. Many behavioral health clinics have insurance restrictions on who they can serve, with some providers having only limited funds to serve uninsured people. Such restrictions will funnel the uninsured to crisis centers.
Due to limited resources, crisis care centers must screen and triage referrals. If people experiencing symptoms related to mental illness or substance use don’t meet admission criteria for a crisis center or a hospital, what then? If under-resourced outpatient clinics remain understaffed or close, these individuals will be forced to wait for treatment. Their symptoms may worsen, precipitating preventable crises.
The King County levy touts the use of peer counselors in crisis centers. Peers with lived experience are valuable, though should not be the primary providers of care. Peers often have the lowest wages and, in some for-profit models, make up the bulk of personnel providing patient care. Many people experiencing behavioral health emergencies are very ill and vulnerable. If these people receive insufficient services, their mental health is more likely to rapidly deteriorate, increasing the likelihood of returning to these centers. If these crisis centers are operated by for-profit organizations, readmissions will increase their revenue. We have already witnessed this pattern in several for-profit psychiatric hospitals where patients experienced harm. Patients and their families deserve better.
Outpatient clinics with robust funding for personnel, technology and other resources, along with adequate reimbursement — things that never happened after the original deinstitutionalization movement of the 1960s — will help people access care, and offer preventative care and early intervention at the first signs of behavioral health challenges. These efforts will decrease behavioral health emergencies.
Ultimately, supporting peoples’ basic needs will prevent behavioral health crises. Living wages, affordable housing, access to food, universal health care coverage, employment opportunities, education and training, and building social connections will reduce psychological burdens and promote wellness.
Crisis care centers are only one step in improving Washington’s battered behavioral health care system.
More needs to be done to improve the mental health of our friends, family and neighbors.
Dimitry Davydow, MD, MPH is a psychiatrist and is Chief Medical Officer of Comprehensive Life Resources, a community mental health organization serving individuals in Pierce County.
Maria Yang, MD, works as a public health psychiatrist in King County who serves people who are experiencing homelessness.
