Spend just a few hours in one of Seattle’s denser neighborhoods, and you’ll inevitably witness the human toll of a deficient behavioral health system: People in the throes of addiction or a mental health crisis, alone but in public, without the support they need and deserve.

The gap between the mental health services we need in King County and what’s available is well documented: We don’t have enough psychiatrists and psychologists, enough long-term care beds, enough facilities for people in crisis, or enough funding for outreach and services. In fact, more than 1 in 3 Washington state residents experiencing anxiety and depression are unable to get the care they need, according to the Kaiser Family Foundation.¹ 

Why do we have this behavioral health gap? What’s being done to close it? And what more can we do? To try to answer these questions, Solid Ground recently convened a panel of leaders on the front lines of behavioral health and homelessness for a Social Justice Salon we called Minding the Gap: Poverty, homelessness, and restoring our broken mental health system.  

Moderated by DeAunte Damper of WA Therapy Fund, VOCAL-WA, and Converge Media, the conversation featured five experts from across the community of providers seeking to confront our behavioral health crisis: 

• Johnny Bousquet, CoLEAD 

• Phillip Carr, Good Intentions Counseling 

• Paul Park, Solid Ground 

• Alix Van Hollebeke, formerly of Downtown Emergency Service Center (DESC) 

• Susan McLaughlin, King Co. Dept. of Community & Human Services 

Together, the panelists explored the challenges they face in addressing mental health needs, the progress that’s been made, and the work that remains to be done. And they all agreed that we’ve arrived, as a community, at a critical juncture. 

“I really believe that we’re in a moment for behavioral health,” said Susan. “People are finally kind of paying attention to how important it is that we all have mental health – mental wellness – and that it’s such an important component of our health and quality of life. And there’s resources that are coming in.” 

 

Healing starts with housing – but it doesn’t end there 

In Seattle, you can’t talk about behavioral health without also talking about homelessness – although clearly many people who are housed also struggle with mental illness, and many people who are homeless do not need behavioral health care. 

But for the large and growing population for whom the two conditions intersect, panelists agreed that closing the behavioral health gap starts with creating much more appropriate housing in King County, particularly permanent supportive housing.  

“We all have a place to live, right?” Alix asked the audience at Town Hall Seattle. “That’s your source of safety and comfort, where you can get food and shelter, nourishment, rest. If you don’t have those things, how do you go to the bathroom? Where do you get water? Where do you stay warm? And what do you do if you don’t have those things? You use drugs because that feels better.” 

And while the panelists agreed on the importance of the Housing First approach to addressing homelessness, Paul argued that behavioral health services need to come in a close second. “We also know that the moment that they enter [housing], they may be leaving their comfort zone, right?  

“Their comfort zone may have been on the streets or in another environment, and all of a sudden they’re living in a different environment. They may not have their previous community of support that they used to have. And if they have underlying mental health challenges or are at risk, that’s not a good situation to be in,” he said.  

“And that’s why we strongly believe that when we say ‘housing first,’ that includes putting the client in the center and making sure that all of their needs – in particular their mental health and behavioral health needs – are addressed as quickly and as appropriately as possible.” 

Investing in care that reflects the community it serves

Panelists said that closing the gap in care will also require investing in our behavioral health workforce so it can meet the needs we face. Effective behavioral health care requires time for patients and providers to build trusting relationships, which is made more difficult due to a lack of providers, as well as low pay in the industry – all of which leads to providers regularly changing jobs in search of an adequate salary.  

“We do not have enough of a workforce,” Susan said. “We have some circumstances where we have money to stand up a program, and we can’t stand it up because there’s no people to work in the program.” 

Phillip said that one growing challenge for mental health providers is the expectation that patients’ insurance companies will pay for it. “That has created a large barrier when we talk about mental health services and behavioral health services,” he said. “Being able to navigate that transition for providers has been very difficult.” 

Phillip also said he’s seen firsthand what happens when clinicians receive the support they need. “We had clients that were really consistent in … receiving mental health services from us, which means the outcomes and their ability to reach their goals was an increase tenfold,” he said. 

Ultimately, it comes down to whether we, as a society, are willing to invest in a solution at the scale required by the crisis. 

“We need more resources,” Johnny said. “If we’re looking at where’s the breakdown, the breakdown is systemic in the lack of resources and the staff and all of the other things to have the capacity to meet the need.” 

But even adequately funded care doesn’t work if it doesn’t reflect the community it serves. Paul acknowledged that past efforts to bring behavioral health care to Solid Ground’s Sand Point Housing failed in part because the providers didn’t reflect the diversity and experience of the residents. 

“So bringing in people with shared lived experiences – bringing people in with similar cultural backgrounds – that was absolutely critical to be successful,” he said. “And we’re really proud that we can see through our data that this round is much better. It’s going to be much more successful – still not perfect, but we know that that’s absolutely one of the barriers we have to tackle. 

Changing how we think about behavioral health 

Despite the challenges we face in meeting the behavioral health needs of our community, panelists said there are many reasons to have hope for the future. Among them is major changes in how people think about the behavioral health crisis, as evidenced by King County voters’ 2023 approval of a Crisis Care Centers Levy that will fund the creation of five regional walk-in care facilities, recovery bed capacity, and more. 

“It gives me hope that the people of King County understand the importance of this issue and value having the services and having access to the care that people need when they need it,” Susan said. 

At the same time, panelists noted that there’s still a tendency among some people to want to further punish those experiencing addiction or mental illness rather provide services for them. Johnny, who’s experienced both addiction and homelessness in his own life, pointed to the city’s recent adoption of a Stay Out of Drug Area ordinance.²  

“We took a couple steps forward,” he said. “It seems like we’re taking a couple steps back. From my understanding, the war on drugs since 1972 has not done anything but be a war on marginalized communities,” he added. “We’re talking about putting people in prison for 5-10 years for $20 worth of drugs sometimes. And then it really depends on what you look like, right?” 

DeAunte said changing these policies starts with countering narratives that equate addiction and mental illness with crime, which can push communities to invest in law enforcement rather than mental health and outreach workers. 

“What we could be utilizing some of those funds for is to pay a lot of these outreach workers more money – these peer navigators more funding – because it is a lot,” he said. “Do you know what it’s like to go out and advocate on the streets that you used to walk on, and you see your people walking out there? Then at times you would have to navigate them and then you take it home. It is a lot for our community folks.” 

Reasons to have hope 

So, what comes next? For the panelists, the answer lies in lowering barriers – both those that prevent people from getting the care they need, and those that prevent providers from delivering the care that their communities require. 

In many cases, this means thinking more broadly about behavioral health care. Not everyone needs care from someone with a medical degree and the authority to write prescriptions, panelists said. 

Paul pointed to Solid Ground’s success partnering with Jones Community Solutions, a company that provides peer counseling for residents at Sand Point Housing. “These are individuals who have gone through a few months of training to be a counselor and have shared lived experience, whether lived experience with substance use, lived experience with homelessness, or being a person of color in our society.

“So someone with shared lived experience that can engage and open that door so that someone who may not even know what behavioral mental health is can start and take that first step and engage with the peer counselor,” Paul said. 

There are other emerging examples of low-barrier care. Susan noted that King County is now funding a 24/7 buprenorphine prescribing line. Anybody can call it anytime to talk to a physician and addiction medicine specialist to get a prescription for buprenorphine, which is used to treat opioid use disorder. 

“You don’t have to go somewhere,” she said. “You don’t have to jump through a bunch of hoops and prove that you need care. You just call and get a prescription.” 

Agencies have also recently had success with an outreach model of psychiatric care for patients at home during the COVID-19 pandemic. 

“We were bringing all of our psychiatric meds to our clients so people could stay home, and we would bring it to them, and they would get the medications they needed,” Alix said. “They didn’t have to come find us, and that really helped people maintain stability. It helped to have our eyes on them. If they needed something, like they needed food, if they needed more resources than they were getting, we could see how they were doing.” 

That’s not the only innovation to come out of the pandemic. After being lobbied for years to allow telepsychiatry appointments, the state finally OKed it in response to COVID-19. 

“There’s a psychiatrist shortage in our country and certainly in Washington state and King County, so telepsychiatry is a way to get that kind of expert evaluation and opinion to help support medications and stuff,” said Susan. 

Unfortunately, some of these advances were temporary and have since gone away. But panelists said they provide a hint of what’s possible. She added, “It’s like we made a little progress, but not completely forward.”  

The good news is that this crisis is not insurmountable, panelists agreed, and its end is not out of reach. “I am also starting to see the light and the tunnel in terms of where we’re at,” Paul said. “But I’ll also say that the light is very far.” 

Sources 

1) Kaiser Family Foundation: Mental Health in Washington 

2) Cascade PBS: Seattle enacts controversial drug, prostitution ‘stay out’ zones 

 All photos by Clarissa Magdich