Addressing the behavioral health system: improvements made, more work to be done

Coming into the 2019 legislative session, AWC knew behavioral health would be a front burner issue. The situation at Western State Hospital, the Trueblood lawsuit and the opioid epidemic all combined to create a crisis that impacts all communities.

As a result of the Trueblood et al., v. DSHS (Trueblood) settlement, the Legislature dedicated $4 million to the mental health co-responder program that AWC helped create in 2018. Of this amount, $3 million is dedicated to implementing the existing program in an underserved region – referred to as Phase One. Phase One includes Pierce and Spokane counties and Southwest Washington. The additional $1 million is intended to be flexible dollars for the Washington Association of Sheriffs and Police Chiefs (WASPC) to administer the grants, create required data and reports and pass additional dollars through to the other areas of the state that already implement the program.

In terms of policy that came from the Trueblood settlement, SB 5444 expands the authority of law enforcement to divert an individual known to suffer from a behavioral health disorder to a crisis stabilization unit, triage facility or facility for civil commitment instead of arresting the individual.; Additionally, SB 5444 creates a path for persons charged with felony and non-felony level offenses in an outpatient setting.

While the Trueblood settlement focused on diverting people with behavioral health challenges away from a jail setting, HB 1767 creates a grant program aimed at supporting local initiatives to properly identify persons with substance use disorders and other behavioral health needs and engage those persons with therapeutic interventions and other services at or prior to the time of jail booking or while in custody. Grants must be awarded to local jurisdictions based on locally-developed proposals to establish or expand existing programs. The lead proposing agency may be a law enforcement agency or other local government entity, tribal governmental entity, tribal organization, urban Indian organization, or a nonprofit community-based organization. The grant program is administered by WASPC. The Legislature dedicated $2.2 million to fund this program.

Another facet of the behavioral health crises involves Opioid Use Disorder (OUD). The Legislature took a step towards addressing this public health crises with the passage of SB 5380 , which requires that individuals be offered evidence-based treatments such as medications approved by the FDA for the treatment of OUD. Any region or county that uses state criminal justice treatment account funds to support a therapeutic court must allow therapeutic court participants to use medications approved by the FDA for the treatment of OUD as medically appropriate. Early in session, the bill required all jails to provide medically assisted treatment (MAT) to incarcerated individuals. However, several smaller facilities in the state lack the resources to provide MAT. AWC advocated for a change and the bill was amended so that MAT is required to the extent funding is available.

One major theme this session was the push to move towards a community-based treatment model for many behavioral health services. The Legislature dedicated $396,000 through the Department of Commerce to support the creation of a model ordinance for cities and counties to use in siting community-based behavioral health facilities. AWC will continue to be active in this process.

City priorities – Outcomes

PRO – Passed SB 5444, the Trueblood bill that establishes forensic navigators to assist individuals referred for a competency evaluation and help coordinate community services for individuals ordered to receive outpatient competency restoration.

PRO – Funded the co-response program to provide a mental health professional to assist law enforcement; $3 million to implement the program in underserved areas and $1 million to support existing programs.

PRO – Passed HB 1767, creating a grant program administered through the Washington Association of Sheriffs and Police Chiefs to help identify individuals with substance use disorders and other behavioral health needs at the time of arrest or incarceration, and engage those persons with therapeutic interventions and other services. Provided $2.2 million dollars in funding.

PRO – Passed SB 5380 to provide a statewide approach to the Opioid Use Disorder (OUD).

CON – Failed to provide funding for jails to provide Medically Assisted Treatment (MAT) services for persons suffering from OUD.

Homelessness & human services bills