Investing in crisis response for people living with psychiatric disorders

You may have missed the November 25 Washington Post article, “Seattle psychiatric nurse counts with the city’s most vulnerable residents,” featuring a psychiatric nurse working at the Downtown Emergency Service Center (DESC) trying to help some of the most vulnerable people in our community.

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

Over a year ago, I joined many colleagues across the behavioral health treatment continuum in sounding the alarm to government leaders about the state of the crisis response system and the scarcity of appropriate community supports. , using phrases such as “people in crisis” and “workforce challenges” and “the underfunded behavioral health system”. The stories told in this article are the raw versions of what these sentences mean.

People living with psychiatric disorders are not inherently dangerous, but in all areas of life the danger increases with despair. If you can’t get the help you need for the symptoms you’re experiencing and the pain you’re experiencing, you may deteriorate in ways that could include a reduced ability to regulate your emotions. When it puts you or others at risk of harm, you need more intense help, and you need it now, not after waiting weeks for an assessment as described in the article. . Same-day assessment with immediate placement in treatment was the norm to respond to these serious situations, but today DESC and other community providers often find themselves without this essential support.

So with such a dark image, what’s the output?

Last year we and others essentially came up with the three-legged stool of a vastly improved crisis response system, including creating places for people in crisis to receive immediate support, major support for behavioral health workforce and investments in the basic infrastructure everyone needs. to have a healthy life, nothing is more important than safe and affordable housing.

We welcome King County’s recent announcement that it intends to ask voters next spring to approve a proposal to build many more crisis centers and provide appropriate compensation and training for behavioral health personnel. Without the successful passage of this measure, the 46-bed DESC Crisis Solutions Center will continue to be the only voluntary crisis care facility for all of King County’s 2.3 million residents, and we will always run out of walk-in behavioral crisis care centers. which people can refer to themselves. And without the workforce stabilization components of the proposal, there will continue to be high levels of burnout and turnover across the gamut of behavioral health programs.

State and federal governments should also provide resources to strengthen this system. While improvements in the capacity of our crisis system are urgently needed, strengthening the crisis response system alone is not enough to fully meet the needs of people in crisis and frontline workers who are struggling. take care of them.

Many crises can and will be avoided if we take full care of the support systems and housing that everyone needs. The Housing First philosophy means providing permanent supportive housing. Specialized rental housing with robust services has proven helpful for people with severe behavioral health issues who have been living on the streets for many years. Likewise, assertive community treatment programs, the most intensive type of outpatient psychiatric care, have been proven to help people who would otherwise remain long-term in psychiatric hospitals. Specialized outreach and crisis intervention programs are needed for people with untreated psychiatric conditions who currently find themselves homeless. These outreach programs provide one-time or short-term follow-up care to people in active psychiatric crisis, engaging them in care options and offering support to make healthier decisions.

Especially at a time when many normal supports have been weakened, these types of successful programs need to be bolstered by a better supported workforce and expanded to meet the broader needs of the community.

The state legislature will convene in January and has the opportunity to invest in behavioral health and affordable housing resources and essential workforce that keep people out of crisis and support their post-crisis recovery .

There are reasons for hope, at least in the long term. On the one hand, there is an incredible, albeit fractured and injured, behavioral health workforce to draw upon. Often at great personal sacrifice, people continue to come forward every day to defend the proposition that people with psychiatric disorders deserve direct personal care and can thrive when they receive it. Likewise, people with these conditions want this help and care, and make best use of it when they are constantly available and not fighting for survival.

The pandemic has certainly exacerbated all of this. As this recedes there should be some level of natural improvement. Investments to restore and build the system we need will get us through the current chaos and into a new era where anyone with psychiatric disorders can resume a healthy and prosperous life.