Too few benefit from the current mental-health system

If someone tells you they are suicidal, do you know what to do? You see your friend abuse substances again after they said it was the last time — how do you help them? There is a man screaming profanities and encroaching on your personal space while you walk down a sidewalk — who do you call? My response to these questions has changed drastically since 2001 when I started my work on the front lines of mental health, substance use disorder and homeless services.

I relocated to Seattle in 2005 and settled into a position with a nonprofit agency primarily serving the homeless community. I observed the emergence of the “10 -Year Plan to End Homelessness” and participated in the “One Night Count,” as it was then called. Now it is referred to as the “Point-in-Time Count,” when volunteers spend one night a year documenting the city’s homeless population. I never imagined 15 years later the homeless crisis would be incredibly worse. Availability and access to mental-health and substance use disorder programs has greatly reduced in that time as well.

The last decade I have almost exclusively been employed in various emergency departments conducting psychiatric assessments and providing crisis intervention as an ER social worker. However, I feel my role has since become more of a professional gatekeeper. Only the most severe individuals actively harming themselves or others are usually granted access to psychiatric hospitalization and next-day appointments. I have read the various opinion pieces and in-depth articles on the state of mental health, substance use disorder and homeless services in Washington. As both a mental-health professional and substance use disorder professional, I am trained and informed regarding the most appropriate interventions for people needing treatment. Yet I am unable to provide or connect most people to such services due to lack of resources. The current pandemic has exacerbated the limited options.

The recent law enforcement response to House Bill 1310 has further complicated interventions. The proposed addition of social workers as first responders will provide little difference in outcomes. At this point, social workers cannot do much better than police when resources and programs are not available for people to receive the help they need.

There are no shelters where I can secure a bed for someone seen in the ER. I am unable to obtain access to medical detox for most people seeking it. When I tell a family member of a patient or individual they do not meet criteria for a psychiatric admission and they ask, “Do I have to try to kill myself or hurt someone else to get help?,” the answer is yes. This is unacceptable, reckless and how does it serve a population needing help?

The current system is benefiting no one. Several years ago the only detox facility in King County, Recovery Centers of King County, closed overnight. There were no medical detox services available for uninsured or Medicaid-covered individuals for nearly a year. I remember telling the mother of an individual using heroin there was no place to send her son for detox. She told me she would hold me personally responsible if her son relapsed after leaving the ER. I am fearful of possible repeat closures of such programs due to lack of funding.

Mental-health and substance use disorder professionals, including myself, have continued to provide crisis intervention alongside medical staff during the pandemic. The ongoing mental-health, substance use and homeless crises have only grown during this time. I feel impotent and defeated in my ability to provide the interventions people require to be healthy. Compassion fatigue is a symptom of a failed system of support. Is anybody listening? Or will these crises continue to worsen over the next 10-15 years? We are all responsible to respond.