Even before the pandemic, the system for responding to mental illness and substance use disorders in Washington was stretched.

“It’s under-resourced, and it can be difficult at times for people to get sustained timely care,” Rep. Nicole Macri, a Democrat who represents portions of Seattle in the Washington state Legislature, said in a forum Thursday.

This system has struggled to respond to a dramatic increase in the past two years in behavioral health needs, which cut across income levels, age and race, she said. People seeking care for the first time face difficulty finding services. Patients departing from treatment facilities, especially young people, have trouble finding safe and secure housing to continue their recovery.

The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

In a virtual event Thursday co-sponsored by The Seattle Times Mental Health Project and the League of Women Voters of Seattle-King County, policy makers, advocates and people who have experiences with mental illness and substance use disorders discussed the historic and systemic issues that prevent people from accessing appropriate and adequate care. The panelists also discussed potential solutions to address these issues and what it would take to make them sustainable and effective.

Here are a few takeaways from the conversation. (Watch a replay of the event above.)

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People seeking care need more access to culturally competent resources, and providers and public officials need to understand the critical role race plays as a factor in treatment.

“One of the most important steps in my own journey was being able to access resources specific to Native people through Native American-led organizations,” said Sharayah Lane, the acting program manager at the nonprofit Philanthropy Northwest. 

Lane, a member of the Lummi Nation who is also Black, said her own experience in receiving behavioral health care at a safe and familiar environment like the Chief Seattle Club, a Native-led housing and human services nonprofit, helped her feel more comfortable and connected. She noted cases of people — particularly people of color — killed by police when officers are called to respond to mental health crises, including Charleena Lyles, who was killed in Seattle.

“It literally could mean life or death for some people if there is integration of a racial justice lens into these programs, and how they’re being rolled out in crisis response for communities of color,” she said.

Issues related to recruiting, training and retaining a diverse mental health workforce are preventing people from accessing care.

The number of individuals licensed to provide mental health treatment is limited, and recruiting and retaining people in the field often has been difficult due to extremely high caseloads of clients, low payment from insurance providers, and the high cost of training programs.

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Jim Vollendroff, a senior adviser for policy and advocacy for the Department of Psychiatry and Behavioral Sciences at the University of Washington, said he often hears about students “going into work in the public behavioral health system and quickly burning out and changing jobs.”

In an effort to boost the availability of behavioral and mental health help, Vollendroff said the state and universities are exploring support for apprenticeships and peer-based programs, which utilize people who have navigated the system themselves to help others.

Mental and behavioral health have been chronically underfunded.

One of the major challenges for the publicly funded behavioral health system is that it has been chronically underfunded — not just in Washington state but around the country, said Isabel Jones, deputy director of behavioral health for King County.

Community-based behavioral health organizations are almost entirely reliant on Medicaid funding, which is intended to be a payer of last resort and is almost always the lowest-level funding source, she said.

“Behavioral health in general has been undervalued in our country and we haven’t invested in it as we have other parts of our health care system,” she said. “Until we can really make a significant investment in behavioral health, we’re going to have a challenge overcoming deficiencies.”

Patients with severe mental health needs require broad support beyond medical services.

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The crisis-response system needs to be more deliberately integrated with organizations that provide social support and relevant cultural connections. Getting well means having access to housing, social connections and more, but providing and connecting those services remains a challenge for the state.

Macri supports a housing-first philosophy that suggests providing stable housing to individuals experiencing homelessness can help reduce the severity of other related issues.

“Get someone into a stable place,” she said. “When you do that and surround people with services and care and community, a lot of the challenges people experience when they’re homeless — health challenges, acute behavioral health symptoms — really start to go away. People’s sense of wellness and community and ability to aspire to do the things they want to do with their lives really begins to take shape.”

Mental health resources from The Seattle Times