Some years ago, one of MaryAnn Kridler’s relatives was in a mental health crisis and needed inpatient care. Nearby hospitals were full. But she eventually found luck an hour away in Bellevue — a city much bigger and with better resources than her rural community in Snohomish County.
Kridler, 62 and now retired, intimately understands the need for more mental health beds. Still, she’s found herself firmly opposed to a plan that would soon bring a mental health facility several dozen paces from the front door of the pale-yellow rambler she’s owned for the past two decades.
At home in October, Kridler motions toward the two-lane road where she says motorists occasionally drive fast and loud at night, and fire trucks blare as they approach from a nearby firehouse. Those interruptions are a nuisance. But nothing like what she worries would happen if the facility is built.
“It’s true, every community needs more places like this,” she said. “All our neighborhood is saying is this may not be just the best choice of location.”
Horses roam near the roughly 5-acre plot north of Stanwood where two 16-bed involuntary treatment centers could be built as part of Gov. Jay Inslee’s plan to move mental health services from large, centralized psychiatric institutions like Western State Hospital to smaller facilities integrated within communities. But the Snohomish County neighborhood standoff, which includes practical concerns but has also been hostile and laden with misinformation, demonstrates the hurdles to expanding community-based care.
Kridler said she worries about more traffic and weakened property values. Others are concerned the facility is too far from medical care and other social services. Many say they feel ignored and left out of a planning process they think lacked transparency.
The debate also raises the specter of longstanding prejudice against people with mental illness, which can be a powerful tool to build opposition to community-based mental health centers.
The darkest corners of the neighborhood debate have devolved into rumors, disparaging comments against people with mental illnesses, and skepticism toward those who own the building site and are putting up $35 million in construction funds: the Tulalip Tribes.
The tribes are leading the effort to fund, plan and build the facility — an agreement brokered in 2020 between state officials and the tribes after a lawsuit over tax-revenue rights. Some residents question why the tribes picked this spot over other plots they own.
Many neighborhood message board posts and complaints filed with the state and county cast people experiencing mental illnesses as a menace. In some complaints filed with the state, for instance, concerned residents mistakenly call patients — who have not been accused of any crime — “inmates,” and call on the state to require that patients wear ankle monitors.
Some of the complaints also posit scenarios about patient escapes and threats to community safety. State data, however, suggests it’s rare for patients to leave mental health facilities. Among the 24,177 involuntary mental health detentions statewide from September 2020 to August 2022, there were 30 instances when a patient left the facility or was reported as absent by staff.
Explaining the purpose, decision-making process and scope of the project has been a difficult juggling act, according to officials at Washington State Health Care Authority, which would have oversight over the facility. The involvement of several different state and local agencies, as well as the tribal government, adds layers of complexity.
While getting community buy-in for any new development can be a hurdle, it’s been particularly challenging to balance the messaging around security — assuring neighbors they’ll be safe — while not contributing to false and prejudicial views that all people with serious mental illnesses are disruptive or violent, said Melissa Thoemke, behavioral health communications manager at HCA.
“The true challenge is being transparent and messaging about this facility in a way that doesn’t alienate people who will use it, but is also clear about the kind of facility this is for the people” who live nearby, she said.
If all goes according to plan, though, construction of the first 16-bed facility on the Snohomish site could begin in April; a second facility of the same size could come later, but would require funding from the state.
State lawmakers have invested $40 million in direct appropriation since 2018 to stand up these types of small, residential mental health centers. But beds are closing down faster than they can be built: None of the state’s 80 planned beds has come online. At the same time, Western State has closed 120 civil beds in wards for patients with similar needs in the past two years.
A 16-bed facility in Thurston County is expected to open in early 2023. Three more 16-bed facilities are set to open in Clark County starting in the winter of 2024. Neighbors there have put up a fight similar to the one playing out in Stanwood, said Tyler Hemstreet, Department of Social and Health Services spokesperson.
In Snohomish County, support for the facility comes in the form of whispers rather than shouts. The local chapter of the National Alliance on Mental Illness advocacy group says it has struggled to attract supporters to speak at community meetings. Talking publicly about the private details of a loved one’s mental illness can be difficult when you live in a small town.
“Families tend to not want to share with neighbors what they’re going through,” said Stuart Heady, who lives on Camano Island and supports the facility. “They know people are not going to understand it without a whole lot of discussion and they don’t really want to go there. So they just take the odd comments and nasty looks and move on.”
Heady’s brother, who had bipolar disorder, died 11 years ago. Before his death, he’d spent 40 years in and out of mental health facilities.
Heady said his brother’s experience gave him a view into why someone might need to be treated involuntarily. They might be so depressed they’ve stopped feeding themselves, or practicing good hygiene. They might harm themselves or act aggressive toward others, and in need of medication or therapy to manage their moods.
Washington is ranked among the bottom half of states for mental health care, and in Snohomish County — the state’s third most populous county — only six beds are available for people whose mental illness is so severe that they are deemed in need of involuntary treatment. Over the last three months, the North Sound Behavioral Health Administrative Services Organization found 296 cases in Snohomish County where someone was so sick, they had to be treated involuntarily.
Since 2018, Washington state has slowly attempted to integrate mental health care into communities — a move necessitated after Western State Hospital lost its federal certification and after years of reports from families who’ve struggled to find care. State psychiatric hospitals were the norm for much of the 20th century, but in 1963, President John F. Kennedy signed the Community Mental Health Act, marking the start of deinstitutionalization.
Now Washington is catching up, investing in community-based mental health care by piecing together funds across several state agencies.
In Snohomish County, the proposed facility would serve people who are involuntarily committed through a process that involves a treatment order from a judge. Treatment would last 90 to 180 days. Unlike Western State, which has shifted to primarily treating people who enter care through the criminal court system, this facility is intended for patients who are not accused of a crime but have severe mental illness and can’t seek care voluntarily.
Locked doors, reinforced windows and 24-hour surveillance are intended to keep patients and staff safe, according to plans outlined by the Health Care Authority. Patients are expected to be discharged not to the street, as some neighbors say they fear, but back to their families, homes or to shelter, such as a motel program.
The land is rural, but it is zoned to allow a residential treatment center so long as the builder secures a county government permit for conditional use. The review process for the permit includes a public commenting period, compliance and environmental reviews and a hearing.
A few weeks ago, a resident filed an appeal that triggered a lengthy evidence-collecting process, stalling the permitting and postponing the hearing until late January.
“I don’t think they can derail it,” said Anna Nepomuceno, director of public policy at NAMI Washington. But, she said, “They’re going to at least try to.”
The North Stanwood Concerned Citizens group has formed and written a letter in opposition to the project. A separate letter submitted to state officials questioning the development plans include signatures from a county councilmember, the town’s mayor, as well as state Rep. Greg Gilday, a Republican who represents the area. (Stanwood Mayor Sid Roberts told The Seattle Times on Wednesday that he is now “mostly neutral” on the project after getting more information.)
“We are simply requesting for our community to work alongside developers and have our concerns heard and solutions brainstormed,” said Ganelle Swindler, a member of the group who grew up in Stanwood and is certified as a drug and alcohol counselor.
A bright orange NOTICE sign is posted at the proposed treatment facility property line, alerting anyone who reads it that change is coming.
Within shouting distance, a Tulalip healing lodge provides housing and treatment for people recovering from addiction. It’s a visible reminder that the building site — and 30 acres around it — is land that’s been owned by the tribe since 2011.
Some of the community’s frustration is rooted in confusion about why the new facility is being built here — and why they didn’t get a say. The answer is simple, according to Teri Gobin, chairperson of the Tulalip Tribes: “It’s our land. And that’s what we chose to do with it.”
In the 1855 Treaty of Point Elliott, the Tulalip Tribes ceded millions of acres of their historic lands to the U.S. government. In return, they were promised sovereignty over the remaining territory. The reason for the tribe’s involvement in this project, however, is more complicated, and dates to a more recent legal agreement with the state.
The case involved a dispute over who had the legal authority to collect taxes from businesses located at the Quil Ceda Village, a tribal municipality recognized by the federal government. A 2020 settlement resulted in a compact that gives the Tulalip Tribes access to 50% of taxes from existing businesses, and 60% of any future businesses.
In exchange, the tribes agreed to contribute $35 million of this new revenue toward construction of the mental health facility; lawmakers passed legislation in 2020 giving Inslee authority to create such a compact. The tribes intend to lease the land to the Washington Health Care Authority, which is expected to contract with providers to run the facility. The facility will prioritize tribal members but is intended to serve anyone living in Snohomish County.
“That was what the state asked for,” said Gobin. “They put that on the table because there was such a need for facilities because of the mental health issues in the area.”
Gobin said the concession was initially a hard pill to swallow; $35 million is equivalent to about one year of tax revenue from Quil Ceda Village businesses that goes to the state. In her eyes, the revenue is rightfully the tribes’ — it’s how the tribal government funds health care and education programs for nearly 5,200 members. She’s also conscious of the scrutiny the tribes have faced as the building project progresses — with neighbors suspicious of the Tulalips’ relationship with state agencies, calling the permitting process opaque, and hurling criticism that often hinges on stereotypes and skepticism about Native people.
“[Neighbors] wanted to know what is the tribe getting out of this and when they found out there were tax incentives, they got even more angry,” Nepomuceno said.
Gobin said her father, who served on the tribes’ council for over 40 years, faced prejudice from the surrounding community. That persists to this day.
The latest backlash, though, has fueled new support from tribal members who previously have kept quiet regarding the facility. During the tribes’ last general council, Gobin said, members asked how they could be supportive, and planned to be present for the next public hearing to share the value in what can come from the treatment center.
“It’s a good, healthy area for people to heal,” Gobin said.
Correction: A previous version of this article indicated Stanwood Mayor Sid Roberts and other area officials supported a citizens’ group opposing the project. While the officials signed onto a letter questioning the project, that letter was not from the citizens’ group, and Roberts said he was not a member. Additionally no Stanwood city councilmember signed onto this letter.