Crisis Care Centers Levy
A countywide network of crisis care centers, the stabilization of residential treatment, and a well-supported work force to ensure timely, lifesaving care.
Last year, King County Executive Constantine announced the Crisis Care Centers proposal. The plan will create a countywide network of five crisis care centers, restore the number of residential treatment beds in the region, and invest in the recruitment and retention of the community behavioral health workforce. The proposal funds the plan through a nine-year property tax levy to treat immediate crisis and support long-term recovery and well-being. Approved by the King County Council in February, the levy now goes to the voters on April 25.
The Crisis Care Centers levy proposes to invest in urgent care needs to transform an aging system and restore a path to recovery. The proposal responds to continued closures, reduced capacity, and significant gaps of behavioral health resources.
- King County is without a walk-in behavioral health urgent care facility.
- Only one 46-bed behavioral health crisis facility is in operation in Seattle for the entire county and requires a referral.
- Residential treatment beds are in decline. In 2018, 355 beds for mental health residential care existed. Today, only 244.
- The behavioral health work force is strained under the magnitude of the need, all while being underpaid, overworked, and stretched too thin.
- Significant additional investment is needed across the spectrum of behavioral health services, not just to respond to crises but for prevention, early intervention and community-based outpatient supports that keep challenges from escalating into crises.
Download information about Crisis Care Centers in Spanish, Somali, Vietnamese and Chinese.
Places to go in a crisis — five new Crisis Care Centers across the region
What is a Crisis Care Center?
A place for people to go in a behavioral health crisis for immediate treatment and care. A regional network of five Crisis Care Centers will provide a nearby place that isn’t the emergency room or jail where people in crisis can get same-day access to multiple types of behavioral health crisis stabilization services. Right now, there is not a single walk-in behavioral health urgent care facility in King County. When people in crisis have no place to go for care, too many end up in jails or emergency rooms. Instead, a Crisis Care Center will provide a safe place in community specifically designed, equipped and staffed for behavioral health urgent care. These Centers will provide immediate mental health and substance use treatment and promote long-term recovery. First responders, mobile crisis teams, families, and people in crisis themselves need places that provide same-day, no-wrong-door crisis care.
With the right care, people can and do get better. The five Crisis Care Centers will:
- Offer immediate on-site crisis support with 23-hour observation
- Open 24 hours, seven days a week as a behavioral health urgent care clinic
- Offer a multidisciplinary staff team, including peers with lived experience
- Deliver on-site evaluation for involuntary treatment when necessary
- Screen and triage treatment needs for people seeking care for themselves and for those referred by first responders, crisis response teams, and family members
- Accept any person, with or without insurance
- Provide a crisis stabilization bed for short-term behavioral health treatment for up to 14 days
The absence of walk-in, regionally distributed crisis care units leads to higher costs, unnecessary travel, long wait times, and delays to time-sensitive care.
Without behavioral health urgent care, too often people must choose between no care or placement in jails or emergency rooms.
Geographic distribution of Crisis Care Centers
The five Crisis Care Centers will be distributed geographically across the county so that first responders, crisis response teams, families and individuals have a place nearby to turn to in a crisis. One center will serve youth younger than age 19, and at least one will be established in each of these four subregional zones:
Currently One 46-bed crisis center for 2.3 million people in our county
Places to recover - residential treatment facilities
King County has lost one-third of residential treatment beds at a time our region needs more behavioral health care facilities. Residential treatment facilities provide:
- 24/7 treatment in a safe, supportive environment where people can receive intensive services to stabilize and recover from behavioral health conditions
- Access to treatment and recovery in a community-based setting, reducing more costly jail stays, institutionalization, and hospital stays.
- A pathway to independent living through support of basic life skills and daily living activities.
Residential treatment supports clients in their recovery journey by helping them identify and overcome barriers to basic living skills and developing and practicing those skills. Geared toward longer stays, residential treatment can be the best and most cost-effective treatment. Clients have meals provided, receive reminders for activities of daily living such as reminders to shower, do laundry, eat meals, take any prescribed medication, clean their room, schedule and attend doctor’s appointments, attend group meetings on-site, and participate in outings.
The need for residential treatment dramatically outstrips what is available now. Between 2016 and 2020, King County providers identified over 6,000 people who would be best served by residential services, according to a screening tool as well as other indicators of need such as homelessness, jail bookings, emergency room visits, crisis program encounters, and involuntary treatment act hospitalizations. Only 315 new people were authorized for residential treatment during this five year period.
Loss of capacity means a loss of care
King County is rapidly losing residential treatment capacity due to rising operating costs and aging facilities that need repair or replacement. There were not enough residential treatment beds in the first place. The Crisis Care Centers Levy will provide funding to restore mental health residential treatment to 2018 levels. This funding will reinforce existing, licensed facilities that may otherwise close, restore facilities that recently closed where possible, and create new ones by:
- Adding new beds to regain the 111 lost since 2018
- Providing capital and maintenance funding to preserve our remaining 7 residential facilities
Current residential treatment capacity
- People who need a behavioral health supportive housing unit or psychiatric residential treatment bed find that providers reach capacity by mid-month.
- In 2018, 355 beds providing community-based residential care for people with mental health residential needs existed in King County. Today, only 244 of these beds are available.
- Loss of 1 in 3 residential treatment beds in since 2018
- As of July 2022, King County residents who need mental health residential services must wait an average of 44 days before they are able to be placed in a residential facility.
It takes people to treat people — supporting and growing our behavioral health workforce
A robust, representative, and well-supported workforce is critical to providing quality, equitable behavioral health care. However, rising staffing vacancies and unsustainable wages are hindering access to care to match the growing needs of King County residents. If approved, the Crisis Care Centers levy would invest in higher wages, employment retention, and employee recruitment to sustain the existing workforce and foster the workforce of the future.
Too many behavioral health workers cannot afford to live in the communities they serve. Too few people are joining this profession, and too many people are leaving it.
The Crisis Care Centers Levy will support the behavioral healthcare workforce through investments like these:
- Keeping our workers: • Promote career pathways to access higher education, credentialing, training and wrap-around supports
- Increasing worker wages: • Provide equitable and competitive compensation for workers at Crisis Care Centers • Invest in retaining more, and more representative, people in community-based behavioral healthcare
- Recruiting new workers: • Invest in apprenticeship programs with funding for mentors, books, and tuition
- Reducing costs for workers: • Reduce costs of living, such as insurance, childcare, caregiving, or fees or tuition associated with training and certification, where possible
- Currently The 2021 King County nonprofit wage and benefits survey showed that many nonprofit employees delivering critical services earn wages at levels that make it difficult to sustain a career doing community-based work in this region.
- Currently A 2021 King County survey of member organizations of the King County Integrated Care Network found that job vacancies at these community behavioral health agencies were at least double what they were in 2019.
- Currently Providers cited professionals’ ability to earn more in medical systems or private practice, and the high cost of living in the King County region, as the top reasons their workers were leaving community behavioral health care, in the same member survey.
Frequently Asked Questions
The five Crisis Care Centers (CCC) will be distributed geographically across the county so that first responders, crisis response teams, families, and individuals have a place nearby to turn to in a crisis. King County would not unilaterally site facilities in the four regional zones identified in the levy.
Instead, King County will partner with cities and providers to identify opportunities to site the Crisis Care Centers. Key components of this process are expected to include procurement processes by which providers locate appropriate sites, as well as consultation with cities to identify potential sites, to ensure geographic distribution throughout the County as described in the ballot measure ordinance. The levy outlines support for centers through new construction, repurposing existing buildings, or a mix of both. If approved, the implementation plan will include more specifics on the siting process for the centers.
Operations and services
Timing and investment of all services is dependent upon the implementation plan that will be proposed by the Executive by the end of 2023 and reviewed and adopted by the Regional Policy Committee and King County Council. That said, the Executive’s proposal envisions early investments in:
- expanding mobile behavioral health services or services at existing sites that promote access to behavioral health services for people experiencing or at risk of a behavioral health crisis
- providing early investments to preserve existing mental health residential facilities and
- investing in growing and retaining the behavioral health workforce to ensure a sufficient workforce is available.
The MIDD Behavioral Health Sales Tax Fund is a countywide 0.1% sales tax that funds initiatives to increase access to behavioral health services and support residents to connect to community and thrive in recovery. As required by state law, MIDD funds must be used for new and expanded mental health and substance use disorder services and may be used for therapeutic courts. Since 2008, MIDD has supported over 50 different high-quality programs and services to address mental health and substance use conditions for King County residents most in need. MIDD plays a critical role in King County’s strategy to increase access to behavioral health services. Like the proposed CCC, MIDD is a local response to behavioral health needs unmet by inadequate funding from state and federal sources. MIDD is focused on keeping people out of costly and ineffective emergency response systems such as jails, emergency rooms, and hospitals, and instead helping people access care in their community.
MIDD generally does not invest in capital infrastructure. Instead, revenues are dedicated to a wide variety of smaller programs and services across the full spectrum of behavioral health care to impact five strategy areas that include Prevention and Early Intervention, Crisis Diversion, Recovery and Reentry, System Improvement, and Therapeutic Courts. The Crisis Care Center, on the other hand, is targeted to make deep investments to preserve existing and create new facility capacity in specific areas of the behavioral health system where resources are most needed.