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Oct
05

Crisis Care Centers Levy

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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 a one-page PDF about Crisis Care Centers

Read Frequently Asked Questions About Crisis Care Centers

Download a Frequently Asked Questions PDF About Crisis Care Centers

Translated materials

Download information about Crisis Care Centers in Spanish, Somali, Vietnamese and Chinese.

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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:

A map showing the boundaries of each crisis response zone in King County.

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:

  1. Adding new beds to regain the 111 lost since 2018
  2. 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

Right now, King County is without a walk-in behavioral health urgent care facility. Only one 46-bed behavioral health crisis facility is in operation for the entire county, and may only be accessed by a hospital diversion or a referral from first responders or mobile crisis teams. Residential treatment beds are going away, and the behavioral workforce is dwindling. The Crisis Care Centers initiative would build out a more functioning and connective system that provides people with a care continuum, as with physical health.

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.

The levy ordinance provides for the possibility of incorporating within the Crisis Care Centers model renovation of existing buildings into crisis care facilities and complementing crisis facilities that currently exist, though few relevant facilities exist in King County today. The levy ordinance also provides for the potential to leverage other funding to accelerate accomplishment of the levy’s purposes or complement levy investments.
DCHS expects the crisis care centers and residential treatment facilities envisioned for this levy to be implemented in phases, seeking proposals for two Crisis Care Centers in 2025, one more facility annually in 2026, 2027, and 2028. Initial models anticipate having the first Crisis Care Center open in late 2026 at the earliest, with the full suite of facilities expected to be operational by 2030.
New mental health residential facilities and crisis stabilization facility components of Crisis Care Centers are expected to be 16 beds each, to ensure that these facilities can receive federal Medicaid funding for relevant services they deliver. King County does not expect behavioral health walk-in facilities or 23-hour observation units to be subject to Medicaid’s 16-bed limit. Therefore, the capacity of each facility will vary based on provider proposals.
The ordinance requires at least one center specialize in serving persons younger than nineteen years old. In learning more from providers and community members, ensuring youth are served in home or similar settings where they can be surrounded by their support system is critical to their recovery. For context, 22 percent of King County’s population (or 1 in 5) is youth under 19, but only 4 percent of those assessed for involuntary treatment in 2022 were in this age group.
The specific treatment approach and age range for the youth crisis care center will be designed further in partnership with youth providers and based on state law and best clinical practices. According to RCW 71.34.530, a minor who is 13 years old or older may initiate an evaluation and treatment for outpatient and/or inpatient mental health services, substance use disorder (SUD) treatment, or withdrawal management without parental consent. The minor has the right to receive services in the least restrictive setting. A youth is admitted for inpatient treatment only if the professional in charge of the facility concurs with the need for treatment and the youth meets criteria for this level of care. Any minor 13 years old or older may receive outpatient mental health and/or SUD treatment without the consent of the minor's parent/guardian.
Specific details on referrals between centers will be developed in implementation planning, in partnership with provider operators, and dependent on state licensing restrictions. The Crisis Care Centers levy is designed to serve people in King County without geographic restrictions. The intention of the levy would be for youth who come to an adult-focused crisis care center to be connected with the youth-focused services they need.
Yes, Crisis Care Centers would accept any person with or without insurance. Each crisis care center facility would be able to provide screening and triage for anyone, even if the person ultimately needs a different type of care response.
The Crisis Care Centers will accept people with or without insurance. How costs and payment structures will look is dependent upon an approved implementation plan, and the selected provider.
If a person is exhibiting risk of harm to themselves or others because of a behavioral health crisis, law enforcement is authorized by state law to take them to an appropriate place for evaluation and treatment. Crisis Care Centers would provide an eligible crisis stabilization and 23-hour crisis relief center (if SB 5120 is enacted). The medical staff at the Crisis Care Center would make the determination as to whether or not the person needs to be referred to a Designated Crisis Responder (DCR) on site.
People will be able to stay for up to 14 days for short-term behavioral health treatment at a Crisis Care Center to stabilize. The centers will work to provide linkages to ongoing care. Additionally, the Crisis Care Centers are expected to have an urgent care walk-in clinic and a 23-hour treatment model for individuals who need shorter-term care.
The Crisis Care Centers would depend on connections to the overall community behavioral health system and other social service systems, and a key part of the crisis care center service would be evaluation of what ongoing treatment or other resources a person needs. A significant component of the Crisis Care Center model is to connect people to available treatment options, and other resources they may need to stabilize after their crisis stay.
King County is losing mental health residential capacity that is essential for people with severe and serious mental health conditions who need more intensive and longer-term supports over a longer-term stay to live supported in the community. Mental health residential beds also make it possible for people to discharge successfully from stays in local hospitals or state psychiatric care institutions.

Workforce

Staffing will be managed by the providers who will operate the centers. King County will support the retention and recruitment of staff at the centers by providing funding at a level sufficient to support equitable and competitive compensation for workers at the centers, and invest in systemwide workforce interventions such as apprenticeship programs and reducing costs for workers.
A multi-disciplinary team of behavioral health workers will staff the centers, consistent with state licensing requirements, including a combination of licensed/credentialed mental health and substance use disorder professionals as well as peer counselors working together on multidisciplinary teams. The County intends to invest in the community behavioral health workforce by providing funding for equitable wages and supporting wage competitiveness for the community behavioral health system by growing the pipeline through apprenticeship programing, and creating pathways for higher education, credentialing, and degrees.
Yes, peers are an essential part of the multi-disciplinary team and are a required part of the staffing model at the Crisis Care Centers in combination with clinicians. Peers with lived experience bring an important skill in connecting with a person and supporting them through shared experience.

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:

  1. 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
  2. providing early investments to preserve existing mental health residential facilities and
  3. investing in growing and retaining the behavioral health workforce to ensure a sufficient workforce is available.
Transportation is an eligible expense under the ballot measure ordinance. King County expects Crisis Care Centers providers to be responsible for providing or arranging for the transportation needs of their clients, especially between the different components of the crisis care center if its elements are not contiguous, and at discharge. The Crisis Care Centers model is designed to provide enough funding, and enough flexibility, to provide for these transportation needs.
Providing behavioral services and intervention when people are in an immediate crisis helps to prevent escalation. By investing in places for people to go in crisis, and long-term residential treatment, we can help people with intensive needs to get care and avoid legal system involvement, thereby supporting the overall health and safety of our communities. Many people recovering from serious behavioral health conditions need supportive services to successfully move out of homelessness, discharge from hospitals, avoid jails, and maintain stability in the community.
The centers are expected to be operated by community behavioral health care providers who have relationships with King County that include mechanisms for performance measurement and evaluation, as well as collaboration on data-informed implementation adjustments and improvements. The Crisis Care Centers levy’s implementation plan will include additional information about the levy’s performance measurement and evaluation approach. This will include reporting to the Council and the community annually about progress, expenditures, and who the levy is serving.
The Crisis Care Centers will provide another place for people to access treatment while in crisis instead of in jails or hospitals. By creating an accessible place for people entering into crisis to turn, the Crisis Care Centers will reduce the number of individuals who go deeper into crisis and risk harm to themselves or others.

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.

People experiencing homelessness who are in a behavioral health crisis can access care at the Crisis Care Centers. The Crisis Care Centers would be available to help people stabilize. The Levy also authorizes investments to support stabilization after discharge. However, the Crisis Care Centers levy is not part of the overarching strategy to address homelessness. The primary focus of the Crisis Care Centers levy is the creation of a crisis care treatment system, similar to physical health, that doesn’t currently exist.
Crisis Care Centers will admit people with a substance use disorder (SUD) and address their immediate crisis needs. If appropriate, the centers could refer people to SUD inpatient treatment, which has a much shorter duration than mental health residential treatment, or other community-based SUD services such as outpatient care or medication for opioid use disorders (MOUD) when needed. Such interventions each help people stabilize and further their recovery through community-based care.

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