Mental health and substance abuse were the topics of conversation for local experts during the Economic Alliance Snohomish County (EASC) virtual Coffee Chat Tuesday.

Moderator Wendy Poischbeg, EASC interim president and CEO, started with an overview of the current state of mental health and drug use in Snohomish County:

– In 2022, the Snohomish County Health Department (SCHD) reported that the county’s opioid mortality rate has almost doubled since 2015. 

– Washington state has the highest increase in drug use in the U.S. in 2022 to 2023, according to the Center for Disease Control (CDC). 

– Community Health Assessment (CHA) has reported that the number of adults with serious mental health illness has doubled since 2015.

Division Manager of Behavioral Health and Vet Services of Snohomish County Cammy Hart-Anderson said that Washington state lacks a sufficient network of mental health care and a public-funded behavioral health system. “The majority of the public-funded mental health system is funded through the Medicaid system, and the rates are not sufficient to keep our providers in business, to hire and retain the most qualified individuals,” Hart-Anderson said. “And it’s a fee-for-service system. If somebody doesn’t show up for an appointment, that provider doesn’t get reimbursed, even though they still have their staffing costs and related costs.”

Hart-Anderson also reported that in 2021, about 48% of adults in Snohomish County had at least one “poor mental health day” in the last 30 days. Such a day is where “you weren’t able to cope with the stresses of life, work, family, school, those types of things,” she said. 

Hart-Anderson added:

– In 2022, 5.8% of adults in Snohomish County had a serious mental illness, compared to the state average of 3.8%

– Suicide is the second leading cause of death in Washington teenagers ages 15 to 19

In December 2023, the Snohomish County Council approved the Housing & Behavioral Health Capital Fund investment plan, which allocates $3 million to construct new behavioral health facilities. Hart-Anderson said that a request for proposal (RFP) is “out on the street right now” and is open to any licensed behavioral health agency in Washington state that is serving Snohomish County and will be built within county lines.

“The priority of these new dollars is new capacity,” she said. “We’re also open to proposals [to those that are] shoring up or preserving existing behavioral health services.” Recipients of the services must also be Snohomish County residents.

Co-Chair of the National Alliance on Mental Illness Snohomish & Island Counties (NAMI Sno-Isle) Karen Schilde said that there is a lack of a capacity for long-term psychiatric care in Snohomish County. She cited the construction of Fern Lodge Behavioral Wellness on Tulalip land near Stanwood in July 2023. It will add 16 beds to the existing six long-term psychiatric beds in the county—”which by national standards should have 435 beds,” she Schilde said. Fern Lodge is expected to open in January 2025.

NAMI Sno-Isle is a nonprofit that provides advocacy, education, support and public awareness for individuals and families affected by mental health conditions in Snohomish and Island Counties. It is modeled after Fountain House in New York City and Clubhouse International.

Compass Health Chief Medical Officer Kate Gilligan said that Compass Health has invested in low-income housing, such as Andy’s Place and Aurora House, and in teaching programs where the company brings social work and medical students and interns to earn their service hours.

Compass Health also is constructing a $68 million behavioral health facility in Everett as part of the Broadway Campus Redevelopment Project. The building is 70,000 square feet (about half a city block), including a 16-bed evaluation and treatment unit, a 16-bed crisis triage center, intensive outpatient behavioral health services, and offices for crisis prevention, outreach and community engagement.

Compass Health Chief Advancement Officer Tom Kozaczynski wants to change the fee-for-service model to a prospective-payment model that allows Compass Health to be “compensated correctly” for the work they do. He added that capital projects such as the Broadway campus are challenging to do because of the current financial structure.

Compass recently announced it is canceling program that provided social workers to assist police officers in the cities of Edmonds, Lynnwood and Mountlake Terrace – citing inflationary pressures and systemic deficiencies in funding for community behavioral health services.

“Between 80 to 82 cents of every dollar goes to hiring, paying and retaining staff,” Kozacynski said. “That remaining 18 cents is pretty hard to do projects like the one we’re doing on Broadway.” 

He mentioned that Compass Health is doing its first capital campaign, with a goal of raising$14 million to help fund the construction project. Currently, more than $12 million has been generated.

Kaiser Permanente Behavioral Health Program Manager Megan Herrenkohl said that Kaiser Permanente provides personalized care and does not adopt a one-size-fits-all approach. These services include evidence-based group programs, intensive outpatient services, health education classes, self-care tools and mindfulness therapy. 

Kaiser is also planning to expand recovery and addiction services in Snohomish County. Currently, the company is partnering with Providence and Evergreen.

Herrenkohl said that any of Kaiser’s  mental health services can be accessible through telehealth, including individual and group therapies, medication management, certain psychological assessments, case management and community resources. 

“We also have something [called] ‘rapid engagement,’” Herrenkohl said. “When someone is calling in for mental health services, they can have their intake over the phone or video or a mental health chat option through the Kaiser app. It’s similar to if you want to chat with a doctor and you don’t want to wait on the phone forever or try to go to an urgent care. They can also refer to additional services after that.”

Herrenkohl also mentioned that an algorithm in Kaiser’s electronic record system is used to detect which patient has the highest risk for suicide, in addition to clinicians’ judgment and other data.

Gilligan said that Compass Health also provides telehealth and wants patients to have an option between virtual and in-person services. “We’ve noticed that after the pandemic, people want to be seen in person,” she said.

Lynnwood Mayor Christine Frizzell posted a comment in the Zoom chat that there aren’t enough health care providers because insurance companies don’t pay for mental health care. “How can we lobby major insurance providers to cover mental health costs so more people will go into the field and help with the supply of providers?” she asked. 

“As far as the insurance Apple Health, it covers care for our low-income [populations] in Washington state,” Hart-Anderson said that the best approach for addressing this issue is to raise it during meetings with elected officials. 

Schilde said that NAMI promotes three simple goals: getting people help early, helping them get the best possible care, and diverting them from the criminal justice system.

“NAMI members and our lobbyists promoted and prioritized five different bills, four of which were passed,” Schilde said. “As a result, we have someone to call, somewhere to go and a place for youths and adults.”

Given the huge increase in opioid addiction and deaths in 2023 in Snohomish County, Hart-Anderson said that the county is continuing to “beef up” the efforts to educate about opioid dependency. This includes education and training about the use of Narcan, which reverses the effects of an opioid overdose.

“You could have a family member, you could have a teenager mowing your yard, you could have it and you could have an elderly person who has taken pain medication and forgot that they’d already taken the dose for that day,” Hart-Anderson said. “If we could all just have Narcan, imagine the impact that we could have.”

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Four Front Contributor

Snohomish County Behavioral Health Facilities

— By Nick Ng