At a press conference this morning, King County Executive Dow Constantine and a coalition of local elected officials and service providers proposed a new property tax levy to generate $1.25 billion to pay for care infrastructure needed to address the region's behavioral health care crisis. 

According to prepared remarks, the plan focuses on four main areas of investment: constructing five new crisis care centers across the County, preserving and restoring King County's limited residential treatment beds, recruiting more people to work in behavioral health care, and standing up mobile or site-based stopgap crisis responders to provide care while the County builds the five permanent facilities.

Constantine will need the King County Council to approve the plan and send the levy to voters in an April referendum, but with a majority of Councilmembers appearing at this morning's press conference in support of the measure, the prospects for conflict over the proposed tax seem slim. The true test for Constantine's coalition will be whether the surge in spending can make an impact fast enough given the extreme toll the pandemic has taken on the behavioral health care system.

It's hard to overstate how overtaxed the county's current behavioral health care system is at this point in the pandemic. Michelle McDaniel, CEO of Crisis Connections, said their crisis call lines have seen a sustained increase of 25-39% in the number of calls since early 2020, and that callers are reporting more severe distress on average than before COVID.

The region also lacks any urgent care facilities where someone in crisis can walk in to get help without a referral from a first responder or law enforcement, and we only have one 46-bed behavioral health crisis facility operating in the entire county.

Without adequate care facilities available, many people in crisis cycle through emergency rooms, the jail, and living on the street simply because there's nowhere else for them to go.

Even those with case managers supporting their hunt for services can be left hung out to dry, as many providers report exhausting their available capacity by mid-month each month. The County says that as of July, people waited an average of 44 days for a bed at a residential mental health facility. The County recently purchased one residential facility to preserve its 64 beds, but a population of more than 2 million people will need a lot more capacity than that to truly address the currently unmet need.

The people doing the work of treating people in crisis aren't faring much better. Wages for care workers are so low that many qualify for the same public assistance programs they help their clients access, even though their work often requires a Bachelor's or Master's degree. By allocating part of the new funding to support the wages these workers receive, County leaders hope to attract more people to the field and bolster a shrinking workforce.

King County Sheriff Patti Cole-Tindall also stressed that these investments are part of a holistic approach to improving public safety in the region. She pointed out that by having more trained health care professionals available to respond to people in crisis, her deputies can focus on addressing higher priority threats to public safety. 

County leaders all acknowledged that these investments will take time to show results, since the care centers will take time to build, and since it will take time to educate and train workers. In the short term, Constantine hopes to address the immediate crisis by supplementing investments from the state and federal government into expanding mobile crisis teams. Those teams employ a trained mental health professional to respond to emergency calls when people are experiencing a behavioral health crisis, who can deescalate the situation and provide emergency care immediately.

Assuming the King County Council approves the plan and voters sign off on the levy in a planned April special referendum—which is a big assumption given the current economic climate, constant concerns about "tax fatigue," etc—Constantine's coalition believes these comprehensive investments will create a system that can finally deliver the behavioral health care people need, when they need it.