23-Hour Crisis Relief Centers.
Pursuant to legislation enacted in 2023, "23-hour crisis relief centers" (crisis relief centers) were established as a new category of behavioral health facility. Crisis relief centers are community-based facilities, or portions of facilities, that offer access to behavioral health care to adults for less than 24 hours. Crisis relief centers are open 24 hours per day, seven days per week, and must accept all clients in behavioral health crisis who arrive voluntarily, are brought in by first responders, or are referred through the 988 behavioral health crisis system, regardless of the acuity of the person's behavioral health condition.
Crisis relief centers are licensed or certified by the Department of Health (DOH). The enacting legislation required the DOH to adopt rules to require crisis relief centers to:
If a person at a crisis relief center refuses to stay voluntarily, the staff may detain the person for sufficient time to allow a designated crisis responder to complete an evaluation if the professional staff believe that the person either presents an imminent likelihood of serious harm due to a behavioral health disorder or presents an imminent danger because of grave disability and may qualify for involuntary commitment. If involuntary commitment criteria are met, the person may be held in custody or transferred to an appropriate facility within 12 hours of notifying the designated crisis responder.
In addition to other listed facilities:
Long-term care facilities are prohibited from discharging or transferring residents to a crisis relief center, as are hospitals with respect to discharging patients, unless the hospital has a formal relationship with the crisis relief center.
Crisis Stabilization Units.
A crisis stabilization unit is a short-term facility or a portion of a facility licensed or certified by the DOH, such as a residential treatment facility or a hospital, which has been designed to assess, diagnose, and treat individuals experiencing an acute crisis without the use of long-term hospitalization, or to determine the need for involuntary commitment of an individual.
Mental Health Professionals.
For purposes of provisions relating to the community behavioral health system and the involuntary commitment system, until recently, a "mental health professional" was defined in the provisions governing treatment of both minors and adults to include psychiatrists, psychologists, physician assistants working with a supervising psychiatrist, psychiatric advanced registered nurse practitioners, psychiatric nurses, social workers, and any other mental health professional defined in rule by the DOH, which included mental health counselors, mental health counselor associates, marriage and family therapists, marriage and family therapist associates, and certain agency staff members. Legislation in 2023 modified the definition only with respect to treatment of adults to include certified or licensed agency-affiliated counselors within the statutory definition, remove the DOH rulemaking authority, and add professions listed in the rule to the statutory definition. The definition in the provisions governing minors was not amended.
The provisions governing crisis relief centers are modified to allow crisis relief centers to accept clients that are children, subject to additional requirements.
By March 31, 2025, the DOH must amend licensure and certification rules for crisis relief centers in consultation with the Health Care Authority and the Department of Children, Youth, and Families (DCYF) to create standards for licensure or certification of crisis relief centers that provide services to children. The DOH must solicit input from stakeholders when engaging in rulemaking for this purpose.
Crisis relief centers treating children must, in addition to meeting existing requirements:
For crisis relief centers proposing to serve both child and adult clients in the same facility, the DOH must establish physical environment standards that require separate internal entrances, spaces, and treatment areas such that no contact occurs between child and adult clients.
Provisions authorizing delivery by law enforcement and emergency detention of minors suspected of meeting involuntary commitment criteria, and parent-initiated behavioral health treatment, are modified to include references to crisis relief centers. Provisions authorizing facilities to release a minor's behavioral health information to the minor's parents in certain circumstances are modified to include crisis relief centers and crisis stabilization units.
The definition of "mental health professional" for purposes of provisions governing treatment of minors is aligned with the definition applicable to the treatment of adults.
(In support) Last session the Legislature created crisis relief centers, and it is critically necessary to expand these facilities to allow treatment of minors. This model has been successful in other states. Minors are experiencing mental health issues that are growing in prevalence and acuity. There are increases in minors coming to the emergency room experiencing behavioral health crises who have nowhere else to go, sometimes languishing for days. These crisis relief centers are equipped to handle all kinds of behavioral health crises, and youth should have designated spaces for crisis relief. Most children who need mental health treatment do not receive it, and doctors have seen the devastating consequences of suicide attempts, including permanent disability and death. Emergency rooms have hazardous equipment and environmental interruptions that are not appropriate for psychiatric care. Many minors with untreated mental health issues face higher rates of school discipline, criminal justice involvement, and other negative consequences. High school students have experienced peer overdoses and suicide attempts. These tragedies spread through rumors and affect entire school environments, making them feel unsafe. Retail business owners have felt the effects of community safety issues and organized retail crime. It will take a multipronged approach to break the cycle that is currently occurring. This bill will expand Washington's crisis services model, and will provide treatment by the least restrictive means possible. The bill as amended requires separate entrances and separate treatment areas for centers that will colocate minors and adults.
(Opposed) It is necessary to look for nonpsychiatric and environmental causes of behaviors that may falsely present as behavioral health issues. Young people may be falsely identified as having mental illness when they do not, and may be administered psychotropic drugs that exacerbate other underlying conditions. A medical evaluation should be offered for every youth entering a center. The mental health system is already overtaxed, and this change will add to that issue.
(In support) This bill is a wonderful policy extension of adult crisis centers to youth. Separation of children from adults is necessary, and this would go a long way to helping youth in the state get behavioral health treatment.
(Opposed) The state needs to look at past failures in psychiatric treatment for children, where we are not getting the results we should be. The chemical imbalance theory has been called into question; there is no test that can show that our children have chemical imbalances. This bill should be amended and a physical exam should be required to avoid sending children to psychiatric treatment and diagnoses that lead to failures.
(In support) Scarlett Coll, Lake Washington High School; Kashika Arora, Seattle Children's Hospital; Mark Johnson, Washington Retail Association; Divya Natarajan, Washington Chapter of the American Academy of Pediatrics; Caitlin Hochul, Inseparable; and Michael Transue, Connections Health Solutions and National Alliance for Mental Illness Washington.
(In support) Michael Transue, National Alliance on Mental Illness and Connections Health Solutions.