A 23-hour Crisis Relief Center (CRC) is a community-based behavioral health facility serving adults which offers access to mental health and substance use care for no more than 23 hours and 59 minutes at a time per patient. A CRC must be open 24 hours a day, seven days a week and accept behavioral health crisis walk-ins, drop-offs from first responders, and individuals referred through the 988 system, regardless of behavioral health acuity, and without requiring medical clearance.

23-hour CRCs were enacted into law in 2023 through 2SSB 5120. The Department of Health (DOH) expects to finalize rulemaking for CRCs and start accepting license applications in May 2024.

A CRC may serve children, but may not serve adults and children in the same treatment area. A CRC which proposes to serve both child and adult clients in the same facility must create separate internal entrances, spaces, and treatment areas such that no contact occurs between child and adult CRC clients.

By March 31, 2025, DOH must create licensure and certification rules for CRCs which provide services to children in consultation with the Health Care Authority and the Department of Children, Youth, and Families. DOH must solicit input from stakeholders in making these rules. The rules must:

• require CRCs to meet the needs of children eight and over and their families,
• provide resources to connect children and their families with behavioral health supports,
• require coordination with the Department of Children, Youth, and Families for children who do not need inpatient care and are unable to be discharged to home;
• address discharge planning for children who are at risk of dependency, out-of-home placement, or homelessness;
• require CRCs to have written policies and procedures that define how age groups will be separated appropriately; and 
• require staffing 24 hours a day, seven days a week, by a pediatric multidisciplinary team.

A peace officer may take a minor to a CRC when the officer has reasonable cause to believe the minor is suffering from a mental disorder and presents an imminent likelihood of serious harm or is gravely disabled. A CRC must provide parents or guardians who bring their children for treatment with written and verbal notice of all statutorily available treatment options.

If a minor is brought to a CRC and thereafter refuses to stay voluntarily, and the CRC staff regard the minor as presenting an imminent risk of harm to self of others or imminent danger from grave disability due to a mental disorder, the CRC may detain the minor for sufficient time to complete a designated crisis responder evaluation, but for not more than 12 hours.

The committee recommended a different version of the bill than what was heard.  PRO: In the last six years we have been working on building capacity for services across the crisis continuum. This bill helps create a safe place to be. Seattle Children's has seen an increase in visits to the emergency departments related to behavioral health crises. Many don't need to come to the ED, but there is nowhere else to go. Expanding this model to minors is critically needed. This closes a gap. Youth deserve therapeutic spaces designed for behavioral health relief. Washington's behavioral health system is chronically under-resourced, especially for kids. We have amendment suggestions to support rulemaking that addresses special concerns of minors. A crisis center for minors offering observation and short-term stabilization fits well in the continuum. Kirkland is partnering with its surrounding cities to build a CRC. We have suggestions to make these facilities more flexible. Retail theft rings prey on vulnerable individuals and often recruit minors. We support treatment instead of jail. The needs of youth and adults are vastly different. Arizona facilities keep youth separated from the adults. An average of 2.6 Washington youth die by suicide every week. Over half of Washington youth experience depression and anxiety. As a teenager who has suffered from major depression I can say the disease affects kids in terrible ways.

CON: We feel this bill will promote diagnosing more childhood behaviors as mental illness. Pathologizing behavior leads to excessive prescription of psychiatric drugs.

PRO: Senator Manka Dhingra, Prime Sponsor; Mark Johnson, Washington Retail Association; Neal Black, City of Kirkland; Anna Nepomuceno, NAMI Washington and Patients Coalition of Washington; Sarah Perry, King County; Kimberlee Hauff, Washington Chapter of the American Academy of Pediatrics; Katie Kolan, Washington State Hospital Association; Kashi Aurora, Seattle Children's Hospital; Dr. Jeff Eisen, Multicare; Beckett Leeson, Parth Parashar, citizens; Michael Transue, Connections Health Solutions.

The committee recommended a different version of the bill than what was heard. PRO: This bill is built on the foundation set by Senate Bill 6120 last year, which established these facilities for adults. We think that extending this model to minors is a great idea. The CRC model has been shown to be cost effective. Many youth end up at emergency departments for behavioral health conditions, and there needs to be a more therapeutic option for minors in crisis. Most kids in our state who need mental health treatment don't receive it, and are forced to use costly emergency department services if they reach the point of crisis. This is not cost effective or therapeutic. This bill will help children stabilize in more cost effective ways. Please pass this bill to provide mental health support to kids in the right place and at the right time. 

CON: We are concerned about the direction that this bill pushes the treatment of youth. There needs to be an amendment to screen youth coming in to these facilities to make sure the services are necessary. This bill will cost more money down the road than some may realize.