Snohomish County’s health leaders ponder fixes for mental health crisis

EVERETT — If Dr. Brett Daniel had a diabetic patient with severe depression, he would want to treat their depression first. It’s nearly impossible to help patients with other illnesses if they struggle to get out of bed, he said.

Local health care leaders like Daniel, a family physician and executive for Optum Pacific Northwest, are trying to bridge the gap between medical, mental and behavioral health care in Snohomish County. At the county Healthcare Summit on Tuesday, industry leaders discussed how they are working to make that happen.

“You can’t go anywhere in Snohomish County without seeing visual evidence of mental and behavioral health needs,” said Tom Sebastian, CEO of Compass Health.

Sebastian has led an effort to transform the 3300 block of Broadway in Everett into a hub for primary care, behavioral health care and housing. About a year ago, Compass Health began constructing a $68.5 million intensive behavioral health facility on the block to replace its former crisis center.

In the meantime, the closure has left a gap in already sparse inpatient behavioral health services in the region. On Tuesday, Sebastian apologized to Kristy Carrington, CEO of Providence Swedish North Puget Sound, as the move has likely contributed to increased emergency room visits.

For hospital leaders like Carrington, the goal is to connect frequent visitors to more sustainable, long-term care. Providence Swedish is working to connect high-risk patients with primary care doctors within a week of an emergency department visit, she said.

In 2019, Providence Regional Medical Center Everett launched a walk-in behavioral health clinic to help redirect emergency room visitors who are in crisis due to a mental or substance use disorder. It’s one of few behavioral health urgent cares in the county — and the only one attached to a hospital. Aside from providing urgent care, workers at the clinic can help patients refill prescriptions or make appointments with mental health specialists for longer-term care.

Stevee Giba, mental wellness clinical supervisor for the Tulalip Tribes, said mental health care in the county needs to be more accessible and culturally competent.

“Just like you can’t address diabetes without addressing mental health,” Giba said, “you can’t address mental health without addressing cultural needs and building trust.”

Earlier this year, the tribes hired its first designated crisis responder for tribal members with persistent behavioral health needs. The crisis responder, Kelly Waibel, and her team are out on calls from morning to evening, Giba said. But so far, the team doesn’t have strong enough connections with other care agencies to help keep track of patients.

Another challenge is state legislation. Sebastian said the state’s funding model for behavioral health has hampered his ability to pay his staff, making it hard to hire and retain caregivers.

In August, more than 350 Compass Health workers picketed in Mukilteo and Bellingham to pressure the nonprofit to improve wages and benefits. Compass Health, with locations in Snohomish, Skagit, Whatcom, San Juan and Island counties, has also closed or shrank multiple service sites since 2020.

Right now, behavioral health systems like Compass Health can only bill for specific services, and billing doesn’t guarantee payment. Outpatient therapy services, for example, have strict billing regulations.

Since behavioral health care can look different for each patient by the day, Sebastian has argued, it’s an uneven system that often leaves agencies with fewer reimbursement dollars than they should have.

Compass Health has advocated in Olympia for a certified Community Behavioral Health Center model. In this model, the state pays providers based on a predetermined, fixed amount. The Community Health Center of Snohomish County uses a similar payment plan.

Washington is on track to pilot the model next summer. About 20 other states have piloted the system with positive results.

Sebastian plans to apply for Compass Health to be part of the pilot.

“After seven years of advocacy,” Sebastian said, “I’m happy to say that Washington is moving forward.”

Sydney Jackson: 425-339-3430; sydney.jackson@heraldnet.com; X: @_sydneyajackson.