As Washington’s gubernatorial candidates have vied for voters’ support over the past few months, mental health hasn’t always been at the forefront of the conversation.
But the topic is closely linked to many of the issues Democrat Bob Ferguson and Republican Dave Reichert have talked about most, including homelessness and public safety.
So what do the candidates have to say about the mental health system and how they would improve the state’s policies for treating patients with the greatest need for behavioral health care?
Though they differ in some of their approaches, both highlight some of the same broad goals: making mental health services and treatment more efficient, building more housing for mental health patients, and increasing the supply of beds for patients with serious mental illnesses.
The big picture
Ferguson, Washington’s attorney general, offered specifics via a four-point plan to ease the state’s mental health and substance use crisis. The plan focuses on enhancing access to care, early intervention, strengthening treatment and systemic reforms. His stated goals include working out of Western State Hospital for a week to better understand that institution’s problems.
Ferguson said he would also aim to streamline the “fragmented” system of mental health-related agencies in Washington — the Department of Health, Department of Social and Health Services and Health Care Authority all play roles in managing care for people with serious mental illnesses.
“I will appoint a mental health czar who shares my passion to better coordinate and align disparate systems, root out inefficiencies and direct the heads of the appropriate cabinet agencies to follow that individual’s lead,” Ferguson, whose campaign staff declined a phone interview for this story, wrote in an email to The Seattle Times.
Reichert, an ex-congressman and former King County sheriff, hasn’t released a formal, written plan specific to mental health. But he said in an interview that he would prioritize getting people off the street and into housing, and providing them ongoing services so they can continue to recover.
Reichert also said he would look to nearby states and borrow from mental health practices there that seem to be working.
“Mostly what I’d like to do is meet with mental health professionals across the state and start getting some of their input to see how they think we should best address these issues,” Reichert said. “I think you have to talk to people who are actually working in these fields.”
Responding to a crisis
People in mental health crises are at a higher risk of being injured or killed in interactions with police officers: The Treatment Advocacy Center, a mental health policy group, estimates that at least 1 in 4 killings by police officers involve someone with a serious mental illness. Since 2015, police in Washington have killed at least a dozen people each year, reaching a high of 39 police killings in 2022, according to a Washington Post database that tracks police shootings. As those numbers remain high, mental health advocates have raised the question of how to de-escalate situations where someone is in crisis.
Reichert drew parallels between mental health and other situations where someone might encounter law enforcement — focusing on those who are homeless or have a substance use disorder.
He said he would prioritize detox services and on-the-ground outreach, and that he would support mental health professionals going out to calls with law enforcement.
“How that looks, I think, should be dependent on each city and how they construct that in partnership with their own police departments,” he said.
Ferguson also said he would increase the number of designated crisis responders in Washington — a unique role with the ability to commit someone involuntarily to mental health treatment. He said he would intend for them to respond with or instead of law enforcement when someone is in a crisis.
Ferguson also said he’d work to expand the understanding of mental illness among social and human services professionals who might encounter those in crisis.
“Washington currently trains all health care providers on suicide awareness,” Ferguson’s plan said. “Bob will expand this training to other key direct service providers. The Ferguson plan will ensure frontline public servants are armed with the training they need to connect individuals with mental health resources.”
Mental health beds
The state has struggled to keep up with the need for mental health beds, both in large institutions and in the community. That has led to backlogs at state psychiatric hospitals, as well as patients cycling between institutions and homelessness because the state lacks places for them to live and receive treatment long term.
Ferguson said he would work to license more mental health treatment beds and increase wraparound services for those needing treatment.
“Hundreds of new beds will be coming online in the next year, but we cannot let up the progress,” Ferguson’s mental health plan read.
Ferguson also said he would invest in recovery housing for people leaving treatment for substance use disorder, and that he would allow doctors to prescribe housing vouchers for those with mental illnesses or substance use disorders when supportive housing is medically necessary.
Reichert talked about his time as a patrol officer, transporting patients between Harborview Medical Center and Western State Hospital.
“Back in those days that hospital was already in a state of disrepair,” he said. “We have to start directing some money toward building facilities that would provide places for our patients to be housed and receive care.”
He also noted that patients who need mental health treatment should not be placed in correctional facilities.
“Jail is not a place for the mentally ill,” he said.
He said he envisions programs that have a track record of success developing “service hubs,” where people can live and get social services that help them get back on their feet.
But he said a condition of staying there would be remaining clean and sober.
“This is why current efforts fail,” he said. “We house people and expect them to get well on their own.”
Workforce needs
Nationally and in Washington, mental health workers experience a high rate of burnout. Long hours, low wages and emotionally and physically taxing work often push people out of direct care jobs after just a few years. For therapists and other clinical workers, educational barriers and navigating insurance can pose even more difficulties.
Reichert said he’d like to help boost the workforce by encouraging kids to develop an early interest in working in mental health careers.
Students in middle or high school, he said, could take classes via a “Running Start program” which earns them college credits and engages them in mental health topics early on.
Ferguson said he would incentivize professions in the behavioral health field, improving reimbursement rates for behavioral health providers, and improving loan repayment and stipend offers for students pursuing behavioral health careers.
Ferguson said he’d also consider restructuring state departments if it meant they could be more nimble and better direct resources.
“It means we focus on building the infrastructure — from housing and recovery centers to the workforce needed to provide care — to bring people into the settings needed to get their lives back on track,” Ferguson wrote.
