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Tri-Cities has more mental health services than ever. Then why are so many in crisis?
Tri-City Herald - 9/30/2022
Sep. 30—The Tri-Cities has more emergency mental health services than ever, so why are people still falling through the cracks?
In recent months the Herald has taken a look at what services are available in the Tri-Cities, and where patients, first responders and mental health professionals say the area is coming up short.
Finding help to begin with can be a struggle.
Brooke Snyder has dealt with a series of mental health issues, and struggled to find help in the Tri-Cities. She's been diagnosed with schizophrenia and depression, and had a hard time even finding a specialist in the area who can treat her condition.
"When I first moved here I was looking for a mental health counselor and there was only one place that would accept me because of what I was diagnosed with," she told the Herald. "It is such a common thing around here with all the drug use, people trying to get clean or coming out of psychosis, it is very common, but it's very hard to get help because no one deals with people like me."
She said that trying to get help often means a long series of phone calls and inquiries met with rejection, which can cause a person to spiral psychologically. It's especially difficult when someone doesn't have insurance or isn't eligible for Medicaid.
"It makes me feel like I'm not human. It's very dehumanizing. You feel like some type of strange alien that they don't want to deal with ... and it makes it worse, you start worrying, and your head gets louder and the depression gets worse and you start isolating and the effect of it is horrible," she said.
"You're putting yourself out there. You're trying to reach out for help and you're getting shut down like you're some kind of animal. It hurts you."
She said that not being able to find help has led to trouble with the law when she suffered an episode.
"It does get to that point. In the past I have reached out for help and nobody would do anything, then I would have an episode and then you get thrown in jail," she said. "Locked away and treated like you're crazy, and it's just not fair."
She's now working at Grace Kitchen in Pasco, which partners with the Benton Franklin Mental Health Court and other community providers to help people struggling with mental health issues find employment and stability.
Grace Kitchen is a nonprofit that guides women struggling to break free of sex trafficking, addiction, homelessness and poverty. They provide job training and other resources, in part through their bistro and Pasta Mama's brand of locally made pasta.
"Since I've been here my whole life has changed, my whole outlook on life. It was like I was prying this door open that had never been touched, and it felt good," Snyder said. "If there were more people like this, if we could spread this love all over it would be so beneficial."
It's not an easy program, requiring someone to volunteer before being taken on as an employee, but Snyder said it's worth it. Thanks to Grace Kitchen and the help they've provided, she sees a better path.
"I actually can see the future now in a happy way, where before it was very dark and lonely," Snyder said. "Now that I'm reconnecting with my family, and showing them that there is another side to life, I can see happiness in my future."
Now she wants to pay it forward and help others in similar situations.
When Comprehensive Healthcare took over emergency mental health services from Lourdes Health earlier this year, the local lifeline number changed. But the 988 Suicide and Crisis Lifeline number still connects patients directly to local help.
The new local number is 509-792-1747.
Since then, the mental health care provider has worked to expand the scope of their services in Tri-Cities.
Yakima-based Comprehensive Healthcare currently has its local offices in Pasco, near the Tri-Cities Airport, but is looking to relocate to Kennewick. They work with school districts and other local partners to provide an array of services.
That can include outpatient mental health services for all ages, substance use disorder treatment, dual diagnosis treatment, family therapy, medication management and more.
The crisis line also is available 24 hours, and Comprehensive has emergency mental health first responders that local law enforcement can request for help on calls.
What they can't provide, though, is inpatient treatment or the necessary beds to do so.
The Tri-Cities area has just 20 inpatient beds for adults.
Leaders in Benton and Franklin counties are working toward a possible bi-county solution, but that could be years out.
Most recently progress fell through when the owners of the former Kennewick General Hospital building in downtown Kennewick only agreed to the sell if it limited inpatient stays.
Comprehensive director Lauri Schoffstall told the herald that even with a new facility for inpatient treatment, that still likely wouldn't solve the problem of a lack of treatment beds for juveniles.
Currently there are none in the Tri-Cities, forcing families in crisis to take children as far away as Yakima for inpatient treatment.
Schoffstall said they always try to find the closest beds available, but can place kids all over Washington state.
How 988 works
When a call comes in to the crisis line, the caller will first speak with their office coordinator who will get their information and a brief idea of what they're calling about.
Depending on the information they gather, it'll either go to a mental health assistant to talk with the person on the phone about services or it may go directly to one of a crisis outreach professional.
The 988 number also accepts text messages.
For a 911 call, dispatch typically calls Comprehensive and lets them know what's needed, whether it's a phone call to the person or sending someone to the scene to talk with a person in crisis.
"From there it may just be offering resources, maybe the person just needed to talk for a few minutes or maybe we're looking at placement, so we have them go to the hospital for medical clearance," Schoffstall said. "There's really no cookie-cutter intervention, how we respond is really based on (what the patient) needs,"
While the emergency mental health hotline saw a drop-off in calls immediately after the phone number was changed, the call volume has ticked back up.
Since taking over the crisis hotline they've hired more crisis responders and case managers.
"There are a lot of hands on deck that help facilitate the traffic as it comes in," Schoffstall said.
Camacho said they want the community to know that the hotline isn't just for emergencies, they're here for anyone struggling with mental health.
"We're a service that's available even for small crisis situations," Camacho said. "If minor stressors come up, there's someone they can reach out to and get some assistance, not just more serious or high risk cases. There's even walk-in services, there's always someone available for help."
Areas of need
Schoffstall said when she first started in the mental health field, there were more options for youth inpatient treatment in the area, but over the past two decades beds for both youth and adults have dwindled across Washington state.
She said that in an ideal world, a local children's facility would be a huge help for families.
"There are a lot of excellent youth services in the area, but when it comes to placement the beds are extremely limited statewide," she said. "I think families have this hope that if their child has to go away for a week they're going to come home and things are going to be great, but really having that solid support system in place through family, friends and community services is important."
"(We hope to see) people reaching out sooner, rather than later," she said. "Reaching out before it becomes a big crisis would be our goal. Providing support early on before things escalate and get to that point before they're needing potential (placement)."
Acute Care manager Favi Camacho said one area of particular need in the Tri-Cities is diversion beds, which allow for treatment of people with dual diagnoses or who require more medical care than what the typical short-term inpatient program can provide.
"In this area what would be really useful to have is a diversion bed, for people on the (autism) spectrum or people with a neurodevelopmental disorder, that provides long-term care in conjunction with psychiatric assistance as well," Camacho said. "So long-term care, instead of our immediate short term."
Their goal is to intervene before a crisis becomes so large law enforcement has to arrest someone.
Franklin County Sheriff Jim Raymond said that while he appreciates the help emergency mental health workers provide, officers are still tied up often for entire shifts on mental health crisis calls.
The reason for that, Raymond said, is that without inpatient beds, officers are unable to pass someone off to mental healthcare workers and resume their regular duties.
When Comprehensive sends someone out to assist, there has to be at least two people with the patient for safety.
Even when they're able to have paramedics transport someone to the hospital, there's no guarantee that will be the end of the call.
A recent tragedy highlighted his point when West Richland officers and Benton County Fire District paramedics attempted to help David J. Lowe by taking him to a hospital.
Once there and handed off from paramedic and police care, officials say Lowe ran — less than six hours before he is accused of breaking into his mother's home and stabbing her to death and seriously injuring her boyfriend.
"What we used to do if we ran into someone in crisis, we would say, 'I'm putting you into protective custody,'" Raymond said. "It still exists, but we have no one to work it."
Raymond was referring to the Lourdes Behavioral Facility on Carondelet Drive in Richland, which offers some inpatient services. That facility has just 20-beds, according to information about the facility.
Raymond said that at one time, officers could take people in crisis directly to the facility and into the care of mental health professionals, which shortened contact time with law enforcement, and more directly served their immediate needs.
"We need to figure out a way to get these people out of cop's hands and get them out of crisis," Raymond said.
He said recently the Franklin County Jail has one inmate who has been in and out since March, often in protective custody in the jail because there are no viable local options for long-term treatment.
"You can take them to a medical hospital, but the hospital may (not be able to take them) they're not equipped for that either," Raymond said. "It's like a vicious system, that puts them right back into the streets."
When it comes to emergency care, some patients in crisis may not be able to go to a hospital if they've been trespassed after a violent outburst. That can mean officers spending even longer with patients to determine what hospital they can take them to.
Mental Health Court
The Tri-Cities has a mental health court program, but it's consistently at capacity.
With the resources allocated, they can manage about 50 to 60 defendants at a time between the two full-time case managers.
Ryan Washburn, coordinator for the Mental Health Court, said that as soon as someone graduates from their program, case managers take on a new person.
"We're pretty close to capacity," Washburn told the Herald this summer. "Which is pretty typical for the mental health court side for the past two to three years, their caseloads have been pretty full. ..."
"In a perfect world, just for the sake that we are an intensive supervision program, ideally I'd like to say our max caseload would be like 25 per caseworker, and that's pretty manageable, right now we have it set at 35," he said.
Washburn said the therapeutic court model is built on treatment over incarceration, and their goal is to ensure defendants build stability in their lives, manage medication, get into therapy, find sober and stable housing and either find work or go to school if able.
Despite the heavy caseload and long hours though, Washburn said the results are worth it.
They're making a difference in the lives of people who otherwise would have found themselves in jail, and helping them get actual treatment for their mental health problems.
"You're taking someone who was struggling with mental health problems and getting them stabilized and rehabilitated to have the fulfilling life they deserve. You know you're making a difference not just in their lives but in the people's lives they-re associated with — their friends and family," he said.
"We had a graduate (in May), her children had taken sort of the same path that she did and she started this program and started making real change. Her children were all grown, and became an inspiration to them and all of them have turned their lives around and are addressing their issues.
"They're all in recovery, employed, their families reunited. To see the effect she had on her family means a lot. We're not just affecting the participant, sometimes we have a downstream effect," he said.
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