Since introducing the bill to adopt the 1/10th for Behavioral Health, I’ve received a ton of comments. The vast majority are in favor which isn’t surprising considering the scale of the crisis. Still, you’ve also had a ton of great questions as well so I’ll answer the most common ones here.
Why can’t you cut something else to pay for it?
This is a new responsibility that came with no new revenue, but a lot of people ask “if it’s a priority, can’t you just stop doing something else?” That would be extremely difficult if not impossible given the nature of county budgets.
Looking at the chart below, you can see that Public Safety and Justice services take up 80% of the General Fund as opposed to 74% in 2006. That doesn’t mean there’s a ton of fluff in those categories. The Prosecutors Office, Superior Court, and Department of Assigned Counsel handle the same number of felony chargings as King County with approximately half the staff. The Sheriff is so badly understaffed thanks to post-recession cuts that a recent staffing analysis showed a need for 70 additional FTEs. Most of the remaining functions you see in the budget below are obligations under state law.
Another way of looking at these expenditures is the bar chart below. The top 9 expenditures you see here taking up $245 million of the $299 million budget are all mandates we have to provide and are struggling to keep up with.
One thing often not understood by the public is that counties aren’t just the local government outside of cities. Per the Washington Constitution and many court rulings, counties are departments of State government tasked with carrying out their duties at the local level. That’s why prosecutors say they’re “representing the State” in trials.
As a result, the vast majority of our revenue is already spoken for by legal or practical obligations.
This is also why 23 of Washington’s 39 counties have already passed the 1/10th for Behavioral Health. This isn’t some left-wing, Seattle idea. Some of the most conservative counties in our state have already passed it. Columbia County, where Donald Trump won 69% of the vote, recently passed the bill.
Can it be put on the ballot?
No. Unlike a lot of local taxing authority where the Legislature specifically requires voter approval, in this case the power rests solely with the County Legislative Authority. In Pierce County, that’s the Council. Here’s the statute:
RCW 82.14.460(1)(a) A county legislative authority may authorize, fix, and impose a sales and use tax in accordance with the terms of this chapter.
The Municipal Research Services Center has an initiative and referendum guide that is helpful in describing the various rules on the subject. They describe the test this way:
“The other test used by the courts to determine if an issue is subject to initiative or referendum is the distinction between a grant of authority by the state legislature to the city or county as a corporate entity or to its legislative authority (the city or county council). If the statutory grant of authority is to the city or county as a corporate entity, direct legislation by the people is permissible in the form of initiative or referendum. On the other hand, if the grant of power is to the legislative authority of the city or county, then initiative and referendum are prohibited.”
There have been numerous court cases ruling on this issue over the years so it’s pretty clear we can’t delegate authority to the people. It’s up to the Council to make this decision, though subject to our County Charter which requires a supermajority for passage.
How much will it cost?
Based on current sales tax, the additional 1/10th of 1 percent would generate about $11,100,000. Per person that amounts about $17 annually. Using the last census’ data on household size and applying that to today’s population, that would come to roughly $46 annually per household.
Why isn’t there a spending plan?
One of the main criticisms has been the desire to create a spending plan prior to adoption of the funding mechanism. The truth is, there’s been a ton of planning done already including three studies, one sponsored and overseen directly by the Council.
Here’s what the culmination of that work looks like.
What we know is that our needs fall largely into five buckets:
- Wellness, Prevention, Early Intervention & Treatment
- Crisis Management
- Recovery and Re‐entry Programming
- System Improvements
- Therapeutic Courts
It will take 7–8 months before the County begins receiving these dollars because of the notice that must be given in the state and the lag in time for collection. That leaves us with plenty of time before there is a nickel in the account before final decisions need to be made.
In order to make detailed appropriation recommendations we’ll need a couple things.
- Hire someone (by contract or in-house) to oversee this new responsibility and set up the program.
- Establish a Behavioral Health Coordinating Committee to make recommendation on appropriations and coordinate care. This was a top recommendation in the HSRI report, with or without the new revenue given how badly fragmented our system is.
We’ll need various departments and branches of County government, non-profits, and cities to invest a lot of time and resources developing the details. Unless they know the Council has done its job, it’s hard to ask them to take on this additional work.
However, Council should also have some of its concerns addressed, and to that end, I’ve got a couple amendments and a resolution to introduce at today’s Public Safety, Human Services, and Budget Committee Meeting.
- An amendment that creates the Behavioral Health Coordinating Committee, creates a special fund and reserves use of these funds solely for behavioral services and their delivery, and requires project level appropriation by the Council before any expenditure of funds. It also puts control of the Oversight Coordinator under the Council.
- A resolution establishing a fiscal policy with clear direction to the Coordinating Committee and staff how the funds will be spent.
Here’s what that fiscal policy resolution looks like:
The programs supported with these funds shall be designed to achieve the following policy goals:
- A reduction of the number of mentally ill and chemically dependent using costly interventions like jail, emergency rooms and hospitals;
- A reduction of the number of people who recycle through the jail, returning repeatedly as a result of their mental illness or chemical dependency;
- A reduction of the incidence and severity of chemical dependency and mental and emotional disorders in youth and adults;
- Diversion of mentally ill and chemically dependent youth and adults from initial or further justice system involvement; and
- Explicit linkage with, and furthering the work of, other council directed efforts including the veterans’ assistance program for indigent veterans and families; and
- Achieving, to the extent possible, regional equity in the delivery of services funded with MIDD CDMH sales tax across all jurisdictions and areas where county MIDD sales tax is collected.
Policies on regional equity:
The County shall appropriate this revenue in a manner that is as efficient as possible while also ensuring geographic and demographic equity.
When the County provides local services that are also provided by cities, such as law enforcement and courts of limited jurisdiction, the County shall provide equal coverage of new behavioral health services, at no additional fee, in those cities. Those services may include, but are not limited to, law enforcement co-responders and therapeutic course.
It is the intent of the Council for this revenue to be appropriated in a manner benefiting all county residents, regardless of jurisdiction.
The County commits to prioritizing programs in municipalities where new revenues can initiate new services or enhance current programs as well as prioritizing services that can provide service to residents living in more isolated parts of the county. Services to be enhanced or supported might include such things the Community Prevention and Wellness Initiative, Zero Suicide Initiative, Recovery After an Initial Schizophrenia Episode (RAISE) project, Coordinated Specialty Care programs, “Get Help Early” educational campaign, the PAR initiative, 2–1–1 program, crisis triage centers, Certified Community Behavioral Health Clinics, expanded behavioral health service capacity in the Federally Qualified Health Centers (FQHCs), crisis residential programs, peer respites, permanent supportive housing, work support programs, assertive community treatment, emergency department peer support, peer bridger program, expanded telemedicine options, eConsults, crisis intervention team (CIT) training, therapeutic courts, the Community Re-Entry and Jail Transition Services Programs, the District Court Behavioral Health Unit, NAMI’s offerings for family support, Behavioral Health Specialists in the 2–1–1 program and the Give an Hour initiative.
The oversight plan shall identify how the Behavioral Health Coordinating Committee will link and coordinate with other existing county groups. The oversight plan shall be submitted to the council by XXXXX, for council review and approval by motion.
The Behavioral Health Coordinating Committee shall prepare a Behavioral Health Action Plan (Action Plan) to implement recommendations contained in the Pierce County Behavioral Health System Study (delivered to the Council on September 27, 2016). The Action Plan shall discuss needed resources, including staff, information and provider contracts; and milestones for implementing recommendations. The Action Plan shall be submitted to the council by XXXXX, for council review and approval by motion.
The Behavioral Health Coordinating Committee shall prepare an evaluation and reporting plan (Evaluation Plan) for the programs funded with the sales tax revenue. This plan shall specify: process and outcome evaluation components; a proposed schedule for evaluations; performance measurements and performance measurement targets; and data elements that will be used for reporting and evaluations. Performance measures shall include, but not be limited to: the amount of funding contracted to date, the number and status of request for proposals to date, individual program status and statistics such as individuals served, data on utilization of the justice and emergency medical systems and resources needed to support the evaluation requirements. The Evaluation Plan shall be submitted to the council by XXXXX, for council review and approval by motion.
That’s what I’ve got so far. Ask me and I’ll add more.