According to the experts
A Q&A with David Johnson, CEO of Navos
Last week, we chatted with David Johnson, Ed.D, a licensed mental health counselor who has led community mental health organizations in King County for 30 years. He is CEO of Navos, one of the largest licensed community behavioral health care organizations in Washington. Navos offers inpatient, outpatient and residential treatment for people of all ages, from infants to senior citizens.
Gov. Inslee toured the West Seattle campus of Navos in July, where he and King County Executive Dow Constantine held a press conference on improving the state’s mental health care system and discussed the recommendations of the Community Alternatives to Boarding Task Force.
We presented a question to David:
What would someone who works on the frontlines of our state’s mental health system want to see in the governor’s budget proposal?
Here is David’s seven-point response to our question and how his ideas stack up against the mental health reforms proposed today by the governor.
More preventive services
What’s Needed: More preventive services mean fewer costly and potentially disastrous situations we will have to deal with. For every dollar we invest in infant and early childhood mental health, we save $17 in costs of services like hospitals, the juvenile justice system, jails, prisons and long-term care institutions later on in that child’s life.
What’s in the governor’s proposal:
- $1.7 million for street outreach to find people who are living on the streets and connect them with peer supports
- $27.8 million for considerable expansion of early learning, including 2,700 more preschool slots for children from low-income families, and a $1.3 million increase in funding to expand home visiting services
- $10 million to begin restructuring family and children’s services into a new, innovative, cabinet-level state agency
Less Involuntary Commitment
What’s needed: Less involuntary commitment — if possible — through use of hospital diversion and hospital alternative options.
Civil commitment to the community and intensive/assertive outpatient services can save grief for individuals with psychiatric symptoms and their families.
What’s in the governor’s proposal:
- $99.6 million to add 356 new community alternative beds for people with mental health, and long-term care and developmental disability needs, plus $24.5 million in capital funds for more capacity in the community.
- $2.9 million for low- and no-barrier, case-managed housing, plus $5 million in capital funds
Inpatient placements
What’s needed: Inpatient placements that are as close to the home and as short in duration as possible.
When involuntary commitment is necessary, this care should be in smaller settings in the communities where patients reside, if possible, instead of at large, state-run institutions such as Western State. The closer to home people are during involuntary commitment, the closer they are to their support network.
What’s in the governor’s proposal:
- Phase-in of nine, new 16-bed state community behavioral health hospitals
- Enhanced discharge placement services, which help more effectively discharge people from the state hospitals and ensure there’s a place for them to go in their communities
- $4.4 million for discharge case managers and financial service specialists to speed up discharges of patients who are ready to leave Western State Hospital and Eastern State Hospital
- $28.5 million to increase the inpatient psychiatric payment rate, which is funding hospitals receive from the state to pay for psychiatric care
Housing, jobs, health care
What’s needed: Affordable housing, employment and integrated health care
David says affordable housing, employment opportunities and integrated health care are all critical to reducing psychiatric crises and cutting the expense of long-term institutionalization at a state hospital. “We all know people need a roof over their heads. They need hope and opportunity for a job. They need health care that treats a person from the neck up as well as from the neck down. When we have the money, we can do these things in unison, and it’s transformative in attaining and sustaining wellness.”
What’s in the governor’s proposal:
- $8.2 million plus $16 million in capital funds for permanent supportive housing
- $4.6 million plus $1.6 million in capital funds for 24-hour step-down housing
- $2.8 million for Housing and Recovery through Peer Services, dubbed HARPS
- Funding for a transitional statewide supportive housing benefit administrator at the state Department of Commerce who will link the housing system to the mental health system.
Hospital Best Practices
What’s needed: 21st century best practices for long-term care at our state psychiatric hospitals
These practices include providing trauma-informed care, teaching symptom management classes and using specially trained and state-certified peer bridgers to assist individuals back to stable placement in their home communities. David says peer bridgers help inspire hope for patients, who see someone with the same lived experience of managing major psychiatric symptoms now working as part of their healing team.
What’s in the governor’s proposal:
- $1.1 million for substance use disorder treatment (SUD) integration at Western State and Eastern State hospitals
- $2.4 million for inpatient SUD peer support specialists
- $52.7 million to hire 137 more staff at Western State Hospital
Substance Abuse
What’s needed: Medication assisted treatment to stop substance abuse
The newly released Surgeon General’s report on substance use disorders highlights that a public health response to illnesses of addictions is the most effective way to proceed. Medication assisted treatment (MAT) is an evidence-based best practice to addressing substance abuse. Additionally, having immediate medication available to counter overdose saves lives, devastation and the expensive aftermath of the opioid addiction crisis.
What’s in the governor’s proposal:
- $2.3 million for a demonstration grant to prevent prescription drug and opioid overdose-related deaths
- $1.9 million for MAT nurse case managers
- $1.4 million for a pain management call center
Health Care Professionals
What’s needed: More qualified doctors, nurses, licensed mental health counselors, social workers and peer support specialists.
There are many vacancies throughout our state’s inpatient and outpatient mental health and SUD organizations. Providing the best practices in coordinated care will require filling these vacancies.
What’s in the governor’s proposal:
- $28.5 million to increase the inpatient psychiatric payment rate (as noted above)
- Ongoing funding for the residency program for ARNPs at Western State Hospital
