Alternative for mentally ill in crisis stirs debate

Feb 7, 2011

Crisis centers for the mentally ill are gaining popularity across Washington, as a way to help people and potentially save taxpayers' money.  They’re an alternative to jails and emergency rooms. 

But these short-term treatment centers are also running into hostility. Potential neighbors are unhappy about being next door to a facility where patients arrive by police car and ambulance, in the middle of a mental health or drug crisis.

In central Seattle, an angry backlash of homeowners is threatening to delay the opening of a proposed “Crisis Solutions Center.” The location is on a block near Rainier Avenue and Dearborn, where businesses and stores give way to single-family homes.  

In downtown Tacoma, shop-owners near the Tacoma Dome say such a facility on their block threatens a fragile business district.

The concept behind the crisis centers appears to have broad support. 

They've been promoted by the National Alliance on Mental Illness (NAMI), an advocacy group for people with mental illnesses. And local agencies also have embraced the approach. 

"We have a record number of people with mental illness in our king county jail, so that’s overcrowded and that’s very expensive," says Amnon Schoenfeld, director of Mental Health, Chemical Abuse and Dependency Services for King County.  "And then, on the hospital side, we have a shortage of psychiatric hospital beds."

That person in crisis won't get treatment, but they might get locked up temporarily. Then the pattern might recur. Whereas, in a crisis diversion center, the focus is on getting the person on a path to stability.

"The philosophy behind it is … if you provide a warm and supportive environment, with caring staff, people do calm down from their crisis and they do start cooperating," says Shoenfeld. 

In dozens of comments to the Central District News and in The News Tribune's coverage of the neighborhood skirmishes, a common theme is: The need for such a facility is clear, but the agencies in charge have not worked with neighbors when choosing their locations.

"Not once have I questioned the need for a program like the Crisis Solutions Center. I DO think the CSC will provide a vital service to King County residents," writes Kristin Wall, in the CD News. "What I do take issue with is violating a fair, transparent legal process of siting the CDS on S Lane St."

Wall is leading a community effort to fight the location in Seattle. She's helped hire a lawyer to challenge the land-use permits. In Tacoma, there's also been talk of a legal fight.

"Maybe it’s convenient that it’s in a part of town that doesn’t have very many people living in it,” Mike Brown, owner of Tacoma Bike at 309 Puyallup Ave, [told Kathleen Cooper in The News Tribune]. “If that facility would have been here before, I wouldn’t have signed the lease here."

Experiments started a decade ago, locally and across the country.

Pierce County was one of the pioneers.  Its center has moved several times and is currently on the vast grounds of Western State Hospital. Now, Optum Health, which has a contract to operate mental health services in Pierce County, wants to move the facility to downtown Tacoma, in an older brick office building. Yakima operates a center near its downtown, and Bellingham has one next door to the county jail. 

King County used to have a triage center in the late 1990's, at Harborview Hospital, but it was eliminated in an earlier round of budget cuts. Shoenfeld says a voter-approved tax for mental healht services is making the new facility possible. It'll cost about $6 million per year, and will be operated by the Downtown Emergency Services Center.

Patients arrive in custody, but are free to leave

About a third of the patients in Seattle are expected to arrive in police custody, and two-thirds from hospitals. They might be picked up for causing a disturbance on a bus.  They might have shoplifted. They could be drunk and off their medications. 

Nobody would be held against their will. That makes it more of a hospital than a jail. It would operate similar to the way nursing homes handle dementia patients, with doors that have alarms and delay opening for 15 seconds. That's to give staff time to accompany anyone who tries to leave before discharge. To reassure neighbors, Shoenfeld says two staff would walk with such a person until he or she can be persuaded to return or until the person accepts a ride back to wherever they originally came from.

Neighbors in both Seattle and Tacoma have remained skeptical of such promises, partly because they weren’t consulted until the final stages of planning.

Those who work with the homeless or mentally ill admit they’ve become toughened to these complaints. Shoenfeld says it didn't occur to anyone in his planning group to invite neighbors into the discussion of choosing the best location.

"Almost  every program that one of our providers tries to build, when they try to build housing for people with mental illness, is initially opposed by the community," he says.

 

The location proposed in Seattle is on S. Lane St.



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