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Your taxes fund King County mental health, addiction programs: Here's where the dollars go

Seattle Times - 3/20/2023

Mar. 20—Michael Given's white New Balance shoes guide the way through a Bellevue building brimming with activity.

Given — a tall gentleman with peppered hair peeking out from underneath a U.S. Navy cap — is a member of Hero House, a nonprofit organization that's open 365 days a year, seven days a week for people with mental illnesses and other behavioral health issues to connect, develop work skills and support each other in recovery.

In the organization's clubhouse, voices sing out "Happy Birthday" and people buzz about, signing up for job tasks ranging from cleaning duties to administrative work.

Across town in West Seattle, Debra Kelly works in the Peer Bridgers program, a service of Navos, where she helps people who are being discharged from psychiatric hospitals into outpatient services. Kelly, like other peers, has personal experience with mental illness, addiction and homelessness.

For Given, the clubhouse has provided stability over the years. For Kelly, she's able to put her experience to work, "giving them hope that this isn't the end. This is their beginning," she explains.

The Peer Bridgers and Hero House programs are connected through MIDD — the King County Mental Illness and Drug Dependency tax, a 0.1% sales tax that the Washington Legislature authorized in 2005 that funds their work. Two years after the Legislature codified the law, King County had a hearing. Law enforcement and service providers spoke in favor, seeing it as a necessary alternative to costly jails. The Metropolitan King County Council gave it the green light and in 2008, revenue started coming in to pay for local initiatives.

"Even then, the community really recognized that we were overdependent on incarceration and emergency rooms to provide that care, and that we could have better responses that were more therapeutic and less focusing on punishment," explained Leo Flor, director of the King County department of community and human services, who's on an advisory committee for MIDD and oversees handling of the tax.

Now, the county is asking voters for more money for mental and behavioral health, but in a different form: Voters will be asked April 25 to approve a $1.25 billion property tax levy to build five new crisis care centers across the county. While the specific intentions of the two tax measures are different, the county's use of MIDD money gives insight into where behavioral health dollars are going today.

MIDD funds about 50 programs in King County that include crisis diversion, rapid rehousing for people experiencing homelessness, and therapeutic courts that help veterans and people with mental illness. Similarly, counties including Kitsap, Spokane and Cowlitz also rely on the sales tax to fund their own programs.

Unlike the proposed property tax levy, MIDD focuses on funding services, not infrastructure. According to the most recent 2021 MIDD annual report, nearly 19,000 people were served through these programs using $64 million in sales tax money. (Some programs also received what's called "braided funding" from other sources like the Veterans, Seniors, and Human Services levy.)

Overall, MIDD funding prioritizes five key arenas: prevention and intervention; crisis diversion; recovery and reentry; system improvements; and therapeutic courts. County officials say they measure each program's success along three main axes, asking them to measure how many people were helped, how well services were provided, and ultimately what longer-term effect the programs had — were people better off? Did they use drugs less often, find jobs or stay involved in outpatient mental health care?

The programs are given targets, based on past performance, for the number of individuals they should aim to serve. To measure longer-term effects, MIDD also tracks some participants' data for three years while receiving services: For example, county data says that for clients enrolled in a MIDD-funded program in 2018, the number of times where those people needed crisis response services, such as being committed for involuntary treatment, decreased by 78%.

COVID-19 complicated MIDD funding in the last couple of years, Flor said: "In 2020, and 2021, we had these really sharp drops and changes in buying behaviors inside of the community and therefore sales tax revenues fluctuated really rapidly."

That led the advisory committee responsible for managing the tax money, which includes about 37 members ranging from law enforcement to hospital officials and advocates, to cut or limit some programs. The committee then had to adjust again as the economy rebounded, leaving the sales tax fund with some additional money. MIDD has $3.3 million that will be reinvested over the coming years. King County officials estimate those priorities will be finalized in the summer at the earliest.

In 2021, about $14 million went toward prevention and intervention. It paid for screening and referral services both in schools and in the community, as well as outpatient mental health and substance use treatment, which made up the bulk of the cost.

The largest portion of funding — $19 million — went to crisis diversion, for 18 programs including DESC's crisis solutions center, a place where people in a mental health crisis can be dropped off by law enforcement upon referral. DESC also runs several mobile crisis teams and respite beds for people recovering from mental health emergencies.

Another program that falls under that segment is Law Enforcement Assisted Diversion, or LEAD, a collaboration among the Seattle Police Department, King County Sheriff's Office and public defenders. People engaged in low-level drug involvement or sex work are moved away from that system and instead receive case management and community services.

According to the King County report in 2021, LEAD served 852 people. Over a three-year term, 84% of people first enrolled in 2018 experienced fewer jail bookings.

Researchers from the University of Washington found similar results, writing in the Journal of Experimental Criminology that LEAD participants spent about 41 fewer days in jail per year and that the program led to "significant" reductions in legal costs, though the data for that study was collected between 2009 and 2014.

The King County Auditor's Office warned in December that the data around the county's adult jail diversion programs, including LEAD, is lacking, and makes it hard to determine how effective they are.

Therapeutic or alternative courts focus on special populations like veterans, or people with mental health or substance use concerns, and they received $9.4 million in MIDD funding in 2021.

Another $8 million in MIDD money went to recovery and reentry services. A quarter of that was for housing supports, but it also includes programs like the ones that Given and Kelly participate in.

"We don't think that this is to replace therapy. It's not to replace medication," explains Michael Brown, the chief program officer at Hero House. "We want to be a piece of that puzzle, where when people are lacking community, they're lacking a place to be, lacking social support, they can come to [our] clubhouse."

Cindy Spanton, the director of hospital outreach services who oversees the Peer Bridgers program adds that part of the work includes getting people set up for success once they discharge from inpatient treatment: "We usually start in the hospital by giving them some things ahead of time, like a driver's license. We'll start their [Medicaid or disability] funding which can be very, very involved," she said.

Peer Bridgers also helps patients get medication, drives them to their appointments and will follow up with them for up to 90 days. Currently, the program has about five peer bridgers stationed at Navos hospital in the Delridge neighborhood of West Seattle, four at Harborview and four at Western State Hospital.

The least-funded MIDD initiatives fall under the category "system improvements" with less than a million dollars going toward rural services and grants focused on supporting communities of color. The fund contributed just $5,483 to workforce development, though Washington and the rest of the country face a shortage of behavioral and mental health workers.

Flor with King County recognizes that gap, "I don't think that we have sufficiently invested in workforce to date," he said. "That's a thing that we're trying to correct and do better on as we propose the crisis care centers for example."

While most of the proposed tax levy would go to the construction of new crisis centers, it also includes carve-outs that would focus on recruiting and retaining a workforce through increased wages, an apprenticeship program, and possibly supports that would help behavioral health staff with insurance, child care, or tuition costs related to their training and certification.

Voters will decide in April. If passed, over $1.25 billion would be raised over nine years. MIDD itself will continue through 2025, at which point the Metropolitan King County Council would have to vote to extend it.

Flor sees it as vital.

"Few things are more fundamental to a healthy community than healthy people," he said. "Behavioral health is the part of our system that remains underfunded, where we have a need that is just drastically outpacing the resources that are available to it."

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