Experts discussed the need for more healthcare services and programs for Washington’s kids, particularly those needing behavioral health support, at the 2024 Washington State of Reform Health Policy Conference last month.
Rep. Tana Senn (D-Mercer Island) chairs the House Human Services, Youth, and Early Learning Committee. She sponsored and helped secure the passage of several bills aiming to help Washington youths—including those with developmental disabilities—last year, and is focused on related initiatives for the 2024 legislative session. She said Infant and Early Childhood Mental Health services are in great need across the state.
“We have a system set up where professionals work with child care providers when there’s a behavioral health issue with kids,” Senn said. “And we work with the childcare provider, the family, and the child to help them address early behavioral health issues. We need to expand that program; it’s been very successful. There’s a huge demand for it. We need to make sure we’re getting more of that into rural areas and further out so kids can get the early mental health support they need.”
Hugh Ewart, senior director of state and federal government relations at Seattle Children’s Hospital, noted that 20 percent of Washington adolescents had a major depressive episode in the past year.
“In our hospital alone, about half of the kids in our emergency department at any given time are in a mental health crisis,” Ewart said. “And they’re typically waiting for appropriate care, which is not delivered in the emergency department. So they’re either waiting for a bed at our psych unit or another facility. Starting this month, the state will now cover partial hospitalization and intensive outpatient (care) for all youth. So that will help. But this crisis remains.”
Washington State Department of Children, Youth, and Families Secretary Ross Hunter said the declining number of beds for youths with behavioral health issues is a primary concern.
“It’s just declining across the system; it’s terrifying,” Hunter said. “I wish I could say why and how to fix it. We’re going to do some work with (the Department of Social and Health Services) to try and build some state-staffed beds. I’d rather have them in the private sector, but if I’m not getting them in the private sector, I’ve got to have them (somewhere). Because having kids at the Best Western with after-hours staff is not sustainable. It’s not safe for children, it’s not safe for adults.”
Seattle Children’s Hospital currently has 407 licensed beds, with 41 serving an inpatient psych unit that previously only had 20 beds, Ewart said.
“In terms of bed supply across the state, we’ve seen a really concerning trend where pediatric inpatient psych units at other hospitals have been closing. So it’s true that we have fewer beds to treat kids who need highly-specialized residential services. We actually need services across the entire continuum.”
— Ewart
Ewart said he is hopeful, however, as legislators on both sides of the aisle have recognized that Washington is in a mental health emergency capacity crisis.
“I’m hopeful because there’s a strong bipartisan commitment across the entire state, whether it’s rural, suburban, (or) urban locations, where mental health is not a partisan issue,” Ewart said. “There is much more work to do but, because there’s an understanding that this is a real crisis, we can start to solve it together.”
Senn believes a new legislative committee can help. She was recently selected as co-chair of the Washington State Joint Legislative and Executive Committee on Behavioral Health, which will develop a five-year behavioral health strategic plan that will include prevention, intervention, and treatment.
“I think one of the reasons I’m co-chair is to make sure we’re working on that prevention piece,” Senn said. “That we’re not just looking at Western State Hospital. We’ve got to go upstream to deal with the now, but also the future.”
The lack of available childcare services for healthcare professionals is also a concern, Senn said.
“We’ve heard loud and clear, during COVID in particular, how critical childcare is to the healthcare field,” Senn said. “And [about] how many nurses, doctors, and other professionals were unable to work because they did not have access to childcare. And within childcare, we have been embedding more mental health treatment.”
— Senn
Hunter said the state’s struggle in fighting the fentanyl epidemic, and how to plan safely around it, is also impacting child health.
“What we’ve seen is an increase in referrals for kids who are really high risk but don’t have an immediate safety threat,” Hunter said. “Most of those are fentanyl users. The lack of treatment for adults is an enormous problem. And our youth have a very hard time getting medically-assisted treatment. People just won’t give it to children, which is insane.”
Hunter noted that the passage of House Bill 1227 in 2022 increased the standard for the court to order that a child be removed from a home at a shelter care hearing to “imminent risk of physical harm.”
“That changed the removal standard to make it less likely that we would remove children unless there’s an immediate safety risk,” Hunter said. “And we’re recognizing that fentanyl is an immediate safety risk.”