Lurks around the edges of my mind,

Watching, waiting

For me to let my guard down

So it can invade.

Or perhaps . . .

Madness will creep in

Under the cover of my denial.

I close my eyes and try to wish it all away.

But I’m no genie.

My genies are pink and yellow and green and white.

And they must escape their bottles often.

Or madness moves in and stays.

               __Ruth White

May 19, 2005


Those of us who are someone or who love someone who struggles with mental illness relate to the poignant description of madness published in her book Bipolar 101, a Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More.  Like Dr. White, it may have taken us or our loved one years to accept that she/he/we have a mental illness. If you aren’t someone who has suffered, you know someone who has.   From the mild, infrequent panic attack to more persistent and life altering mood, substance or thought disorders, we and families like ours often have difficulty with acceptance both within our families and outside of them in the wider world we inhabit. All too often, we fear being judged, blamed, shamed and otherwise focused on for what is deems wrong and not what is strong in us. Stigma can keep us silent and isolated from one another, lessening the chance of reaching out and connecting with others who also struggle and suffer in silence.


May is Mental Health Awareness Month. This month, as every month, every year, it’s personal for me.  Raising awareness seems more urgent because, as May, 2019 begins, I find myself on the uphill side of the battle to support loved ones who are currently in crisis find their way back into recovery. Recovery? Yes. Recovery and mental wellness. Perhaps some of you are unaware that many of the 1 in 5 adults in the U.S. – 43.8 million people – who experience mental illness in a given year do recover and live full, healthy, productive lives.  Mental illness is not a dark, irremovable stain on an otherwise untarnished health report card or badge of honor, character, moral standard or spiritual fortitude. Even those 1 in 25 – 9.8 million – adults in the U.S. who experience a serious mental illness in a given year that substantially interferes with and limits one or more major life activities can and do recover.


This month I strongly urge you to become more aware.  Find and share information about mental health. Start a dialogue in your home, workplace or community.  Support one of the many organizations whose mission is to remove stigma, advance mental wellness, save lives and contribute to our ability to not only survive but to thrive.

Since 2012, I have been fortunate to lead Guided Pathways – Support for Youth and Families (GPS), King County, Washington’s only family support organization.  Our mission: We are families helping families. We empower and support families and youth struggling with behavioral, emotional or substance abuse challenges in navigating resources to achieve wellness and resilience.  I am blessed to be part of an ever-growing peer support network in King County, Washington State and beyond. Yet the fault lines and dire condition of our country’s mental health system, state budget cuts to mental health care, laws that often make it harder for those in need to get help when they need help the most make caring for those we love a dauntingly arduous task.


I choose to persevere.  On May 6th, I will join others like me at the Washington State Health Care Authority sponsored 3rd Annual Children’s Behavioral Health Summit “Voices Together Bring Change.”  I am looking forward to this opportunity to participate in discussions about effective behavioral supports within schools, engaging youth in living a healthy life, and supporting children in successful transitions.  I am also looking forward to participating in the University of Washington, Psychiatry & Behavioral Sciences School of Medicine’s Psychosis REACH Training, May 14th through 17th, which will provide insight, information and skill building in Cognitive Behavioral Therapy for family members supporting a loved one who experiences psychosis.  I hope that this training experience will add to my toolkit and allow me to help the families GPS serves as well as my own.

Musings from Susan’s Desk

Posted by on Apr 11, 2015 in Uncategorized | Comments Off on Musings from Susan’s Desk

Thankful for the Support of Caring Community Members


Artist and author Deb McCarroll donated one of her paintings.

When Deb McCarroll was eight years old, her mother took her on a journey through the streets of Albuquerque and the New Mexico desert. Deb’s book The Long Hot Walk tells her story of being raised by an “unshakable” mother with escalating mental illness. Deb, the author of two books and an artist whose paintings hang in more than a few downtown Seattle businesses, is just one of the wonderfully supportive community members who contributed to Guided Pathways’ first fundraiser, the Youth Empower Happy Hour, April 8th, 2015, at the Mt. Baker Community Club.

Not only did Deb design the logo for Youth Empower, she also contributed the proceeds from the sale of her memoir and a beautiful painting our guests happily entered a drawing to win.

Sponsored by Seattle Children’s Hospital and Amerigroup, our first fundraiser was an outstanding success by many measures – not the least of which is the outpouring of support we received from friends and family.  Our spirits are as bright as the beautiful sunshine and mild spring temperatures that graced our special day. We are thankful for the support of a caring community who believes in our mission and who have cheered us on from the beginning of our brief history as a family support organization.


Guided Pathways Youth Peer Ashley Peoples shared her story.

The generosity of many helped make Youth Empower possible and contributed to our efforts to offer the support King County youth and families tell us they need and want.  Among those community members are our keynote speaker Dr. Leslie Walker, our program emcee Micki Flowers and Sean Goode who joined us to asks our guests to give. Talented pianist James Sears generously gave of his time and talent to fill the club’s hall with melodic sound.  Our own Ashley Peoples powerfully and eloquently told the story of how she progressed from a youth at risk for negative life outcomes to one whose experiences, lessons learned from them, life skills, and passion for mentoring lead her to the position of Youth Peer Coordinator at Guided Pathways.  Her testimony was authentic, deeply heartfelt and heart touching.

A special note of gratitude for volunteers Mary Sands, Wendy White, Tessa and Cayla Wells –your work helped our event truly shine!

On behalf of our Board, staff and the families we serve, thank you for caring and giving to Guided Pathways.  Your support means everything to us!


James Sears and his keyboard made beautiful music.

James Sears and his keyboard made beautiful music.


Emcee Micki Flowers elevated the program as mistress of ceremonies.

Seattle Children’s Hospital’s Dr. Leslie Walker shared her knowledge and experience working with King County’s youth.

Seattle Children’s Hospital’s Dr. Leslie Walker shared her knowledge and experience working with King County’s youth.

Sean Goode encouraged giving.

Sean Goode encouraged giving.

Board Youth Representative Hunday Sylvester with Deja Slade, supporting our mission.

Board Youth Representative Hunday Sylvester with Deja Slade, supporting our mission.

Board Treasurer and founding member Ron Jaeger and wife Kathy joined us.

Board Treasurer and founding member Ron Jaeger and wife Kathy joined us.

Guided Pathways Office and Volunteer Coordinator Pam Romine, Amerigroup’s Nathasja Skorupa, Guided Pathways ED Susan Millender and Board President Jamie Weber

Guided Pathways Office and Volunteer Coordinator Pam Romine, Amerigroup’s Nathasja Skorupa, Guided Pathways ED Susan Millender and Board President Jamie Weber

Founding Board member Crystal Lyons, Micki Flowers, Sean Goode, Susan Millender and Dr. Leslie Walker

Founding Board member Crystal Lyons, Micki Flowers, Sean Goode, Susan Millender and Dr. Leslie Walker

On Losing My Darling Natalie – Children’s Mental Health Network

Posted by on Mar 24, 2015 in Children's Mental Health, depression, Mental Illness, Suicide | Comments Off on On Losing My Darling Natalie – Children’s Mental Health Network

A touching story of a mom and her daughter’s struggle with mental health published in the Children’s Mental Health Network.

On Losing My Darling Natalie – Doris Fuller

I lost my darling daughter Natalie to terminal mental illness last weekend.  She killed herself one month short of her 29th birthday by stepping in front of a train in Baltimore.

Transgender Students Learn To Navigate School Halls

Posted by on Mar 12, 2015 in Bullying, Children's Mental Health, young adults | Comments Off on Transgender Students Learn To Navigate School Halls

img_6215A wonderfully, readable story of transgender students from

The first time I learned that gender could be fluid was in sex ed in the ninth grade. I remember the teacher mumbling under her breath that some people don’t identify their gender with the biological sex they were born with.

At the time it didn’t faze me because I’d never known anyone who’d talked about it or felt that way. But now, three years later, I have a 16-year-old classmate who’s transgender. His name is Jace McDonald.

For the rest of the story please go to:


Restore Non-Medicaid Funding for Mental Health and Substance Abuse

Posted by on Mar 6, 2015 in Advocacy, Children's Mental Health, depression, family support organization, GPS for Youth and Families, King County, Mental Illness, Policy Day | Comments Off on Restore Non-Medicaid Funding for Mental Health and Substance Abuse

Pam+Romine_smallerby Pam Romine, GPS Office and Volunteer Coordinator

Even during the best of economic times, youth and adults living with mental illness struggle to access essential mental health services and supports. Services are often unavailable or inaccessible for those who need them the most. One in 17 people in America lives with a serious mental illnesses such as schizophrenia, major depression, or bipolar disorder. About one in 10 children live with a serious mental disorder.

Unfortunately, the public often focuses on mental illness only when high visibility tragedies of the magnitude of Newtown or Seattle Pacific University occur. However, less visible tragedies take place every day in our communities—suicides, homelessness, arrests, incarceration, school drop-out and more. These personal tragedies also occur because of our failure to provide access to effective mental health services and supports

During the last two legislative sessions, it became apparent that there is a common misconception that Medicaid expansion under the Affordable Care Act (ACA) would greatly reduce or eliminate the need for state general funds in the mental health and substance abuse budgets. However, Medicaid’s expansion does not address the many essential services that are not Medicaid Reimbursable, most notably inpatient psychiatric treatment, Nor does it cover the many people with mental illness who do not qualify for Medicaid, either because their income is slightly higher than the Medicaid threshold (which is well below poverty level in most states) or because they are too ill to take the steps necessary to apply and qualify for Medicaid.

State general funding of mental health care is the “safety net of last resort” for children and adults living with serious mental illness. Over the recent years states have cut vital services for tens of thousands of youth and adults living with the most serious mental illness. These services include community and hospital based psychiatric care, housing and access to medications.

In Washington State, flexible non-Medicaid mental health funding from the state general fund has been reduced by 33.2 million (27%) since 2009. And, state non-Medicaid substance abuse funding has been reduced by 20.2 million (25%) statewide since 2010.

Communities pay a high price for cuts of this magnitude. Rather than saving states and communities’ money, these cuts to services simply shift financial responsibility to emergency rooms, community hospitals, law enforcement agencies, correctional facilities and homeless shelters.

For youth and adults living with serious mental illness, these consequences include frequent visits to emergency rooms, hospitalizations, homelessness, entanglement with juvenile and criminal justice systems, the loss of critical developmental years, premature deaths and suicides.

With appropriate services, people living with serious mental illness can and do achieve recovery and independence in their lives. Let’s restore non-Medicaid funding for mental health and substance abuse services, and improve the lives of children and adults, and the health of our community.

Two of my Favorite Objectives

Posted by on Mar 4, 2015 in Advocacy, Children's Mental Health, depression, family support organization, GPS for Youth and Families, King County, Mental Illness, Recovery | Comments Off on Two of my Favorite Objectives

Ron Jeagerby Ron Jaeger, GPS Board Member

I’ve been looking over my notes from the King County Mental Health Forum last November.  The forum touched on two of my favorite objectives for legislative advocacy.  They are both general but apply to a lot of the changes I believe that families want to see:

1) Empower families and communities to help loved ones

2) Incentivize the systems to help people as early as possible

You may remember the comments of Jim Volendroff, the new Division Director of King County Mental Health and Chemical Abuse Dependency who said  “As an adolescent, I had my own struggles with depression and anxiety and have experienced involuntary treatment which saved my life.” 

SHB 1450 concerns involuntary outpatient mental health treatment.  SSB 5649 is its companion bill.  This is not compulsion.  It creates incentive.    It requires a plan identifying readily available services.  The services are incentivized by having a judicial mandate to serve.   Families are empowered to take action knowing the services are upheld by the law and won’t be challenged.

It would be counter-intuitive to authorize only treatment for adults after they and their families have suffered years of consequences while neglecting the stage of life where help might have been applied to prevent those years of suffering.  Fred Jarrett, the Deputy King County Executive mentioned how  “Looking ahead, we want to increase our efforts to prevent severe mental illness and addictions… With earlier assessment and recognition of behavioral health problems, we can help children and youth before mental illness or addiction steals their chance for healthy lives and futures.”

It is not a stretch to wish for an involuntary law similar to SHB 1450 to help persons between the ages of 13 and 18.    Indeed, the beginnings of it may already exist under the heading of an At-Risk-Youth petition for adolescents through the Juvenile Court system.  That current section of the RCW and its corresponding WACs might benefit from a review to determine whether they adequately empower both systems and the family to seek and find helpful services at crisis points in a youth’s life.  I believe those thoughts are consistent with Penny LeGate’s plea for parents to organize a kind of coalition to challenge the law that allows a 13 year old child to walk away from treatment without their parents’ consent.

In an era of transforming health systems, new discoveries about neurological development and modernized information systems, opportunities must exist to empower families and incentivize the systems to provide help for youth struggling through substance addiction, traumatic stress reactions and stages of atypical brain development.  We are just beginning to tap those opportunities and we need the legislature’s help.  Without change, our current directives risk sanctioning an unstable future by incentivizing inaction as the most comfortable and least contentious response for systems and communities during formative adolescent years.


Police Engagement Workshop

Posted by on Mar 2, 2015 in Children's Mental Health, family support organization, GPS for Youth and Families, Parent Class, Volunteers, young adults | Comments Off on Police Engagement Workshop

Guided Pathways -Support for Youth & Families is one of many youth- and family-serving organizations concerned about the school to jail pipeline and police use of force against youth of color and those who struggle with emotional, behavioral and substance abuse challenges. In partnership with Atlantic Street Center, Guided Pathways is leading a series of community conversations on these issues. The first of the series began last week with a parent class on involvement with police.

Police Engagement Workshop, by Samantha-Jo Fry, GPS Social Media Volunteer

Zakia opening the Workshop

Zakia Ruquiya opening the Workshop

The Atlantic Street Family center is tucked on a small street with only a bold black and white sign to let you know that you are exactly where you’re supposed to be. It’s a modest building that, on this day, had adopted a red faced duck who wandered outside helping to greet anyone who arrived to this event.

When I first learned that I was going to attend the Police Engagement Workshop, I felt completely out of my element. I’m a girl who was born and raised in small town America, you can hardly find a stop light, let alone the need for an entire workshop. But in minor preparation in writing this blog, I discovered that the African American community has good reason to come together. I heard a statistic that there are more African Americans incarcerated right now then there were in slavery. That they represent 60 percent of the population currently incarcerated. And while this February we celebrate the 1965 march from Selma to Montgomery, African Americans are three times more likely to be searched during a traffic stop, two times more likely to be arrested, and four times more likely to be on the receiving end of police force. And since 1 in 15 African Americans are incarcerated, these numbers didn’t seem so surprising. Yet here I was, watching Oprah’s Selma win awards on TV, and the audience cry as John Legend and Common are making mainstream music to remind us of those Civil Rights victories, these numbers made me feel smaller, less aware.

Leading the discussion

Zac Davis Leading the discussion

As the meeting space started to fill, I, along with everyone else, was impressed at how many young people were in attendance. Everyone was laughing and talking, the panel of speakers coming in, making sandwiches from the little station set up next to the sign in desk, eventually everyone making their way into the room.

As introductions were made, the church welcomed Reverend Harriet Walden, Steven Dozier, Pastor Carl Livingston, Tamera Cook, and Dustin Washington. Applause went out and immediately the crowd was hit with facts and advice. The advice provided the audience of parents and youth included: asking for a ranking officer if you feel uncomfortable when stopped by police; if you are a minor, be sure to respectfully follow directions; only give out your name and age; as of 2010 you are no longer read your Miranda Rights unless you are arrested or you bring it up yourself, and, one of the most clearly stated tips; always ask for a lawyer, don’t assume that you understand the law, or as a minor, that your parents do.

Many people in attendance spoke up, many added in their own information or experience, and with every hand raised and voice heard, I felt the passion and emotion of those whose history raised awareness, whose knowledge was there to empower. It was infectious, I wanted to stand up, call a politician, march, something that made a difference. But instead I watched as the panel made their way up the steps to take their chairs, ready to answer outlined questions and pass on their wisdom to this room of concerned citizens.

I listened as they told their stories, brought to light facts and information, expressed the importance of education and history, spirituality emanating through every word. They told parents to know who their children’s friends are, focus on the positive and continue to identify goals, seek community support, encourage conversations, every piece of advice circling back to education. After all, African American youth make up about 17% of the youth population, 37% of their cases, when arrested, end up being moved to criminal court, and 58% find themselves in adult prisons. They also spoke of the inability for this community to ignite change, and I thought “Vote!” Isn’t that what we learn? Use your right to vote! Write in! You matter! But a staggering 5.3 million Americans are denied the right to use this basic right because of a felony, and 13% of those are African Americans.

What a great crowd!

What a great crowd!

However as the night wound down and the discussion came to a close, I couldn’t help but notice how hopeful the room was, how much just knowing what you can do, march, attend, read, or simply just express a curiosity, can impact your experiences. Behind me sat a group of young men, one of whom, statistically speaking, will have an encounter with the police and might be more aware and more powerful than he was before. And for everything that this community has working against them, sitting in that church I was moved by the idea that this is exactly what has the potential to reach young minds. Ideas as significant as Civil Rights started in small forums such as this, by people who believed in spreading awareness.

The panel came to a close, and the energy morphed into something lighter, the crowd making their way downstairs for a dinner provided by Teen Feed, an organization that provides support for at risk youth. I left the church with my mind just a little more open, my awareness expanded, knowing that while that the African American community may have a long way to go to make the justice system less flawed, I had the pleasure of watching a community bring these issues to light.

Full Behavioral Health Integration Requires an Integrated Commitment Statue

Posted by on Feb 26, 2015 in executive director, King County | Comments Off on Full Behavioral Health Integration Requires an Integrated Commitment Statue

By Susan Millender, GPS Executive Director

During the 2014 King County Mental Health & Substance Abuse Legislative Forum, the integration of behavioral health involuntary treatment laws (ITA) and the launching of a 16-bed secure detoxification facility was highlighted as a request and legislative priority.  Why is this request an important one to our families?  “Unless you’ve been there, you can’t imagine what it’s like to watch helplessly as someone you love descends into addiction,” David Sheff writes in his book Clean, Overcoming Addiction and Ending America’s Greatest Tragedy.  Sheff’s lived experience was chronicled in his first book A Beautiful Boy which dissected his son’s addiction to methamphetamine.  In Clean he reflects that the transformation to addiction defies logic “until you understand that your loved one is gravely ill with a brain disease that’s debilitating, chronic, progressive, and, if left untreated, often fatal.

Many parents are struggling with their own addiction challenges, creating even more unimaginably adverse environments for children who depend on them.

2016 is the onset of behavioral health integration and, as we move toward integration, now is the time to develop an involuntary commitment law that addressees risk stemming from both mental health and substance abuse. Doing so would help to stop the detention of individuals with substance abuse disorders in the mental health system. Having an integrated commitment framework and a secure detoxification facility to serve such individuals would provide better outcomes for them.

The model has already been created. A successful 2006-09 integrated commitment pilot included secure detoxification facilities.  Sites were established in two counties for the Integrated Crisis Response (ICR) pilot program. Designated Crisis Responders (DCRs) at the pilot sites had authority to detain individuals up to 72 hours if there was a likelihood of serious harm or if a person was gravely disabled as a result of a mental disorder, substance abuse disorder, or both.  The pilot’s secure detoxification facilities served individuals detained under this law.
A rigorous evaluation of the ICR detoxification facility found that its use was correlated with fewer admissions to inpatient psychiatric and substance abuse treatment, more rapid entry into substance abuse treatment, and higher rates of employment.

Clearly, a more comprehensive response to crisis results in better outcomes. An integrated commitment statute would allow designated mental health professionals (DMHPs) and Designated Crisis Responders (DCRs) to respond more comprehensively to clients’ overall risk and vulnerability, especially if paired with new resources such as a secure detoxification facility.

Join us in Olympia on Monday, March 23rd, as we meet with our policymakers, tell our stories and make known the mental health and substance abuse needs of King County children, youth and parents.

Redirect Marijuana Excise Tax

Posted by on Feb 23, 2015 in family support, GPS for Youth and Families, King County, Policy Day, Recovery, young adults, youth peers | Comments Off on Redirect Marijuana Excise Tax

By Gary Streile, GPS Parent Partner

In 2012 WA state voters approved I-502, which removed state legal prohibitions against producing, processing, and selling marijuana. It also made marijuana sales subject to licensing and regulation by the liquor control board, and subject to an excise tax. Details of the disbursement of this excise tax were laid out in RCW 69.50.540. Item 5d of that RCW specifies that a portion of the excise tax should go to the state Basic Health Plan (BHP) trust account. The intent was for this money to be used for prevention, recovery support, and treatment services for persons with mental illness and substance use disorders.

However, because of the advent of the Affordable Care Act (ACA) (with expanded Medicaid and an active health insurance exchange), the BHP was eliminated in 2014. When the BHP was eliminated, the marijuana excise tax set-aside for it never occurred.

As a Parent Partner here at Guided Pathways, I’ve worked with a number of parents who are concerned with the marijuana use of their kids and its apparent impact on their behavior, day-to-day life regimen, and performance regarding school or work. Dr. Leslie Walker, chief of the adolescent medicine at Seattle Children’s and a professor of pediatrics at the University of Washington (UW), works with kids who use marijuana. And she has seen marijuana cause the kinds of physical withdrawal and cravings that make kids continue to use even in the face of serious negative consequences. According to the National Institute on Drug Abuse (NIDA), research shows that about 9% of those who use marijuana become addicted, and 25%-50% of those who use marijuana daily end up abusing it. Furthermore, 62% of youth who have been admitted to treatment for substance abuse say that marijuana is what got them started. Dr. Kevin Haggerty, associate director of the Social Development Research Group (SDRG) at the UW, says that marijuana is the number one drug kids go into treatment for. And some emergency room visits are also related to marijuana, including visits for treatment of young kids. In a post I-502 world, “consumable” marijuana products will be increasingly available. And researchers at the Rocky Mountain Poison and Drug Center have announced that half of all cases of ER visits for kids younger than age 12 for “unintentional ingestion” of marijuana in the past few years involved consumables.

Public systems provide most of the substance abuse treatment services in Washington. However, they only have the capacity to serve a small portion of the need that exists. Data from the National Survey on Drug Use and Health (NSDUH) indicate that only 1 in 18 young people in Washington who need treatment receive it.

Because of the legalization of marijuana provided by I-502, and the greater access to marijuana that should result, it is expected that the need for prevention and treatment services will grow (even as resources for behavioral health services have been shrinking). So, it makes logical sense to me to use some of the revenue resulting from its legal sale to provide the publicly-funded prevention and treatment services that are necessitated (at least in part) by its use.

The BHP portion of the excise tax was originally designated for these programs. A simple legislative fix could achieve the intended purpose for the BHP funds by directing them to evidence-based or research-based intensive community interventions shown to promote recovery and reduce the need for inpatient hospitalization for persons with behavioral health and substance use conditions.

I’m telling the policy makers how I feel and why. Let your legislators know what you think.

Join us in letting our policy makers know why this is so important to our families. On March 23, 2015, we will go to Olympia for the ‘Stand In Our Shoes’ Rally at 1 pm on the Flag Circle between the Washington State Supreme Court Building and the House of Representatives. Let your voice be heard! Register to attend at

Through the month of February you can read our Blog for more information about King County mental health and substance abuse legislative priorities.

Revise Federal IMD Exclusion Rule to Allow Medicaid to be Used for Acute Care Stays of 30 Days or Less

Posted by on Feb 12, 2015 in Uncategorized | Comments Off on Revise Federal IMD Exclusion Rule to Allow Medicaid to be Used for Acute Care Stays of 30 Days or Less

By Pam Romine, GPS Office and Volunteer Coordinator

At this year’s King County Mental Health and Substance Abuse Legislative Forum, attendees were presented with a slate of legislative priorities and requests related to behavioral health and substance abuse. One of the requests is to revise the federal Institutions for Mental Disease (IMD) exclusion rule to exempt stays of 30 days or less. This would allow Medicaid to be used nationwide for mental health evaluation and treatment (E&T) facilities as well as substance abuse detoxification facilities that are larger than 16 beds (classified as IMDs), thereby preserving critical resources foe individuals in behavioral health crisis.

First we need to understand the federal (Medicaid) Institution for Mental Disease (IMD) Exclusion. Medicaid is the nation’s largest Insurance program spending approximately 53% of total national expenditures for the treatment of conditions classified as mental diseases under professional medical guidelines. However the exclusion, known as the “Medicaid IMD exclusion”, part of the federal program since1965, bars federal contributions to the cost of medically necessary inpatient care incurred in treating Medicaid beneficiaries ages 21-64 who receive care in certain institutions that fall within the definition of an “institution for mental disease.” An “institution for mental diseases” is defined as “a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care and related services.”

Under the rule Medicaid funds cannot be used to reimburse care for adults 21-64 years of age with long term mental illness or drug and alcohol issues who are in facilities with more than 16 beds. This exclusion has a profound effect on the poor who cannot afford to pay for mental evaluations and treatments. By revising the exclusion rule to exempt stays of 30 days or less would allow Medicaid, federal funding not state funding, to be used for mental health evaluations and treatment facilities as well as substance abuse detoxification facilities. This will allow the poor to have more services.

In September 2014 Medicaid updated Washington State’s waiver to include temporary and limited authority to use Medicaid funds in IMD facilities for short-term mental health stays in lieu of more expensive inpatient hospital stays. Although great news, this waiver is subject to renewal every 2 years and it does not cover substance abuse services including Detoxification.

Two of the largest psychiatric facilities in the state – Fairfax and Navos, and the main detoxification facility in the state – Recovery Centers of King County, are classified as IMDs. If we revise the Exclusion then Medicaid would be would allow to reimburse these facilities for inpatient stays less than 30 days for the 21-64 ages patients, enough time for mental evaluations and detox services.

If the federal IMD exclusion is revised as proposed to exempt stays of 30 days or less, individuals in need of urgent care will have greater access to services. Millions of dollars in state funds would be saved and redirected to new and improved community services.

A permanent and comprehensive legislative solution is needed. So join us in letting our policy makers know why this is so important to our families.  On March 23, 2015, we will go to Olympia for the ‘Stand In Our Shoes’ Rally at 1pm on the Flag Circle between the Washington State Supreme Court Building and the House of Representatives.  Let your voice be heard! Register to attend at

Through the month of February you can read our Blog for more information about King County mental health and substance abuse legislative priorities.

Raise Liquor Tax for Substance Use Disorders and Treatment

Posted by on Feb 12, 2015 in GPS for Youth and Families, Policy Day | Comments Off on Raise Liquor Tax for Substance Use Disorders and Treatment

by Zakia Ruquiya, GPS Parent Partner

We would like to create a Substance Use Disorders Treatment Account and require 30% of the funds collected from alcohol license issuance fees from spirits distributor licensees to be deposited into the account.  Revenue from this account should be directed to support community-based prevention, recovery support and treatment services.

This initiative is designed to provide funding for programs where state and federal funding falls short.   State revenues are anticipated to decline further as the state looks to make up a deficit. Despite declining revenues, people are in need of services more than ever.

The Washington State Department of Social & Health Services has estimated that prevalence of mental illness in our state to be 3.83% for adults and the prevalence of “Serious Emotional Disturbance” to be 7% for youth.

According to the Washington State Office of Financial Management, “Division of Alcohol and Substance Abuse” has estimated that almost 11% of adults living in our state need Drug and/or Alcohol Treatment.

Health and Substance Abuse Tax

Many people seen all around the County Counseling Centers suffer from debilitating illnesses like Major Depression, Bipolar Disorder, Schizophrenia, and Drug Dependence.   Most have already tried to get help from their families, support systems, and churches. As beneficial as that help is, it often times isn’t enough and “bridges are burned” as a result of the chronic and severe problems.

Yet quality mental health and substance abuse treatment services have been scientifically shown to reduce health care costs, medical and psychiatric hospitalization, emergency room visits, crime and criminal justice costs, social service and welfare costs, and improve family functioning, employment, and worker productivity.

Why our law makers should vote to pass this initiative, many people with mental illness and/or substance abuse issues are seen repeatedly in the criminal justice system and in the health care system. This causes the cost of these services to rise, and neither the criminal justice system nor our local medical health care systems are designed to treat serious psychiatric or substance abuse problems. Thus, people with mental illness and/or substance abuse problems that do not receive effective treatment cost taxpayers more money every time they encounter the criminal justice system or our health care system.

This initiative will help to save money, we are already spending tax funds to address the emergency needs of this population in our medical and criminal justice systems. According to the Washington Community Mental Health Council, the average cost per client for community mental health services is under $5,000 per year. In contrasts, the average annual cost of incarcerations is $27,000 and the average annual cost of psychiatric hospitalization is $70,000. This tax is an opportunity for the local community to more effectively direct our tax dollars to our priorities, and address the mental health and chemical dependency issues in our community.…behavioral…/substance-abuse

Like most health conditions, mental health and substance use disorders can be prevented and treated.  Preventing the health and safety impacts on children and adults, and the costs to communities, is a high priority.

Goals to Be Achieved
Passing this Use Tax would help to Provide For Operation and Delivery of Chemical Dependency or Mental Health Treatment and Therapeutic Programs And Services.

Those goals are to:

  • Reduce the incidence and severity of chemical dependency and/or mental health disorders in adults and youth
  • Reduce the number of individuals with chemical dependency and/or mental health disorders using costly interventions such as hospitals, emergency rooms, or jails
  • Diverge adults and youth with chemical dependency and/or mental health disorders from initial or further involvement with the criminal justice system
  • Support linkages with other county efforts
  • Provide outreach to underserved populations
  • Provide culturally appropriate service delivery