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When it comes to mental health, some of us are thriving and others are spiraling all over again. Experts call it a disaster cascade.
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King County centers turn away 27% of people in mental health crises. Why?

People suffering a mental health crisis can turn to one of King County's evaluation and treatment centers, known as E&Ts, which help stabilize patients going through a psychiatric emergency. But things can be made even worse if a facility declines the patient, which happens more often than you might think.

KUOW’s Angela King talked to Seattle Times Mental Health Project reporter Esmy Jimenez about the situation.

This interview has been edited for clarity.

Angela King: Break down for us who is being referred to the centers and why?

Esmy Jimenez: You can think of these E&Ts as a crisis center for anyone in a mental health crisis. Someone could be actively suicidal or perhaps experiencing psychosis. And in some cases, the evaluation and treatment centers also provided detox services.

You discovered centers in King County declined more than a quarter of patients seeking treatment last year. According to your reporting, there are a number of reasons why that is happening. Tell us about those.

There are so many. It can be that someone has a walker, a wheelchair, an oxygen tank, or they use a CPAP machine for sleeping. All those are considered potential safety risks. Staff worry that they can be used as weapons either against them or other patients.

Pregnant women can be turned away. It's hard to safely restrain pregnant patients. And it's harder to find a placement for trans people in some facilities. Typically, patients are two or three to a room, and trans individuals are usually placed by themselves. But only 7% of people are turned away because there are no beds. At least, that's what the King County data found.

It sounds like these facilities work with a wide range of people experiencing a wide range of crises. That's what they're there for, right?

That was my question going into this as well. If not these crisis centers, whose job is it really to care for people in crisis? My reporting found it's a lottery game. People can be declined from one facility, but maybe they get into the second or the third facility they call. It’s a bit of a waiting game. It's a bit of a gamble.

Did any stories stand out to you as an example of how the system might not be working for the people who need it most?

Yes, I think of Don Bremnor. His adult son was diagnosed with schizophrenia. He was looking for an evaluation and treatment center around 2018. His son ended up waiting over 100 days at two different hospitals to be admitted to a facility. He said, "We used to live in Hawaii before coming to Washington. How is it that an island in the middle of the Pacific Ocean can provide better care for my son than Washington state?"

Is there anything the county or state can do to alleviate the situation for people like Don Bremnor? Are there any long-term solutions?

I know at least one state senator, Emily Randall, was working on a bill that would essentially say, all evaluation and treatment centers need to take all patients regardless of what's going on. The bill did not even make it out of committee. Both medical staff and the Washington State Hospital Association came out against it. They thought it was well-intentioned but just not the right thing to force all centers to take everyone because the most vulnerable people really do need specialized care, not just any bed. For them, the issue is funding — leveraging more resources to keep staff and build more facilities.

Listen to the interview by clicking the play button above.