5 takeaways on what’s next for mental health care from ‘Lost Patients’ event

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Why aren’t people with serious mental illness getting the care they need, and how can we build a better system? 

KUOW Soundside host Libby Denkmann and “Lost Patients” podcast host Will James moderated a conversation about Washington’s mental health care system in a live event at Seattle’s Central Library on May 9.

Listen to the discussion here and read takeaways from the event below.

1. History provides essential context for understanding how our mental health system works.

James and Seattle Times investigative reporter Sydney Brownstone both discussed the importance of considering historical context while reporting on mental health. 

Brownstone’s reporting on Northern State Hospital, a state-run psychiatric hospital that closed in the 1970s, gave her a new perspective when covering modern-day homelessness and serious mental illness.

“Many of the issues that I’m covering right now … actually have their roots in very old ideas about who is productive and who is unproductive, whose life is valuable and whose life is not,” Brownstone said.

Investigative journalism sometimes focuses on finding a single person or agency who needs to be held accountable for a problem. But James said he didn’t want “Lost Patients” to point to one scapegoat. Discussing the podcast episodes about Adam Aurand, a man who died shortly after being discharged from Western State Hospital into homelessness, James said the failures that led to Adam’s death are “bigger than any one person.”

“The people who work within this mental health system are often trying their best within a structure that limits how effective they can be, a structure that predates them ever working in this field,” James said. “That structure was created over decades and generations by people like us declaring our priorities when we go to the voting booth, when we talk to politicians.” 

2. Crisis centers will add a care option for people with serious mental illnesses.

King County’s forthcoming crisis care centers, funded by a $1.25 billion property tax levy, will create a new option for people with serious mental illnesses, or anyone in a mental health crisis. The five planned centers will be geographically distributed throughout the county, and one center will focus on youth. 

The first center is slated to open in 2026. Each center will contain a behavioral health urgent care clinic that could screen people and triage them to appropriate services, an observation unit where people could stay for up to 23 hours, and a short-term stabilization unit where people could stay for up to 14 days before being discharged or referred elsewhere. People will be admitted to the crisis centers voluntarily.

“I am very optimistic about the crisis care centers levy that we have here,” patient advocate Laura Van Tosh said. “That will help shift our system once implementation begins.”

James asked what will make the crisis care centers more than another stop in “the churn” of homelessness, incarceration and hospitalization. They’ll have to play a different role, Van Tosh said; she’s hopeful that serious mental illnesses will be addressed earlier on and decrease the number of patients institutionalized. 

3. Community-based mental health care could provide a different model.

Isolation and connection can significantly affect people’s experiences in psychosis and recovery. Patient advocate and TikToker Carolynn Ponzoha pointed toward community care as a model for recovery.

“In the community is the best way to recover… I know that’s been the most beneficial for me,” Ponzoha said. “The recovery community in my area is very tight-knit.”

She said organizations like Seattle’s Recovery Café, which offers free meals, support groups and resource referrals, have been helpful to her. 

“The Recovery Café has its feelers out all over, helping people with domestic violence services, with housing, they have access to all of these services and they can refer you,” Ponzoha said. “I would love to see more things like that.”

4. The relationship between drugs and mental illness is complicated.

People with mental illness sometimes use drugs to self-medicate, but those same drugs may act like a trigger for psychotic disorders.

Drugs affect everyone differently, and it’s hard to untangle how they contribute to serious mental illnesses, said Dr. Paul R. Borghesani, an associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. 

“I like to avoid the idea that it’s either drugs or mental illness,” Borghesani said. “I’m always talking about it as being both.” 

We all know people who use substances like alcohol or cannabis safely, he said — which leads some patients to ask, why can’t I use those substances? He tells patients that if they’re experiencing psychosis or mania or depression with cannabis, they should start limiting that substance because it’s probably a contributing factor.

The potential relationship between THC and psychosis has been a focus for local researchers, medical professionals and policymakers, as doctors here report seeing more youth visiting emergency rooms for psychotic episodes that appear to be tied to use of high-potency THC products.

5. Creating better care systems will take time and investment.

It will take more than one policy change to improve care systems to where involuntary treatment isn’t necessary, Borghesani said. Right now, many people can’t get treatment before they reach a point where they don’t realize they’re sick. 

We need to be honest about the fact that quality mental health care costs money, said Timothy Jolliff, acting senior director of Clinical Programs for Seattle’s Downtown Emergency Service Center.

“The need is so great, we need to buy into the belief that everyone needs to have a common shared goal around what needs to happen,” Jolliff said. “And it’s not cheap. That level of investment is what is needed to push the needle forward and to kind of turn the tide on things.”