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Behavioral Health: Mental Health and Substance Use Disorder

Bob Ferguson has visited all 39 counties in Washington and in every corner of our state he has heard the same frustration and seen the same suffering: individuals, their families, and our communities are in the grips of an entrenched mental health and substance use crisis. 

In recent years Washington has been working to course correct but we need to make behavioral health the urgent priority for state government that it is for people experiencing the impacts of this crisis firsthand. 

Most Washingtonians know the contours of this crisis all too well. Youth suicide is up and yet the waitlist for youth in need of inpatient beds is longer than any time in recent memory. Overdose deaths recently topped 2,000 for the first time in Washington history. Our jails are collectively our largest mental health provider in the state. Families struggle to navigate our systems. And fewer than half of individuals with a mental health disorder are getting proper treatment. It is unconscionable that we do not have treatment and responses that match the scale of the crisis. 

The good news is that we know what works. And Bob is committed to getting it done. 

As Attorney General, Bob took on opioid manufacturers and drug companies who preyed upon people to hold them accountable — he won and brought more than $1.2 billion back to Washington to help undo the damage they have caused. But we need to do more than just intervene once people and communities are hurt — we need to work upstream to keep people healthy, in treatment and recovery and housing. 

The Ferguson Behavioral Health Plan will intervene in today’s crisis and prevent tomorrow’s crisis. His track record of success and commitment on this front make him the right one for the job.

We need change. And we need real leadership. 

Bob Ferguson has been fighting for mental health access for his entire career. He received the Sound Mental Health Award for his leadership. As Governor, Bob will continue this leadership.

Bob's Promise

In order to communicate to his cabinet and the people of Washington his personal investment and his commitment to improving Washington's behavioral health challenges, Bob pledges to move his office to Western State Hospital and work out of the Hospital for a week. He will fight to build the strongest behavioral health system in the country to help individuals and families struggling with issues of mental health and substance use. 

Bob’s Leadership on Behavioral Health Reform
  • Bob won more than $1.2 billion for all Washington communities to address the opioid crisis by taking Big Pharma to court and holding multinational corporations accountable for their role fueling the opioid epidemic. 

    Bob delivered more resources for treatment services, more support for pregnant women and babies suffering from neonatal syndrome, additional help for first responders, and prevention efforts to educate youth about the risks of fentanyl by making the people responsible for fueling the opioid epidemic pay.

  • Bob developed a crisis hotline for Washington youth experiencing bullying, suicide and self-harm, mental illness, or harassment.

  • Bob successfully fought for mental health parity among insurance companies. He stood up to a large travel insurance company that was discriminating against Washingtonians with mental health challenges by categorically denying claims for Washingtonians who had to cancel or reschedule their travel plans because of mental health events. He won full financial restitution for Washingtonians who experienced discrimination, including a mother who had to cancel a trip as a result of a son’s suicide and a student who changed travel plans because of a panic attack. Behavioral health conditions need to be treated like all other health conditions by our healthcare system, insurance companies, and government if we are going to resolve this crisis. 

  • Bob successfully fought to ensure that financial constraints are not a barrier to care by passing a law that provides 4 million Washingtonians access to free and reduced-cost care at Washington hospitals.

  • Bob supported additional mental health support for law enforcement and first responders. He also worked with the Criminal Justice Training Commission to improve law enforcement training for crisis intervention.

  • Bob stood up to social media companies that were targeting youth and putting their mental well-being at risk. He is fighting these powerful companies in court to achieve corporate reforms that will protect youth mental health. 

  • Bob developed a Mental Illness and Drug Dependency (MIDD) Action Plan when he was a King County Councilmember. Thanks to the foundation Bob helped build, every year King County is able to serve more than 20,000 individuals in need of help. As part of that effort, Bob led the creation of a Crisis Solutions Center as a resource for police, medics, crisis mental health professionals and other first responders when they meet individuals in crisis might otherwise receive no help, or be taken to jail or an emergency room. The center provides an alternative to jail or the emergency room when police and paramedics encounter an individual accused of a minor crime who is experiencing a behavioral health crisis. The Center also works to find long-term housing and services to help break the cycle of homelessness and crisis.

The Ferguson Plan

Bob Ferguson has a plan to build the best mental health and substance use support system in the country. The Ferguson Behavioral Health Plan will implement four key strategies:

  1. Enhancing access to care; 

  2. Prevention and early intervention —working upstream to support the next generation before they ever reach crisis;

  3. Strengthening treatment and recovery support; and

  4. Systemic Improvements and Policy Reforms.

1. ENHANCE ACCESS TO CARE TO CONNECT WASHINGTONIANS TO QUALITY CARE WHEN THEY NEED IT, WHERE THEY NEED IT

Cut down on waiting periods by investing in proven programs that bring providers into behavioral health.  As Governor, Bob will support competitive recruitment and retention of behavioral health workers by adjusting reimbursement rates to the levels necessary to improve recruitment and retention for a skilled behavioral health workforce, including in underserved areas. Bob will reduce barriers and increase access to clinical training for those entering behavioral health occupations. He will increase opportunities to provide additional incentives for behavioral health professionals, including loan repayment and stipends, and expand the number of behavioral health workers in Washington who receive loan support through the Behavioral Health Program. He will pursue private philanthropy and matching contributions from the private sector. 

Bob will focus on the part of our system that is responsible for outpatient care. These are often the hardest and most complex cases, and are too often treated as a de facto training ground where people work for a stint before getting a better job in hospitals, government, primary care clinics and private practice. Bob’s plan will transition these from entry level and self-sacrifice jobs into stable and successful careers. In addition to wages this is going to require improvements in health care and retirement benefits and career ladders so that these professionals can stay in the field for decades and grow. 

Adopt a ‘No Wrong Door’ philosophy.  Bob will implement a “No Wrong Door" philosophy when it comes to behavioral health. Regardless of the type or nature of someone's mental health or substance use challenge, they should be able to receive treatment in the same location. In addition, our system must be able to support individuals with conditions such as intellectual and developmental disabilities, dementia or traumatic brain injury and ensure they can access the specialized care they need outside of the behavioral health system when appropriate.

Integrate behavioral health into primary care settings. The Ferguson Plan will fully integrate behavioral health care into primary care settings so that individuals seeking care receive it in a timely manner. Equipping primary care providers with the tools to identify, treat, and manage behavioral health conditions is a proven approach for connecting individuals with depressions and other behavioral health challenges with quality, timely care.  

Embed and co-locate mental health and substance use providers into community-based settings. Expanding pathways to care requires creating new, low-barrier access points, in settings where Washingtonians already live, work, and play. Bob will embed and co-locate behavioral health services into non-traditional settings such as homeless shelters.  He will also continue his successful advocacy for “street medicine teams” to meet individuals in crisis where they are.

License additional behavioral health treatment beds and increase wrap-around services. Hundreds of new beds will be coming online in the next year, but we cannot let up the progress. Bob will also work with federal partners to amend an old federal rule that limits inpatient mental health beds in Washington.

The Ferguson Plan will build on Washington’s successful Wraparound with Intensive Services (WISe) model for youth by adopting a similar program for adults. Bob will invest in additional recovery housing with individuals exiting treatment for substance use disorder while improving oversight of these programs. Additionally, Bob will empower doctors to prescribe housing vouchers when supportive housing is medically necessary for those suffering from mental illness or substance use disorders.

Expand tele- and virtual mental health options. Tele-mental health services are revolutionizing the delivery of timely care, particularly in rural and remote areas where access is limited. Bob will facilitate widespread, confidential, and easy access to telehealth services from trained, licensed providers. Bob will establish reimbursement mechanisms and develop infrastructure to support and secure reliable telehealth platforms. 

2. PREVENTION AND EARLY INTERVENTION

Expand access to mental health support in schools and colleges and universities. As Governor, Bob will address the mental health needs of students by investing in more school nurses, counselors, and social workers in our public schools. Many students deal with manageable mental health challengers, but their needs are too often ignored. Bob will fully implement the landmark law passed in 2022 to ensure that educators and parents have access to the support systems they need and students’ needs are met. He will increase investment in Social Emotional Learning, a special education program that helps students show empathy, develop supportive relationships, manage their emotions and develop healthy identities. He will also support social workers and other public servants serving abused and severely neglected youth through fair compensation and additional FTEs to reduce caseloads. The frontline workers supporting vulnerable youth need the resources and time to provide the dependability, attention, and protection these kids need.     

Expand screening and referral programs. Bob will implement routine behavioral health screenings in various settings such as primary care, schools, and workplaces. He will advance policies to establish clear referral pathways and coordination between different service providers to ensure individuals identified through screenings receive appropriate follow-up care and support.

Increase neonatal support services for infants and pregnant mothers. Nearly one out of every one hundred infant hospitalizations in Washington is caused by neonatal abstinence syndrome. The state estimates that approximately 800 children are born every year with neonatal abstinence syndrome. The Ferguson Plan will improve pregnancy screening and intervention to ensure mothers and infants receive the care they need, including peer recovery coaches, residential treatment, and services that continue until the child’s first birthday to improve long-term outcomes.

Invest in youth outreach, education, and prevention. For years Bob has been fighting to support parents and prevent youth substance use disorder. He led the fight to increase the purchase age to 21 for tobacco and vapor products. His opioid initiative helped fund millions in prevention efforts to warn youth about the dangers of fentanyl and other opioids. Bob’s Plan will build on these efforts to better enforce youth access laws, and improve youth-targeted outreach efforts. The goal of these efforts will be to reduce substance use among youth of all grade levels. Bob will develop public awareness campaigns to reduce stigma surrounding mental health and substance use disorders. He will promote education and community dialogues to increase understanding, empathy, and early help-seeking behaviors.

Institute stronger online protections for youth. Studies have connected online platforms to youth depression. Social media platforms are designed to be addictive, too often deliver age-inappropriate content, promote unhealthy social comparisons, and enable harassment, child sexual exploitation, stalking, and cyber-bullying. Children, adolescents and teens are uniquely vulnerable to harmful and dangerous content online. As Governor, Ferguson will continue efforts he spearheaded as Attorney General to improve standards and practices of online platforms to avoid harassment, exploitation, and other conduct that impacts youth health and well-being.

3. STRENGTHEN TREATMENT AND RECOVERY SUPPORT

Expand access to buprenorphine and other medically assisted treatments that help individuals suffering from opioid addiction by curbing withdrawal symptoms. Individuals suffering from acute opioid use disorder often cannot stop using without facing debilitating withdrawal symptoms. In the face of Washington’s crisis, Ferguson’s Plan will dismantle barriers to medically assisted treatment for opioid use disorder. Medication for substance use disorder is linked with a drop in arrests and fewer emergency room and hospital visits. The link between drugs and crime also makes prisons and jails important for expanding buprenorphine treatment. Bob will save lives by implementing mandatory screening for opioid use disorder in all Washington jails and prisons, and prescribe buprenorphine for those in need. He will also work with first responders to help emergency medical services agencies administer buprenorphine in the field.

Train human services professionals in basic mental health skillsSocial and human services providers who regularly intersect with Washingtonians experiencing behavioral health challenges must also be equipped to identify, understand, and respond to signs of mental illness and substance use disorder among those they serve. Washington currently trains all health care providers on suicide awareness. Bob will expand this training to other key direct service providers. The Ferguson Plan will ensure frontline public servants are armed with the training they need to connect individuals with mental health resources.

Increase navigation resources. Bob will make it easier for Washingtonians both to find and receive help for behavioral health challenges. Bob will lead the effort to build new easy-to-access, user-friendly online treatment locator tools so Washingtonians can find care when and where they need it. 

Increase peer support services. Bob will expand peer support programs, employing individuals with lived experience of behavioral health challenges to provide support, mentorship, and advocacy. He will integrate peer support services into treatment settings to enhance engagement, reduce stigma, and promote long-term recovery.

Increase support services for parents and foster parents, and social workers serving children. In Washington, the number of children in foster care has increased by 20% since 2012. The foster care system is tremendously overburdened. In 2019, the State’s Department of Children, Youth and Families was forced to place an unprecedented number of children in hotels, racking up 1,500 overnight stays for almost 300 foster children. These children are dealing with trauma and other mental health challenges.

The state estimates that more than 37,000 Washington children are living with parents suffering from opioid use disorder, and more than 4,000 children are in foster care due to parental opioid use. These estimates do not include other substance use and behavioral health challenges. 

The Ferguson Mental Health Plan will make necessary investments in socio-emotional supports for these children, fix our broken foster system, and provide families with necessary support to overcome challenges and thrive. He will also support social workers and other public servants serving abused and severely neglected youth through fair compensation and additional FTEs. The Ferguson Plan will reduce caseloads for social workers serving youth with intense behavioral health needs.

Through early intervention and intensive services for families in need, the Ferguson Plan will reduce the number of severely neglected Washington youth.


4. SYSTEMIC IMPROVEMENTS AND POLICY REFORMS

Appoint a Mental Health Director to oversee and coordinate Washington’s behavioral health system. Washington’s behavioral health system is fragmented among multiple state and local agencies. The Department of Health oversees behavioral health hospitals. The Department of Social Health Services manages Western State Hospital. The Health Care Authority manages Medicaid Rates. Bob will appoint one individual who will report directly to him to coordinate Washington’s behavioral health systems and implement these reforms.

Fight for Washington’s fair share of federal dollars. When Washington adopts innovative reforms to better meet Washingtonians’ needs, Bob will pursue Medicaid waivers.

Hire and train more designated crisis responders who can respond with law enforcement, or in lieu of law enforcement. Bob will increase the number of designated crisis responders in the state, and work to better integrate them with law enforcement and first responders. Better integration and collaboration among designated crisis responders and law enforcement will improve outcomes by ensuring that trained professionals are on hand to respond and avoid unnecessarily escalating certain behavioral health challenges. Bob will also ensure law enforcement and other first responders are appropriately trained with crisis intervention training that includes cultural competency and implicit bias training. As Attorney General, Bob worked with the Criminal Justice Training Commission to improve the training for new peace officers, including training on implicit bias, the history of race and policing, and the history of police interaction with tribal communities, and LGBTQ+ communities. He will continue these efforts to ensure all law enforcement personnel receive this training. 

Reform Washington’s Involuntary Treatment Act by fully implementing Ricky’s Law. The Legislature passed Ricky’s Law in 2016 to help community members who are a danger to themselves or others, or are gravely disabled due to a substance use disorder. The law allows designated crisis responders to involuntarily detain these community members to a secure withdrawal management and stabilization facility—also known as secure detox. The law is proven to save lives, but it still has not been fully implemented. A dozen sections of the law adopted in 2016 are set to take effect on July 1, 2026 to allow for system build-outs. Bob will ensure Ricky’s Law is fully implemented so that every Washingtonian who desperately needs help can be treated at a secure detoxification center or approved substance use disorder treatment program.

Expand and support Crisis Facilities. When a person in crisis arrives at a Crisis Facility, a multidisciplinary team composed of mental health professionals, peer specialists, behavioral health case managers, substance use professionals, and medical staff help stabilize them, in a voluntary short-term inpatient setting. King County voters recently adopted a measure to build five Crisis Facilities, and Bob plans to advance that reform statewide so that every Washingtonian and their family has a resource that is not a hospital and a number one behavioral health facility that is not their county jail. They also immediately work to refer participants to long-term services and possibly housing, tailored to each person’s needs. 

Keep improving Washington’s 988 Crisis Hotline. Continue building on the promise of Washington’s 988 crisis hotline to consolidate Washington’s all of crisis response systems across police, fire and mobile crisis teams, and across state agencies, county and tribal lines, and connect to a robust behavioral health system that can provide next-day crisis appointments and support families with resources and treatment options.

Address systemic inequities. Bob will increase diversity in the behavioral health workforce and ensure culturally competent care by requiring training on cultural humility and implicit bias for all licensed providers.