In May 2018, Alyssa Reed died after an almost lifelong struggle with mental illness and drug addiction. Even after hundreds if not thousands of interactions with county social services, from the hospital to the jail to Discovery Behavioral Health and the courthouse, Alyssa Reed could not be saved.

Her struggle is an example of what county leaders have called a “vicious cycle” of jailings, hospitalization, drug addiction and homelessness prevalent in Jefferson County.

New state and federal funding on the Olympic Peninsula is funding projects meant to help people like Reed. County and local organization officials hope these projects will create a proactive approach to community health and policing and a comprehensive regional system for opioid and mental health treatment.

In December 2015, The Leader ran on its front cover a photo of a woman sleeping on a bench on Taylor Street downtown. That woman was Reed. She had been banned from the winter shelter at the American Legion because of aggressive behaviour. Port Townsend police officer Patrick Fudaly told The Leader in 2015 that in the three years since they had been keeping records, the department had responded to 104 calls involving Reed. That was three years before her death.

In 2018 Barbara Morey, a housing advocate, wrote a perspective piece to The Leader after Reed’s death.

“She was a client of Discovery Behavioral Health since way back when it was still known as Jefferson Mental Health. She was served at various times by DSHS, OlyCAP, the Justice System, the Fairgrounds Campground, and Jefferson Healthcare. They all were supposed to be her ‘support network’,” she said, “but she fell through the cracks.”

Former prosecuting attorney Scott Rosenkrans wrote in 2018, “Alyssa could be the poster child for the deadly combination of substance abuse, homelessness and mental illness.”

THE CYCLE

A person may enter the system through a multitude of paths. It could be a drug overdose sending them to the emergency room or a mental health episode which results in detention at the county jail. But once they get in, Sheriff Joe Nole said, they have a hard time getting the help they truly need.

While in jail, he said, they receive minimal mental health treatment and often after being released will eventually return. Even if they are transported to Jefferson Healthcare’s emergency room for a mental health evaluation, he said, they are often released after stabilization and receive no real treatment.

“Those are the two most expensive and least appropriate places to take people,” said Lori Fleming co-executive director of CHIP, the Community Health Improvement Plan.

A person can only go to the emergency room without having committed a crime if they voluntarily agree to go or if they are believed to be a danger to themselves or others. Nole said in his own experience, this has at times led to waiting for someone to commit a crime to get them help.

Nole estimates 80 percent of detainees at the Jefferson County Jail have a mental health or substance abuse related problem. Port Townsend Police Chief Mike Evans also said a large number of calls the Port Townsend Police deal with are mental health or substance abuse related. According to data provided by the Port Townsend Police Department, in the last six weeks these made up roughly 16 percent of the total calls.

According to data provided by Jefferson Healthcare, the hospital has hundreds of cases per year in the emergency room with primary diagnosis of a mental health or substance abuse related issues.

In May, The Leader requested this and other data on mental health services provided in the emergency room. Of the hundreds of recorded cases beginning in the emergency room, with the way Jefferson Healthcare’s data is collected, it is not possible to tell if these people were actually treated, how they were treated, how they were delivered to the emergency room, how long they stayed in the hospital, where they went after they left the emergency room or if they received follow up treatment.

If a determination is made at the emergency room that a person needs in-patient psychiatric treatment, voluntarily or involuntarily, a state-wide shortage of beds means they may need to wait at Jefferson Healthcare for a bed to open up at a facility off of the peninsula, Jefferson Healthcare Chief Nursing Officer Tina Toner said.

Toner said since she came to the hospital in October, no one has had to wait for more than just a couple of days for a bed to open up. Jennifer Wharton, chief ambulatory and medical group officer said in the past these waits have sometimes been several weeks or months. While waiting, patients are not receiving intensive mental health treatment, she said.

One challenge, Toner said, to helping the homeless and mentally ill is that even after receiving successful stabilization in the emergency room, they may not attend follow-up appointments or seek primary care, maybe from a lack of insurance, or transportation to their appointments.

THE SOLUTION

Facing a mental-health crisis in Washington State, Governor Jay Inslee in May signed into law four bills meant to reform the state’s mental healthcare system by discharging non-criminal patients from large and overcrowded state hospitals to small regional hospitals. These new facilities are meant to spur a community-driven approach to mental health treatment where patients can be closer to their support networks at home.

“People do much better when they are treated in their own communities,” said Rep. Steve Tharinger, D-Port Townsend, who chairs the House Capital Budget Committee.

One of these facilities is a new 16-bed psychiatric facility and opiod treatment center in Sequim, that was funded $7.2 million this spring.

A local consortium made up of county organizations such as the Jefferson County Sheriff’s Office, the Jefferson County Jail, the Community Health Improvement Plan, East Jefferson Fire and Rescue, Discovery Behavioral Health and Jefferson Healthcare, was awarded $200,00 in June to study a potential crisis stabilization center to serve as triage for the new facility in Sequim.

This means that instead of taking people in a mental health crisis to jail or to the hospital, they can instead be stabilized in a specialized environment. If from there it is determined they need further in-patient treatment and beds are available they can go to a facility on the peninsula instead of across the Hood Canal.

The study, Fleming said, will help the group determine how to interrupt the cycle. After the research is concluded, she said, it may be determined that another type of facility may better serve the county’s mental health needs instead.

When the study is complete and all the involved local organizations are on board, Fleming said the project will be in the position next year to seek funding from the state legislature and other sources.

“There’s a huge need for behavioral health, mental health and addiction treatment on the North Peninsula,” Tharinger said. “This year was the biggest investment the state has ever made and we will continue to try and fund those until we have a comprehensive system.”

This new system, if successful, will most likely save the county money Fleming said, since they will not have to transport people off the Peninsula to receive treatment and because it could break the cycle, taking people out of the system who continually use county services.

Nole said this can be a step toward a proactive approach to mental health care that hopes to stop problems before they begin.

“People never set out to have a mental health or opioid problem,” Nole said. “It’s stuff that happens to people and a lot of times they need help to get out of that situation.”