Statewide and regional programs supporting rural behavioral health in Washington state

Access to mental health care provides essential intervention for those in need of support, especially when care is localized and culturally relevant. Expanding services across Washington presents a unique set of challenges in rural communities. 

Wendy Brzezny, director of clinical integration for Thriving Together North Central WA (NCW),  serves four counties in Washington. Though this region spans a wide geography, there is just one inpatient mental health treatment center and only two inpatient substance use treatment facilities — with only one accepting voluntary commitment.

That means a two-hour one-way car ride or longer could be necessary to reach a detox facility, which might only accept daytime referrals. The distance to treatment often means leaving behind a supportive community, along with arranging childcare or pet care to accommodate the time away.

There also may be more acute needs within rural communities. Some of the highest rates due to overdose from any drug are in Washington’s least-populated counties, including Eastern Washington’s Okanagan, Ferry and Columbia counties.

Addressing staffing gaps and providing holistic local solutions are key steps to improving outcomes in rural communities.

Professional shortages

Addressing the critical shortage of behavioral health professionals has been a key priority of the Washington State Legislature and state agencies, like the Washington State Health Care Authority (HCA) in recent years. Increasing the volume of behavioral health practitioners in a range of roles is essential to supporting a robust prevention and crisis response system, shared Todd Jensen, behavioral health workforce analyst with Washington State HCA. All counties in Washington currently experience some degree of a shortage of mental health providers, with many of the rural areas in the state experiencing this county-wide. 

“Recruitment for qualified mental health and substance use providers is very difficult,” Brzezny says. “It takes a deep commitment to rural living and a passion for service to move to a sparsely populated area with fewer than 10 people per square mile, such as in Okanogan County.”

“We’re trying to grow our own and promote behavioral health careers among our own population, but it takes time to do that,” she says.

Big Bend and Wenatchee Valley community colleges are creating a Bachelor of Applied Science in Behavioral Health, Brzezny says, with the first cohort entering in Fall 2025. The hybrid classes can be taken in-person or remotely, easing long drives and other barriers preventing continued education, while building a pipeline of behavioral health professionals within the region.

Statewide, the Washington State HCA has launched a campaign called “Start Your Path” to increase awareness of a range of behavioral health careers from substance use disorder prevention to mental health counseling. In addition to providing accessible career resources for jobseekers, the campaign is also specifically focused on reaching and including bilingual and BIPOC (Black, Indigenous and People of Color) providers who reflect the diverse communities of Washington.

Professional solutions

In 2023, the Washington State Legislature passed several bills with bipartisan support designed to improve the behavioral health care workforce and access. For example, professional amendments led to newly created peer-specialist professional designations, while another bill expanded mental health first aid training. HCA provides online training and credentialing for Peer Counselors. This role helps facilitate access to recovery support and provides a potential employment pathway for those with lived experience.

Other innovations include those launched by regional organizations. For example, Thriving Together NCW, has trained over 200 recovery coaches to provide intervention and support to local community members in emergency rooms, jails, behavioral health agencies and youth nonprofits.

The coaches have lived experience and help model “what recovery looks like,” Brzezny says. “For example, we’ve had tremendous support from our region’s jails to help individuals transition into recovery while incarcerated, which has been shown to reduce recidivism rates,” she says.

Programs that foster long-term recovery support are especially important in rural communities that may face an even greater strain on resources to support residents in crisis.  Over time, maintaining stability and recovery means fewer people frequenting already crowded emergency rooms due to severe addiction and mental health crises. 

One program to address emergency calls is described by Sharon Brown, chief executive officer, and Rebecca Betts, chief operations officer of Greater Health Now, which serves as a Community Care Hub for nine counties and the Yakama Nation in South Central Washington.

Betts and Brown describe how Mobile Integrated Health programs offer an innovative, community-centered approach to addressing mental health crises, helping to reduce the burden on emergency systems and ensuring individuals receive timely and appropriate care. Mobile Integrated Health programs allow paramedics and emergency medical technicians to respond to calls for mental health concerns rather than dispatching an ambulance crew and transporting them to an emergency department. Greater Health Now sponsors six Mobile Integrated Health programs in their region.

Mobile Integrated Health providers play a crucial role in improving responses to the mental health crisis by providing more personalized, accessible and holistic care.  They are trained to assess mental health crises and provide support in a community setting. They can offer interventions such as de-escalation techniques and help connect individuals to mental health professionals. They also screen for “health-related social needs.” 

These are defined as social and economic factors that complicate the ability to maintain mental and physical health and well-being. Factors could include a lack of food, safe housing or transportation, domestic violence, or a need for behavioral health services. 

The provider then offers resources and follows up to ensure that the person in crisis has a plan to access resources.

“If you look at the return on that investment, you no longer have to transport someone in an ambulance, which can be costly and unnecessary,” Brown says. “The overall savings are pretty large when we consider health-related social needs.”

A similar Greater Health Now program sends “promotoras” or trusted bilingual community members, to liaison between migrant workers and social services to address all types of health issues, including mental and behavioral health. 

“We all benefit from these investments when we improve the system and save lives,” Brown says.