We must address deficits in behavioral healthcare

We live in a behavioral health desert. No providers of behavioral health services in the Tri-Cities region are members of the Washington Council for Behavioral Health (WCBH), the professional association of licensed community behavioral health agencies across the state of Washington who put on the annual Washington Behavioral Healthcare Conference.

Six hundred fifty-five people attended the 41st annual Washington Behavioral Healthcare Conference at the Three Rivers Convention Center in Kennewick on June 14–16. Most were psychiatrists, psychologists, social workers, mental health and drug counselors, and administrators, many of whom had personal experience of addiction and mental illness themselves. They have joined together to provide a unified, representative voice speaking on behalf of community behavioral health since 1979. 

Behavioral healthcare deficit 

Recently, there has been great concern — locally, statewide, and nationally — due to the increase of drug overdoses and suicide of young people, about the lack of available behavioral healthcare. Behavioral health generally refers to mental health and substance use disorders (SUD), life stressors and crises, and stress-related physical symptoms. The conference provided opportunities for addressing these issues, for individuals to get relevant training, and for provider organizations to find out how others were meeting these challenges.

The conference program facilitated the open sharing of information and experience by scheduling the keynote speakers at meals shared at large tables with eight to ten other people. This setup provided the opportunity to immediately discuss and evaluate what was being presented. 

The three keynote speakers were Nathaniel Morris, MD, who spoke about “Mass Incarceration and Mental Illness: Rethinking the Frontlines of Mental Health Care”, Nii Addy, PhD, who spoke about “Racial disparities in Mental Health”, and Maia Szalavitz, who gave a talk entitled “How Harm Reduction Saved My Life”. 

Szalavitz’ keynote rapidly gave a straightforward, usable definition of Harm Reduction (HR), along with its origin and history. She also recently published a book called Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction. 

While the book provides the data and references necessary for the academic to understand the complex information it provides, both the book and her talk were delivered in a style understandable by any thoughtful person in the general public. In short, Szalavitz quotes Washington State's own Dave Purchase from Tacoma saying, “Harm Reduction is against harm, neutral on the use of drugs, and in favor of any positive change as defined by the person making the change.” Dave Purchase started a syringe exchange in 1988 after notifying local officials. They observed what he was doing and its effects, and after six months, the public health department funded him. Syringe exchange is perhaps the best known example of drug-focused Harm Reduction. I will not give away how HR saved Szalavitz’ life; you’ll have to read the book!

Harm Reduction

Szalavitz and I met in the ‘80s, just as she had begun writing about Harm Reduction (HR) for the Village Voice. Our paths have crossed a few times since, and I consider her a friend. That is why I was so pleased I got the opportunity to interview her during the conference. 

The first question I asked her was, “Are you still as optimistic about the growing acceptance of Harm Reduction as you were when you finished your book two years ago?” She answered, “I’m worried!” and went on to express concern about the unwillingness of so many people to look at relevant data, think things through, find common ground, and consider alternatives to the positions they had already taken. 

I asked about strategies supporting HR in communities which opposed it on ‘moral’ grounds. Szalavitz suggested finding some common ground, such as saving lives, and identifying activities both could support, such as feeding the hungry, and doing these together. When appropriate, they could then invite nay-sayers to HR activities in nearby communities so they could see the impact first-hand.

While avoiding the harm caused by unsterile syringes was the HR strategy at issue when we met in the ‘80s, there are several additional strategies available now which didn’t exist back then. Methadone maintenance, which began in 1964, was perhaps the first broadly-used medical HR strategy, and the one most people are familiar with. Among newer strategies are the availability of Naloxone (Narcan) and Buprenorphine maintenance. While these were not the focus of the conference, it is important to see them as examples of Harm Reduction. 

Narcan is the fast-acting antidote to opioid overdose, including heroin, morphine, and Fentanyl. It was FDA approved in 2015. Having Naloxone available and knowing how to use it, in schools, libraries, by first responders, and by drug users themselves, is critical to counteracting the rapid rise in overdose deaths. Narcan is now also available over the counter in Washington State. Learn more at https://www.youtube.com/watch?v=LmxZkNW7VKM. 

Buprenorphine maintenance treatment (BMT) is a medication-assisted treatment for individuals with opioid dependence. It alleviates withdrawal symptoms, suppresses opiate effects and cravings, and decreases the risk of overdose as a result of the illicit use of opioids. Learn more at https://www.youtube.com/watch?v=PQG6dqjlKNI. 

Both Narcan and Buprenorphine case management are provided to anyone who needs it by Blue Mountain Heart to Heart in Kennewick.

Rehabilitation over incarceration

The percentage of our population we put in jails and prisons far exceeds any other country in the ‘free’ world. Many prisoners are there for behavior related to their mental illness, and more are there for drug use (not trafficking… just use). But most prisoners get no help with their behavioral health problems. Access to help in and out of prison varies greatly by race and class, so poor Black communities suffer most. While these keynote addresses dealt with limited but important aspects of Behavioral Healthcare others might deal with, the HR-focused talks provided strategies evoking questions of “What if?”

There were 35 workshops over two days at the conference, and participants could attend as many as five. One of them was presented by a local expert, Michele Gerber, Chair of the Benton Franklin Recovery Coalition. She presented her work to develop a comprehensive substance use and mental health treatment center at the site of the old Kennewick Hospital and a nearby warehouse. There was a useful discussion following Gerber’s presentation about repurposing old buildings and the role of the local county commissioners. You can find the information at https://www.509recovery.org/recovery-center-vision. 

In addition to dealing with themes of racism and incarceration, some of the workshops dealt with behavioral health problems related to wellness, primary care, youth, police, ethics, peer support, schools, Indigenous peoples health, insurance (both private and governmental), prevention, LGBTQIA+ issues, housing, community advocacy, aging, developmental disabilities, crisis services, and training for the health professions. Many of the attendees were individual service providers who could update their training and credentials by learning more about rehabilitation and Harm Reduction.

The future of the Washington Behavioral Healthcare Conference

At the final session of the conference, I was surprised to hear that the conference would return to Kennewick and the Three Rivers Convention Center next year, as it had been seven years since the conference had come to the Tri-Cities. We now have the opportunity for several good things to happen, but only if people put in the effort: 

• Local behavioral health providers can affiliate with the WCBH and participate in preparation for the conference, making it more relevant to the specific needs of the area.
• We can hear an update from Michele Gerber about the progress the Benton-Franklin Recovery Coalition has made in the establishment of a comprehensive substance use and mental health treatment center here.
• Local professional staff can request and attend workshop training that helps meet their academic goals (and local client needs).

We can be an oasis of engagement in the desert of unmet behavioral health needs rather than a desert of non-participation in the middle of Eastern Washington.

Psychologist Charles Eaton worked directly with heroin addicts, ran programs for the prevention, treatment, and rehabilitation of Substance Use Disorders, and led Public Health programs for the prevention of HIV in drug injectors for more than forty years in New York City.