Your (Unofficial) Guide to State-Sponsored Therapy in Washington

There’s a way to get affordable mental health care that you might not know about. That’s Washington’s mental health system.

If you qualify, you can get mental health care from a local agency for a small co-pay or a low sliding-scale fee. But even if you don’t qualify for services at a state-funded provider, Washington’s system can still give you information, referrals to affordable local providers, and other essential help for free.

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If you’re in a hurry and want to get the most important information about what’s available in the Washington mental health system and who it’s for, you can read our quick start guide below.

To learn more about public mental health services in Washington, keep reading. We’ve done the research to uncover essential facts about who’s eligible, what services you can get, when to go, where to call, and how it works so you can decide if Washington’s mental health system might be right for you.

Who Is Eligible?

You should look into the Washington mental health system if you (or a loved one) are having a mental health crisis, have a severe mental health condition, have Medicaid, or have a limited income.

Everyone in Washington can use the state-funded mental health emergency response system. If you or someone you love is in crisis, you can call a state or local crisis line to get the help you need, quickly.

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Public mental health services are usually the best option if you’re having a mental health crisis and need help right away.

State mental health programs are required to provide mental health crisis response services and are one of the fastest ways to get care when you’re having a mental health emergency.

The people who answer state and local crisis lines can provide caring attention and support as they help you determine the best response to a crisis, whether it’s inpatient treatment or an appointment with a counselor.

Even if you’re not in crisis, you can call your local mental health hotline for information about affordable mental health services in your area. When you call, you can find out whether you might qualify for state-funded mental health services, schedule an assessment or intake appointment, or get free information about other affordable local providers.

Other parts of the system have stricter eligibility requirements. You need to be eligible for Medicaid or have a serious mental health condition (a diagnosable condition that affects your daily functioning) to qualify for public funding for outpatient mental health care in many Washington counties.

Washington splits its public mental health system into two parts. One is for people who have or are eligible for Medicaid, while the other serves people who may not have or be eligible for Medicaid. To qualify for state financial assistance to get non-Medicaid public mental health services, you must meet Washington’s Access to Care standards.

DEEP DIVE

Washington’s Access to Care standards define eligibility for its publicly-funded non-Medicaid mental health services. To meet Access to Care standards, you must have a covered mental health condition that affects your ability to function.

Many diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) are covered under Access to Care standards, including:

Personality disorders
Obsessive-compulsive disorders
Schizophrenia and other psychotic disorders
Anorexia, bulimia, and other eating disorders
Bipolar disorder, major depression, and other mood disorders
Post-traumatic stress disorder and other trauma-related conditions
Generalized anxiety disorder, panic disorder, phobias, and other anxiety disorders

Access to Care standards also require you to meet at least one of four functional criteria to qualify for publicly-funded care. To be eligible, you must:

Present a serious risk of harm to yourself or others;
Be unable to care for yourself or live independently without support;
Have problems at work or school or other difficulties with role performance; or
Risk further deterioration of functioning without intervention, often because of factors like social isolation, poverty, or extreme chronic stressors

Washington directs those who don’t meet Access to Care standards to seek care through their Apple Health (Medicaid) or private insurance provider networks. The exception is if you’re in crisis; you can call a crisis line any time you need immediate help.

However, Access to Care standards only apply when you’re looking for non-Medicaid funding to help you cover the cost of mental health services. Whether you need to meet Access to Care standards to get care at a publicly-funded clinic varies from region to region and program to program.

Behavioral Health Administrative Services Organizations (BH-ASOs), the regional behavioral health organizations that oversee the public mental health system in Washington, don’t directly provide any mental health services. Instead, they contract with private programs to deliver state-funded mental health care. This means whether you’re eligible for services and for any sliding-scale discounts depends on the provider where you’re seeking services.

Counties that directly provide services may be able to serve people who don’t meet Access to Care standards under specific circumstances. Independent providers that contract with the state often accept public and private insurance and offer sliding-scale fee options if you don’t have insurance (or don’t have a plan they accept) regardless of whether you qualify for public financial assistance.

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Medicaid is a great way to access the public mental health system in Washington. Not only do most programs that participate in the public mental health system accept it, but you can also use it to access the Medicaid-specific mental health network and get services from many other programs and private practitioners.

Washington accepted federal Medicaid expansion in 2011, so you’re eligible for Medicaid if your income is 138 percent of the federal poverty level or less. You may also qualify based on a combination of your income, your medical history, and your mental health condition.

If you’re not sure whether you’re eligible, it’s worth looking into. You can apply for Medicaid in person, by phone, or online. To learn more, you can go to a Home and Community Services office or fill out an online application on the Washington Health Plan page or Healthcare.gov.

How important it is to have Medicaid or meet Access to Care standards depends on what kind of service you’re looking for and where you’re looking.

Most of the programs that participate in the public mental health system in Washington don’t have the same eligibility criteria for all of their services and programs, and if you’re looking for therapy, you may not need to have a severe mental health condition to qualify. However, at times of high demand, low-cost mental health clinics may have long wait lists for therapy.

If you can’t get the service you need from any of the programs in your regional public mental health network, your BH-ASO or a local agency may be able to help you find other affordable local programs. Many non-profits offer affordable, discounted, or even pro bono therapy, even those that aren’t part of the public system.

On the other hand, if you’re looking for specialty services such as case management or community support programs, you’re more likely to find what you need in the public mental health system. These intensive mental health services are available at a variety of providers, but they can be hard to find at agencies that don’t accept Medicaid.

PRO TIP

The public mental health system in Washington is a great place to find programs that offer specialized and intensive mental health services like case management and day treatment. These specialty services can give you extra help when you’re dealing with severe symptoms and can be hard to find anywhere else.

You can find the numbers for your regional behavioral health organization (BH-ASO), local crisis lines, and outpatient providers that participate in the public mental health system in the directory below.

You can call your BH-ASO, a local program, or a state or regional mental health hotline to learn more about what’s available in your area. You can call any clinic you’re interested in to learn more about what services they offer, whether you’re eligible, and whether there’s a waitlist.

We encourage you to call even if you think a state-funded mental health program might not be the right fit for you. Even if you’re not eligible, or if they don’t offer the service you want, they can probably still help you. Community mental health workers are knowledgeable about local resources and will often give you free information or even referrals to other affordable providers nearby, including local non-profits that provide free or low-cost counseling.

Where Do You Call to Get Started?

The easiest way to learn more about state mental healthcare in Washington is to call your regional behavioral health organization or mental health crisis and information hotline. You can find contact information for your region in the directory in the next section.

There are also many numbers you can call for help no matter where you are in Washington. You can find numbers for statewide helplines and hotlines in the information box directly below.

PRO TIP

The statewide Washington mental health crisis hotline is 988.

The Crisis Text Line for the state of Washington is 741741.

For help and referrals for mental health and many other needs, you can call 211.

The National Alliance on Mental Illness (NAMI) Helpline is 1-800-950-NAMI (6264).

You can reach the non-emergency NAMI Washington Help Line at (206) 783-4288.

You can find contact information for other local NAMI Washington affiliates on this page.

If you just need to talk to someone, you can talk to a peer between 9AM and 10PM any day of the week by calling the Washington Warm Line at (877) 500-9276.

You can talk to a peer from 4PM to 12AM any day of the week by calling the CVAB Warm Line in Vancouver at (360) 903-2853.

You can contact the Washington State Health Care Authority by calling (844) 461-4436.

You can contact the Department of Social and Health Services by calling (800) 737-0617.

Public mental health services in Washington are managed on the state level by the Behavioral Health Administration in the Department of Social and Health Services and by the Washington State Health Care Authority. For general information about Washington’s system, you can contact HCA at (844) 461-4436 or DSHS at (800) 737-0617.

However, you’ll probably get the best results by calling your regional behavioral health organization or calling the program you’re interested in directly. You can find contact information for your region in the directory below.

Regional Mental Health Directory

The Washington mental health system is divided into ten regions. Each region has a behavioral health administrative services organization (BH-ASO) that plans and manages the provider network for state-funded mental health services in their area. Each region also has a region-specific mental health crisis and information line.

You can find the websites and contact numbers for all Washington state BH-AHOs, regional crisis lines, and adult outpatient clinics that participate in the public mental health system in the directory below.

If you need information after hours or aren’t sure whether you’re experiencing a mental health crisis, it’s okay to call a crisis line for help. The staff who answer are trained to quickly figure out what you need and can tell you what steps you need to take to connect with the right services.

Also Consider: Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are another great way to get affordable publicly-funded mental health services in Washington.

These federally-funded programs provide cutting-edge care in places where good primary healthcare was once hard to find. Most provide integrated care so you can get primary medical and mental health services at the same location.

Each FQHC accepts Medicaid and Medicare and offers low sliding-scale fees if you don’t have insurance. Their eligibility requirements are generally less strict than the requirements for the state-funded system.

You can search for FQHCs near you by using the online search tool on the U.S. Health Resources and Services Administration website.

Troubleshooting Guide

The state mental health system is complicated and can be confusing to navigate. If you’re having any issues, we’re here to help. Here are some of our solutions to common problems you might experience.

If you’ve run into a problem that we haven’t addressed, don’t give up. Call someone at the program (or a state or regional mental health hotline) and tell them what’s going on.

You’re much more likely to get the help you need when you advocate for yourself and are persistent. Tell the person you talk to what you need or what problem you’re having.

If they don’t help the first time, call them back and tell them. If you keep calling and keep calm and focused, you should eventually get through to someone who can help you.

Deep Dive: How Does the System Work?

To understand Washington’s mental health system, it helps to understand how it started and how it’s changed since then.

Public mental health services have been around for a surprisingly long time. But for over a hundred years in America, the only way to get them was in a psychiatric hospital.

In the 1960s, Americans started thinking differently about mental health care. Conditions in psychiatric hospitals were getting worse and new medications made it possible to provide mental health treatment on an outpatient basis.

In response, new laws were passed that required state and local governments to establish community mental health programs as alternatives to institutionalization for people with serious mental illness. The most important was the Community Mental Health Act, which President John F. Kennedy signed into law in 1963.

DEEP DIVE

To learn more about what the public mental health system was like in the early days—and how psychiatric inpatient care has evolved since then—you can read our article “Do Insane Asylums Still Exist? The Surprising Past and Present.”

To learn more about what inpatient mental health treatment is like now, and the differences between how it works in general hospitals and specialized psychiatric facilities, you can read our article “How Inpatient Mental Health Treatment Works.”

Many state mental health programs trace their origins back to the 1960s when these important changes started to happen.

Washington is no exception. It enacted its own Community Mental Health Services Act in 1967, which authorized the construction of community mental health programs across the state.

But despite its early start, Washington lagged behind other states in decentralizing its mental health system. While some counties started building and organizing local mental health services in the 1970s, the state did not officially create county mental health boards until it passed its Mental Health Reform Act in 1989. Until then, it continued to rely largely on its state hospitals for state-funded mental health services.

Washington’s efforts to reform its public mental health system have continued ever since. In 2016, Washington updated the structure of its mental health system again in an effort to move toward a Medicaid managed care system. It made another set of updates in 2019 to better integrate mental health services with other statewide healthcare systems.

DEEP DIVE

Washington’s 1989 mental health reform law established 14 Regional Support Networks (RSNs) tasked with overseeing community mental health programs. In 2016, Washington replaced RSNs with Behavioral Health Organizations (BHOs) as part of a shift to a Medicaid managed care system. In 2019, it started transitioning from BHOs to Administrative Service Organizations (BH-ASOs).

These regional organizations are responsible for providing or contracting other programs to provide crisis services to people in their region. This includes making sure each region has its own mental health crisis and information hotline.

Regional behavioral health organizations also develop and maintain the provider network for state-funded mental health services in their area and direct state mental health funding to those programs. There are currently 10 mental health regions in Washington.

Some counties in Washington directly provide mental health services, particularly rural counties with low population densities. However, most counties contract mental health services, including crisis lines and crisis intervention teams, to independent providers licensed and overseen by regional planning boards.

Public mental health services are managed on the state level by the Behavioral Health Administration in the Department of Social and Health Services and by the Washington State Health Care Authority. The BHA runs the two state hospitals and other statewide programs, while the HCA manages community mental health services and coordinates with BH-ASOs to develop regional mental health networks.

Washington faces many challenges in its efforts to update and improve its mental health system. Washington has one of the highest rates of mental illness in the nation but lacks the mental health workforce to keep up with the demand.

The Washington mental health department has been sued multiple times over the last decade for lacking enough resources to meet the need for mental health care, especially for mental health evaluations for people involved in the criminal justice system and people needing inpatient care.

This lack of resources has led to long wait times for treatment. The 2014 Trueblood lawsuit over these delays led to the system updates Washington began in 2016. The Department of Social and Health Services was sued again in 2023 by 22 counties over ongoing issues with a lack of psychiatric inpatient capacity across the state, especially for mentally ill criminal offenders.

Fortunately, there are signs of hope. Over the last decade, Washington has consistently increased the state mental health budget to fund new programs, facilities, and initiatives.

Washington increased its mental health budget by nearly half a billion dollars in 2021. It launched the statewide 988 crisis line in 2022 and invested in a new state inpatient facility in 2023 in order to increase statewide inpatient capacity. It continues to expand mobile crisis teams and other community-based interventions.

You can use these state services to get the care you need. If you’re in crisis or need mental health care and aren’t sure what to do, you can start by calling 988 or a regional crisis line—the people who answer know how the system works and will help you get where you need to go.

Conclusion

According to the Substance Abuse and Mental Health Services Administration, only 46 percent of people in Washington who have mental health conditions get treatment for them. Many of them qualify for public mental health services but don’t know about them.

You can make a difference by reaching out and connecting with local mental health resources to get the care you need. If you’re not sure whether you qualify for Washington state mental health services, call your regional behavioral health organization, the program you’re interested in, or the state hotline. You may find out you can get mental health services through a state-funded program or that there’s another affordable option nearby.

The most important thing is to get started—the help you need may be only a call or click away.

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

Therapy with No Waiting Rooms or Driving. Take a quick quiz about your preferences and needs and get matched to a therapist in as little as 48 hours.

Your (Unofficial) Guide to State-Sponsored Therapy in Washington

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

Have you been in therapy before?

Quick Start Guide

Who Is Eligible?

PRO TIP

Use the State System When You're in Crisis

DEEP DIVE

Washington's Access to Care Standards

PRO TIP

Check If You're Eligible for Medicaid

PRO TIP

Check Out the State System If You Need Specialized Services

Where Do You Call to Get Started?

PRO TIP

Important Numbers in Washington

Regional Mental Health Directory

Washington Clinics and Crisis Lines

Northeast Washington Clinics and Crisis Lines

North Central Washington Clinics and Crisis Lines

South Central and Southeast Washington Clinics and Crisis Lines

Southwest and Coastal Washington Clinics and Crisis Lines

King County Clinics and Crisis Lines

North Puget Sound Clinics and Crisis Lines

West Puget Sound Clinics and Crisis Lines

South Puget Sound Clinics and Crisis Lines

Also Consider: Federally Qualified Health Centers

Troubleshooting Guide

Problems and Solutions

Deep Dive: How Does the System Work?

DEEP DIVE

For More Information

DEEP DIVE

What Is the Structure of the Washington Mental Health System?

Conclusion

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

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