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Washington Mental Health Services Guide

Many people don’t realize that publicly-funded mental health services are available in their state. People looking for free or low-cost counseling often think their only options are counselors in private practice and don’t know that publicly-funded providers in their communities may also offer counseling services.

While state-based programs are not for everyone, they are often a great place to start for people who face geographic or financial barriers to therapy. Intake specialists at community mental health programs can help people learn whether they qualify for state-funded services and can refer people who don’t qualify to other low-cost programs that may be able to meet their needs.

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When Should You Go to a State Mental Health Program?

Few mental health providers outside of those in the public sector are able to immediately serve people in crisis. This usually makes public mental health services the best option for anyone who is having a mental health crisis and needs help right away. The people who answer crisis lines offer caring attention and support as they help people determine the best response to a crisis, whether it’s inpatient treatment or an appointment with a counselor.

In most cases, community mental health programs serve as alternative providers for people who lack the means to access services in the private sector. County mental health programs usually prioritize people with severe mental illness that impairs their functioning puts them at risk of hospitalization. However, Washington’s system also includes providers that serve people with a wide range of mental health needs. You can call your local providers directly to see if you qualify.

The Central Washington Recovery Help Line is a great resource for people who want information about local mental health services. County and regional crisis and information lines are another great way to get information about mental health treatment in Washington. If you’re not finding what you need through the public mental health system in Washington, you can search for free or low-cost counselors on OpenCounseling.com or try affordable online counseling at BetterHelp (a sponsor).

Who Is Eligible for Public Mental Health Services in Washington?

Washington’s Access to Care standards define eligibility for its publicly-funded mental health services. To meet Access to Care standards, people must have a covered mental health condition that affects their 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 people 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
  • Risk further deterioration of functioning without intervention, often because of factors like social isolation, poverty, or extreme chronic stressors

Washington directs people who don’t meet Access to Care standards to seek care through their Apple Health (Medicaid) or private insurance provider networks. The exception is people who are in crisis; any Washington resident can use local or regional crisis resources regardless of whether or how they are able to pay for them.

People who lack insurance can seek services through their regional mental health organization’s provider network. Whether people can access public mental health services when they do not meet Access to Care standards varies from region to region and program to program. 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 to people without insurance regardless of whether they qualify for public financial assistance.

How Can You Find Out More About Local Programs in Washington?

A mix of regional, county, and independent crisis lines are available in Washington. The people who answer these crisis lines can guide you through mental health crises as well as give you information about local services, make referrals, and sometimes even help you set up appointments.

Unlike many other states, Washington also operates a statewide mental health information line that people can call to get the same information even when they’re not in crisis. The Washington Recovery Help Line provides 24-hour help for people dealing with issues related to substance abuse, problem gambling, or mental health. You can use the phone line or website to find helpful information, links, and provider lists for yourself or a loved one. You can reach the Recovery Help Line by calling or texting (866) 789-1511 or by following this link.

Each regional behavioral health organization in Washington operates a phone line and website where you can find out more about options for mental health care in your local area. The following list has been compiled from these sites and includes contact information about each regional board, associated information and crisis lines, and contracted mental health providers in each county.

This list focuses on adult outpatient mental health service providers and crisis centers. Note that many providers accept clients from their entire service region, not just the county where they are located, though some programs are limited to special populations or groups. You can call these programs directly to find out whether you qualify for affordable counseling through them.

Northeast Washington Clinics and Crisis Lines

North Central and Southwest 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

Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are another option for public mental health care in Washington. These federally-funded programs provide medical and mental health services to people in underserved communities. Their purpose is to provide high-quality coordinated care to people with complex needs and to link behavioral healthcare with primary medical care. Each FQHC accepts Medicaid and Medicare and offers sliding scale fees to people without insurance. You can search for FQHCs using the online search tool on the U.S. Department of Health and Human Services website.

How Does Washington's Public Mental Health System Work?

In the 1960s, Americans started thinking differently about how to treat mental health conditions. New laws required state and local governments to establish community mental health programs as alternatives to institutionalization for people with serious mental illness. Many states’ public mental health programs trace their origins back to this period.

Washington is no exception. The state enacted its own Community Mental Health Services Act in 1967, which authorized the construction of community mental health programs across the state. As in other states, the main purpose of these programs was to provide the resources necessary to allow people with serious mental illness to manage their conditions in the community instead of in large state institutions.

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 of Washington 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 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 (ASOs).

The public mental health system in Washington now consists of a mix of BHOs and ASOs. These two types of organizations serve the same functions of supervising, developing, and funding local programs, though ASOs function more independently from state and local governments than BHOs. There are currently eight regional behavioral health organizations 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.

According to Mental Health America, Washington ranks 22 out of 51 states (including the District of Columbia) for access to mental health care. However, many people in Washington still don’t get the care they need. According to SAMHSA, only 44 percent of people in Washington with mental health conditions get treatment for them. You can help change these statistics—consider reaching out to a local or statewide information or crisis line to learn how to access mental health care in your area.

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