"The mission of the Mental Health Division is to promote recovery and safety."

Answers to Questions Frequently Asked About Mental Health Services

What is the Mental Health Program?

The Department of Social and Health Services (DSHS) administers the mental health program for the State of Washington. The mental health program:
• Provides care and treatment for people with severe and recurring mental illness, and children with serious emotional disturbance and their families;
• Operates a crisis response system for all of Washington's citizens;
• Regulates the individuals that provide mental health services; and,
• Develops mental health policy for all providers of mental health services.

What services are offered through the Mental Health Program?

The legislature created the Regional Support Network (RSN) system in 1989 as part of Washington's effort to manage the increasing cost of health care. "Managed care" started in the private health sector, and has moved to state-funded care of people with major mental illness.

There are 13 RSNs that manage Washington's mental health program. Each RSN is made up of one our more counties. The Department of Social and Health Services (DSHS) purchases mental health services from the RSNs for people covered by Medicaid, and others that may be eligible for these state-funded services.

Each RSN then contracts with mental health agencies throughout the county(s) served by the RSN, to provide direct outpatient clinic services and short-term inpatient treatment in community hospitals.

The RSNs authorize the following core mental health services to be provided by mental health agencies in the community:

Crisis Services
A 24-hour crisis telephone line, a team of crisis professionals, crisis counseling and treatment.
Outpatient Community Mental Health Services
Assessment to determine the medical necessity for additional services, individual/family/group counseling; medications; case management and medication management when longer term more intensive care is needed; help with returning to school, employment or a finding a more secure living arrangement.
Acute Psychiatric Inpatient Services
Individuals who are assessed to need, and voluntarily request to be hospitalized for their mental illness, may be admitted to a community psychiatric facility.
Involuntary Commitment Services
When an individual's actions create a substantial risk to self or others, results in substantial loss or damage to property, or the individual is unable to provide for his/her own care and safety, the law permits a special County Designated Mental Health Profession (CDMHP) to evaluate that person for involuntary commitment to a psychiatric facility.
Long-Term Inpatient Care
If long-term inpatient care is needed for an adult, the RSN can authorize treatment at one of two state-owned psychiatric hospitals: Western State Hospital (WSH) or Eastern State Hospital.

If long-term inpatient care is needed for a child under age 18, the RSN can make a referral for a Children's Long Term In-Patient (CLIP) facility. There are four CLIP facilities in community settings around Washington, and one state-owned psychiatric hospital, the Child Study and Treatment Center (CSTC).

Who qualifies for Mental Health Services through the RSN?

Children and adults qualify for medically necessary mental health services through the RSN if they are covered by Medicaid.

Other people not eligible for Medicaid, but having serious or long-term mental illness, can receive services as resources allow.

All citizens of the state are eligible for crisis mental health services, disaster response services, and involuntary treatment services.

How do I get help for mental illness?

In an Emergency:

Call 911 for police assistance if the emergency is life threatening, or may result in immediate physical harm to a person or substantial destruction to property.
Call you local 24-hour Crisis Clinic. The number is on the inside cover of the telephone directory, or Contact the RSN [link to RSN Locator page] that serves the county where you live.

When the situation is NOT life threatening:

Contact your local Regional Support Network

What if I don't agree with a decision about receiving Mental Health Services through the RSN?

Contact your local Mental Health Ombudsman. The Ombuds is an independent service created by Washington State law to receive complaints, resolve grievances, and protect the rights of individuals that receive mental health services through an RSN.

You may request a fair hearing if you don't agree with the decision, but you must do so within the time frame shown in the decision letter.

How can I find out more about Mental Health Services?

Contact the Regional Support Network (RSN) that serves the county where you live.

See mental health services information.

Check out the resources available on Mental Health Internet Links.

Who is eligible for public mental health services?

Medicaid recipients are automatically enrolled in a local mental health managed care plan which is called the Regional Support Network (RSN). RSNs coordinate mental health services offered within their service area through contracts with community mental health agencies.

People who receive Medicaid coupons are eligible for medically necessary mental health services at no cost. Any person needing mental health crisis services is eligible to receive them. If you think that you may need mental health services, you can call or drop by one of the authorized agencies located in the RSN where you live to schedule an appointment to learn what you may need. A list of agencies can be found on the RSN pages. All services must be authorized by the RSN in your area. This process will happen between your agency and RSN.

What services are available?

Hospital and outpatient mental health services are available to you and your family if they are needed. Some of services include:

Crisis services;
Individual therapy;
Group therapy; and
Medication evaluation, prescription and management.

You may also receive employment support services, case management and other services through your RSN.

For more detailed information, please call the RSN for your community listed on the RSN pages or call the Mental Health Division (MHD) at 1-888-713-6010.

Interpreter services are available upon request. Most written materials are translated into languages other than English based upon the service area population.

Some community mental health agencies have staff who speak other languages besides English. There is more information on the page for your RSN. If you or someone you know wants services in another language, your RSN must provide language assistance at no cost to you. Assistance can be provided both orally and in writing.

If you need mental health services, an individual service plan will be developed with you. Your plan will consider your age and your culture. You may receive one or more of the services listed above. The plan will be fit to you, according to your strengths and needs. Your mental health care provider will decide with you which services you will be provided and for how long.

Your mental health care provider may also ask permission to work with people who provide you other services such as housing, healthcare, and employment.

Other Medicaid benefits may be available to you. Here are some reference numbers:
Physical health: Contact information on back of your card
Substance Abuse: 1-877-301-4557
Aging and Disabilities Services: 1-800-422-3263
http://www.aasa.dshs.wa.gov
Transportation Broker: 1-800-562-3022/911 for crisis

Who provides services?

The Washington State public mental health system has fourteen (14) Regional Support Networks (RSNs). They are made up of one or more counties that serve your county and community. Locate your local community on the Regional Support Network (RSN) pages. Each RSN contracts with licensed agencies to provide mental health services. You can find information about each RSN and the authorized service providers that contract with the RSNs.

You may only go to these authorized agencies for covered services. You may be responsible for costs if you receive mental health services through other providers.

What choices do I have?

You may choose a mental health care provider at the agency from which you receive services. If you don't choose a mental health care provider, one will be assigned. You have the right to change mental health care providers during the first 30 days. You can also ask for a change once a year for any reason. If you think you have a good reason, you can ask for more changes. The change may or may not be granted.

What if I need crisis services?

If there is a life-threatening emergency, please dial 911. If you have a mental health crisis you can call your RSN's crisis line. All RSNs respond to crises 24 hours every day. You can find your RSN's crisis line looking up your county on the Crisis Line list.

How can I get outpatient services?

If you think you need services, call the toll-free or local telephone numbers. Those are listed with other information on the Regional Support Network (RSN) pages.

Public mental health services are designed to keep you well in your own community. All efforts will be made to keep you from needing hospital care.

What if I needed to be in the hospital for my mental illness?

Psychiatric hospital services are available to Medicaid enrollees. These services may be at no cost, but must be approved in advance. If you think you need to be hospitalized, contact your mental health care provider. Your provider will help you with hospital services if they are necessary.

What if I get a bill?

If you received services from an agency that is not contracted with your RSN, you may be responsible for costs. If your coupon was not active, you may have to pay. If you had a coupon and receive a bill for an agencies services in error, contact the agency billing office. If you need further help, contact your Regional Support Network (RSN).

As a person receiving public mental health services, what are my rights?

YOU CAN EXERCISE THE FOLLOWING RIGHTS:

To be treated with respect and dignity
To have your privacy protected
To help develop a plan of care and services that meet your needs
To participate in decisions regarding your mental health care
To receive services in a barrier-free location (accessible)
To request information about names, location, phones, and languages for local agencies
The right to receive the amount and duration of services you need
To request information about the structure and operation of the RSN
The right to services within 2 hours for emergent care and 24 hours for urgent care
To be free from use of seclusion or restraints
To receive age and culturally appropriate services
To be provided a certified interpreter and translated material at no cost to you
To understand available treatment options and alternatives
To refuse any proposed treatment
To receive care that does not discriminate against you (e.g. age, race, type of illness)
To be free of any sexual exploitation or harassment
To receive an explanation of all medications prescribed and possible side effects
To make an advance directive, which states your choices and preferences for mental health care
To receive quality services that are medically necessary
To have a second opinion from a mental health professional
To file a grievance with your agency or RSN
To choose a mental health care provider or choose one for your child who is under thirteen years of age
To change mental health care providers during the first 30 days, and sometimes more often
To file a request for an administrative (fair) hearing
To request and receive copy of your medical records and ask for changes
Be free from retaliation

You may want to ask your mental health care provider for more information about your rights. Your rights will be provided to you in writing when you request services. An independent Ombuds may be available in your RSN to help you if you have complaints. When you receive mental health care in a hospital, you have additional rights.

You have the right to request policies and procedures of the RSN and CMHAs as they pertain to your rights.

What is a mental health advance directive?

A mental health advance directive is a written document that describes what you want to happen if you become so incapacitated by mental illness that your judgment is impaired and/or you are unable to communicate effectively. It can inform others about what treatment you want or don't want, and it can identify a person to whom you have given the authority to make decisions on your behalf.

How do I complete a mental health advance directive?

A model "fill-in-the-blanks" form was included in the state law and it is probably the best and easiest way to create a mental health advance directive. You can print or save the mental health advance directive form. Your mental health provider may also have copies of the form.

Does my provider have to follow what I say?

The law requires mental health providers to respect your mental health advance directive, but they are not required to follow it in all cases. If instructions or preferences in your mental health advance directive are against hospital policy or are unavailable, or would violate state or federal law or immediately endanger you or others, providers are not obligated to comply with those provisions. Also, if you are involuntarily hospitalized under the Involuntary Treatment Act, or are incarcerated in jail, your mental health advance directive may not be fully honored.

Member Satisfaction

Once a year, the Mental Health Division does a survey to see what you or your child feel about the services you received. Questions are about access, quality and appropriateness. Your participation is voluntary, however, we strongly believe that your voice is the best way to improve the system. Therefore, we hope that if you are contacted, you will take the time to respond.

What is a complaint?

A complaint is an informal way the state allows you to express your dissatisfaction with either a Community Mental Health Agency (CMHA) or a Prepaid Inpatient Health Plan (PIHP), also known as a Regional Support Network (RSN). It's a good idea to try to resolve your complaint with the person directly involved or ask the Ombuds to assist you, before you try other things. Explain your concern. Let the person know what would work better for you. Be clear about what your complaint is. Also, be clear about what an acceptable solution will be. Try to find some ways to reach agreement that will satisfy both you and the other person.

What does an Ombuds do?

Ombuds receive complaints and help enrollees resolve them. Each PIHP has an Ombuds Service that can assist you with the complaint and grievance process. See listing of Ombuds Service phone numbers listed for each PIHP in this booklet. If you are receiving services, your CMHA can also provide you with the number.

What is a grievance?

There are two types of formal complaints that you may make. One type is an appeal, which is a formal complaint about an action. An action is a denial, suspension, reduction, or termination of certain services. See below for a description of the appeal process.

The second type is a grievance, which is a formal complaint about any other issue. Here are the steps in the grievance process:

To start a grievance, contact the Community Mental Health Agency where you receive services or the PIHP in which you reside. See the end of this booklet for a list of PIHPs and CMHAs.
You may request assistance with your grievance from your PIHP's Ombuds service. See the end of this document for the telephone number for the Ombuds service in your PIHP. Interpreter and TTY/TTD services are available to help you, if needed. You may also receive help from other individuals of your choice.
You may start a grievance with a phone call or a letter. If you choose to start with a phone call, you must also send a letter within 7 days. Please include in your letter your name, how to best contact you, the nature of your grievance, and what you are requesting as a resolution for your grievance.
When your CMHA or PIHP receives your grievance, you will get a letter or phone call within one working day telling you that it has been received.
Your grievance will first be considered by people at your CMHA who have not been previously involved with the issue of concern in your grievance. If your grievance is about treatment issues, these people will also be mental health professionals.
While your grievance is under consideration, you may request to continue your services. However, in some circumstances if your grievance is not resolved in your favor, you may be asked to pay for these services.
Your CMHA will make a decision about your grievance within 30 calendar days from the day you started your grievance.
You will receive a written statement of your agency's decision.
If you are unhappy with this decision, you may ask for additional consideration of your grievance from the PIHP but you must do so within 5 calendar days from your receipt of your agency's decision.
Your PIHP will make a decision about your grievance within 60 calendar days from the day you started your grievance, if you started with your agency or within 30 days if you started with your PIHP. You may request an additional 14 calendar days if you believe it is in your best interest to request this extension. Or, in some instances, the PIHP may request up to 14 additional days to make its decision if there is a need for additional information and the delay is in your best interest.
You will receive a written statement of your PIHP's decision.
If you are unhappy with this decision, under certain circumstances you may ask for additional consideration of your formal grievance from the state Mental Health Division but you must do so within 5 calendar days. To contact the state Mental Health Division, call 1-888-713-6010. The Mental Health Division will have 90 days from the day you started your grievance to make its decision.
After your grievance is resolved, your CMHA, your PIHP, and the MHD must keep any records about your grievance separate from your treatment records in a confidential file. Also, your PIHP will follow-up with you to be sure that no one has treated you badly because you filed a grievance.

What is an action?

An action is a denial, suspension, reduction, or termination of your services as defined below:

Denial: The decision by a PIHP not to authorize covered Medicaid mental health services that meet the Mental Health Division Access to Care Standards or the Medical Assistance Administration memorandum #01-03 MAA, Psychiatric Hospitalization. Or the decision by a PIHP not to authorize covered Medicaid mental health services due to lack of medical necessity. The decision by a Community Mental Health Agency not to provide a covered service is not a denial and can not be appealed. However, an enrollee who objects to a CMHA deciding not to provide a covered service may request a grievance or second opinion.
Suspension: The decision by a PIHP to temporarily stop an enrollee's previously authorized covered Medicaid mental health services. The decision by a CMHA to temporarily stop a covered service is not a suspension.
Reduction: The decision by a PIHP to decrease an enrollee's previously authorized covered Medicaid mental health services. The decision by a CMHA to decrease a covered service is not a reduction.
Termination: The decision by a PIHP to stop an enrollee's previously authorized covered Medicaid mental health services. The decision by a CMHA to stop a covered service is not a termination.

If one of the above events occurs, you will get a written Notice of Action. You may file an appeal whenever you get a Notice of Action.

What is an appeal?

An appeal is a formal complaint to a PIHP about an action.

Here are the steps in the appeal process:

To start an appeal, contact the PIHP that sent you the Notice of Action you wish to appeal. You must start the appeal within 20 days of receiving the Notice.
You may request assistance with your appeal from your PIHP's Ombuds service. See the last section of this booklet for the telephone number of the Ombuds service in your PIHP. Interpreter and TTY/TTD services are available to help you, if needed. You may also receive help from your community mental health agency or anyone else you choose.
You may start an appeal with a phone call or a letter. If you choose to start with a phone call, you must also send a letter within 7 days unless you are requesting a fast appeal (also called an expedited appeal). Please include in your letter your name, how we can best contact you, the reason for your appeal, and any evidence you wish to submit.
You may request a fast appeal if you or your mental health care provider believe that a longer time for resolution would jeopardize your ability to maintain or regain maximum functioning. If your request for a fast appeal is granted, your PIHP will make a decision about your appeal within 3 working days. If the PIHP takes additional time without your request, you will be notified of the reason for the delay. If your request for a fast appeal is not granted, your PIHP will promptly notify you that your appeal will be decided within the usual 45-day timeframe.
When your PIHP receives your appeal, you will get a letter or phone call acknowledging its receipt within one working day. If you choose, your PIHP will allow you 72 hours to informally discuss your appeal with the PIHP before you decide to continue the appeal process.
During the appeal process, you and anyone helping you can look at your treatment and other records to help you prepare your appeal.
Your appeal will be considered by persons who have not been previously involved with your Action and who have the proper training.
While your appeal is under consideration, you may request to continue your services, if:
• Your appeal is filed timely;
• Your appeal involves the reduction, suspension or termination of previously authorized covered Medicaid mental health services;
• Your covered Medicaid mental health services were ordered by the CMHA;
• The current period covered by the authorization has not expired; and
• You have requested a continuation of services.
If the decision is not your favor, you may be asked to pay for the services you received during the appeal.
Unless you request a fast appeal, your PIHP will make a decision about your appeal within 45 days from the day you started your appeal. In some instances, additional time may be taken if you request it or if it is in your best interest. If the PIHP takes additional time without your request, you will be notified of the reason for the delay.
You will receive a written statement of your PIHP's decision.
If you are unhappy with the decision regarding your appeal, you may ask for additional consideration of your appeal from the state Office of Administrative Hearings. An administrative hearing, also known as a fair hearing, is a complaint to the State Office of Administrative Hearings (OAH). The OAH is an independent part of state government. They are not part of the Department of Social and Health Services (DSHS), the Mental Health Division (MHD) or any PIHP. The OAH decision about your appeal must be carried out by the MHD, the PIHP, and your CMHA. You may have an Ombuds represent or assist you with the hearing at no cost. A lawyer or anybody you choose at your own expense may also represent you. You must ask for an administrative hearing within certain time limits. You should consult the Ombuds or somebody who knows about the time limits. The toll free number for the Office of Administrative Hearings is 1-800-583-8271.
Note: In some situations, an enrollee may request a state fair hearing before filing an appeal with a PIHP. This is allowed when a CMHA or PIHP has violated a state rule. Examples are the failure of a CMHA to provide services in a timely manner or the failure of a PIHP to process an appeal according to the required timelines. You may call the OAH or your Ombuds if you feel your complaint may qualify for a state fair hearing prior to your PIHP reviewing it.
After your appeal is resolved, the PIHP and CMHA must keep any records about your appeal separate from your treatment records in a confidential file.

What is an Administrative or Fair Hearing?

If you are unhappy with the decision regarding your PIHP appeal, you may ask for additional consideration of your appeal from the state Office of Administrative Hearings. An administrative hearing, also known as a fair hearing, is a complaint to the State Office of Administrative Hearings (OAH). The OAH is an independent part of state government. They are not part of the Department of Social and Health Services (DSHS), the Mental Health Division (MHD) or any PIHP. The OAH decision about your appeal must be carried out by the MHD, the PIHP, and your CMHA. You may have an Ombuds represent or assist you with the hearing at no cost. A lawyer or anybody you choose at your own expense may also represent you. You must ask for an administrative hearing within certain time limits. You should consult the Ombuds or somebody who knows about the time limits.

Note: In some situations, an enrollee may request a state fair hearing before filing an appeal with a PIHP. This is allowed when there has been a violation of state rules. Examples are the failure of a PIHP to authorize services in a timely manner or to process an appeal according to the required timelines. You may call the OAH or your Ombuds if you feel your complaint may qualify for a state fair hearing prior to your PIHP reviewing it.

If you want to ask the Office of Administrative Hearings to review your complaint, you can send a request to:

Office of Administrative Hearings
P.O. Box 42489
Olympia, WA 98504
The toll-free telephone number is: 1-800-583-8271.

There are several local offices of OAH. Your case will be assigned to one near your home. If an in-person hearing is needed, it will be held in a location close to you.

What are the responsibilities of the Mental Health Ombuds?

The Mental Health Ombuds Service:
- Is responsive to the age and demographic character of the region and assists and advocates for consumers with resolving complaints and grievances at the lowest possible level
- Is independent of service providers
- Receives and investigates consumer, family member, and other interested party complaints and grievances
- Is accessible to consumers, including a toll-free, independent phone line for access
- Is able to access service sites and records relating to the consumer with appropriate releases so that it can reach out to consumers, and resolve complaints and/or grievances
- Receives training and adheres to confidentiality
- Continues to be available to investigate, advocate and assist the consumer through the grievance and administrative hearing processes
- Involves other persons, at the consumer's request
- Assists consumers in the pursuit of formal resolution of complaints
- If necessary, continues to assist the consumer through the fair hearing processes
- Coordinates and collaborates with allied systems' advocacy and Ombuds Services to improve the effectiveness of advocacy and to reduce duplication of effort for shared clients
- Provides information on grievance experience to the regional support network and Mental Health Division's quality management process
- Provides reports and formalized recommendations at least biennially to the Mental Health Division and Regional Support Network advisory and governing boards, quality review team, local consumer and family advocacy groups, and provider network.
Toll-free telephone numbers for your local Ombuds Service

Does mental health treatment work?

YES: The best treatments for serious mental illnesses today are highly effective. Between 70 and 90 percent of individuals have a significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.
For children and adolescents, research shows improved functioning and school performance, improved quality of life and reduction in violence and self-destructive behaviors.
Treatment also decreased recidivism rates for juveniles previously incarcerated in correctional facilities.

What is Wraparound or Individualized and Tailored Care (ITC)?

Wraparound or ITC is NOT a program, a type of service, or family therapy. It is a process based on the idea that services should be tailored to meet the needs of children and their families. There is an underlying value and commitment to create services and supports "one kid at a time" to promote community-based options to support children and youths with complex needs and their families.
Often one or more agencies are involved with the family and work collaboratively with them and others who are close to the family. They function as a team to support the family and each other, working towards common goals.

What is family-centered care?

Family-centered care and supports are developed with the philosophy that recognizes the pivotal role of the family in the lives of children. This approach ensures that families are supported in the natural care giving and decision-making roles for their children by building on their unique strengths as people. Communities Can!
Miscellaneous

What is the difference between a psychiatrist, psychologist, and MSW?

Psychiatrist: A person having a license to practice as a physician and surgeon in this state and in addition has completed three years of graduate training in
psychiatry in a program approved by the American Medical Association or the American Osteopathic Association and is certified or eligible to be certified by the American Board of Psychiatry and Neurology. RCW 71.34.020
Psychologist: A person licensed by a state examining board. This person must pass an oral or written exam or both as prescribed by the examining board. In addition, this person must have a doctoral degree from a regionally accredited institution obtained from an integrated program of graduate study in psychology. This person must also have had at least two years of supervised experience of which at least was one must have been after the doctoral degree was granted. RCW 18.83.070
MSW: A person with a masters or further advanced degree from a school of social work or a degree deemed equivalent under rules adopted by the Secretary of DSHS. RCW 71.34.020

What is a County Designated Mental Health Professional (CDMHP)?

The Designated Mental Health Professional (DMHP) investigates facts and credibility of the persons providing information, that an individual presents a likelihood of serious harm or is gravely disabled as a result of a mental disorder.
Based upon that investigation, the DMHP makes decides whether that individual should be detained for further evaluation and treatment. RCW 71.34.050

Can parents access their adolescent's mental health records without his or her consent if the adolescent is over thirteen years of age?

If your adolescent is over thirteen, be aware he or she will be asked to sign a release of information before you can access your adolescent's mental health records. RCW 70.02 and RCW 71.34

What is parent support?

Parent support is unique in that the support is based on personal experiences of a parent or caregiver who has raised or is raising a child with complex mental health needs supporting another parent raising a child with similar needs.
Types of supports might include:
- Emotional support through telephone, email, or face-to-face contact
- Assistance with navigating the formal systems
- Attending meetings with the parent for support
- Advocacy
- Parent facilitated support groups
- Parent trainings and workshops such as Wraparound, System Navigation, Parents Empowering Parents, Individualized Education Plan, and other topics of interest to parents
Some RSNs and counties contract for parent support activities with parent organizations. Many of these parent organizations employ parent partners who provide support to parents of children and adolescents with complex mental health needs. Parent partners are mentored and receive training from other parents experienced in parent support.
In some communities, there are parent volunteers that provide similar types of support.
Parent groups are an integral part of shaping and improving the mental health service system and de-stigmatizing emotional, behavioral and mental disorders.
Family organizations and parent groups are listed on page 30.

Where do I get more information and assistance regarding treatment resources?

Contact:
- The RSN serving the county you reside in listed on the RSN pages. They can give you information on mental health services in your community.
- The family organization in your area listed on page 30. They can assist you with system navigation and problem-solving issues, provide you with emotional support and training opportunities, and link you with other parents facing similar situations as you are facing.
- The Parent Advocate at the Mental Health Division at 800-446-0259 extension 3.

I am having a problem with my connection to the Mental Health Division Intranet Web Site?

For those who have access to the divisions intranet site and might experience a problem or have a question, please email the staff at the Mental Health Division at MHDIntranetHelp@dshs.wa.gov and provide the following information.

Contact Name, e-mail and phone number of the person requesting.
Description of the problem and include the problem page (ie: http://www.website.com)
If this is a request for data, please include,a list of all the data elements being requested,
a date span (ie: Jan 1,2002 to Jan 1 2003) and when the data result is needed.
Wait for a response. Allow two working days for the division's Information Technology staff to assess the request and estimate when/if your request can be fulfilled.

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