Mental Health Frequently Asked Questions
ELIGIBILITY FOR STATE-FUNDED SERVICES
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.
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.
- For 24-hour help for crisis counseling and referrals:
Call the Recovery Help Line or the 24-hour Crisis Line in your area.
- Suicide Prevention - 1-800-273-8255
TTY Users 1-800-799-4TTY (4889)
- When the situation is NOT life threatening:
Contact your local Regional Support Network
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.
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 Division of Behavioral Health and Recovery 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
Aging and Disabilities Services
Transportation Broker: 1-800-562-3022/911 for crisis
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.
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).
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.
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 Benefits booklet for more information (page 14).
- 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.
- 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.
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!
- 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
- 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
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
- Call the Regional Support Network (RSN) that serves the county you reside in and request the name and phone number of the mental health agency that serves your area.
- Call the mental health agency for an appointment. They may do a screening over the phone and schedule an intake appointment.
- Outpatient mental health services are provided by community mental health agencies. Services could be provided at the mental health agency, in your home, or elsewhere in the community.
- An assessment is a process performed by a clinician to determine if treatment is necessary, functioning level, the diagnosis and if your child meets the Access to Care Standards. Additional information will be gathered to determine medical necessity, the length and level of care. This is done through an interview with the youth and could include parents and other family members. The clinician will also ask for historical and family information. In this process, it is important to remember that this is about exploring solutions and not about blaming.
- Information and records with the consent of the parent, legal guardian or youth if appropriate might be gathered from other sources. These could be medical, mental health, school, juvenile justice and other types of records.
- The assessment also includes the child and family's strengths, needs and situation. The clinician might also perform diagnostic tests.
- Based on the assessment, a determination of whether the individual meets all the following requirements to be considered for a level of care assignment:
- The individual is determined to have a mental illness. The diagnosis must be included as a covered diagnosis in the list of Covered Childhood Disorders.
- The individual's impairment(s) and corresponding need(s) must be the result of a mental illness.
- The intervention is deemed to be reasonably calculated to improve, stabilize or prevent deterioration of functioning resulting from the presence of a mental illness.
- The individual is expected to benefit from the intervention.
- The individual's unmet need would not be more appropriately met by any other formal or informal system or support
- If a level of care is assigned, a decision on the appropriate course of treatment will be made by the parents or legal guardian, the child or adolescent if appropriate, and the clinician.
- Community mental health agencies provide mental health services through contracts with the Regional Support Networks. Services could be provided at the mental health agency, in your home, or elsewhere in the community.
- Treatment services should be individualized and tailored to meet the needs of your child and family.
- Treatment modalities could be:
- Brief intervention or individual treatment: A solution focused, outcomes oriented, time limited intervention designed to achieve goals identified in the treatment plan.
- Medication management: The prescribing and/or administering and reviewing of medications and their side effects.
- Medication monitoring: Cueing, observing, and encouraging consumers to take their medication as prescribed and reporting back to persons licensed to perform medication management services.
- Psychoeducation: A set of activities that teach and explore the provision of emotional support, education, reducing stressors, resources, and problem solving skills to consumers and their family members.
- Group treatment: Face-to-face activities provided by one or more staff to two or more individuals under the supervision of a mental health professional.
- Family support: Support groups and advocacy to families to which there is a seriously disturbed child or adolescent.
- Other services and supports as defined in the treatment plan.
- YES: A parent may bring his or her minor child to a provider of outpatient mental health treatment and request that the minor be examined to determine whether the minor has a mental disorder and is in need of treatment. The consent of the minor is not required for evaluation. RCW 71.34.600
- The professional person may do an assessment to determine whether the minor has a mental disorder and is in need of outpatient treatment. RCW 71.34.600
- Community mental health centers primarily serve publicly funded clients. If you have private insurance, you may be eligible for services at a community mental health agency or one of your insurer's preferred providers.
- For publicly funded services, an appointment is necessary.
Both the public mental health and chemical dependency (Division of Alcohol and Substance Abuse) systems have specialists able to assess and diagnose a range of disorders. In the past few years, there has been an increase in the number of mental health providers that are also chemical dependency providers.
Crisis triage is a continuum of activities and services that provide a coordinated, integrated and multi-disciplinary approach to the assessment and stabilization of persons who are experiencing behavioral health crisis and the linkage of these persons to other needed supportive services.
No, you are not financially liable if you have not given consent. Once you give consent, you may be financially liable unless your child or adolescent is eligible for Medicaid.
- Acute psychiatric inpatient treatment is provided in a community hospital or a certified freestanding Evaluation and Treatment facility (E&T facility) when a child or adolescent is in need of immediate inpatient mental health services due to the acuity of their mental illness.
- For publicly funded services, a medical necessity determination is made by the RSN/PHP or Designated Mental Health Professional (DMHP). For privately funded services, the family's insurance company makes that determination. The length of stay in the hospital is variable, depending upon the child's needs.
- The state of Washington defines medical necessity for inpatient care as "a requested service which is reasonably calculated to diagnose, correct, cure or alleviate a mental disorder or prevent the worsening of a mental condition that endanger life or cause suffering and pain or result in illness or infirmity or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction and there is no adequate less restrictive alternative available." RCW 71.34.020 (12)
- For publicly funded admissions, the RSN or the DMHP determines medical necessity for acute psychiatric care.
- The CLIP Administration makes determination of medical necessity for voluntary long-term inpatient care regardless of whether the child has public or private insurance.
- For both levels of care, adolescents committed for 180 days of involuntary inpatient treatment have been determined to meet medical necessity through the detention and commitment process as defined in RCW 71.34.750
- Federal requirements apply to all inpatient services provided to Medicaid clients.
- Admission to any inpatient setting requires a determination of medical necessity, financial eligibility, and willingness of the program to admit the youth.
- The following are referred to as voluntary admissions:
- For all minors under 13 years of age, a parent must give consent.
- A minor 13-18 years of age and their parents may jointly give consent.
- A minor 13-18 years of age may give consent for admission without parental agreement.
- The treatment facility must notify the parents in a way that will most likely reach the parent within twenty-four hours of the admission. RCW 71.34.044
- Involuntary admission:
- In the event of any minor 13 years of age or older (and/or his/her parent) refuses admission, the minor may be evaluated and detained involuntarily by a DMHP (DMHP) in accordance with RCW 71.34.
- If the DMHP makes a decision that the minor does not require inpatient treatment, the parent can seek review of that decision made by the DMHP in court. RCW 71.34
- Parent initiated admission (an option created in 1995 through legislation known as the At Risk Youth or "Becca" bill):
- A parent may give consent for admission of their minor child. The consent of the minor is not required. RCW 71.34
- A parent may give consent for continued in patient care in the event his/her previously unwilling minor child requests discharge during an inpatient stay. RCW 71.34
- Providers are not obligated to provide treatment to a minor under the provisions of this section. RCW 71.34 (4)
- This is NOT considered an “involuntary admission” in spite of the fact it is against the minor's will.
- YES: A parent may bring a minor in acute need of inpatient care to an evaluation and treatment (E&T) facility and request that the professional person examine the minor to determine whether the minor has a mental disorder and is in need of inpatient treatment. RCW 71.34.600-660 (1) NOTE: There are very few acute inpatient evaluation and treatment facilities in Washington State. A parent may NOT bring a minor to a CLIP facility for an assessment because CLIP facilities do not provide emergency or urgent care. They only provide long-term inpatient care.
- The consent of the minor is not required for admission, evaluation, and treatment if the parent brings the minor to the facility. RCW 71.34.600-660(2)
- A minor cannot be admitted to inpatient treatment unless it is medically necessary as a result of a mental disorder. RCW 71.34.052 (4)
- Prior approval by the RSN is necessary for all admissions for publicly funded treatment in acute inpatient facilities.
- While the law states that a parent can authorize the bringing of his or her minor child to an evaluation and treatment facility, it does not establish specific procedures, responsibilities or funding for transporting minors to an evaluation and treatment facility for evaluation of medical necessity for admission. It does not require law enforcement to transport or apprehend minors in these circumstances.
- When called upon to assess whether a minor needs involuntary treatment, a DMHP may take the minor or cause the minor to be taken into custody and transported to an Evaluation and Treatment facility providing inpatient treatment. RCW 71.34.600-660
- If the minor is not taken into custody for evaluation and treatment, the parent can seek review of the decision made by the DMHP in court. RCW 71.34.600-660
Parents have the right to participate in hearings and be represented by counsel when decisions are made to involuntarily commit their minor. After the hearing, the final decision of the court is binding.
- A minor thirteen years or older may admit himself or herself to an evaluation and treatment facility for inpatient mental health treatment without parental consent. RCW 71.34.500-530
- The professional person in charge of the facility must agree that inpatient treatment is necessary because of a mental disorder and that it is not feasible to treat the minor in any less restrictive setting or the minor's home. RCW 71.34.500-530
- Written renewal of voluntary consent must be obtained every twelve months and the need for continued inpatient treatment shall be reviewed and documented every one hundred and eighty days. RCW 71.34.500-530. NOTE: Given the short stays in acute inpatient care, this rule only applies to minors being served in CLIP facilities. Even in a CLIP facility, this type of admission rarely, if ever occurs.
The treatment facility must notify the parents in a way that will most likely reach the parent within twenty-four hours of the admission. RCW 71.34.500-530
- YES: The referral process, the prior authorization process, and the process of obtaining consent are the same regardless of who initiates the referral.
o School district personnel who refer minors to an inpatient treatment program must notify the parents within forty-eight hours. RCW 71.34.500-530.
- A child in the legal custody of the Division of Children and Family Services may be referred by their Department of Social and Health Services (DSHS) social worker. However, the child's parent must provide the consent for the admission. In an emergency and if the parent is unavailable, the social worker may give consent for an inpatient admission. However, a court hearing must occur by the next judicial day and a judge must authorize that emergency consent. A judge cannot order any child into inpatient treatment except in accordance with RCW 71.34.
- Any minor thirteen years or older who voluntarily admitted to an evaluation and treatment facility with the consent of his/her parents may give notice of intent to leave at any time.
- The notice has to be written and intent discerned.
- The professional person must discharge the minor from the facility immediately upon receiving the notice of intent to leave. RCW 71.34.500-530
- Any minor thirteen years or older who voluntarily admitted to an evaluation and treatment facility without the consent of his/her parents may give notice of intent to leave at any time.
- The notice has to be written and intent discerned.
- Copies of the notice shall be sent to the minor's attorney if any, the DMHP and the parent.
- The professional person shall discharge the minor by the second judicial day following receipt of the minor's notice of intent to leave. RCW 71.34.500-530
- Under a “parent-initiated” admission :
- A minor receiving inpatient treatment cannot be discharged from the facility based solely on his or her request. RCW 71.34.052.
- The minor admitted under this section may, however petition the superior court for release from the facility. RCW 71.34.052 (6)
- Minors involuntarily committed for 180 days of inpatient treatment cannot legally sign themselves out of treatment.
- To be eligible for public funds to help pay for acute inpatient treatment, the family must qualify for public assistance through the local DSHS Community Service Office.
- All minors certified for admission to publicly funded CLIP beds are eligible for Medicaid funding for that inpatient stay based upon his/her own income.
- Your adolescent can:
- File a grievance with the inpatient provider.
- File a grievance with the Mental Health Ombuds service from his/her home region.
- Apply for a fair hearing.
- The adolescent may seek the assistance of his or her attorney.
A less restrictive alternative (LRA) is outpatient treatment provided to a minor who meets criteria for commitment but is not residing in a facility providing inpatient treatment. If the court finds that the minor meets the criteria for commitment, the court can either authorize commitment of the minor for inpatient treatment or for a less restrictive alternative treatment. Release under a less restrictive alternative is subject to conditions set by the court.
If the professional in charge of the outpatient treatment program or a DMHP determines that a minor is failing to adhere to the conditions of the court for a less restrictive alternative treatment or conditions for the release or if there is deterioration in functioning, the child can be taken into custody and transported to an inpatient evaluation and treatment facility. The DMHP must then file a petition with the court for revocation of less restrictive alternative treatment. RCW 71.34.740 (5), RCW 71.34.740 (10).