There’s a narrow idea of what “help” looks like for those experiencing behavioral health issues. Too many people have decided not to seek help because they believe hospitalization is the only option. Hospitalization is long-term care in a large, highly institutional environment like Western State Hospital or Smokey Point Behavioral Hospital.
JanRose Ottaway Martin is the executive director of North Sound Behavioral Health-Administrative Services Organization (BH-ASO). BH-ASO contracts publicly-funded behavioral health crisis services in the North Sound region (Whatcom, Skagit, Snohomish, Island and San Juan counties).
“There are aspects of hospitalization, whether it’s voluntary or involuntary, that I think can be traumatic,” Ottaway Martin said. “If we can solve those issues without that level of care being needed, I think that’s the goal.”
Hospitalization is the best option for some, but not all. Many would do better with local, short-term care.
When that’s the case, Whatcom County has a handful of services like the Whatcom County Triage Center (WCTC). The WCTC offers three-to-five-5-day inpatient crisis care. Ottaway Martin describes crisis care centers as emergency rooms for behavioral health.
The WCTC can’t meet Whatcom County’s crisis care needs alone. The WCTC only has 16 beds, which is the limit an inpatient psychiatric facility can have and still accept Medicaid, as per Medicaid’s Institution for Mental Diseases Exclusion.
Ella Colwell, a student at The Evergreen State College, spent some time at the Tamarack Center, a long-term psychiatric hospital in Spokane, where the 16-bed limit was a problem.
“They would kind of seem to be pushing out the people who were like, a little better but not fully there,” Colwell said.
With the 16-bed cutoff, a handful of crisis care facilities doesn’t cut it. Whatcom County needs more.
The proposed 23-Hour Crisis Relief Center, which has been in the works since 2023, could help. Patients stay at the facility for just under 24 hours (23 hours and 59 minutes, as stated in the legislature). The 23-hour center will likely open by mid-2026, according to the Incarceration Prevention and Reduction Task Force. However, the project needs more funding.
Services like the WCTC and the 23-hour center can be alternatives to hospitalization for people who don’t need long-term care.
“Sometimes, they just need a place to sleep, get some snacks and have some stabilization,” Ottaway Martin said.
Time spent in a facility often isn’t the helpful part. It’s the services patients receive inside. Colwell has spent time in five psychiatric hospitals in Washington State. Her first hospitalization was at Seattle Children’s, where she was diagnosed with Bipolar Affective Disorder and Generalized Anxiety Disorder. This helped her parents take the situation more seriously.
“In the past, before Seattle Children’s, it was kind of like, ‘Oh, that’s just Ella, she’s just a crybaby — that’s her personality,’” Colwell said. “And then after going to Seattle Children’s, everyone was like, ‘Oh no, we actually have to take this seriously. We have to get her the help she needs.’”
At psychiatric hospitals, services like mental evaluations and diagnoses are often rolled out slowly. At some hospitals where Colwell stayed, psychiatrists and other mental healthcare professionals were away on weekends. Colwell remembers nursing staff would try and distract patients with “fun things” like movies and yoga. This usually didn’t work out because patients were distressed they couldn’t see their therapist or nutritionist.
“They really tried, but people were freaking out anyway,” Colwell said.
The WCTC brings mental health assessments and personalized care plans to patients before their short stay is up.
“Whatever they identify as their top needs for stabilizing their crisis, that’s what we focus on,” said Shannon Prescott, who works at the WCTC.
Prescott is the medical director and psychiatric nurse practitioner at Compass Health. Compass Health is a healthcare agency that provides services in the North Sound region. The WCTC is one of their locations.
This allows people to reap some of the same benefits of hospitalization without staying long-term.
“I don’t often see where the length of time [in the WCTC] is limiting to stabilizing somebody,” Prescott said. “In the cases that it is, sometimes we can extend people for an additional five days if there’s a medical necessity.”
The WCTC and 23-hour center also allow patients to leave whenever they want. Unlike hospitals, checking out before your stay ends is difficult. This gives patients the autonomy they lack in hospitals.
Colwell recalls feeling confident at the start of her hospitalizations and trapped during the middle.
“Going out, I’d be filled with so much relief like, ‘Thank God I’m not there anymore, and I have my phone now,’” she said.
Stays in psychiatric hospitals are typically five to seven days, sometimes longer. Ottaway Martin said hospitalization can be a huge interruption in someone’s life.
“If you have a job, if you’re going to school — that’s a period of time you don’t get to engage,” Ottaway Martin said.
Many people decide not to get help because they can’t spend a week away.
“It’s really difficult to make that first call,” Colwell said. “I have so many things to do that I can’t do while I’m in here — being a student especially.”
Turning to hospitalization is daunting. An unfortunate amount of people decide not to seek inpatient care because of what hospitalization entails.
Colwell doesn’t enjoy hospitalization, but she gets to the point where she can’t care for herself.
“I just, like, shut down everything; I don’t eat. I don’t brush my teeth. I just lay in my own filth forever,” Colwell said.
Seeking inpatient care wouldn’t be such an excruciating choice if it didn’t mean a week away from your life. Often, stabilization is harder when patients worry about the outside world.
Short-term crisis care like the WCTC and 23-Hour Center allows people who need stabilization to get it in as little as a day. Nobody leaves feeling ‘all better,’ but they get immediate attention, stabilization and resources for later.
Prescott said the WCTC is actively trying to connect patients with outpatient services.
If a patient doesn’t already have outpatient care when they arrive, staff will help set them up. This helps bridge the gap between immediate and long-term care.
“We’re meeting people when they’re in crisis. We’re giving them a few days to get stable, and then they know that next week they have an appointment with a therapist or psychiatric provider as follow-up,” Prescott said. “That’s kind of the ideal situation.”
When a person is in crisis, they don’t want to deal with bureaucratic red tape. The paperwork, phone calls and consultations required for hospitalization come as a huge burden on people having the worst days of their lives.
The WCTC and 23-hour center accept walk-ins, making admissions easier. This is vital for people like Colwell, who may lose the motivation to do anything during a crisis.
There aren’t enough short-term behavioral health facilities like the WCTC and the 23-Hour Center in Whatcom County. Washington State as a whole is a mental health desert. Washington State Ranks 41st for need and access to mental health care. This means high rates of mental illness and low access to care.
Whatcom County needs much more than one facility to meet current demand. In 2023, Washington State had 386 fewer beds than patients. According to a 2023 Ways and Means Committee Work Session, Washington will have a projected bed gap of 168 by 2026. The proposed 23-Hour Crisis Relief Center for Whatcom County could help fill this gap. Not completely, however. But it would be a start, and more facilities like it may be the way to go.
“But right now, we see a gap in funding for that at a state level,” Ottaway Martin said.
Ottaway Martin said she thinks we can see this lack of access to care in the increased homelessness and behavioral health issues that law enforcement has to deal with across Washington State. In 2024, there were 31,554 recorded homeless people in Washington State, according to the U.S. Department of Housing and Urban Development. That’s up 12.5% from 28,036 in 2023.
“Instead of giving people safe places to be, we see them being placed in jail and being homeless; not getting the care that they need,” Ottaway Martin said. “So yes, we need more facilities.”
If you need immediate help for a behavioral health crisis, call or text the 988 Suicide and Crisis Lifeline. Find a full list of crisis services available in Whatcom County on the Whatcom County Health and Community Services Website.
Hope Rasa (she/her) is a city news reporter for The Front this quarter. She is a second-year Western student majoring in news/editorial journalism. She enjoys running, hiking, reading and spending time with her cat. You can reach her at hoperasa.thefront@gmail.com.
