RE-AIR: Better Behavioral Health Crisis Response with Brook Buettner and Kenmore Mayor Nigel Herbig

On this topical show re-air, Crystal learns about north King County’s innovative new Regional Crisis Response (RCR) Agency with its inaugural Executive Director Brook Buettner and Kenmore Mayor Nigel Herbig. Following national guidelines and best practices for behavioral health crisis care, a five-city consortium established RCR in 2023 as part of a vision to provide their region with the recommended continuum of behavioral health care - which includes someone to call, someone to respond, and somewhere to go.

Executive Director Buettner and Mayor Herbig share how the program grew out of a need for a person-centered mobile crisis response, rather than the traditional law enforcement response which is often without the right tools or expertise for the job. They describe the collaborative process of getting buy-in from police agencies, electeds, and city staff to design a service that has evolved from the RADAR co-response program to approaching a 24/7 behavioral health first response. Finally, they cover impressive early results in cost-savings & outcomes and offer advice to other cities looking to bring similar solutions to their own communities.

As always, a full text transcript of the show is available below and at officialhacksandwonks.com.

Follow us on Twitter at @HacksWonks. Find the host, Crystal Fincher, on Twitter at @finchfrii and find Mayor Nigel Herbig at @nigelherbig.

 

Brook Buettner

Brook Buettner is inaugural Executive Director of the groundbreaking Regional Crisis Response Agency, which deploys services to people experiencing behavioral health crisis in the North King County community. She is a Licensed Clinical Social Worker and an experienced human services professional with a focus on policy advocacy and program implementation for high-needs populations. During her two decade-long career, she has been focused on transforming systems to meet the needs of individuals who are high utilizers of both criminal legal and health and human services systems. Ms. Buettner holds Masters in Public Administration and Social Work from the University of Washington.

Mayor Nigel Herbig

Nigel grew up in the Seattle neighborhood of Wallingford, attended Seattle Public Schools, and graduated from the University of Washington with a degree in Political Science and Comparative Religion. Nigel and his wife, Tiffany, decided to move to Kenmore when their daughter was a baby as they were looking for a great place to raise their daughter where they could purchase their first home. They have never regretted that decision.

Nigel has worked in broadcasting, fundraising, and politics. He currently works at the King County Regional Homelessness Authority.

Mayor Herbig represents the Council on the Eastside Transportation Partnership (Vice Chair), and the Sound Transit SR 522 Bus Rapid Transit Elected Leaders Group. He also sits on the King County Affordable Housing Committee.

 

Resources

The Regional Crisis Response Agency | City of Kirkland

 

“RCR Agency Welcomes Brook Buettner as Executive Director” from City of Kirkland

 

National Guidelines for Behavioral Health Crisis Care - Best Practice Toolkit Executive Summary | SAMHSA

 

The North Sound RADAR Program | City of Shoreline

 

King County Outcome Data for North Sound RADAR Navigator Program

 

“RADAR: Response Awareness, De-Escalation, and Referral Final Evaluation Report” prepared by the Center for Evidence-Based Crime Policy Department of Criminology, Law & Society at George Mason University

 

“North King County cities will broaden mental-health response to 911 calls” by Amy Radil from KUOW

 

“New Crisis Response Center in Kirkland to Serve North King County” from City of Kirkland

 

 “$500k grant from DOJ to help reduce use of police force in North King County” by Hannah Saunders from Bothell-Kenmore Reporter

 

Transcript

[00:00:00] Crystal Fincher: Welcome to Hacks & Wonks. I'm Crystal Fincher, and I'm a political consultant and your host. On this show, we talk with policy wonks and political hacks to gather insight into local politics and policy in Washington state through the lens of those doing the work with behind-the-scenes perspectives on what's happening, why it's happening, and what you can do about it. Be sure to subscribe to the podcast to get the full versions of our Friday week-in-review show and our Tuesday topical show delivered to your podcast feed. If you like us, the most helpful thing you can do is leave a review wherever you listen to Hacks & Wonks. Full transcripts and resources referenced in the show are always available at officialhacksandwonks.com and in our episode notes.

Today, I am very excited to be welcoming Mayor Nigel Herbig - he is the mayor of Kenmore. And Brook Buettner, who's the Executive Director of Regional Crisis Response - a collaboration for a mental health alternative response between the cities of Kenmore, Kirkland, Lake Forest Park, Shoreline, and Bothell that's really innovative and I think a number of cities are looking at this in the region - want to just explore what this is. So starting out with Brook, how did you get involved in this work and what interested you in this?

[00:01:27] Brook Buettner: Thanks, Crystal - I'm so happy to be here with you. So my background is that I'm a licensed clinical social worker and I also have a background in public administration. And most of my social work career has been in service of folks that have chronic behavioral health conditions, are living homeless, and then have some overlap with the criminal legal system - either with the police, or with having multiple charges around poverty, or around homelessness. So this is a really exciting program for me to be able to be involved in.

[00:01:54] Crystal Fincher: Excellent. And Nigel, as mayor of Kenmore, what got you involved in this particular program and work?

[00:02:00] Mayor Nigel Herbig: First, I want to start off by saying that I'm a long-time listener, and I'm excited to be here, Crystal - so thank you for having me. Kenmore entered into this work back in - I want to say 2017 or 2018 - when we joined with other cities and King County MIDD funds and started the RADAR program, which was a co-response model across parts of North King County to give folks other ways to have service calls responded to - without the only response being a police response, because I think we all recognize that a solely police response is not always the right answer and is not always in the best interest of everybody involved. And we did that successfully for a few years. And then in 2021, we started larger conversations with the cities of Bothell, Lake Forest Park, Shoreline, and then we reached out to Kirkland also, about expanding what we were doing with RADAR and making it into a larger regional model. And so our staff and our councils worked for about a year and a half trying to figure out how that would all work.

And what we ended up doing was folding the North King County's RADAR Navigator program with Kirkland's Community Responder program to form a new entity that's regional in nature, is going to have a lot more resources, will be operating more hours during the day - I think we're aiming towards 24/7, I don't think we're quite there yet - and will really be a resource for folks who are experiencing, or decompressing in public, or having some sort of other issues so that they'll get a response that actually meets them where they're at. And gets them help immediately rather than the other alternatives, which are the ER or jail - both of which we know are not ideal for anybody who's experiencing either an issue with drug addiction or a mental health issue. So yeah, it's exciting to see multiple cities all coming together to recognize the issue and working together - 'cause as individual cities, there's no way that we could have done this - little Kenmore could've never done this on our own. But working with other cities, we're gonna be delivering something that I think will be meaningful to folks who are experiencing issues out in the field, and I think we'll be getting better outcomes for everybody. And I think that's something we're very excited about.

[00:04:00] Crystal Fincher: Absolutely. You talk about how challenging this is for individual cities to address and to deal with. I do think it's notable that there was an attempt, a recognition by Kenmore that this was something that needed to be tackled. There was the RADAR program, previously in place, that you just mentioned - this was built on top of and leveraged with the region. How did the discussions go with the region? How did you get buy-in for taking this collaborative approach? And how did you work through the design of the program? How did that work, Brook?

[00:04:34] Brook Buettner: We're very lucky in North King County that there was already a great deal of support for alternatives to police response for people in crisis. As you mentioned, the commitment to the RADAR Navigator program that had been going on for about four years prior to this conversation and showing really successful outcomes for folks. And across our elected officials, our police leadership, and our community, there was a strong commitment to doing things in a new way for people in crisis. And so it was a matter of not having to bring people on board, but just discussing what's our shared vision - what do we want our community to look like and how are we gonna get there? And so it was a big lift for city staff to come up with the agreement, the interlocal agreement, that governs this entity - but it was done pretty quickly in my experience and very well to where we have a strong and robust infrastructure to start really offering these alternative services to folks in crisis.

[00:05:29] Crystal Fincher: Nigel, what advice would you give to other cities working through this process right now in terms of figuring out the agreements that are going to govern these collaborative approaches, getting buy-in from various stakeholders? How did that work in your experience and what guidance would you give other folks working through this?

[00:05:48] Mayor Nigel Herbig: I think part of what made things work, where we are in North King County, was the fact that we'd already been partnering with other cities with RADAR. But we also have other regional models that we're used to - we're used to doing regional collaboration around here. Kenmore is part of ARCH, which is a regional coalition for housing - which is a multi-jurisdictional affordable housing developer that covers kind of Kenmore and then down to the Eastside. And so we're very used to working in a collaborative manner with our neighbors to address issues that we really can't do, again, by ourselves - we can do affordable housing, but it's very hard for a smaller city, right? It's a lot easier if people are pooling things together. So we already had those models that we were familiar with, which I think really helped some of the conversations - 'cause Kirkland's also part of ARCH, I think Bothell is too. So we're starting from a place where we understand how these models work. I think having trust between the cities is important also. We have good relationships with - I have good relationships with my colleagues in Kirkland and in Bothell and Lake Forest Park and Shoreline - I think that's helpful. And then also having staff that's willing to really dig into the details and work collaboratively with their colleagues is important.

A lot of this came out of the fact that - and I think we all recognize this - the state and the county have largely been underfunding our mental health response for a long time. And even on our council, there was some pushback to - this should be a county response, this should be the county's responsibility. And I don't completely disagree with that assessment either, but I think we all recognize that something had to be done. And at the end of the day, sometimes cities just have to step up and figure out a way forward. And it's nice to see five cities coming together to work together towards a solution, while we try to figure out the larger long-term solutions that are truly regional and even statewide, frankly.

[00:07:25] Crystal Fincher: So can you walk me through what your most frequent calls look like, feel like, what that process is? I think for a lot of people - they're familiar with the concept of alternative response, they're familiar with how important it is, and understanding that police can't do everything and they are not the most effective response for every kind of crisis - so having a tailored response that is most appropriate and most effective is really helpful. How, as you work through this, what does a typical call look like? What does a typical day look like?

[00:07:58] Brook Buettner: In crisis, of course, there's no typical call or no typical day. But we are looking to deploy social workers or mental health professionals on any 911 call that comes in that has some identified component of behavioral health. So that's mental health, or substance use, or some social service need like a homelessness component, a family dynamic issue where it could be helpful to have a social worker there. And then the social workers - we call them crisis responders - the crisis responders are going either in the car with the police officer, or when possible in an independent vehicle and meeting the police officer on the scene. And we are stepping more and more in our community into the space of two crisis responders going to - responding to the scene - without a first responder. And that is really what we call the alternative response model.

And it can be anything from somebody that has called 911 because they themselves, or somebody that they care about, is suicidal - has made suicidal statements or gestures. Or someone that is in a community space and is having mental health symptoms or substance use-driven symptoms that are causing them to be troubling to the other folks in that environment. To, like I said, family dynamics where someone calls 911, for example, because their teenager is so agitated and escalated that they become violent. And our crisis responders are very, very good at identifying what's going on, deescalating folks, bringing them down to a level of calm where they can talk through what's underlying the crisis. And then the crisis responder's job is to figure out what to bring to bear on the situation to alleviate the immediate crisis and then connect the person to the system of care so that they don't fall into crisis again.

[00:09:33] Crystal Fincher: Absolutely. And it looks like you've structured the program on best practices for the continuum of behavioral health care starting with having someone to call - we have our 988 line, someone to respond - these crisis responders, and then having somewhere to go once it's determined where the appropriate place is for them to receive the help that they need. Especially when it comes to that somewhere to go, we just passed a county-wide behavioral health center levy that will fund a number of those services and staff. But that's been a big challenge in our region. How have you navigated through this in the program, Nigel, and how's it working?

[00:10:14] Mayor Nigel Herbig: Well, I'm really excited. I mean, Kenmore and our partner cities - we're actually out ahead of King County a little bit and had been working in partnership for - I don't know, a little while now, I think going back to 2021 - really reflecting on the lack of a door for people to go to, a place for people to go to when they're in crisis. And working together, we identified funds and we identified a location, we identified our provider, and we will be opening up the first crisis response center for North King County. And again, it's the same cities - it's Kenmore, Lake Forest Park, Shoreline, Bothell, and Kirkland - and we're excited to have this model here. They selected Connections Health Solutions, which is a national innovator in the space. They've done a lot of great work in Arizona, and that model is also what I believe the executive based his models off of. And they should be opening up next year, and it's gonna offer a place for people who are facing any sort of mental health issue or behavioral health issue - a place where they can go and actually talk with somebody, regardless of insurance, regardless of where they live, or any of that. It'll give people a place to go, which right now is severely lacking throughout the county.

[00:11:23] Crystal Fincher: What happens when there is no place to go?

[00:11:26] Brook Buettner: I can kind of speak to that. So in the past, when we encountered someone in the field in crisis, the options were either that they stay where they are, that they go to the emergency department, or an arrest and jail - if it's not safe for them to stay in the community setting or in the home where they are at - safe for themselves or safe for the people around them. And this allows us an alternative to say - Maybe the emergency department is not the right place, and certainly jail is not the right place for somebody in deep behavioral health crisis. We're gonna take them somewhere that we know will accept them, we know will allow them to stay, will provide robust psychiatric and behavioral healthcare, and do discharge planning so that they're walking out with a plan and a connection to ongoing care. Connections, in particular, has a model that has multiple levels of acuity and step-down so that if somebody comes in at the highest acuity, they're in one setting. And as they deescalate, as they get different treatment on board or medications on board, they can step down to a lower acuity setting and even to an outpatient model while they wait to get hooked up with the local behavioral health system of care. And Crystal, you mentioned the behavioral health continuum of care, and I love that you brought that up because this is - North King County is about to have, kind of the first in our state, fully-executed crisis continuum of care when this facility opens up and it's super exciting.

[00:12:44] Crystal Fincher: It's very exciting and so necessary. And I appreciate you all doing the work to get this implemented to be a model for the region. Other areas are looking at this - some areas are eager to adopt this and have public safety agencies, police agencies that are willing partners. Others have some concerns and there's almost a concern of - Okay, is this competition for us? Are they looking to move us out? What feedback have you heard from law enforcement officials, and how have they said it's impacted their job and the work that they have to do?

[00:13:19] Mayor Nigel Herbig: To be honest, I haven't heard anything negative from our police partners - Kenmore, like Shoreline, contracts with the King County Sheriff's Office - they've been great partners in this. I think our chief is always looking for better ways to interact with folks who are in crisis and this gives him another tool. This gives him more resources to address the problem at hand, rather than only having law enforcement resources to fall back on - and I think he views that as a positive. So I have not heard any pushback from our law enforcement community up in North King County around this, and I think they're looking forward to using this as a resource and being partners in this.

[00:13:56] Crystal Fincher: Yeah, absolutely. For years and years - going back a decade and more - have heard several officers, chiefs talk about how challenging it is to respond to calls where there's a behavioral health component, or there isn't any illegal activity per se but someone is clearly in crisis, or people are being impacted around them and an intervention needs to take place but a criminal or a legal intervention doesn't seem to be the most positive. Brook, what have you heard from officers who have co-responded on these, or who are looking forward to a complete alternative response? How are they saying it's impacting their work and their ability to do their job?

[00:14:37] Brook Buettner: We have been extraordinarily lucky in North King County that we've had support from law enforcement leadership since the get-go. Law enforcement was who asked for this program initially five years ago, saying these are not the kind of calls that we're supposed to be on - we need help, we need support. And so it has been a journey to get all of the responding officers - patrol officers and deputies - socialized to this idea. But once an officer or a deputy sees it in action, it's an easy sell. So what we find is that the more interaction we are having with law enforcement, the more referrals we're getting because they see - wow, that works - or we'll let them know that the follow-up that we did ended up keeping somebody from falling into deep crisis again. And it becomes a really good alternative for them and a good tool in their tool belt. I also am really attentive to making sure that we maintain good relationships on a one-on-one basis with all of our law enforcement partners, so that it's not a pain to have a social worker along but rather a pleasure - to say we're a great team, we work well together. Both sides recognize that each role has something to bring to a highly escalated crisis situation, and both sides recognize where their limits are. And so it's just been a constant growth of support and of buy-in. I've heard from several chiefs that they see shift in the culture - in the willingness to talk about behavioral health in a new way among the community and also within the department - that it opens up conversations that otherwise may not have happened. So it has really been a positive for our five police agencies.

[00:16:05] Crystal Fincher: I think that is really an outstanding observation. And strikes me as important, especially as we hear from several police agencies across the state really that they're trying to recruit, they're short on officers, they're having a tougher time on that - and needing to triage their time and resources, and response times being impacted, other things that they're saying are being impacted. How can this help manage the workload for officers and across the public safety continuum? How has that been working?

[00:16:34] Mayor Nigel Herbig: Speaking for Kenmore, our officers, right - until we had RADAR in place and until we had these partnerships - if somebody was out on the street decompensating, yelling, screaming, doing something like - like you said earlier, that's not illegal, but is disruptive to the community and the person is obviously in crisis - the only response we had was a police response. And I think even our officers recognize that there are better ways for them to be spending their time than dealing with somebody who's decompensating. It's not what they were hired for, it's not what their expertise is in. And this gives them a tool so that they can - working with the social workers - find what the right response is, hand off the person to the social worker, and then get back to catching speeders or investigating break-ins or whatever it is that they could be doing rather than dealing with the guy who is having a breakdown. So I view this as actually an expansion of our response, if you will - it gives us the ability to respond to more calls on both sides of things, both law enforcement and people experiencing a crisis.

[00:17:38] Crystal Fincher: How have you seen that play out, Brook?

[00:17:40] Brook Buettner: It is absolutely allowing officers to focus more on life safety and law - criminal law issues - by kind of carving off this segment of the work that comes into the 911 system and routing it to the appropriate resource, the right tool at the right time. I see what we're doing as a third kind of branch of the first response system. Going back again to the continuum of care, the level of care that someone gets should be based on the acuity of their need and of their crisis. And we have outpatient behavioral health for folks that have behavioral health challenges that are at a low acuity level. We have other systems in place that are secondary responses for people that are in crisis. And when people are in very high acuity crisis and 911 is needed, we now have this first response behavioral health tool in our toolbox - that crisis responders that are skilled and trained and experienced in meeting people that are in the highest acuity level of behavioral health crisis, but still not committing a crime. So it is a 911 call - it's not necessarily a law enforcement need, but there is a need for a very high level response - and we're now able to provide that.

[00:18:47] Crystal Fincher: Did you have anything to add, Nigel?

[00:18:49] Mayor Nigel Herbig: Well, I was gonna say - I think a lot of this came out of the recognition that we've seen over the last 150 years that when your only response is a police response, the outcomes are not ideal. We have seen too many folks who are dealing with a mental health issue - and that is a huge section of our population - it's not something we talk about, but a huge proportion of folks are dealing with some sort of mental health issue. And just because somebody is having a very hard day doesn't mean that they should end up in jail or be put at risk, frankly, of a police interaction. We know that sometimes those interactions can turn out tragically. And being thrown into jail or worse, because you're experiencing a mental health issue, can ruin somebody's life or - and frankly, can ruin not only their lives, but also their kids' lives. When we enter somebody into the criminal justice system, it has long-lasting effects on not just the person impacted, but also their family, their kids, their kids' kids - it can have multigenerational effects on people. And we've seen that play out over the last, well, 50, 100 years. This gives folks, this gives our police officers a different response. And I think it's - that's what I'm excited about - I'm excited that people who are experiencing mental health issues can actually get the treatment they need rather than a pure law enforcement response, because nobody deserves to go to jail because they're having a breakdown.

[00:20:12] Crystal Fincher: Absolutely. And it's a shift in how we've been doing things. What are the results that you're seeing from this? Obviously, people are looking to justify these expenditures and implement these in their own areas. What results are you seeing when it comes to amount of calls, recidivism? I know in some other cities, they talk about how many calls come in about behavioral health issues that aren't someone breaking the law but that are someone in crisis, as you've talked about, and how much time that takes up, how many repeated calls those spur, and how much time that demands - just the amount, enormous amount, of resources that demands. How are you seeing that impacted and what results are you seeing from this program?

[00:20:55] Brook Buettner: Directly to your question, Crystal, we don't have a lot of data yet on reduction in 911 calls, or 911 dispatch center or officer time. I do have some outcome data though that our King County partners were able to pull together for us for the RADAR Navigator program - that folks that were touched by the RADAR Navigator program - in two years following that program touch, we saw a 67% reduction in adult jail bookings. And that is a tremendous impact. We saw a 60% reduction in behavioral health crisis events. And that is measured by King County's Department of Community and Human Services who oversees the behavioral health system crisis response. They also experienced a smaller 4% reduction in emergency department visits. And of the folks that our program touched, 14% were subsequently enrolled in publicly funded behavioral health services. And I think that's a significant undercount because a lot of the folks in our community do have private pay insurance and so there would be no way to count that. But we know that interaction with this program results in a reduction in jail, a reduction in crisis services, and an increase in engagement with the behavioral health system. And those are all big wins.

And to your specific questions, those are the kind of things we're gonna be looking at in our program analysis as we go on. How is this saving on 911 calls? How is this saving on officer time? My dream is that we capture the cost savings of reduction in jail nights and say - let's put that back into the earlier end of the continuum of care and fund diversion, and ultimately fund a robust system of community-based behavioral health care so that people don't fall into crisis. Again, I wanna say we're extraordinarily lucky that our electeds and our city staff are all so interested and committed to doing this kind of analysis and thinking in this way.

[00:22:37] Crystal Fincher: Thanks - I appreciate that data, that information - it's really, really powerful. And what strikes me hearing that is that when you talk about being booked into jail, emergency room visits - these are the most expensive parts of our system to use and to utilize. And savings on these are incredible - I'm looking at that reduction in the jail number, and that is a budget-altering number right there. Pretty incredible. And I recognize this is a newer program - certainly you've done the work with the RADAR program, this predecessor, and getting the data there. I'm sure more will be rolling in as this continues and you move on, so that's great. Did you have something you wanted to add, Brook?

[00:23:16] Brook Buettner: Yeah, just a thought that this is what we sometimes call a different purse problem - that each of these reductions affects a different financial system. And so part of our work is gonna be pulling together those cost offsets and making sure that the savings are redirected appropriately to meeting people's needs.

[00:23:34] Crystal Fincher: Yeah, that is such an incredible problem in the public sector - yeah, this is saving a billion dollars, but if that's spread across a ton of different budgets in different ways, it's a whole different animal than someone handing someone basically a rebate check for a billion dollars. As you look forward, you talked about moving forward and moving towards a program where it truly is an alternative response where there are one or two crisis responders who respond to these calls without law enforcement initially - they can certainly call them in if it's warranted or they need backup. How do you see this progressing with that change and beyond it? What are the plans?

[00:24:14] Brook Buettner: First, I'll say that the primary challenge that stands between us and a pure alternative response system is the dispatch question - and the ability to understand when a 911 call comes in, what's really going on - and that is often not clear from a 911 call. So we really wanna work through this very carefully with all of our partners and make sure that we're doing the outreach in a way that's safe and appropriate, that meets people's needs, but also keeps our responders safe. And so that is probably my work for the next two years - is digging into - How do we do call receiving? How do we triage? And then how do we appropriately dispatch the right resource? I have kind of been moving from calling it alternative response to thinking of it as a behavioral health first response. Whatever - when someone is in behavioral health crisis - whatever resource is the right resource. And I can see, for example, that being a crisis responder plus an EMT when someone has or has stated that they will take too much medication - and that's a medical plus a mental health need. Whereas if there's maybe a weapon in play, then that's a law enforcement plus a mental health need. And so thinking of it as a first response system with all of the tools that we need available to our dispatchers.

[00:25:27] Crystal Fincher: Absolutely. Nigel?

[00:25:28] Mayor Nigel Herbig: I think something that Brook kind of glossed over a little bit - but I think is an important thing that we're gonna have to work out - is the fact that we're using multiple different police. We have different police forces, if you will, and different dispatch systems. So like I said earlier, in Shoreline and Kenmore you have King County Sheriff's Office and they're dispatched in one way. And then Lake Forest Park and Bothell, they have their own. And Kirkland, they have their own police officers and they're dispatched differently. And so it does create - it is a complication that I believe we'll work through. And I know with Brook's leadership, that'll get worked out - but it's not as straightforward as just having one dispatch system that we need to educate and get up to speed.

[00:26:06] Crystal Fincher: How is this being funded? How much did you have to come up with as individual cities in this regional partnership? How is the funding talked about? Because this is something that has been kind of thorny when we look at the Regional Homelessness Authority, but with this collaboration, how does this work, Nigel?

[00:26:25] Mayor Nigel Herbig: I can't get into what the specific numbers are we're spending - I do know it's more than what we were with RADAR. Part of that is because we're expanding things from - we're approaching 24/7 is part of the goal. Part of this is also funded by King County MIDD, the Mental - oh, I don't remember -

[00:26:41] Crystal Fincher: I know - I always try to remember what MIDD stands for.

[00:26:43] Brook Buettner: Mental Illness Drug Dependency.

[00:26:45] Crystal Fincher: Thank you.

[00:26:46] Mayor Nigel Herbig: Thank you, I was just digging around.

[00:26:48] Crystal Fincher: Very, very useful.

[00:26:50] Mayor Nigel Herbig: No, super useful - and they're the reason why we were able to do RADAR and test out, essentially test out the model, set the foundation for where we are now - is because of the MIDD funding. And we're very thankful to King County and Councilmember Dembowski for his help with that. Our expenses are definitely higher than they were in previous years with RADAR - there's no question around that, and it was part of our budget discussions last year. But I think it's something that we're all committed to because we do see the long-term payoffs - not just on our budgets, but frankly in outcomes - and all the councils seem fairly committed to that. So I believe that they - I wasn't involved in these negotiations, staff was - but I believe that they were negotiating based on population and number of hours that would be required to cover each jurisdiction, and then breaking up the cost and using some sort of formula that we all agreed to. Brook can probably speak a little bit more to that, but we got to a place where everybody was comfortable with the investments that we'd be making.

[00:27:47] Crystal Fincher: Sure, Brook?

[00:27:48] Brook Buettner: Yeah, so like Mayor Herbig said, the MIDD funding has been really foundational to piloting this as the RADAR Navigator Program and even to the expansion. We also have some funding through the Washington Association of Sheriffs and Police Chiefs' Trueblood dollars for Mental Health First, or Field Response teams. And we have had some support from the Association of Washington Cities. And then I'm so delighted that starting this year, we have general fund contribution from each of our five cities. It is per capita-based at this time. We have plans to really keep a close eye on utilization and think about whether some cities have higher utilization and that may affect their contribution rate. But I also have plans to get the payers on the hook for this as well. So when we talked about the wrong purse problem - a 4% reduction in emergency department visits is a big bonus for insurers and for the managed care organizations. And King County Department of Community and Human Services and the behavioral health services organization have been thinking about this as well. How do we get the private insurers to be picking up what they are supposed to be covering for their covered lives around crisis services? There are a couple of folks at the State Legislature that are really thinking carefully about this. And I see us as being kind of a test case outside the traditional behavioral healthcare system to be reimbursed by the health payers for this service that ends up with better outcomes and lower costs over time.

[00:29:07] Crystal Fincher: Absolutely. As we move to close this, what advice do you have to other cities approaching this? And what would you tell residents about why this is so useful and so important?

[00:29:21] Mayor Nigel Herbig: I think I would advise other cities to take a look at their 911 calls, talk with their police officers - see what sort of calls they're responding to that maybe they're not the best equipped first responder for. I don't think police officers enjoy these sorts of calls on their own. I also think that you can point towards the outcomes that we will have around better results for the people involved, better results for the community, and frankly, cost savings at the end of the day when it comes to jail days and ER visits. And other cities might be big enough to do this on their own, which will make their lives a little bit easier and all of that. But I think other cities - and if you're looking in other parts of the county, there are places where there are multiple cities all right next to each other that could, if they wanted to, join together and do this sort of work. And I would encourage them to have those conversations and really ask themselves - What do they want the response to be when somebody calls 911 in crisis? Because I don't think anybody actually thinks the right answer is a person with a badge and a gun. And I think people need to really reflect on that, and really think about how they truly serve the people that they are working for, and make sure they're doing that in the best and most responsive and person-centered way possible. And this is, I think, a huge step in that direction.

[00:30:36] Crystal Fincher: Any final words from you, Brook?

[00:30:38] Brook Buettner: I love what Mayor Herbig said - just asking yourselves - What is it that we want people in crisis to get from our first response system? And then from my social-worky side, building relationships across jurisdictions and across sectors to bring - this is very complex - so to bring all the players to the table to offer the kind of response that people deserve when they're in crisis.

[00:30:59] Crystal Fincher: Well, thank you both to Brook Buettner, Mayor Herbig - sincerely appreciate you spending time with us today and helping to educate us on what's going on there in the north part of the County. And it's certainly a lot to reflect on and hopefully emulate moving forward. Thank you both.

[00:31:16] Mayor Nigel Herbig: Thank you.

[00:31:17] Brook Buettner: Thank you so much for having us.

[00:31:18] Crystal Fincher: Thank you for listening to Hacks & Wonks, which is produced by Shannon Cheng. You can follow Hacks & Wonks on Twitter @HacksWonks. You can catch Hacks & Wonks on every podcast service and app - just type "Hacks and Wonks" into the search bar. Be sure to subscribe to get the full versions of our Friday week-in-review shows and our Tuesday topical show delivered to your podcast feed. If you like us, leave a review wherever you listen. You can also get a full transcript of this episode and links to the resources referenced in the show at officialhacksandwonks.com and in the podcast episode notes.

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