'I want them to come here': Centralia is a proving ground for new crisis treatment model

When a child breaks an arm, your friend gets in a car crash or you have a scary-high fever over the weekend, you turn to emergency medical services.

You don't want to pay for an ambulance or an emergency room bill, so you go to urgent care.

But what would you do if your friend was showing signs of psychosis or a sibling was experiencing a mental health crisis or substance use withdrawal?

"People are becoming used to going into urgent care," said Cascade Community Healthcare Chief of Inpatient Services Mindy Greenwood. "I want them to feel that same thing. It's urgent care for behavioral health. I want them to come here."

Centralia has suddenly become a test case for a new model of behavioral health treatment - a general term that applies to everything from schizophrenia to substance use disorder and withdrawal.

The Cascade Community Healthcare center even offers minor wound care and can refer patients to higher-level medical treatment if necessary.

Cascade Community Healthcare opened the doors of a 23-hour crisis relief center in February under the state's new crisis relief center model. The model promises an alternative to an emergency room or even the back of a police car.

The future of the program depends on the answer to one common question: Is it worth it?

The question will be answered by how many people new crisis relief centers actually serve and how much of the operations and treatment costs the state will have to cover.

Greenwood and the executive director of the Great Rivers Behavioral Health Administrative Services Organization (BH-ASO) Trinidad Medina believe establishing these centers as a place people can go just like the emergency room or urgent care is essential.

"I think, over time, we'll see these types of facilities, crisis relief centers and 988 be utilized, just like 911, but specifically for behavioral health," Medina said.

The challenge is in getting to that point.

Just as the model is getting off the ground with the first two centers up and running, and many more planned to open in the next three years, it already faces a crisis in funding.

The state has already helped fund the construction of many of these crisis centers and is invested in others that have yet to open.

It's the money for operations and treatment that threatens to break the bank. The state offered up $19 million for operations this year, but that's still shy of the $38 million the Washington state Healthcare Authority requested to support the model.

The centers, which are staffed 24/7, 365 days a year, require highly trained staff to work at all times regardless of the number of patients. The centers are also expected to treat a high number of people who are enrolled in Medicaid, Medicare or are uninsured, requiring the state to foot some - if not all- of the bill for treatment in most cases.

That concern is only increased with the pending implementation of federal House Resolution 1, also known as the "One Big Beautiful Bill Act," that increases work requirements for Medicaid eligibility and could increase the number of uninsured patients in the state.

The Centralia center

Cascade Community Healthcare opened its 23-hour crisis relief center Feb. 2 at its Steelhammer Lane facility on the west side of Centralia. The truth is, Centralia becoming a proving ground for the state's new crisis center model is not actually all that sudden of a development.

Greenwood said the local crisis center has been in the works for at least two years. The crisis relief center facility already hosts a crisis stabilization unit for longer term voluntary commitments and an evaluation treatment unit that accepts involuntary commitment patients. When Cascade began the work to add a crisis relief center to the facility, it was so early that some of the requirements for licensing weren't even established as the facility was being developed.

"I went for the grant not realizing that the WACs (Washington administrative codes) weren't already in place," Greenwood said. "Then they did the WAC, which, knock on wood, we had written the grant to what the WAC actually came out as. So we were lucky."

WACs are state regulations or codes that set rules for state agencies and, in this case, requirements for licensure and funding grants.

Greenwood feels the Centralia location and the model as a whole is in a similar situation today: figuring it out as they go.

For Greenwood, the solution to that is proving that the model can work and earning a deeper commitment financially and otherwise from the state.

"It's just so important in these next four and a half months that we have left to make sure that we get that data and we get it to people to prove that this is huge," Greenwood said.

The first six months for a facility are important because they are considered the "ramp-up period" by the Washington state Healthcare Authority, which expects the centers to be operating at a consistent level by the end of the first six months in operations. By then, the costs of operations and the amount of patients treated should be relatively consistent.

The Centralia location is just over halfway through that period and is beginning to see an increase in its usage, according to some simple statistics provided by Greenwood toward the end of May.

In its first month of operation in February, the center treated 43 individuals for 384 total hours of treatment in a shortened month. The center treated 40 patients in March, 52 in April and 74 patients through the first 28 days of May.

The new crisis relief center at the facility, as is required, accepts a minimum of 90% of the patients who come to the facility and, also as required by the state, accepts any and all patients dropped off by local law enforcement. The facility has already been accepting law enforcement and other first responder dropoffs for roughly two years for its crisis stabilization unit.

The center accepts dropoffs from first responders across the region and serves patients from Lewis, Grays Harbor, Cowlitz, Pacific and Wahkiakum counties.

For Greenwood, a successful rollout would mean that the facility is billing between 800 and 1,000 hours of treatment per month by the end of the year. For her, that represents a job well done and likely cost savings for the state and local governments as the facility takes on patients who otherwise would be sent to the local emergency room without insurance or even to a local jail cell.

In the four months of operations, 85% of patients coming to the local crisis relief center have billed their treatment to Medicaid. About 10% have billed their treatment to private insurance, and about 5% have been uninsured and relied on the state to cover the costs.

That outlook could be a good sign for the local center and the state's model as a whole as the number of uninsured patients in that mix is well below what is expected by the state. That means treatment costs to the state at the local crisis relief center are, so far, below expected rates.

Even so, Medina worries the Great Rivers BH-ASO, an organization that is granted money by the state and the federal government to fund behavioral health services, may not have the funding to keep things going as they are right now. Without additional funding from the state, it might come to a point where the local crisis center cannot accept all of the patients that it is supposed to care for.

The broader scene

The biggest concern for the 23-hour crisis relief center model statewide is the cost of treating uninsured patients.

The issue has already caused problems for sites that have yet to open. The Seattle Times reported in February of last year that the organization expected to operate a brand new 23-hour crisis relief center in Lynnwood, Recovery Innovations International, had pulled out due to financial concerns with billing treatment. The facility is expected to open sometime this year and be operated by Seamar.

According to a frequently asked questions page developed by the Washington state Healthcare Authority this spring, the state expects nearly half of the patients - 46% - coming to crisis centers statewide to be underinsured or uninsured. It predicts another 47% to be enrolled in Medicaid and the remaining 6-7% to be commercially insured.

In an interview with The Chronicle, Washington state Healthcare Authority Assistant Director Jason McGill said figuring out who will pay for treatment between the state, the federal government and medical insurance providers is key to long term success.

"We want the right mix of insurers paying and people covering, from a health insurance point of view," McGill said. "Medicaid doesn't pay everything. Medicare doesn't cover everything either, by the way."

The 23-crisis relief center model is pitched as a way to save costs for medical providers and even local law enforcement, but it's still expensive. According to the healthcare authority, the service costs between $74 and $79 an hour or as much as $1,700 to $1,890 for a full 24-hour period.

The healthcare authority estimates the average emergency department admission to cost $2,500. It also estimates the average per night cost at a crisis stabilization center at $570, or $1,250 a night in an evaluation treatment unit. Stays in these units range from five to 17 days.

The good and bad of the crisis relief center model is its per hour billing. While a full stay could cost $1,700, patients may be in and out in two hours, dropping a $2,500 emergency room visit to a roughly $158 crisis center visit.

Even as costs remain a concern, the state is expecting to have another seven facilities online and operational across the state in the coming years. Facilities in Kennewick, Lynnwood and Fife are expected to open by the end of the year. Locations in Seattle and Spokane are expected to open by the end of 2027. Two more planned facilities in Tacoma and somewhere in the Thurston-Mason county area are without an official opening date.

The state has not announced the location of the planned Thurston-Mason facility, which is expected to be operated by the same company that operates the only other up and running facility in Kirkland, Connections Health Solutions. However, the operating company said in an email to The Chronicle that it had recently identified a suitable location.

"Connections remains committed to providing behavioral health crisis services in Thurston-Mason," said Connections Health Solutions Senior Communications Director Lauren Brendel. "We have identified a property for the crisis center, and are working with the TMBH-ASO, and with Washington state and the Department of Commerce and Health Care Authority, on next steps."

The Washington State Department of Commerce awarded the company a $4.96 million grant in July of last year to construct a 16-bed crisis relief center in the Thurston-Mason area.

Copyright 2026 Tribune Content Agency. All Rights Reserved.

This story was originally published June 2, 2026 at 11:21 AM.