When a person is in a mental health or substance use crisis, law enforcement or emergency medical services are often the first to arrive. In some instances, Designated Crisis Responders (DCRs) also come to provide an essential service. DCRs investigate, evaluate, and ultimately decide whether to detain an individual under State statute for involuntary psychiatric or substance use care. 

People can experience a wide range of behavioral health needs, and with that comes a range of services to respond to these needs. DCRs are a critical part of the continuum of care.  So, who are DCRs? 

  • DCRs are master’s level (or higher) licensed  behavioral health clinicians with specialized training in Washington state Involuntary Treatment Act (ITA) law. 
  • DCRs respond to a behavioral health crisis and balance the individuals needs, their civil rights and public safety, while also considering the least restrictive option available to meet the critical need. 
  • Per Washington State law, in cases where a person presents with an imminent threat to themselves, others or another’s property or is gravely disabled; DCRs are provided with the authority to place this person on an emergency behavioral health hold.    

During the height of the pandemic, DCRs were often the first to respond or the first call made by providers, hospitals, and community members to help someone. This is in large part because of their 24/7 availability and because of the critical work they provide, especially when behavioral health challenges are on the rise.  

The Department of Community and Human Services (DCHS) is grateful to the team of DCRs in the department for their tireless work responding to people in crisis. DCRs are doing some of the most critical work in our communities. This spring, the King County Council approved an updated union agreement that resulted in wage increases for DCRs in an effort to keep up with the competitive labor market, and reflect the valued role of DCRs alongside first responders and emergency response teams.  

During the pandemic, DCRs experienced increased caseloads, limited support from first responders, and staff turnover. This continued even after King County’s COVID-19 emergency order was lifted in 2023. This increase in caseloads made it so the average time it took for DCRs to respond to community referrals was 13.5 days. We in DCHS know that is too long to wait, and we are working to bring down this response time. The fact is a large majority (~80%) of referrals have not historically resulted in involuntary treatment but do signal strain across the behavioral health system. To reduce response times, DCRs took a number of steps, including hiring new people to help bring the wait times down. As of June, the median response times for community requests were reduced to 1 hour for emergent requests and 22 hours for urgent requests.    

We know there is more work to do and DCHS remains focused on recruitment and retention of DCRs and is working to identify other strategies to respond to community needs. To learn more about a broader range of crisis services offered by King County, visit: kingcounty.gov/bhrd  

If you’re interested in hearing more about the work of our DCRs, check out a local podcast by KUOW and The Seattle Times, ‘Lost Patients.’ The six-part docuseries examines what treatment can look like for people with severe mental health conditions. In the series, Lauren Richards, a DCR Supervisor at King County, shares her experience on the job and her motivation to continue in this important work.  

FREQUENTLY ASKED QUESTIONS  

Who are DCRs? 
King County Crisis and Commitment Services (CCS) provides investigation and evaluation for involuntary treatment, under RCW 71.05 and RCW 71.34, to people in King County who are experiencing a behavioral health crisis. The staff who provide the investigation, evaluation, and decision to detain an individual under State statute are the Designated Crisis Responders (DCR). DCRs provide assessments 24 hours a day, 7 days a week, 365 days a year, operating five shifts per day to ensure there is sufficient coverage to support our community. 

What hours do DCRs work? 
The supervisors work staggered shifts Monday through Friday spanning the five work shifts of the DCRs. The Supervisors also maintain a weekly rotation of on-call duties 24-hours a day, 7 days a week. DCRs provide coverage 24/7/365, across 5 defined shifts. 

What does a DCR evaluation include? 
The DCR role includes evaluation for involuntary treatment of adults and adolescents 13 years of age and older who present a likelihood of serious harm to themselves, others, other’s property or are gravely disabled due to a psychiatric or substance use disorder. When DCRs do or do not detain, they clearly document a rationale for their decision in either the court petition or in department documentation. The DCRs role is to evaluate risk and decide whether a person is currently a danger to themselves or another or gravely disabled due to a behavioral health disorder and whether or not the person can be helped at a lower level of care in the community. They review their records and any available information from a witness to make that determination. 

What challenges do DCRs face?  
The DCRs provide an essential service required by the the State of Washington. DCRs work to respond as quickly as possible, and because of the chronic underfunding of human services, staffing shortages, and varying policies by jurisdiction, community responses can be delayed. King County is actively working to lower wait times and reach people in need.