What is means to be a Behavioral Health Ombudsman

Author: Kala Buchanan, BA Psych, CPC
Behavioral Health Ombudsman serving the North Sound Region of Washington, Snohomish, Skagit, Whatcom, Island, and San Juan

I will never forget the time I told a good friend of mine what I do for living and he responded “Oh, that’s cool… Can you pass the ranch?” At that moment, I wondered if what I had just said, meant anything to him. What is the first thing that crosses your mind when I say “I work as a Behavioral Health Ombudsman”? It probably wouldn’t be ranch. But did it make you curious as to what an Ombuds really does?

Most people don’t know that behavioral health includes both mental health and substance use healthcare. There are people out there who are appointed to assist behavioral health consumers in resolving complaints. These people are your Regional Ombuds.

The term Ombudsman is so foreign, that the title in and of itself, presents a barrier. Oxford Dictionary defines an Ombudsman as “an official appointed to investigate individuals’ complaints against maladministration, especially that of public authorities.” This is quite a mouthful when you’re trying to tell someone what you do. Over time, my explanation was eventually simplified to “I work in behavioral health”. But being an Ombudsman is so much more than just a term defined by Oxford Dictionary.

Ombudsman are often people with lived experience. In fact, the Washington Administrative Code (WAC) states that “Behavioral health Ombuds must be current consumers of the mental health or substance use disorder system, or past consumers or family members of past consumers.” The WAC also mandates that the Ombuds office will operate independently of the Behavioral Health Administrative Service Organizations, health plans, Medicaid agencies, and the provider network. (WAC 182-538D-0262)

The Medicaid healthcare system is full of acronyms that often have complex meanings. Healthcare plans are known as Managed Care Organizations (MCO). In Washington State, Medicaid recipients may be offered one of the following as their health plans: Amerigroup, Coordinated Care, Community Health Plan, Molina and United Healthcare. There is a good chance, you or someone you know has one of these companies as their publicly funded healthcare insurance.

Washington state is divided into 10 regions. Each regional Ombuds office will advocate for enrollees living in those counties that the region represents. In the North Sound region, the Behavioral Health Ombuds office is a program within Community Action of Skagit County. Our office contributes towards Community Action’s mission by equipping people for success and stabilizing lives. Because the availability of health plans, behavioral health agencies and the regional crisis contact information is unique, I can offer you specialized guidance within the North Sound Region.

Behavioral Health Ombuds staff are trained in navigating their specific regional services in order to assist individuals in meeting their treatment needs and recovery goals. Someone who utilizes publicly funded healthcare has specific rights. One of those rights is to have the ability to voice concerns to their regional Ombuds. Behavioral Health Ombuds services are free, confidential and available through a toll free number.

Having voice and choice in navigating one’s healthcare requests can be a stressful and challenging process. Ombuds assist in the development of self-advocacy and conflict resolution skills. This is done by educating peers, providers and community partners on the rights of a managed care enrollee. Ombuds services will encourage a self-directed approach in meeting an individual’s mental health and substance use needs. Obtaining a resolution that aligns with these needs is essential in promoting resiliency and recovery within each of our communities.

For more information or assistance please call 360 416-7004 or 1 888-336-6164.