Psychiatry • Connection • Whole-person wellness
Compassionate psychiatric care that makes room for your story, your body, and what gives your life meaning.
Rooted in science. Held in relationship.
The idea behind REFUGE
You may be carrying anxiety, exhaustion, grief, or questions that are difficult to put into words. There is room for all of that here.
REFUGE takes its inspiration from the forest. A place to pause, find your footing, and notice a path opening ahead. Our work begins with understanding what life feels like for you and what you hope might change.
We bring psychiatric assessment and treatment into conversation with the body, relationships, culture, and meaning. Your goals and preferences help shape each next step.
Explore the care available ↗Ways we can work together
Thoughtful psychiatric treatment and therapeutic care, connected through a shared understanding of your life.
Integrative psychiatry
Comprehensive psychiatric evaluation, diagnosis, medication management, and collaborative treatment planning. Together we consider symptoms alongside sleep, stress, physical health, relationships, and everyday life. When medication can help, we look for the simplest plan that works and keep reviewing it with you.
Psychotherapy
Existential therapy explores meaning, uncertainty, grief, identity, and the choices before you. Relational work brings curiosity to attachment patterns and the ways you experience yourself with others.
Mindfulness & embodied care
Mindful attention and somatic awareness invite you to notice sensations, emotions, and patterns at a pace that respects your experience. Care draws on attachment theory and interpersonal neurobiology.
Groups & shared connection
Facilitated groups offer opportunities for reflection, learning, and connection. Group format, suitability, and upcoming offerings will be shared as the practice develops.
A relational approach
Interpersonal neurobiology offers a way of thinking about how our experiences, nervous systems, and connections shape one another. At REFUGE, this perspective supports attentive, individualized care.
What may bring you here
Depression, persistent worry, restless sleep, stress that settles in the body, and the effort of getting through the day.
The effects of difficult experiences, attachment patterns, and a longing for connection.
Loss, changing roles, burnout, and seasons when familiar answers no longer fit.
Questions of identity, purpose, belonging, and how to live with greater intention.
The initial evaluation helps determine which services fit your needs and whether referral or additional support would be appropriate.
Meet Heather
Heather McKay-Maddox
ARNP, PMHNP-BC
MSN in Psychiatric Mental Health Nurse Practitioner
MSN in Health Systems Leadership
I’m a board-certified psychiatric mental health nurse practitioner, educator, and group facilitator. More than thirty years in nursing have brought me alongside people through illness, trauma, loss, and change.
My approach integrates psychiatric care with existential therapy, mindfulness, attachment, somatic awareness, and interpersonal neurobiology. I value a relationship where you can speak honestly and participate actively in your care.
I work collaboratively with primary care clinicians, therapists, and other specialists as appropriate to your needs. With your consent, we coordinate care and share relevant information to support a team approach grounded in evidence-informed best practices.
Explore appointments & fees ↗Finding your footing
Learn about REFUGE and consider the kind of support you’re seeking.
An initial evaluation explores your history, concerns, strengths, health, and goals.
Develop a plan that may include medication, therapy, wellness practices, or coordinated care.
Follow-up visits, spaced to fit where you are, to notice what is helping and refine the plan as life shifts.
Appointments & fees
Private-pay psychiatric care for patients physically located in Washington State. REFUGE does not accept or bill insurance.
Your first appointment
$400 / 90 minutes
Unhurried time to explore your concerns, health history, strengths, and goals, and develop an individualized treatment plan.
Continuing your care
$200 / 45 minutes
Review how you are doing, discuss treatment response, and adjust the plan together as your needs evolve.
Good Faith Estimate. Under the No Surprises Act, people paying for care without insurance have the right to a Good Faith Estimate of expected charges before care begins. You can ask for one when scheduling.
Collaboration with your clinicians and relevant specialists supports a coordinated team approach. We bring clinical perspectives together to guide best practices and care that fits your life.
Practical questions
Care begins with a psychiatric assessment and may include medication, psychotherapy, and attention to sleep, nutrition, movement, stress, and relationships. Recommendations are individualized and discussed together.
Medication decisions are made collaboratively after assessment. We discuss potential benefits, risks, alternatives, and monitoring in the context of your needs and preferences.
Heather is licensed to provide psychiatric care in Washington State only. Patients must be physically located in Washington State at the time of each appointment, including telehealth visits. Appointment format and location will be confirmed before booking.
REFUGE is a private-pay practice and does not accept or bill insurance. A 90-minute initial psychiatric evaluation is $400. A 45-minute follow-up appointment is $200.
Group offerings and enrollment dates are being developed. Each group will include information about its focus, format, and who it may be appropriate for.
Yes. With your consent, Heather collaborates with your primary care clinician, therapist, and relevant specialists to coordinate treatment, consider recommendations together, and support continuity of care.
REFUGE does not bill insurance. Some plans reimburse part of the cost of out-of-network mental health care, so it is worth asking your insurer about your out-of-network benefits before your first visit.
A secure way to send messages between visits is being set up along with scheduling, and details will be shared before appointments open. For anything urgent, call 911 or go to the nearest emergency department.
Scheduling is coming soon. Before booking, please review the appointment fees and Washington State location requirement. A dedicated scheduling and secure communication process will be added before appointments open.
Your next chapter
REFUGE is taking root in Washington State. Explore appointment options and private-pay fees as you consider your next step.
View appointments & feesScheduling and secure patient communication are coming soon.