The two-year state budget approved by lawmakers on Friday will boost spending for Washington’s mental health system and kickstart an overhaul of Western State Hospital.
The problem-ridden, 800-bed psychiatric facility in Lakewood is one of the main beneficiaries of more than $100 million in new money for mental health. Top lawmakers praised the investment, while some mental health advocates criticized it as insufficient.
Some of the money will go toward a key bipartisan goal: reshaping Western State and Spokane’s Eastern State Hospital to primarily serve forensic patients who are committed because they have been charged with or convicted of crimes.
Lawmakers plan to accomplish that — in the aim of improving safety, quality of care and capacity issues at the hospitals, particularly at Western State — by moving treatment for civil patients to a range of facilities around the state.
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Civil patients are better served closer to family and support systems, many lawmakers say. The shift also will free space at overloaded Western State.
There’s no target date for completing the transition at the hospitals, said Sen. Steve O’Ban, a Republican from Tacoma who chairs the Senate’s Human Services, Mental Health and Housing Committee.
The state plans to start by converting four 30-bed civil wards at Western State to forensic wards, and closing a fifth civil ward by 2021, according to information provided by House Democrats.
“This was probably the best package we’ve ever put together to help in this area,” said Sen. Randi Becker, R-Eatonville, who helped negotiate the mental health budget in the Senate. “Washington should be proud of this one.”
To create space in the community for civil patients, the state is boosting resources for preventative services to help patients get treatment before they need hospitalization. Six new walk-in crisis centers are planned in the next two years with a total of 96 beds.
The centers can also help prevent people with mental illnesses from committing crimes, O’Ban said.
“If we can divert people away from the criminal justice system and get them the care they need, that’s going to save us lots of money and headache,” he said.
One of the centers will be in southern Pierce County and two will be in King County, O’Ban said.
The budget also spends money on long-term care programs for patients who are ready to be discharged from Western State but need ongoing mental health treatment.
The state has historically struggled to discharge those patients, many of them geriatric, contributing to a lack of psychiatric beds.
The budget has several other strategies to add beds. One emphasis is working with community hospitals to serve involuntarily committed patients normally treated at Western State, said Rep. Eileen Cody, a Seattle Democrat who chairs the House Health Care and Wellness Committee.
The state expects to add about 96 beds at community hospitals in the next four years.
O’Ban said moving civil patients into community settings is primarily motivated by court orders to provide faster care and competency services for mentally-ill defendants at Western State. Lawmakers hope the transition will shorten wait times for admission to the hospital.
Patients waiting to get in to Western State have been left in local hospital emergency rooms or jails without proper treatment, a practice known as “boarding.”
Another driving force behind efforts to upgrade Western State: Federal regulators are still threatening to pull roughly $65 million in annual funding unless Western State reduces escapes and assaults.
Those issues were exacerbated by cuts to staff and budget during the Great Recession, according to a consultant’s report on the hospital.
Western State entered a 13-month agreement last June with the federal Centers for Medicare and Medicaid Services to implement a host of safety and quality of care improvements.
After an inspection in May found some progress but other continuing issues, the Department of Social and Health Services announced Friday that CMS is giving the hospital a 60-day extension on the agreement.
Hospital staff and state officials have reported better conditions at the hospital in recent months.
Many attribute that to a hiring blitz sparked in part by temporary raises the Legislature approved last year. The raises were meant to make salaries for Western State employees more competitive with private-sector jobs.
The state also has poured millions into other upgrades the facility in recent years, along with leadership changes and reforms.
This year’s contract with state workers gives front-line nurses a 27.5 percent raise over three years, as well as raises to other staffers.
Barbara Shelman, a member of the executive board of Western State’s local union chapter of SEIU 1199 NW, said those pay hikes are critical to keeping staff from leaving the hospital for other employers. More staff also ensures better care and more attention to safety, she said.
“We’ve made major improvements” at Western State, Shelman said. “And now we can count on continuing them.”
Along with better staffing, Cody said a stronger focus on harder-to-serve forensic patients at Western State can help stop assaults.
Not all are satisfied with the state’s spending plan on mental health, however.
David Carlson, a lawyer for Disability Rights Washington, told the Associated Press he wanted the state to match Gov. Jay Inslee’s earlier proposal to pour $300 million into the mental health system. That figure includes money in Inslee’s capital budget proposal, which is dedicated mainly to construction projects.
A full capital budget has yet to pass the Legislature, but that budget is expected to have additional money for mental health projects such as the crisis walk-in centers.
Carlson’s organization sued the state in federal court over the speed of competency services given to mentally ill defendants in Washington.
“It doesn’t look promising,” he said of the state operating budget.
Inslee initially lobbied to transition Western State to a forensic-focused hospital by 2020 while building nine new 16-bed treatment centers around the state and adding roughly 1,000 beds to the system as a whole.
But the governor praised the budget he signed Friday night for “making significant new investments in transforming our mental health system.”
It’s unclear exactly how many beds the new budget will create, but top lawmakers from both parties said building enough services for most civil patients to get treatment outside of Western State — and hiring staff to run those programs — will take longer than four years.
Cody said she wanted to see how many cheaper psychiatric beds at community hospitals the state can open before building pricey treatment centers.
O’Ban said there’s money in the budget to get a consultant’s advice on the best way to create more community beds, which he said takes “huge analytical work.” He said creating community beds is further complicated by Washington’s ambitious plan to integrate its medical care, substance abuse treatment and mental health care by 2020.
Unlike the contentious battle over meeting a court order to fully fund public schools, lawmakers said negotiations over mental health were bipartisan, constructive and fruitful.
Democrats and Republicans were in agreement “from beginning to end” on most aspects of mental health negotiations said state Rep. Laurie Jinkins, a Tacoma Democrat involved in mental health at the Legislature.
Cody said she was happy the budget begins pointing Western State toward what she believes is the hospital’s long-term future.
“I’m glad that we’re moving ahead on this,” she said.