‘Unthinkable’ — Pierce County has a mental health bed shortage. So why is the state getting rid of a quarter of them?

Jim Presson, administrator of the Telecare Recovery Partnership, stands in the doorway of an unoccupied room while a staff member checks rooms with patients.
Jim Presson, administrator of the Telecare Recovery Partnership, stands in the doorway of an unoccupied room while a staff member checks rooms with patients. dmontesino@thenewstribune.com

In the midst of a mental-health crisis and capacity shortage, Pierce County is about to lose one quarter of its local psychiatric beds, thanks to the state.

On Tuesday (Dec. 12), the Telecare Recovery Partnership, a 16-bed evaluation and treatment center on the grounds of Western State Hospital in Lakewood, will shut its doors.

State leaders have declined to renew Telecare’s lease, citing the need to add space for patients at the state hospital, which faces troubles of its own.

The closure comes despite a last-minute plea from state Sens. Steve O’Ban, R-Lakewood, and Jeannie Darneille, D-Tacoma, who sought a reprieve from Gov. Jay Inslee, calling the prospect of losing Telecare’s beds “unthinkable.”

The practical effect: 16 precious beds out of a local total of 64 designated for patients committed involuntarily by the state will disappear.

Telecare administrator Jim Presson said several of the patients have been transferred to other facilities. Five or six patients remained as of Wednesday, and Telecare is seeking placements for them, in Pierce County, if possible.

“We’re in the full swing of closing down,” Presson said in a recent interview. “I don’t think the state worked against us. It would have been nice if they could have been more flexible.”

The reason is prosaic: Telecare’s lease with the state has expired. State leaders extended it in 2016 and the clock ran out this month.

Telecare has plans in the works for a new facility in Milton, but it won’t be ready for another year, Presson said. The letter from O’Ban and Darneille, along with private lobbying from various advocates, represented a final, failed push for an extension.

Inslee spokeswoman Jaime Smith said the governor was aware of the letter from the two senators, but chose not to intervene.

“This is not a sudden development,” she said. “The governor supports Western’s efforts to find a way forward that lessens any negative impacts. It’s a very difficult balance.”

Asked for comment on the closure, Carla Reyes, assistant secretary of the state department of Social and Health Services, which runs Western State, acknowledged Telecare’s importance, but noted that the state couldn’t wait any longer.

“Given the importance of the services Telecare provides and our work to develop capacity in other facilities, we agreed in February 2016 to authorize their lease extension to December of 2017,” she said. “This allowed them nearly two years to make the necessary transition arrangements.”

Following online publication of this story, DSHS spokeswoman Kelly Stowe said agency officials spoke with Telecare leaders Friday and offered to discuss a month-to-month extension of the lease. The offer was declined, Stowe said; Telecare had moved too far into the shutdown process to pull back.

Telecare is one of four evaluation and treatment centers in Pierce County, all with 16 beds, a number dictated by state and federal law. The facilities are intended for patients detained involuntarily for up to 14 days if their condition warrants it.

The private agency has operated the facility at Western State since 2009, following Pierce County’s decision to withdraw from providing public mental-health services. Since then, the state has contracted with several private agencies to deliver the same services.

One of those agencies is Greater Lakes Mental Healthcare, which operates its own evaluation and treatment center in Parkland. Terri Card, president and CEO, called the loss of the Telecare facility “unsettling,” and adding that the agency is the best of its kind locally.

“They’re the highest functioning E&T in the county,” she said. “They run a sharp outfit out there. They know what they’re doing, they have a national model, and they’re good at it.”

The Telecare closure comes at a bad moment: Involuntary commitments are soaring. The state is grappling with a spike in psychiatric admissions, especially for individuals charged with crimes who are waiting for treatment related to competency restoration.

The latter factor, tied to a federal court case known as Trueblood, subjects the state to continuing fines for failing to provide competency restoration in a timely manner, forcing patients to wait for weeks or months in jail.

A separate push from federal regulators to improve safety at the state hospital or risk the loss of funding locks the state in a procedural vise, coupling the need to provide treatment with a mandate for improved conditions.

A third layer of pressure appears in the number of patients designated for short-term commitment who are forced to wait in hospital emergency rooms due to bed shortages.

The practice, known as single-bed certification (SBC) or psychiatric boarding, was deemed unlawful by the Washington State Supreme Court in 2014, but the numbers continue to rise.

O’Ban and Darneille referenced those points in the Nov. 28 letter to Inslee.

“This unfortunate reality shows that the involuntary mental health system remains in crisis, making this a particularly bad time to reduce community E&T bed capacity,” they wrote. “The prospect of Pierce County losing 16 of its 64 civil beds is unthinkable.

“If Pierce County is left without a quarter of its certified E&T beds for months, more individuals will decompensate, waiting lists and SBCs will increase, and our local communities and families will suffer without timely inpatient services.”

In her statement Reyes, the DSHS assistant secretary, alluded to the same pressures.

“We continue to face a critical need to expand capacity to serve people waiting in jail for competency services,” she said. “Demand has risen at unprecedented rates and the state incurs fines every month for individuals who are not admitted within the constitutional standard of seven days.

“There is limited space available around the state that can be renovated and brought online in relatively short order to serve these individuals. As Telecare is aware, the space they currently occupy in Building 27 on the grounds of Western State is one such location.”

While the state intends to use the former Telecare location for competency restoration, the money isn’t available yet; it would come from the state’s capital budget, not yet adopted due to continuing debates in the state Legislature.

“We intend to continue brainstorming options that would lessen the impact to the community once Telecare’s current lease ends,” Reyes said.

Presson said Telecare’s efforts to find new space were slowed by community resistance to such facilities and the associated stigma.

“It is an incredible challenge to find a property that you can modify or build on,” he said. “Everybody’s like, not in my backyard.”

So what happens next?

Presson said his staff has been working closely with Optum, the private agency that oversees contracts for mental-health service in Pierce County. The hoped-for outcome is a bit of a bridge, with Telecare staff members continuing to provide a menu of treatment services in the community until the new facility opens.

“Our staff will try to support people in their current living situations when there might be a risk of them being hospitalized,” Presson said. “They will go to various locations around the community where people may be living, and there’s a chance that they may be regressing.

“It’s nothing to sneeze about. This’ll be a challenging situation for everybody.”