The city home to Washington's main psychiatric hospital is fighting to stop patients from being discharged to residential treatment centers within its borders.
Lakewood on Monday approved a moratorium on city business licenses for new adult family homes and authorized a lawsuit against the state to end what it calls the unsafe release of people with histories of violence or sexual offenses into its city.
“Injecting sex offenders and violent criminals into a residential neighborhood was never the idea of the authors of this legislation,” said Mayor Don Anderson, addressing state law around discharges, before the legal action was approved.
Adult family homes routinely contract with state government to serve people with disabilities and mental illnesses, a small portion of whom are leaving the 857-bed Western State Hospital. They can serve up to six people and are in residential areas.
Lakewood officials also want adult family homes to be more spread out around Washington. The city has one of the highest concentration of adult family homes in the state.
Lakewood’s measures come at a time when Washington is desperately looking for places to discharge patients who the state considers healthy enough to leave the hospital. State officials, mental health advocates and owners of adult family homes have have slammed the city’s efforts as discriminatory, short-sighted and cruel towards people in need.
John Ficker, executive director of the Adult Family Home Council, testified at the council meeting Monday that the care facilities are a community asset and a success story that other cities should imitate.
“They are reducing the backlog in your hospital. They are helping people live in the most community-based option available,” he said. “In my opinion this really boils down to nothing more than a ‘not in my backyard' kind of story.”
Friction over adult family homes in Lakewood is not a new phenomenon. But tensions spiked last year when Western State nearly discharged a man with mental illness and charged with murder to an adult family home in the city's Oakbrook neighborhood despite psychological evaluations that ruled him a risk.
The release of Lawrence David Butterfield was postponed after sharp outcry from local officials.
While the Butterfield saga is a noteworthy case in Lakewood's argument, there are other patients discharging into adult family homes and other facilities from Western State with histories of arson, violence or sexual offenses.
In those cases, the state has deemed the patients psychologically stable enough to leave the hospital but ruled they need ongoing care and mental health treatment.
City officials contend state law requires those patients to be served at more secure treatment centers, preferably in non-residential neighborhoods. One type of treatment center that has attracted support for tough-to-place patients are enhanced services facilities. They have more supports, including specialized behavioral health workers and required around-the-clock nursing staffs, among other features.
Washington has only three enhanced service facilities, holding between eight and 16 beds each. A fourth is set to open in September and the state is encouraging more of them — namely with construction money. There are none in Pierce County.
Many on Lakewood's City Council also expressed distrust of hospital officials, saying they are motivated enough to release dangerous people out of Western State that safety worries won't stop them.
Alleged driving factors: It's far cheaper for the state to serve people in community settings, and the hospital has a severe admission wait list caused in part by its inability to discharge patients who are ready to leave.
Lakewood officials have accused the hospital of skirting state law around stringent review of certain dangerous patients before ordering Butterfield's discharge.
"They have every incentive not to be too tough of a regulator because at the same time they need to move the merchandise out of places like Western State," City Councilman Paul Bocchi said on Monday.
State officials have not directly commented on the Butterfield situation, citing patient privacy concerns. But they hold nearly a reverse perspective to Bocchi's on Western State's issues with discharging patients.
Hospital officials argue people discharged from Western State with criminal pasts often have low risk to re-offend under proper supervision. Some are older. They also attribute part of the hospital's backlog to their careful work to not discharge patients to unsafe conditions.
A poor discharge can lead a patient right back into Western State, said Bea Rector, who runs a division at the state Department of Social and Health Services that oversees the process of finding a step-down home for patients who need mental health care.
"We know that they are healthy and safe in the state hospital," Rector said in a recent interview with The News Tribune, The Olympian and public radio's Northwest News Network. "And so until we find that right placement, we are making that difficult decision to have them in the hospital while we continue to build the community resource that will meet their need."
Rector called Lakewood's efforts to block people with certain criminal histories from living in adult family homes "discriminatory."
"There is state and federal law that require for housing to be fair and to not use people’s background as a way of saying, 'You can’t live here,'" she said.
Ficker, of the Adult Family Home Council, said he would estimate fewer than 100 adult family homes in the state serve patients from Western State. Data offered by DSHS show there are more than 2,500 adult family homes in total across Washington.
Because of the discharge troubles, the state has been boosting its efforts to increase the number of beds at adult family homes, enhanced service facilities and care centers as part of a larger strategy to reshape and improve Washington's mental health system.
One branch of Lakewood's lawsuit filed in Pierce County Superior Court on Tuesday is an allegation that Washington is violating the Growth Management Act, which regulates development. The city argues the state is unequally distributing adult family homes, leading to a crush of them in Lakewood and specifically the city's Oakbrook neighborhood.
The GMA stipulates essential public facilities be spread out fairly. Lakewood says adult family homes meet the definition of an essential facility.
Lakewood had 81 adult family homes in early May, according to state data, meaning it has the fifth-highest rate of the treatment centers per capita in Washington.
Vancouver and Seattle appear to have the highest raw total of adult family homes — 153 and 123, respectively in early May — but their populations also are far higher.
In fact, large cities tend to have low rates of adult family homes. Seattle is 35th in the state when comparing its family homes to population. Tacoma is 32nd, Spokane is 33rd and Olympia is 22nd. Shoreline has the highest ratio of adult family homes to population.
"There’s no effort by DSHS to make sure these things are in different geographic areas of the state," said Bocchi, the Lakewood councilman.
A handful of community members from Oakbrook testified before the Lakewood City Council on Monday that adult family homes are beginning to dominate the neighborhood and that they may have dangerous people near them.
A DSHS spokesman would not comment directly on the allegation in the lawsuit that it's violating the GMA, saying the agency wouldn't address the pending litigation.
Yet in a May 9 letter to Lakewood, the assistant secretary of Aging and Long-Term Support Administration for DSHS pushed back on the idea that his agency has control over where adult family homes are.
"The department does not select the location of its contracted providers," wrote assistant secretary Bill Moss. "Where adult family homes are located is largely market driven."
Ficker said a huge determining factor is housing costs, which are higher in bigger cities. Another is building type. Ficker said Oakbrook has an abundance of large one-story houses, which are ideal for adult family homes.
In a meeting with adult family home owners before the Lakewood council meeting, Ficker stressed that Lakewood's ordinances would hurt businesses owners, employees and patients across the spectrum — not just the slice of patients from Western State Lakewood is hoping will go to more secure treatment centers.
Isabela Njeri, 41, is one person who might be affected by Lakewood's moratorium. In an interview after Ficker's meeting, she said she has been working for five years at a facility that helps people who have Alzheimer's disease, dementia and other disorders that affect memory, but recently decided to set up her own adult family home.
She's settled on Lakewood and has been searching since last year for the right property.
Njeri said that if Lakewood successfully blocks her and others from setting up homes, it will leave elderly people with fewer options close to home and less access to one-on-one care.
"They're well taken care of," she said.
On a personal level, she said it would certainly throw a wrench in her long-made plans.
"I would probably have to look for something else to do which is not where I want to go," she said.