Just throwing money at Western State Hospital not working

A Western State Hospital patient has been charged with second-degree assault after allegedly biting off part of a nurse’s ear.
A Western State Hospital patient has been charged with second-degree assault after allegedly biting off part of a nurse’s ear. AP Photo

The mental health care system in Washington is a mess and has been for a long time.

No one should be surprised by this week’s announcement by federal watchdogs that Western State Hospital has lost its certification and $53 million in funding. The feds essentially put the hospital on probation three years ago.

But all taxpayers should be alarmed that the state, starting July 9, must pick up the nearly 20 percent share of the hospital’s budget previously covered by Uncle Sam.

According to the latest inspection of the nearly 150-year-old facility in Lakewood, conditions have improved but still don’t comply with four of 26 broad health and safety standards.

Notes from regulators with the Centers for Medicare and Medicaid Services reveal a litany of infractions at Western State, ranging from restraining a patient for hours without cause to an insufficient number of sprinklers in parts of the hospital.

The report begs the question: Just who’s in charge at the 850-bed psychiatric institution?

Suffice it to say leadership has been a revolving door. The recently appointed interim CEO, David L. Holt, is the hospital’s fourth leader in less than 2 ½ years.

Turnover at the top is emblematic of the growing shortage of providers and support staff up and down the public mental health safety net. Psychiatric medicine receives the least amount of reimbursement dollars, which leads to non competitive salaries.

But money is only a piece of this systemic pathology. In the last four years alone, the Legislature has allocated $286 million to increase pay and make other changes at the problem-ridden hospital. Results have been spotty at best.

Psychiatric inpatient admission is just one leg of a three-part treatment model. The other components are permanent, supportive housing and steady outpatient monitoring. Until all three pieces are addressed, Washington’s mental health crisis will continue.

Gov. Jay Inslee said he sees the federal sanctions as a chance to push forward on a major expansion of community beds for civilly committed patients.

He’s right about the need to spread such treatment around the state. With only three enhanced-service facilities holding between eight and 16 beds each, most Washington residents afflicted with mental illness have nowhere to go.

One consistently strong voice in the Legislature on this subject is Sen. John Braun, a Republican budget writer from Centralia.

Braun pushed this year for a public vote on $500 million in bonds to build community mental health treatment centers, but his fellow lawmakers didn’t advance it. This week’s bad news ought to provide fresh urgency.

It’s easy to fault state officials for being short sighted, and ultimately the buck stops with Inslee.

But the truth is that local governments have also failed to do enough for a vulnerable population. One of the most telling examples was the Pierce County Council’s vote in 2016 rejecting a modest .01-percent sales tax increase for local mental health services, which most Washington counties already impose.

Others have let fear and NIMBYism prevail.

In May, the Lakewood City Council approved a moratorium on business licenses for new adult family homes, an ordinance meant to protect neighborhoods from taking on more than their share of individuals discharged from Western State.

The reluctance is somewhat understandable, given Pierce County’s history as a so-called “dumping ground” for state prisons and institutions.

Communities are also wary of Western State in light of occasional escapes, such as when two criminal patients – including one accused of murder – exploited lax security in April 2016.

But more than 40 percent of the hospital’s 500 or more civil patients have been deemed healthy enough to leave; they’re just waiting for permanent, supportive housing. Since most can’t live independently or with family, they tie up hospital beds that could be used by people in crisis.

And so the gridlock continues.

Here in the 21st century, one would hope the days of people languishing behind walls of overcrowded mental institutions are far behind us, but to our shame, that’s not the case.

It will take more than money to change this. It will take the collective will of the governor, state legislators, DSHS managers and local communities to build a new treatment paradigm.

Under this model, our state’s two psychiatric hospitals will focus on criminal and high-risk patients, while the larger population of civil patients are stabilized in decentralized settings closer to home.

Inslee’s five-year plan to make the transition needs to be fast-tracked, with bipartisan support from influential legislators like Braun.

This mess must end.