Psychiatric need here is clear, but who will fill it?

The state Department of Health is being asked to consider whether there’s a need for more psychiatric care in Pierce County.

That should be a foregone conclusion. The only question is who should fill that need.

Two candidates have stepped forward seeking approval for proposals by filing certificates of need: a joint venture between CHI Franciscan and MultiCare health systems, and Signature Health Care Services LLC, a for-profit company that operates health care facilities in the East. Two other for-profits have also expressed interest by submitting letters of intent with the department.

Compared to other urban counties in Washington state, Pierce is woefully lacking in psychiatric beds: The joint venture estimates that ratio at 2.8 per 100,000 compared to King County’s 27.1 per 100,000 and the statewide ratio of 14.2 beds per 100,000. Combine that with the ruling in August by the Washington Supreme Court that it’s unconstitutional to park mentally ill patients in hospital emergency departments for lack of psychiatric beds. It becomes clear that Pierce County’s need for expanded mental health care is dire.

The Franciscan-MultiCare joint venture looks particularly appealing. These are reliable, well-funded health systems with long track records in Pierce County. They propose building a $41 million, 120-bed nonprofit psychiatric facility on the Allenmore Hospital campus, a centrally situated location in Tacoma with convenient freeway access. Their plan would almost double the number of psychiatric beds in the county.

It makes sense for the county’s two biggest health care providers to be interested in providing psychiatric beds. It’s their emergency departments that feel the effects when obviously impaired individuals cannot be moved because there are no state-approved beds available.

And the project pencils out better since enactment of the Affordable Care Act, which creates a payment source that wasn’t available before.

It used to be that Medicaid dollars couldn’t go to large facilities treating more than 16 involuntarily committed patients; the joint venture proposes to offer about 60 involuntary beds and 60 voluntary. But a waiver from the federal government under the ACA now allows Medicaid reimbursement to larger facilities for short-term care as a less expensive alternative to medical hospitalization.

If any of the proposals are approved, South Sound lawmakers should work to ensure that the state doesn’t use the facility as an excuse to pull back on mental health funding to Pierce County. These beds must be considered badly needed additions to the number of psychiatric beds.