The state runs two mental hospitals. Eastern State near Spokane has had far fewer problems than Western State in Lakewood, which has officials looking to replicate its strengths.
Maybe an institution that is the target of multiple lawsuits and less than four years removed from a patient-on-patient strangulation can’t be labeled a model.
But by some comparisons, Eastern State Hospital near Spokane has a leg up on its counterpart across the Cascades.
Staffing is less thin there than at Lakewood’s far larger Western State Hospital, where federal inspectors have identified a slew of safety risks caused, in part, by a lack of trained staff.
And for some reason, it takes patients on the west side of the mountains roughly three times as long to make their way in and out of state-hospital detention. Those figures have caught the attention of state lawmakers.
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“It’s not that I think that Eastern is the perfect model of all mental-health care in the world,” said state Rep. Laurie Jinkins, D-Tacoma, “but doing some of the things they’re doing, especially with ward size … if we aim ourselves in that direction, it’s the right way to go.”
Wards at Western State Hospital were filled to an average 98.2 percent of capacity this past month, according to figures compiled by legislative staff.
Eastern State Hospital used 79 percent of its wards’ capacity.
State Senate budget chairman Andy Hill, R-Redmond, wants to lower the number of patients per ward at Western State to the levels seen at Eastern State, while keeping the number of employees per ward steady.
“Let’s steal that from Eastern,” Hill said.
Hill’s plan calls for freeing up the space by stepping up efforts to find a facility that will take 30 geriatric patients from Western State.
With a smaller load for each employee, he predicts fewer injuries to staff and better care that speeds exits from the hospital.
Last fiscal year Eastern State had 15 percent more full-time-equivalent employees per patient than Western State, according to a staffing report from the Department of Social and Health Services (DSHS) that manages both hospitals. The report notes the figures predate staffing increases Western State made in response to federal inspections.
“If Western were staffed like Eastern, we’d be spending about $20 million more a biennium on staff,” said Andi Smith, a senior policy adviser to Gov. Jay Inslee.
The staffing gap between the hospitals is roughly the same whether counting budgeted positions or actual spending, so the recent increase in vacancy rates at Western State isn’t necessarily to blame.
Having fewer staff for each patient makes Western State a less costly place to treat a patient and would be a good thing if it simply indicated economies of scale at a larger facility.
But the staffing report shows fewer front-line staff — nurses and nursing assistants — working on a typical Western State ward than one at Eastern State.
Just three shifts out of 27 the report shows at Eastern State have lower target staffing levels than shifts covering similar units at Western State.
Democrat Inslee shares Hill’s goal of reducing the number of patients per employee, but he wants to achieve that goal by adding staff, including more than 50 nurses.
Hill hasn’t ruled out additional staff but points to recent infusions of money after years of cuts. He said he has had difficulty learning reasons from administrators for the differences between the two hospitals.
Inslee wants more than $1 million for a series of studies and planning efforts at the hospitals. Carla Reyes, DSHS assistant secretary for behavioral health, said some of the research would identify industry practices and examine differences between the two hospitals.
Reyes said the staff levels the hospitals target today are based on historical levels rather than some ideal practice.
“We haven’t been able to spend a lot of time analyzing the differences, but it is something that we want to look at,” she said.