The most important step lawmakers could take is bolstering Medicaid rates that enable community mental-health clinics to offer competitive salaries, hire more staff and treat more patients.

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As representatives of Washington’s community mental-health clinics, we read with interest the recent Seattle Times editorial “Time to dig into management problems at Western State Hospital” [Dec. 17, Opinion]. We recognize the need to address the crises in our state psychiatric hospitals and to respond to the federal court ruling regarding timely treatment for criminal defendants found mentally incompetent to stand trial.

However, the ultimate goal of the mental-health system should be to care for people in community settings. Failure to support an accessible, responsive community-treatment system will only feed the cycle of growing demand on state hospitals.

While Western State and other inpatient treatment options constitute vital parts of the system, they are far from ideal settings for the vast majority of people in need of mental-health treatment. We cannot make lasting progress in the mental health system until we balance investments in expensive inpatient care with investments in community-based treatment.

For every 100 patients served in the public mental-health system, only two receive care in state hospitals. The remaining 98 are served by community mental-health clinics, receiving treatment and recovery supports in their home communities that, for many, are the key to helping them avoid institutional level care.

Nevertheless, media attention, policy debate and the lion’s share of new funding remain focused on institutional care, the most costly and traumatic settings in which to provide health care. Instead of waiting until commitment and incarceration are the only options, our system should be focused on getting help to people as early as possible in the course of their illness. This would prevent avoidable suffering, visits to ERs, interactions with the criminal-justice system and expensive hospitalizations. Community mental-health clinics throughout the state are doing these things every day, but adequate resources must be devoted to meet the growing need for treatment.

Over the past several years, we have seen infusions of tens of millions of dollars into the institutional side of the mental-health system. In 2015, we saw close to $28 million; in 2016, $96 million; and in 2017, almost $90 million. Much of the investments were focused on raising hospital-staff salaries or adding more positions. These are important goals, but do they really buy the state a sustainable mental-health system that best addresses the needs of our most vulnerable citizens?

In his 2018 budget proposal, Gov. Jay Inslee requests an additional $100 million for state hospitals, and close to $60 million to expedite evaluations and inpatient treatment for criminal defendants not competent to stand trial.

As community mental-health clinics strive to provide prompt and quality care, we are faced with a growing workforce crisis of our own. Medicaid rates paid to community mental-health clinics are at the bottom of the provider payment food chain. Community hospitals, federally qualified health clinics, and state and local government all are able to offer salaries ranging from 15 to 30 percent higher for comparable positions. Ironically, every wage increase to state-hospital workers puts community clinics further behind in recruiting and retaining professional staff. We do not begrudge the state hospitals the resources they need, but this cannot come at the expense of an adequately funded, responsive community treatment system.

We urge the Legislature to take action in 2018 by focusing on the entire mental-health system, particularly the part of the system that cares for the vast majority of our friends, family and neighbors. The single most important step that policymakers could take toward that end is supporting community mental health Medicaid rates that enable community clinics to offer competitive salaries, hire more staff and treat more patients.

We can and must do better for people living with serious mental illness, the people who love them, the professionals who care for them and the communities in which we all live. It is time to invest in community solutions.