Why limit our treatment options to just Western and Eastern state hospitals? Why not create a more regional model of care, with more community-based facilities?
NEWLY appointed Western State Hospital CEO Cheryl Strange was facing possible jail time for refusing to comply with a court order to admit a patient currently being held at a Pierce County community hospital. Western State is full, and Strange said she wouldn’t override the hospital’s waiting list, where other patients who are sicker have priority.
The problem at Western State is capacity to house patients, not the decision-making of its leaders. The decisions Strange, as CEO, is making are the same ones hospital leaders and clinicians make daily. Our ethical obligation, always, is to treat the sickest patient first. Treating a patient with a broken leg before a patient with a heart attack would be ethically untenable. Mental illnesses have the same variations in urgency that physical illnesses do.
The threat to jail Strange does not solve the problem, and we are relieved the court has indicated it agrees. That said, we do strongly agree with Pierce County Superior Court Commissioner Craig Adams, who is overseeing the case, that more must be done.
The legal mandate for reform is in place. Adams has a long history of working with mental-health patients, and his insistence on fixing the system is right on. Three years ago, he sent a case to the state Supreme Court, which then ruled clearly that keeping people in a hospital without treating them is a violation of their civil rights.
While some change has happened, Western and the state’s mental-health system have not made the reforms needed to meet this fundamental obligation.
One challenge is getting patients into the state’s hospitals. Patients on commitments of more than 90 days need to be transferred to Western or Eastern state hospitals. Right now, about 70 people are on the waitlist to get into Western State. When patients can’t leave community facilities to be transferred to Western State, other patients who need shorter-term psychiatric services cannot get in to the community facilities.
The flip side of the challenge is getting people out. There are many people who are stable enough to leave Western State, but the process for assessing and placing patients who are ready to leave is intolerably slow. We don’t have enough facilities or housing for people with chronic mental illness, partially because the state’s payment rates are insufficient to maintain safe facilities and hire enough qualified staff.
Western State also cares for patients with dementia, which compounds the problem. Keeping people with dementia at Western State freezes up scarce beds, and is not the best place for patients who would likely do better in a long-term-care center in their home communities.
The answer is not, of course, expansion of Western State as the sole solution for patients in mental-health crises. Currently, all patients who need longer than 90-day treatment are supposed to be in either Western or Eastern state hospital. But why limit the options? Why not create a more regional model of care, with more community-based facilities?
One of the reasons this doesn’t happen is the state’s approval process for new facilities. Across the state, hospitals are proposing to add psychiatric capacity and open new psychiatric units. But despite strong community support and investment of state capital funds, these projects often get mired in state approval through the “certificate of need” process.
Commissioner Adams has scheduled a hearing to address issues in the mental-health system as a whole. Issues on the table include the wait to get into Western State and the difficulty in transferring out. The commissioner also wants to understand the impact on local hospitals when they must keep psychiatric patients who are not admitted to Western State. The Washington State Hospital Association has been ordered to participate and will do so enthusiastically.
Gov. Jay Inslee, the Legislature and the state Department of Social and Health Services also need to provide strong leadership. The future of Western State is in danger of becoming a partisan or politicized issue; it should not.
We must provide better, more humane care to people experiencing a mental-health crisis. Washington’s community hospitals look forward to being part of the solution.