How WA is trying to get kids in mental crisis out of hospitals

For years, some of Washington’s most vulnerable youths have wound up stuck inside hospitals without the services they need. 

Instead of being paired with a therapist, receiving timely behavioral treatments or getting medication, thousands of Washington kids with psychiatric diagnoses have been hospitalized in small windowless emergency rooms or hospital units — some for weeks or even months at a time. 

Part of the reason kids end up warehoused is because Washington has added too few specialized long-term beds that could benefit those who struggle to stay stable living at home. These beds are expensive, and existing facilities have faced high employee turnover. Piecing together outpatient alternatives is also tough, leading some families to leave their kids at emergency departments without plans to bring them home.

Following a Seattle Times investigation, lawmakers passed legislation in 2023 that gave the governor’s office new power to get kids out of hospital wards and into proper treatment. The law created a position tasked with coordinating kids’ care. 

Taku Mineshita was recently hired into this new role. Mineshita, who brings a decadeslong career in social services including several years at the state’s Department of Social and Health Services, recently spoke with The Seattle Times about how he balances oversight duties with his charge to smooth families’ path to treatment. 

“We have expected [children, youth and their families] to adapt and change and navigate our really complex system,” he said. “I truly believe it’s the system that needs to evolve and change.”

This conversation has been condensed and lightly edited for clarity.

What interests you — professionally or personally — about advocating for vulnerable youth and their families?

“I’m originally from Japan, and English isn’t my first language, which has deeply influenced my personal and professional journey. Being an immigrant has expanded my understanding of racial equity and social justice, and I carry those values with me in my work today.”

Hands-on field experience, he said, sparked his interest in a career focused on systemic change. From 1999 to 2009, for instance, he worked in a Children’s Long-term Inpatient Program unit, a public program that serves Washington kids ages 5-17 who have such intense behavioral health needs that it’s unsafe for them to live at home. “What I took away from there is how complex it is to work [in] the inpatient psychiatric [setting] at the highest level of intensity. It was clear to me that there were gaps in our system for children, youth and families.”

What should Washingtonians know about your new role in the governor’s office?

“My job is to work with the [state] Health Care Authority, DDA (Developmental Disabilities Administration), DSHS [and] DCYF (Department of Children, Youth, and Families) to create an environment where we can come together as a cross-systems team to hold care conferences” for children in crisis, he said.

Although government workers in DDA, DSHS and elsewhere have long been responsible for ensuring access to a bevy of youth services, before the creation of Mineshita’s new role, no one was charged with keeping these agencies in check.

The care teams he now helps oversee, he said, should be “collaborative and try something new, knowing that what we have been trying for children, youth and families has not been working.”

The teams are charged with finding ways to discharge youth from emergency departments or supporting them through other means, like securing a more permanent placement for those who are in foster care and need long-term psychiatric care.

“My job is not just to hold care conferences and problem-solve one child at a time,” he said. “That is certainly a huge part of my job, [but so is] learning from each struggle so we can accumulate data, understand the patterns and identify the barriers and lack of services and resources so we can say ‘Hey, here’s the direction we can head to.’ ” 

What power do you have to make change for kids stuck inside hospitals?

With the passage of House Bill 1580, the position Mineshita now holds was created with the power to direct agencies to provide kids in need with timely and appropriate services. “It is a bold approach,” he said, that tries to “resolve an historical and persistent issue.”

It’s tough for individual government agencies to coordinate with one another, he said. His position should help improve communication.

“Being able to say that we will commit to building human-centered, data-driven, integrated systems of care with children, youth and families at the core of every decision — if a governor’s position can say that to agency representatives, that means a lot.”

Is access to mental health and other resources getting easier for Washington kids in crisis?

“There is a lot of work we can do to streamline access to systems of care. Children, youth and families have been struggling because of the complexity in navigating these services,” he said. Families are often left wondering whether they qualify for certain benefits, he said, or they might struggle to locate a provider who takes their insurance or has an opening.

“Part of the solution is not just about increasing the resources, it’s to simplify the process,” he said.

Do you have any updates about how many Washington youth are still getting stuck inside hospitals?

During the initial conferences Mineshita attended in his new role, the topic of conversation was often “those children who had been staying [inside hospitals] without medical necessity for literally 150 days,” he said. “We do still see those children and youth,” he added. But more and more, he said, hospitals across the state have begun asking for help before a child has been hospitalized for a long period.

“We have been starting to see those at-risk cases as well as those who are already staying at the hospital. My hope is that we build a system that intervenes much earlier. Families go through so much before they get to the emergency department and children’s hospitals contact us saying, ‘We have a problem.’ ”