Despite spending millions of dollars to add beds and staff to the state’s mental-health system, state lawmakers and Gov. Jay Inslee continue to confront a shortage of resources and pressure from court orders that psychiatric patients be treated better.

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OLYMPIA — State lawmakers and Gov. Jay Inslee are finding that quickly improving and expanding the state’s mental-health system is no easy task.

Despite earmarking millions of dollars to add beds and staff to the system last year, Inslee and legislators continue to confront a shortage of resources — and pressure from court orders to improve the treatment of some psychiatric patients.

It’s a problem highlighted by the staffing and safety concerns roiling the state’s largest psychiatric facility, Western State Hospital. A federal inspection last fall of the hospital put the facility in jeopardy of losing certification and $64 million in annual federal funding.

The inspection found conditions at the hospital — which is struggling with a shortage of psychiatric doctors and nurses — so severe they threatened patient safety.

The state Department of Social and Health Services (DSHS), which oversees the hospital, learned Wednesday that its plan to correct the issues had been approved by the Centers for Medicare & Medicaid Services’ regional office and the state Department of Health.

But the inspection prompted DSHS to stop the opening of new psychiatric wards, which lawmakers funded in 2015.

Some of those beds were intended to help comply with a court ruling requiring the state to provide better mental-health competency and restoration treatment to people arrested and in jail awaiting trial. That court order came as people were sometimes spending months in jail waiting for psychiatric evaluations or a state hospital bed where they could be treated.

U.S. District Judge Marsha Pechman ruled in April 2015 that such competency evaluations must occur within seven days of being jailed, and the state must provide more psychiatric beds to treat people awaiting trial in order to restore their mental competency.

But in December, only 14 percent of jail-based evaluations met the seven-day deadline, according to a recent DSHS update to the court.

DSHS officials say they are doing as much as they can with the new money — about $100 million in new funding for the 2015-17 budget cycle — to shore up a mental-health system cut during the recession.

“The Legislature has put in a lot of additional resources this last year into the system,” said Carla Reyes, assistant secretary of the Behavioral Health Administration of DSHS. “But it takes a little time to take it to fruition.”

The agency had about 170 fewer mental-health workers in 2015 than in 2008, according to the state Office of Financial Management — and fewer psychiatric beds.

Even the money budgeted by lawmakers last year for 90 new psychiatric beds won’t restore Western State Hospital’s capacity to what it was before the recession.

In 2015, the hospital had 827 beds, down from 947 in 2008, DSHS said. Throughout that time, the state’s other psychiatric hospital, Eastern State Hospital near Spokane, has held steady at 287 beds.

Now, Inslee and legislators are proposing a range of measures, from more funding to more oversight, to get the state out of crisis mode. But lawmakers are more than halfway through a 60-day session, and mental-health fixes are competing against other priorities.

Rep. Hans Dunshee, D-Snohomish, and chief Democratic budget writer, said mental-health spending will be a priority in the proposed House budget to be unveiled Monday.

In a Feb. 8 order, Pechman gave the state more time to comply with her 2015 ruling on competency evaluation and treatment but criticized DSHS for delays.

While she extended the deadline for DSHS to comply until May 27, Pechman gave the state a series of deadlines to deal with certain aspects of her ruling.

It was necessary, she wrote, “Because the defendants have demonstrated that they are unable to achieve anything resembling compliance when left to determine their own time frames and priorities.”

Staffing shortages

Western State Hospital is on a campus in the city of Lakewood. Patients are referred there through the state’s regional mental-health systems, or because a civil court has deemed the criteria has been met to be involuntarily committed. Other patients are ordered there by criminal courts.

The hospital’s staffing and safety problems aren’t necessarily new, said state Rep. Eileen Cody, D-West Seattle.

“I remember having a fight … 20 years ago over staffing at Western (State), and the safety problems,” said Cody, chairwoman of the House Health Care and Wellness Committee. “Sometimes it gets better and then it gets worse again.”

But because of the federal inspection, DSHS Secretary Kevin Quigley in November put the planned expansion on hold. (Quigley announced his resignation in January and Inslee has appointed an acting secretary who will take the position Feb. 23.)

The staffing shortage was so dire that one new ward that had partially opened was closed and its workers dispersed to beef up existing wards.

“Our inability to fill staff vacancies at almost every level has not allowed us to provide the quality of care and the treatment hours our patients need and deserve,” Quigley wrote in a November letter to DSHS staff announcing his decision.

The delayed expansion at Western State included 30 beds for people who got a competency evaluation. In the meantime, the state is temporarily contracting for 30 competency-restoration beds at a facility in Chehalis, which could be available by April.

DSHS officials acknowledge the dilemma.

“We can’t bring wait times down until we have more capacity in the system,” said Reyes, of DSHS.

One bright spot is that nearly all of the nine new positions for workers who evaluate people for competency at Western State have been filled, according to state data.

Officials say the shortage exists because the hospital staff are paid less than those holding comparable jobs, and psychiatric workers in general are in short supply.

To counter that, Inslee in his 2016 supplemental budget has proposed spending $6.8 million to hire 51 more nurses.

The governor also has proposed $9.5 million for bonuses and pay raises to help recruit and retain psychiatric staff. That includes psychiatrists, of which there is a nationwide shortage.

Inslee’s plan also includes $5.2 million for a quartet of 16-bed crisis-triage facilities. Those beds — to treat patients before a spot at Western State becomes necessary — would be split between the eastern and western sides of the state.

In addition to the funding, lawmakers and the governor are examining how the hospital is organized and overseen.

Sen. Andy Hill, R-Redmond and chief GOP budget writer, sent out a policy memo on Feb. 10 on problems at Western State.

Citing data gathered by legislative staff, Hill wrote that patients’ stays in certain types of beds average about a year — nearly three times the average comparable stay at Eastern State Hospital.

Among other things, Hill also suggested taking some of the burden off psychiatrists by using psychiatric nurse practitioners.

Sen. Steve O’Ban, R-University Place, said lawmakers have been working to get more information on how the hospital is managed — and more details on how staff is deployed every day. O’Ban said a staffing model is essential to figuring out what exactly the facility needs.

State senators this month passed Senate Bill 6445, which would clear the way for physician-assistants positions at the psychiatric hospitals.

Over in the state House, lawmakers are considering a bill to increase legislative oversight of the two state hospitals. House Bill 2453 would, among other things, authorize a consultant to review DSHS practices and visit the state’s hospitals.

The proposal is “trying to send the message that we wanted to have more input into what was going on at Western (State),” said Cody, a co-sponsor.

Psychiatric boarding

The issues with the state mental-health hospital and the ruling on competency and restoration treatment have overshadowed another court ruling. In August 2014, a judge ruled that due to bed shortages, the state was unlawfully warehousing psychiatric patients in hospitals.

In those cases, patients involuntarily committed were being boarded in hospitals, often without proper treatment, until a state psychiatric bed became available.

Building capacity

Since the ruling, lawmakers and Inslee have invested millions of dollars to build up the state’s capacity of what are known as evaluation and treatment beds.

While 180 psychiatric beds have been added in community settings — often in hospitals or smaller facilities — at least one of the planned openings has been delayed.

A location for a 16-bed facility originally scheduled to open in Burien late last year fell through, so that center will open in Federal Way in late 2016 or early 2017, said Daphne Phillips, spokeswoman for Telecare, the company that will operate the facility.

Meanwhile, a law passed by state lawmakers last year made short-term stays for psychiatric patients in hospitals, known as single-bed certifications, legal under some conditions. But lawmakers and mental-health professionals acknowledge that it still isn’t ideal.

“That’s obviously not the best place to provide the treatment these patients need,” said O’Ban. But, “I’m confident we’ve funded that adequately, so as more beds come on … we won’t see as many single-bed certifications in the hospitals.”