OLYMPIA — State officials have struggled for years to reduce violence at Western State Hospital, Washington’s largest psychiatric facility.

In 2018, for instance, one patient at the roughly 850-bed hospital in Lakewood, Pierce County, assaulted three other patients before punching a nurse and stomping on her face. Another patient allegedly vaulted across a nurse’s station to choke a staffer and bite off part of her ear lobe. Hospital workers even staged a rally calling for safety improvements.

Now, the hospital is set to open a pair of newly renovated psychiatric wards to try and reduce by half the violence coming from a handful of patients deemed most dangerous.

“It’s usually the top five to 10 patients that are doing a huge percentage of the violence,” said Jenise Gogan, a director with the state Department of Social and Health Services (DSHS), which oversees the hospital.

A 10-patient ward — set to open Monday — will combined increased staffing, more therapy for patients and tighter security to help stabilize and treat those who are hardest to handle. Known as the Specialized Treatment, Assessment and Recovery (STAR) ward, it will include video surveillance and higher staffing levels to help provide greater safety.

The idea is for patients to get more attention and intense treatment than they receive on the regular wards, with the goal of improving their condition within 90 days. Then, those patients could be moved to the other new ward, which would house 20 patients to keep them stabilized at their improved level, according to Gogan. That ward is slated to open in May.


A psychiatrist and pharmacist will work closely with patients on those wards to make sure they’re getting the right treatment, she said.

The project is being paid for with $22 million that’s included in the current, two-year state-operating budget, according to Gogan. Western State created dozens of new positions to operate the wards, including security personnel, institutional counselors, nursing staff, mental-health technicians and others.

The wards are intended for patients who have been civilly committed to the hospital by a judge,  and for those who come to Western State after being charged with crimes, but are not competent to stand trial. Some are ultimately transferred to the hospital’s less-secure civil side.

For 2019 through November, there were 470 assault-related injuries reported on patients at Western State, according to DSHS. During that time, hospital officials reported 463 assault-related injuries to staffers.

Lawmakers and Gov. Jay Inslee are hoping to eventually move all of Western State’s civilly committed patients to new community facilities, many of which have yet to be built. Approved last year by lawmakers and Inslee, a new plan would reshape the state’s mental-health system. That plan envisions using the Western State campus ultimately for patients coming from the criminal system.

But for at least the next few years, officials must find ways to keep Western State’s civil wards functioning. The hospital has endured a host of struggles in recent years; federal regulators decertified the hospital in 2018, over a variety of safety and other issues. That move cost Washington $53 million in annual federal funding.


The hospital is now finalizing its list for the first 10 patients to enter the new STAR ward, according to Gogan.

Broadly speaking, the most violent patients are in their 20s through mid-30s and often have histories of substance-abuse or schizophrenia, she said.

Hospital officials will evaluate how effective the program is for reducing violence. But in the toughest cases, patients might only see degrees of improvement.

“If before you were hitting people so hard they went to the hospital, and this week you’re just screaming and punching the wall, that’s progress” said Gogan, adding later: “We don’t expect the violence to go down right away, obviously. But over time, with those treatments, we expect to make an impact.”