OLYMPIA – Washington legislators took substantial steps to reshape the mental-health system, including funding for new facilities, legislation to increase the number of qualified workers, and the creation of new types of treatment centers.
Lawmakers approved the plan – which sprawls across two different state budgets, as well as several other bills – in the legislative session that ended April 28.
The work comes after years of court orders and federal inspections that meticulously documented the poor treatment of psychiatric patients in the state’s care, as well as a steep shortage of treatment beds and staffers to operate them.
“We’ve never had a plan before,” said Rep. Joe Schmick, R-Colfax, part of a bipartisan group of lawmakers who worked on the issue. “Always before, it’s just ‘we’re going to throw money at something and we’re going to put out fires.'”
It remains to be seen how the complex plan comes together in the coming years. Grants will have to be awarded, facilities sited, permitted and built, and staff must be found to run them.
But, “I think we made really big steps toward moving us toward a true community-based mental-health system,” said Sen. David Frockt, D-Seattle, who worked on capital-budget negotiations.
The 2019-21 capital-construction budget spends roughly $33 million for pre-design and design of a new behavioral health teaching hospital at the University of Washington. The facility would train mental-health professionals while also providing as many as 150 treatment beds.
That budget includes about $118 million toward building new facilities, or expanding existing ones, across the state. Among other places, it funds projects in Bremerton, Centralia, Colville, Edmonds, Spokane, Issaquah, Sedro-Woolley, and for the Jamestown S’Klallam tribe.
That money also provides for psychiatric beds at new or expanded community hospitals in Everett, Auburn and Yakima.
Lawmakers included some competitive grant money for projects still to be determined and funds to build a 16-bed state-run facility and a 48-bed facility that would be partly state-run. Also, there is $24 million in the state Housing Trust Fund for residential placements and case management for people struggling with chronic mental-health issues.
The budget also pays for building improvements to the state’s two psychiatric hospitals, Western State and Eastern State.
After years of inspections revealed unsafe conditions, federal regulators last year decertified Western State Hospital, located in Lakewood. That cost the state $53 million in annual federal funding.
The plan calls for most patients committed to the state hospitals through civil courts to be moved into community facilities. But that will take years, and both hospitals are still expected to handle patients coming through the criminal courts in the future.
When looking at Western State, federal inspectors raised several issues over the conditions of the campus’ old buildings.
Lawmakers also included money to improve the campus at Eastern State, located in Spokane County, to make sure it continues to keep its certification, according to Rep. Norma Smith, R-Clinton.
“We want to make sure we’re investing in patient safety, and the successful operating of these facilities,” she said.
That budget also includes $1 million in initial design funding for a new hospital on the Western State campus for patients coming from the criminal court system.
Lawmakers this year also passed a bill that provides the settlement agreement for the federal court ruling known as the Trueblood decision, which focused on people with mental health problems waiting in jail.
To implement that, Senate Bill 5444 makes changes intended to speed up competency evaluations for defendants in jail by boosting staff and starting diversion and outpatient restoration services.
The new two-year state operating package – which funds parks, schools, prisons and other programs – budgets $74 million for the Trueblood settlement.
Overall, the new operating budget sets aside roughly $280 million for mental health, including increases to improve Western State. It also provides money to contract with private hospitals and other operators to provide psychiatric beds and supported-housing.
Lawmakers this year also passed House Bill 1394, sponsored by Schmick, which creates two new types of treatment facilities that can be placed in communities. One is for people with intensive needs, like some of the patients waiting to be discharged from Western State.
The other type, called a peer respite center, is intended to give short-term, voluntary treatment to people, according to Rashi Gupta, a senior policy adviser with Gov. Jay Inslee’s office.
They could help people considered a harm to themselves or others, but who don’t meet the legal threshold to be involuntarily detained through the civil courts process, said Gupta.
“To me, it’s one of the most important things” in the plan, she said.
In addition to the teaching hospital, lawmakers also passed legislation to combat the shortage of qualified mental-health workers that spans both the state and the nation.
Senate Bill 5054 directs the state to establish a reciprocity program for chemical dependency professionals, psychologists, mental-health counselors and others moving into the state. That would allow the state to grant a probationary license so qualified professionals can begin working here while they get their Washington licenses.
Lawmakers also passed House Bill 1668, which encourages behavioral-health workers to take jobs in underserved areas by offering a student-loan repayment program.