Gov. Jay Inslee speaks at Centralia College in June 2017.
Seeking to reverse the multitude of crises that have engulfed Washington's mental-health system, Gov. Jay Inslee on Tuesday released a plan that would radically reshape the care of patients.
Inslee's $675 million proposal would fund hundreds of new community mental-health beds and create a partnership with the University of Washington to establish a new teaching hospital focused on behavioral health. It would boost the ranks of mental-health workers, who have been in short supply, and provide long-term housing options to ease the bed shortage.
The plan for the 2019-21 budget -- which lawmakers will begin to draft in January -- comes after years of court orders and federal inspection findings that highlight the suffering and unlawful treatment of Washington's mental-health patients at the hands of the state.
"We know we need to transform our mental-health-care system," Inslee said Tuesday at a news conference at the Navos Mental Health and Wellness Center in Burien.
"For too long, we've had too long of a line of people who need to get into the door of mental-health-care treatment," he added.
Lawmakers and the governor in recent years have poured about $900 million into the mental-health system, even as troubles have continued. Legislators in both parties have broadly agreed that vast improvements are still needed.
Still, lawmakers have many other budget priorities, as does Inslee as he entertains the prospect of a 2020 presidential bid. His include a clean-energy package to bolster his long-stalled environmental agenda.
The governor is expected to unveil his full budget plan Thursday, including details about how he'd pay for that plan and his mental-health proposal.
The state Supreme Court in 2014 found that Washington unconstitutionally kept psychiatric patients in setting likes emergency rooms without proper treatment because of a lack of bed space, a practice that in some cases continues.
Another judge in 2015 ruled in favor of a lawsuit brought on behalf of people housed in jails for weeks and months at a time while awaiting competency services for their mental-health issues.
At the heart of those and other troubles is Western State Hospital, Washington's largest psychiatric facility. The approximately 850-bed hospital has weathered years of alarming federal inspection reports over its levels of safety and patient care, as well as the outdated buildings on its sprawling Lakewood campus.
State officials wrestled for years to correct those problems. But the U.S. Centers for Medicare and Medicaid Services this year decertified Western State, costing Washington more than $50 million in annual in federal funding.
The governor previously announced his intention to close the civil wards at Western State and its sister hospital, Eastern State, near Spokane. Most of those patients -- sent to the hospital through the civil-commitment process -- would be moved into the community. The hospitals would continue to treat patients getting treatment as part of a criminal case or who have been found not guilty by reason of insanity.
Inslee's new plan, which first must pass the Legislature, would begin to add hundreds of beds for those civilly-committed patients, who suffer from diagnoses like schizophrenia.
It provides $110 million in grants to community hospitals and other facilities to create a total of more than 500 new beds. Those beds would help divert patients from going into state hospitals or take patients waiting to be discharged.
The proposal provides some funding for the design of four 16-bed facilities, two 48-bed facilities and three 150-bed facilities. Those would be state-owned and operated and spread across Washington at yet-to-be-determined locations.
Also included is some design funding for a new teaching hospital at the University of Washington that would focus on both training for behavioral-health medical staff and providing needed beds.
At the news conference, Jürgen Unützer, chair of the Department of Psychiatry and Behavioral Sciences at the University of Washington, said the school was "super excited to roll up our sleeves and get to work with all of you on this problem."
Western State would be temporarily shored up under the plan, with $56 million for improvements to that facility and Eastern State, which is in Medical Lake.
Inslee also provides some design funding for a new hospital to treat patients coming from the criminal system. The Department of Social and Health Services, which oversees the state hospitals, earlier this year pitched that idea as a replacement for Western State.
The hospital's buildings include broken or outdated fire-suppression systems and so-called "ligature risks" -- such as places in bathrooms and bedrooms where patients could potentially strangle or hang themselves.
Even Western State's dedicated building for criminal-competency patients -- completed in 2020 -- might not pass muster with current national hospital standards.
As well as being decertified, Western State has recently seen an increase in patient assaults on staff. Because of the shortage of beds in Washington, 71 civil patients in late November were on a waiting list to get into Western State. Meanwhile, 189 patients currently there could be discharged if there were beds in the community.
Inslee's plan also provides $4 million to help add mental-health professionals like psychiatrists and care workers, who have been in short supply.
Some Republicans Tuesday criticized the governor's focus on building more state-run hospitals, which are likely to use union labor.
Sen. John Braun, R-Centralia and the top GOP lawmaker on the Senate budget-writing committee, said legislators should focus on helping to build community mental-health centers that would be run by private or nonprofit organizations.
"He's still talking about multiple, state-run hospitals around the state, and I would strongly argue that that is not the most cost-effective and medically effective," said Braun.
Community-health centers "can provide the type of services we need, close to their [patients'] doctors, close to their families, and none of them are run by the state," he added later.
Braun said he liked the idea of the partnership with the University of Washington, as well as more state funding in general to build new facilities.
Tuesday's plan represents a shift by Inslee, who had previously focused on opening smaller 16-bed facilities to expand the number of psychiatric placements. A federal law has long prevented Medicaid from reimbursing for mental-health care at facilities with more beds than that.
But last month, the Trump administration announced that states would be able to seek waivers from that law to give more treatment to those with serious mental health issues. Inslee said he hopes that will make it possible to build the larger facilities in his proposal.
The governor also acknowledged the challenges for getting approval in the communities across the state for a large number of 16-bed facilities.
It could still be difficult to get communities on board with his plan.
Said Inslee: "We're going to need to talk to neighborhoods and communities to make sure they're comfortable with those provisions."
