Inslee announces 5-year plan to shift civil mental health out of big state hospitals in favor of smaller, community-based facilities

LAKEWOOD — Gov. Jay Inslee announced today he will pursue a five-year plan to modernize and transform the state’s mental health system. At a meeting with hospital leadership, Inslee said he will be working with legislators to expedite efforts to end civil patient placements at the state’s large hospitals by 2023 in favor of smaller community-based facilities that are primarily state-run with some community hospital capacity throughout the state.

Western State and Eastern State will continue to focus on serving forensic and certain hard-to-place civil commitment patients, while other patients will be served in the community through a combination of smaller, more cost-efficient, state-run programs that will be disbursed throughout the state and private community hospitals.

The governor originally proposed this transition in his 2017–19 budget proposal. Western State Hospital, the larger of the two state hospitals, has struggled to keep up with increasing demand for services as well as challenges in finding appropriate placements for patients ready to be discharged. It is the focus of ongoing federal and judicial scrutiny.

“The staff at our hospitals have shown nothing but dedication and commitment to serving these patients. Safety has improved. The quality of care has improved,” Inslee said. “But here’s the reality: We are trying to provide 21st century medical care using a 19th century model of care. Large institutions were popular in 1918, but in 2018 we know smaller hospitals closer to home are far more effective. Through a combination of mostly state-run options, we will be able to serve nearly all our civil patients in smaller facilities that are much closer to home, and much more able to sustain the kind of supports that ensure patients get the right care at the right time.

“I have been so impressed by the dedication and commitment our state employees have shown under the most challenging of circumstances and this is why I believe in transitioning our civil population to state run facilities as much as possible is the best option. Ensuring that we have quality, stability and continuity of care will ensure our success,” Inslee continued.

Inslee was joined at Western State by Department of Social and Health Services Secretary Cheryl Strange, Sen. Steve O’Ban, and Reps. Laurie Jinkins and Christine Kilduff.

Today’s announcement builds on actions that Inslee and the Legislature have taken over the past several years to strengthen the services and care offered at the state hospitals, transform behavioral health by integrating behavioral and mental health, and grow capacity for care in community settings.

Since Inslee came into office, more than $360 million has been invested in state funds for state hospitals. The state has added a combined 72 civil and forensic beds and hired nearly 760 more staff to improve both patient and staff safety and well-being, staff training, and the actual buildings themselves.

Inslee says more money won’t fix fundamental challenges of treating patients in a centuries-old system based on large institutions that take patients away from their families, friends and support systems.

“This is a heavy lift. It’s an aggressive timeline,” Inslee said. “There are upfront costs that mean difficult budget decisions, and local communities will be called upon to do their part in assisting with siting and placement of facilities. 2023 is tough, but doable. And it’s necessary.”

“Governor Inslee has a compassionate and grounded vision of how treating mental illness can be done right,” Strange said. “We must remember that mental illness is treatable. Ensuring that people get the right care at the right time and, most importantly, in the right place — where they are supported by loved ones, friends and their community — is the right thing to do.”

Earlier this year, Inslee signed a bill to overhaul the oversight of behavioral health programs in Washington and integrate those programs with other health care services. Part of that vision includes increasing the number of behavioral health resources available throughout the state, so that patients can receive treatment in their own communities.

“This plan aligns well with the recommendations put forth by the bipartisan Select Committee on Quality Improvement in State Hospitals, which I had the honor of co-chairing,” Jinkins said. “Now the real challenge will be building out what we need in our communities to best serve patients, families, mental health workers, and the public.”

“I appreciate that the governor is being assertive about providing folks on civil commitments with a higher quality of life during long-term inpatient stays in less institutional settings in their home communities,” said David Johnson, CEO of Navos, a community-based organization that provides treatment and support to those with mental health issues and substance use disorders. “In this transition we will need to keep every local psychiatric hospital bed that we currently have as we add the new settings. I am confident that the governor knows that this will be a great success if adequately funded or a great disappointment if his plan does not get the funding it deserves.”

The governor’s 2019–2021 budget proposal will include the policy changes and funding needed to make the transition.

The governor and his staff will work closely with legislators, state agencies, patient advocates, labor and others in the coming months to ensure the plan adequately takes into account the funding and timing to coordinate workforce transition and facility siting and construction.

“Ultimately, we want what is best for these patients,” Inslee said. “Our current mental health system is under tremendous pressure. Our hospitals are struggling mightily to maintain a high level of care and safety while serving rapidly growing numbers of patients who are being referred to our facilities. This change will make a tremendous difference for patients, their families and the people who are charged with their care and their safety.”