In Washington state, mental health funds sought as help falls short

The OlympianFebruary 4, 2013 

It’s nothing new: horror stories about people whose mental illnesses turned them into killers; a safety net that failed to catch them; and now, politicians in Olympia vowing to do something.

“There’s suddenly a lot of movement, and it’s sad that it’s taken a series of catastrophic tragedies to start addressing this, but it’s a catalyst,” said Larry Thompson, a therapist at Western State Hospital in Lakewood who said he’s more hopeful for change than he has been in years. “Maybe the iceberg that has been funding for mental health is starting to thaw and break apart.”

Momentum does seem to be building for action on mental health. But state lawmakers still haven’t paid the bill from the last time they acted.

That was in 2010, when they voted unanimously to make it easier to detain potentially dangerous people for treatment of mental illness.

The new standards would have allowed more consideration of a patient’s past behavior for what is known as an involuntary commitment, which now requires some kind of immediate threat or danger. But cost estimates pushed lawmakers to postpone most of those changes until mid-2015.

“We’re seeing the impacts of that. The amount of mentally ill in the jails just awaiting evaluation has skyrocketed,” Thompson said. So many mentally ill inmates have crowded the Pierce County Jail, many while awaiting a Western State Hospital evaluation, that corrections officers are piling up overtime.

“The system is probably as broken as I’ve ever seen it in 40 years,” said Thompson, a member of the Washington Federation of State Employees union who has worked in the mental health field since his days in the Air Force at the age of 18.

Similar sentiments accompanied the 2010 law, inspired by the New Year’s Eve 2007 stabbing death of Shannon Harps in Seattle and a 2008 shooting spree in Skagit County that left a sheriff’s deputy and five others dead.

This time around, the cases include a sleeping father in Tacoma slain with a hatchet, allegedly by his son; a Key Peninsula market shooting, allegedly by a woman who told detectives she wanted to try killing others before she committed suicide; and much farther away in Connecticut, the massacre of children at Sandy Hook Elementary School.

BOTTOM OF STATE RANKINGS

Sen. Karen Keiser, a Kent Democrat, introduced a proposal — Senate Bill 5480 — Thursday to put the more expansive standards for involuntary commitments into effect next January.

Lawmakers will have to find money to do that — or even to start preparing for the July 2015 date, as former Gov. Chris Gregoire called for in her budget.

And money is hard to come by as the Legislature grapples with a shortfall approaching $1 billion and calls for devoting another billion or so to schools to comply with a state Supreme Court ruling. Similar shortfalls in past years have led to cuts that have closed wards at Western State and shrunk options for less restrictive treatment.

The number of state-hospital beds for civilly committed patients as a share of the state’s population has declined by a third over the past 11 years, according to the Legislature’s nonpartisan staff, which said space for patients coming from the criminal system has actually stayed roughly steady.

In the private hospitals where many patients go first, Washington’s number of psychiatric beds per person in 2009 trailed 46 other states, according to American Hospital Association rankings cited in a state-commissioned study. It is generally believed that the shortage of beds in those community treatment programs is contributing to the surge in mentally ill inmates at jails.

18 MONTHS: $22 MILLION?

The changes now postponed until 2015 would have added up to an extra 2,700 short-term commitments a year, on top of the 7,500 in 2009, according to the study by the Washington State Institute for Public Policy. That would require up to 168 more short-term beds across the state and up to 25 beds at Western and Eastern state hospitals.

One estimate had put the cost to the main state budget at $22 million for the first year and a half.

The Washington chapter of the National Alliance on Mental Illness advocacy group disputes the state cost estimates as too large, and wants to implement the changes sooner. So do lawmakers such as Democratic Rep. Tami Green, whose district includes Western State.

“We’re seeing heavier and heavier demand for services with nothing for people to go to unless they’re in crisis,” said Sandi Ando, chairwoman of NAMI Washington’s public policy committee.

PAYING FOR THE EXTRA BEDS

Lawmakers like Green and Puyallup Rep. Dawn Morrell, who chairs a panel on human-services funding, see an opportunity in new federal money that is about to flow to Washington if their fellow Democrats have their way.

Many previously ineligible psychiatric patients will suddenly be eligible for Medicaid health insurance if the Legislature decides to accept the funding in President Barack Obama’s health law. But the strings attached to the funding worry many Republicans, including responsibility for matching a fraction of the money in the future.

That funding would free up state money going to the same patients now. Depending on decisions legislators make, the two-year savings for mental health could top $60 million, the Legislature’s staff estimates.

“The fight is going to be: I’m going to want to keep that $60 million in mental health, and other people are probably going to want it to go other places,” Green said.

In her final budget proposal before leaving office, Gregoire proposed devoting about $52 million in new state and federal funding to mental health. She called for getting ready for the 2015 rules by restoring two 30-bed state-hospital wards and opening several new facilities, including three 16-bed facilities for mental evaluations and short-term commitments, and 42 beds spread among multiple small facilities that would be alternatives or follow-ups to hospital commitment.

The Legislature long ago authorized, but never funded, those alternative sites.

Gregoire’s successor, Democrat Jay Inslee, is developing his own budget plan. Health officials in his administration’s Department of Social and Health Services are rethinking the call for new wards, they told lawmakers at a briefing Wednesday, considering responding to the increased need with more outpatient treatment instead.

Similarly, Cheri Dolezal, director of the mental-health network that serves Pierce County — one of 11 throughout the state but the only one run by a private company, Minnesota-based OptumHealth — told lawmakers Wednesday that they should spend money on alternatives to involuntary commitments. She said her network would like another triage unit like the one it operates in Fife that mostly serves voluntary patients.

Green wants to focus on outpatient care that doesn’t require more hospital beds, but does involve detaining potentially dangerous patients. She calls for creating a new category of court-ordered care, this one for outpatient treatment and modeled on those of other states including New York, whose so-called Kendra’s Law is named for a woman who was pushed to her death in front of a subway train.

Green, a nurse who treats mentally ill patients and has dealt with her own depression, said people with mental illness are more likely to be the victims of crime than the perpetrators — but said she isn’t one to turn down an opportunity to address the need.

“Sadly, tragedies like Sandy Hook and all the gun shootings we’ve had, and tragedies we’ve had here, are sort of what’s giving people the political will to make things happen,” Green said.

LATEST SOLUTION

Lawmakers could move to make it easier to commit people like Jonathan Meline, who, months after a release from Western State, was sent back there on charges of killing his father as he slept in their Tacoma home.

His case presents special circumstances because Meline, like several others in recent cases being cited in the Legislature, had been charged with crimes before but was found incompetent to stand trial.

The standards for incompetency are different from those used to commit patients. Prosecutors have proposed tying the two areas together for situations when mental illness forces them to drop a violent felony charge. Under their proposal, being shepherded by Rep. Jamie Pedersen, D-Seattle, and Sen. Jim Hargrove, D-Hoquiam, a court would have a separate, lower standard for committing someone whose mental illness makes similar criminal acts likely.

The proposal, in the form of House Bill 1114, is scheduled for its first vote Tuesday in a House committee.

Prosecutors say a relatively small number of offenders would be affected. Still, mental-health advocates say some money would be needed to expand beds to meet the new need. The prosecutors’ state association agrees, said its executive leader, Tom McBride — although he argues that without the law, released patients who end up back in the legal system are costly in other ways.

“We’re spending a lot of money on them now,” he said.

Another solution would provide for certain mentally ill patients who are now being considered incompetent to stand trial to be declared “guilty and mentally ill” and sentenced to prison, while also receiving treatment. It’s proposed by Sen. Mike Carrell, a Lakewood Republican and chairman of the Human Services committee. He says it would save money by housing offenders in prisons instead of special secure — and costly — wards at state hospitals.

Civil-liberties advocates and defense lawyers oppose both, saying they would deny patients due process.

“They’re looking for a simplistic answer to a complex problem, and that’s the difficulty here. Everybody wants the silver bullet and there isn’t one here,” said Bob Cooper, a lobbyist for defense attorneys.

Carrell also wants to convene a task force to rethink the whole mental-health system. He said money is only part of the problem.

“If we’re spending $180,000 a year for the average person at Western State Hospital,” Carrell said, “it’s pretty hard to say we’re not spending a lot of money on it.”

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