Mental health spending gains ground

Legislature working to rectify overtime costs and shortage of professionals at state hospitals

Staff writerApril 7, 2013 

The social safety net became ground zero last week for a fierce debate in the Legislature over how to fund schools, but there was consensus among lawmakers on at least one social service: treating mental illness.

“We had to put some resources there, or there would be no room at the inn for people who were in serious trouble,” Hoquiam Sen. Jim Hargrove, lead budget negotiator for the Democrats, said Friday night after senators approved the Republican-flavored plan.

But major funding has yet to be secured for one of the most critical problems in the mental health system: Bottlenecks that have left patients languishing in emergency rooms and jails. House Democrats said their plan would do more.

The Senate proposal and Democratic Gov. Jay Inslee’s spending plan both spend nearly $16 million to avoid making the backlogs worse as lawmakers loosen standards for detaining patients with mental illness. Existing standards are seen as too high to catch some dangerous people.

A second area of common ground in the two budgets is an immediate $2.6 million state outlay to cover state psychiatric hospitals’ unexpectedly high overtime costs, along with three to four times that sum over the next two years for fences, metal detectors and other equipment, and five- to six-dozen extra nurses and security personnel.

Past years’ budget cuts placed workers on unpaid furloughs, leaving holes in hospitals’ schedules even as they scrambled to ramp up staffing to respond to a pair of homicides last year at Western State Hospital in Lakewood and Eastern State Hospital near Spokane. Western State also experienced a suicide, and Eastern State briefly had its accreditation suspended.

“You can’t flip a switch and hire new staff,” Jane Beyer, head of behavioral health within the Department of Social and Health Services, said in an interview, “so you need to ask your existing staff to work more.”

The result of all the overtime? “Both of the state hospitals are overspent by millions of dollars,” Beyer told lawmakers at a recent hearing. She didn’t provide the exact figure by press time, but said monthly overtime costs varied widely from a bit more than $300,000 in April 2012 to more than $1 million in December.

Those putting in extra hours included some Western State employees who volunteered to go over the Cascades to work at Eastern State during their Christmas holiday, Beyer said.

NO HOSPITAL WARDS

The most costly part of the Senate’s and Inslee’s budgets for mental health is the new standards for involuntary commitment of patients. Lawmakers voted to change the rules in 2010 but never funded them. This year the House and Senate have agreed to let the changes finally take effect in 2014.

The new rules would allow more consideration of patients’ past behavior in addition to the immediate threat they pose.

To cope with the influx that is likely to result, DSHS plans to add three freestanding 16-bed evaluation and treatment centers.

Similar facilities exist around Washington, including in Pierce County. DSHS officials and lawmakers including Hargrove and Puyallup Democrat Dawn Morrell, a budget writer in the House, see them as an attractive alternative to state hospitals because they can pull down federal matching money that the hospitals can’t.

Lakewood Democratic Rep. Tami Green said she hopes to make sure the three facilities go to the Puget Sound and Spokane areas.

None of the budget plans in play would open more wards at the state hospitals. Nor will the House push for more wards, Morrell and Green said. “Our philosophy is to stabilize the state hospitals — stop adding, taking away,” Green said.

DSHS also expects to avoid opening wards for the influx of hospital patients expected under a bill pushed by prosecutors that has passed the House and Senate in different versions this year, dealing with suspects found incompetent to stand trial on criminal charges.

The measure would set a less strict standard for extending the detentions of people who have been found incompetent and whose mental illness makes similar criminal acts likely — people like Jonathan Meline, accused of killing his father as he slept in a Tacoma home after Meline’s release from Western State.

DSHS said it would seek to release many of the newcomers under the bill into court-ordered “intensive support services.”

Those are likely to include psychiatric and drug treatment, monitoring to make sure they take their medications, and housing and educational help. Beyer said the concept is modeled on a successful program for inmates leaving the state prison system.

Beyer, lawmakers and prosecutors all said they expect the less-restrictive settings could be fine for many, though not all, suspects and could prevent them from becoming dangerous.

“If you put the funds into a less-restrictive alternative, it can be safe,” said Tom McBride, executive leader of the state prosecutors’ association.

He cautioned that budget writers shouldn’t expect to save money by using the alternatives. “You don’t want a good policy bill that fails because we didn’t fund the impact.”

The Senate and governor’s budget writers did not include money for the measure, but Hargrove said the Senate’s omission was connected to a changing price tag. It’s currently projected to cost the state about $1.3 million.

STILL WAITING AT HOSPITALS, JAILS

A trickier goal is helping patients who might already be eligible to be committed, but who sit in local emergency rooms because of a lack of space.

No budget plan so far has called for additional evaluation facilities to take the burden off emergency rooms, but Green said Friday that House Democrats’ budget is likely to have capital-construction money for new facilities in the form of competitive grants. Rural hospitals should be able to take advantage of that money, she said.

Another proposal that might help with the backlog: The Senate budget calls for nearly $1 million for a DSHS-backed measure passed in different forms by both the House and Senate that would start the process of funding long-promised facilities for patients who can be moved out of state hospitals.

“The emergency rooms are getting overcrowded. Some of the outside agencies are backed up. Even the jail system is backed up now, with some of the clients we normally would serve,” said James Robinson, a counselor at Western State and president of the union local.

A shortage of psychologists is one of the hospitals’ top budget problems, Robinson said.

Hospitals aren’t meeting state targets for evaluating jail inmates to decide if they are competent. Beyer told lawmakers the state is trying to address the shortage but money is tight, and turnover among evaluators is high.

To fill the gaps, both the House and Senate have passed versions of a Pierce County-requested measure to temporarily allow counties to contract with private psychologists. Counties say once the jail backlog is addressed, the temporary fix can expire.

Robinson called it a “Band-Aid” solution that ignores the real problem: competition from better-paying employers such as Madigan Army Medical Center.

Under the legislation, DSHS predicts as little as one tenth or as much as one half of evaluations could be contracted out. But the Senate slates funding only for the bottom end of that range.

On Friday, the Senate added another spending item that lines it up with Inslee’s plan: two more positions for DSHS to conduct mental-health background checks of gun buyers and applicants for concealed-weapon permits.

That would double the number of people working on the checks. Their workload shot up after the presidential election and the talk of gun control following the deadly school shooting in Newtown, Conn.

Jordan Schrader: 360-786-1826 jordan.schrader@ thenewstribune.com blog.thenewstribune.com/politics @Jordan_Schrader Download the Capital Update app for iPad and iPhone for a seven-day free trial.

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