Clean up mess at Western State

Backlogged mental-health programs at Western State Hospital are in urgent need of repairs. Our state’s largest psychiatric hospital must not dither in making big improvements to care.

Underscoring a long-unfolding crisis at the hospital in Lakewood, the federal Centers for Medicaid and Medicare Services announced that Western State is being terminated from the Medicare program.

The decision is very disappointing and followed an inspection in May. It means an immediate cut of $53 million in yearly federal payments to the hospital.

The state must cover the loss with state dollars for new patients starting July 9.

Western has long been plagued by aging structures, understaffing and a backlog of patients needing evaluations or to be released to less restrictive care settings in their home communities.

About two-thirds of the 857-bed hospital's patients are civilly committed, due to a risk of harm to themselves or others. A third are held after the filing of criminal charges, many of which led to findings of not guilty by reason of insanity.

The backlog means that mental health evaluations of individuals newly facing criminal charges are delayed.

To the credit of state leaders, Washington’s Legislature allocated roughly $360 million in new funds to improve state and local mental health services in recent years. In response to troubles at the Western, Gov. Jay lnslee has also changed leadership at the institution twice, raised pay and added staffing to improve care for patients.

In May, Inslee pledged to pursue a five-year transition to more 16-bed community care treatment facilities. The goal is laudable.

Republican state Sen. Steve O’Ban of Lakewood has proposed bills in each of the past two years to relieve this backlog at the hospital by using community hospitals and nonprofit providers of mental health care. Unfortunately those bills did not pass.

In a bid to avoid cuts in federal funds, our state Department of Social and Health Services entered into a “systems improvement agreement” with CMS officials last year. A second so-called SIA was completed last November, which led the followup inspections at Western in May that triggered the federal funds cutoff.

In a June 22 letter to Western State, CMS acknowledged Western had made “significant strides toward correcting its areas of non-compliance,” but the agency cited four areas of noncompliance – in governing, quality assessment, nursing services and the physical environment.

The letter concluded that Western fell short of “substantial compliance” with Medicare’s conditions for participation.

The hole dug by the Great Recession was deep for mental health services in our state. But the system failures are obviously harder to fix than officials recognized.

We hope Inslee, a second-term Democrat, can now focus like a laser beam – to use one of his favorite phrases – on turning around Western State. Though he leads the Democratic Governors Association in a pivotal election year, Inslee might want to skip his next out-of-state visit to an election-related DGA event.

There is plenty to fix in this Washington.