State hustling to end psychiatric warehousing

Dec. 10--OLYMPIA -- With only a couple weeks to go before a state Supreme Court order bans the warehousing of psychiatric patients, state officials are scrambling to expand the number of beds and hire new mental-health workers.

More beds are becoming available and the number of psychiatric boardings is dropping, according to data from the state Department of Social and Health Services (DSHS).

During July, 567 patients were warehoused, awaiting treatment, in emergency rooms and other medical facilities across the state. That number steadily declined to 300 in October.

While more beds are being added, some are concerned about the ability to find qualified workers to staff the expansion. It still isn't known what will happen when the court's reprieve ends on Dec.26 and the ban against warehousing takes effect.

"Come Dec. 26, we will still be scrambling to look for beds," Joe Valentine, director of North Sound Mental Health Administration, told lawmakers in a legislative committee hearing last month.

Shortage of workers

The warehousing of patients takes place when authorities forcibly detain psychiatric patients in order to treat them, but then don't have the beds available to treat them.

Patients wait days, sometimes months in hospital emergency departments or other medical rooms and are often bound to beds or parked in hallways. Such boarding quintupled between 2009 and 2012 in King County.

After the state Supreme Court decision in August found the practice unlawful (it was estimated to affect 200 people at the time), Gov. Jay Inslee authorized $30million to help the state stop the practice. The court ruled that the holding of patients temporarily in settings that don't provide individualized psychiatric treatment violates state law.

The state drafted a plan to add 145 more psychiatric beds so those involuntarily committed could be evaluated and treated immediately rather than being warehoused. Since August, 117 psychiatric beds have been brought online, most in the Puget Sound region, according to DSHS.

DSHS officials anticipate having another 28 beds by Dec. 26. Some of those will come from a new psychiatric bed unit operating at Western State Hospital.

But even as the mental-health system adds capacity, administrators say they worry there won't be enough qualified staff to work all the beds in the plan.

One expansion is taking place at Providence Regional Medical Center in Everett, according to Valentine of North Sound Mental Health Administration, a regional support network of counties that deals with mental-health issues.

But that 30-bed ward -- which is included in the state list of beds brought online since October -- is only operating half its beds because administrators can't hire enough staff, according to Valentine.

DSHS officials and staff in the governor's office are also expressing concern over finding workers.

"That is the single biggest challenge that I think DSHS is facing," said Andi Smith, senior policy adviser on human services to the governor.

"We hear about it most with doctors, nurses, psychiatrists, but also attendants," Smith said.

Jim Vollendroff, director of the King County Mental Health & Substance Abuse Division, told lawmakers that mental-health workers are also trying to do more to help people before they get to the point of being involuntarily committed.

"If we can meet them earlier in the process, we can avoid them going through the involuntary system altogether," said Vollendroff.

Vollendroff, who also testified in the recent legislative committee hearings, told lawmakers that more resources for substance-abuse and addiction issues would help keep people from developing psychiatric issues.

Uncertainty ahead

A recent bright spot is that cost estimates for expanding the number of beds has dropped. Of the $30 million authorized by Gov. Jay Inslee for the rest of this year, only about $14 million has been needed, according to DSHS.

One reason for that is the federal government gave the state authority to use Medicaid funds for acute short-term treatment at more facilities than were allowed before, according to Jane Beyer, assistant secretary for behavioral health and service integration for DSHS.

The federal government covers a portion of Medicaid costs.

The amount in state general-fund money needed to comply with the court order in the 2015-17 budget cycle will be about $32 million, according to the state Office of Financial Management.

Nonetheless, officials don't quite know how the transition will go when the state Supreme Court's order goes into effect after Christmas.

"It's too early to know what the negative impact will be," Valentine told lawmakers.

Beyer wouldn't speak to what best- or worst-case scenarios would look like when the court order takes effect.

"We are trying as hard as we can to be in a position where we will be in compliance," she said.

Joseph O'Sullivan: 360-236-8268 or josullivan@seattletimes.com. On Twitter @OlympiaJoe

___

(c)2014 The Seattle Times

Visit The Seattle Times at www.seattletimes.com

Distributed by Tribune Content Agency, LLC