What's working, what's not, and who's 'picking up the slack' at Western State Hospital?

In Washington state — as progressive as it may be — overhauling the mental health system has proven easier said than done.

Not surprisingly, changing a complicated medical system takes more than sheer political will. Even when it works, not everyone will be pleased with the direction, let alone the outcome.

Esmy Jimenez reports on mental health for The Seattle Times. She recently toured Western State Hospital near Lakewood and the site where the state Department of Social and Health Services hopes to build a new, 350-bed hospital for people being transferred from jails.

She spoke to KUOW's Angela King about the plan and why it may not be as easy as officials had initially hoped.

This interview has been edited for clarity. Find the original story from The Seattle Times here.

Angela King: This is not the first time Western State Hospital has made headlines like this. So, what's going on now? And how is this playing into Gov. Jay Inslee's plan to improve mental health care in the state?

Esmy Jimenez: Well, for those that don't know, Western State Hospital is this really large psychiatric hospital — the largest in the state. It serves two kinds of people: forensic patients, who are coming from jails and criminal courts; and civil patients, who are from the community.

The issue is that Western State is very, very old. It's always been plagued with issues, whether that's staffing shortages, assaults between patients or even assaults from patients on staff, patients leaving the facilities without permission.

And then in 2018, Western State Hospital lost its national accreditation with the Center for Medicare and Medicaid Services, which means it lost funding. So that year, Gov. Inslee set out this plan to reimagine mental health as a response to many of these problems. Now, here we are in 2022, and we're kind of in the middle of that giant transition.

So, what changes are being worked on now?

The goal is to build a new forensic hospital on the campus near Lakewood. Construction might start next summer, and doors will open sometime in 2027. The hope is that patients would have a more therapeutic environment. It would be a modern facility, and it would essentially just be able to potentially get certified with the feds again and get that funding back.

The second thing, though, is that this is all part of a larger plan to shift away patients from the civil side, from these large psychiatric facilities like Western State, and instead focus on smaller local facilities in Washington. The idea is people should be able to get mental healthcare in their own community. They shouldn't have to lead to this one centralized giant institution, but the state has to build those smaller places as well, then.

Why might it not be working as officials had hoped?

The first challenge is discharging those civil patients; it's hard to find a place for them to go home to. And so, when you have that pipeline slow down, it makes it harder to make bed space for the people on the forensic side. Because these two groups do overlap.

I talked to Kimberly Mosolf, a lawyer with Disability Rights Washington, an advocacy group that sued the state for the issues around people waiting in jail for mental health services. She told me: "So, you still have this hospital that's trying to balance between the needs of those two populations and the bed needs of those two populations. Unfortunately it does not look much different than it did in 2015, when we won that case and when the court ordered the state to stop violating people's constitutional rights and to get them moved in a timely fashion."

Jimenez: So, there are still these big issues with waitlists to get in and get out. And that's partially due to Covid-19. But it's also partially just a long-existing problem. It takes time to build good behavioral health facilities to do the permitting, the construction, hiring and training more staff specialists. We have shortages right now among mental health care workers. I'd say, fundamentally, it's kind of like driving a car while you're also trying to change the tires.

What about the community around the hospital? The state's goal for the hospital doesn't necessarily align with what some Lakewood residents are saying. What's the disconnect?

Jimenez: There's a public perception issue. I think that's happening as people think about building this new hospital. A lot of them are worried about how close the campus is to a high school and parks and that patients could potentially escape.

The other thing that I heard from Lakewood officials is that the city does have an incredibly high concentration of behavioral health facilities, not even just focusing on Western. The city of Lakewood has the second highest concentration of adult family homes in their region. And there are others being built there.

Here's how Jim Kopriva, with the city of Lakewood, he thinks about it:

Kopriva: We have 135 adult family homes and about 18 to 20 applications for new ones every year. We're clearly, you know, very understanding for behavioral health and very accommodating and we expect that other communities should begin to pick up the slack.

So listening to that makes me wonder how this is affecting the state's new approach.

Jimenez: So far, the city of Lakewood has not approved the master plan to build the new hospital. So, officials are waiting to kind of go through more of these hoops to actually get it built. But it's also something other cities are watching closely. Auburn and Burien are two other cities where smaller, community-based mental health facilities were proposed, but residents pushed back. Ultimately, neither of those facilities got built.

What happens now?

What I'm looking out for is the response from state officials. They're expected to resubmit their master plan for the new hospital sometime this month. City officials are either going to have to accept that plan, and the hospital will be built. Or, they will make it hard and there will be some back and forth there. For context, the city of Lakewood has tried suing the state before for this kind of thing. It didn't exactly pan out.

Secondly, I'm curious about what Disability Rights Washington and state officials are going to do when it comes to the people that are currently waiting in jails right now to get a mental health evaluation. Those folks are waiting to get into Western, and we still don't know what's gonna happen to them afterward.

Listen to the interview by clicking the play button above. Find the original story from The Seattle Times here.