Laws to help shift mental health care to communities

OLYMPIA – Washington residents can expect a major transformation of their mental health care system in the coming years, shifting many patients away from large state-run institutions, as a result of a series of laws signed Thursday.

“Getting people the help they need in their communities, close to their families and support systems, is crucial to success,” Gov. Jay Inslee said.

Through the University of Washington School of Medicine, the state will help create a new 150-bed hospital for psychiatric care, which will treat patients and increase the number of doctors, nurses and other medical staff in mental health fields. It would be the first facility of its kind in the nation, he said.

The extra psychiatric medical personnel are needed to move mental health care for many patients out of institutions like Western State and Eastern State hospitals and into communities, Inslee said. The bill requires the university to present a plan for the teaching hospital to the Legislature by Dec. 1.

To get more local treatment for patients, Inslee also signed a bill that authorizes the state Department of Health to license “intensive behavioral health treatment facilities” in communities around the state. These facilities will treat patients who don’t require involuntary commitment but do need 24-hour supervision and settings with a high staff-to-patient ratio.

The department will also develop credentials for “respite centers” with short-term services focusing on recovery and wellness, a pilot program for mental health drop-in center and make it easier for hospitals with psychiatric services to the number of beds they have by suspending the certificate of need requirements through June 2021.

“We all know someone, or many people, who struggle, and we all want the best care for our family members, friends, colleagues and neighbors,” Inslee said.

A third bill attempts to treat “the whole person,” Inslee said, by integrating mental health and physical health care. It allows managed care organizations to manage community behavioral health systems and sets up a work group under the state’s Health Care Authority to determine the best way to manage long-term commitments in community and state hospitals.

A fourth bill tries to address a federal court order that found the state was liable for excessive wait times for criminal defendants who needed to be examined to see if they were competent to stand trial or receive the mental health treatment needed so they could become competent. Known as the Trueblood decision, the ruling and subsequent contempt citation cost the state some $83 million in fines until last December when a settlement was reached requiring specific action to reduce those waits.

To help defendants get quicker evaluation and treatment, the state will hire “forensic navigators” who will help the defendant, prosecuting and defense attorneys and court officials. They’ll collect relevant information, meet with the defendant and present recommendations to the court. If a defendant is ordered to go through treatment to have his or her competency restored, the navigator will help with appointments, finding housing, coordinate with health services and medication, and report on progress to the courts.

A court may order outpatient treatment to restore competency under certain conditions, including that the defendant abstain from alcohol and unprescribed drugs, and space is available in a certified program.

The bill also gives police officers the authority to divert a person known to suffer from a mental health disorder to a crisis center or hospital rather than arresting them for a crime.

The goal is to reduce the numbers, have shorter wait times in jail and use community-based facilities when possible, Inslee said.

Those four laws were prompted by legislation the governor asked lawmakers to consider.

A fifth new law designed to increase the number of mental health care professionals in the state calls for the Department of Health to establish a reciprocity program for workers from other states that have license or certification standards “substantially equivalent or greater scope” than Washington.

The reciprocity program would allow psychologists, chemical dependency professionals, mental health counselors and social workers to receive a probationary license to work in Washington while the department determines if any additional training or education is needed to get a full license or certificate.