OLYMPIA – A key component of the Legislature’s plan to combat the state’s mental health care crisis and satisfy federal complaints about its current system passed the Senate on Wednesday on a unanimous vote.
The Senate gave final approval to a new behavioral health campus at the University of Washington to treat long-term patients while training medical residents.
The 150-bed hospital teaching hospital is central to the Legislature’s efforts to address the state’s varied behavioral health problems. As the bill’s primary sponsor and Speaker of the House Frank Chopp, D-Seattle, put it: “We need more care for the people of our state, and we need more caregivers.”
The hospital would mainly serve civilly committed patients who don’t need the intensive care provided at the state hospitals.
But lawmakers don’t agree on how to pay for the estimated $225 million project.
The Senate set aside $1 million in its capital budget to design a concept. The House is considering a more aggressive approach and allocated about $34 million for a simultaneous design and build.
A $500 million bond proposal from Sen. John Braun, R-Centralia, would set aside $200 million to build the hospital. If approved by the Legislature and state voters, money from the bonds would provide immediate money toward the behavioral health crisis.
Both chambers would likely fund the rest of project in the 2021-23 biennium, said Ian Goodhew, director of government relations at University of Washington College of Medicine. A difference in how to pay for it doesn’t signal a lack of enthusiasm for the concept, he said.
Part of the new campus proposal would also offer a 24/7 telemedicine center to connect communities without access to psychiatric care.
“It will make our teaching services available to practicing physicians and nurse practitioners in the field where they have nowhere else to turn,” Goodhew said.
The hospital would open midway through 2023, but the telemedicine component could start sooner if money is available for staff.
One goal is to incorporate general medical students who often don’t know how to handle behavioral health crises, Goodhew said.
The proposed hospital is a cornerstone of the state’s effort to shore up a behavioral health care system that remains largely inadequate, despite nearly $1 billion of investments in recent years. There has simply never been a long-term plan, said Rep. Joe Schmick, R-Colfax.
“We have not put a primary focus on mental health until this time and I think that was shortsighted,” Schmick said. Money was spent on immediate needs and “putting out fires,” he added.
A shortage of psychiatric beds means jails and emergency rooms often serve as a community’s main treatment facilities. That reality cost the state $83 million in fines in a federal lawsuit. Further, the federal decertification of Western State Hospital – an 850-bed psychiatric ward in Lakewood, Washington, with a long history health and safety issues for patients and workers – costs the state $53 million annually in lost federal money.
Washington ranked among the worst states at providing accessible inpatient facilities and needs an additional 1,500 treatment beds to meet demand, according to a 2018 report from Public Consulting Firm.
Now, the Legislature is looking at a more integrated approach to the behavioral health care system.
Lawmakers want to shift care toward community treatment and designate the long-embattled state hospitals to serve those in the criminal-justice system. Among the proposals are a heightened focus on prevention programs and adolescent behavioral health services that
could help people before they get too sick. Faster forensic competency evaluations to allow sufficient treatment at properly outfitted facilities are also under discussion.
But the state can’t expand the capacity for behavioral health without a workforce in place, said Sen. Sharon Brown, R-Kennewick.
“We need to have a lot of tools in the box. There’s not one solution that’s going to be the panacea for everything,” Brown said.
A rapidly changing healthcare framework – with underlying systemic challenges – affect the state’s ability to recruit and retain a “sufficiently large and adequately skilled” workforce to meet those requests, according to a 2018 assessment from a state board and the University of Washington.
Developing and maintaining a workforce is more complicated than simply “turning on the spigot” at education programs across the state, the assessment added.
Lawmakers could increase the workforce by easing restrictions on certain worker classifications to fill grossly understaffed positions.
For instance, the Senate approved a bill Wednesday that would allow those who previously committed crimes due to a substance use disorder to serve as peer counselors. They would no longer be barred from applying for certification.
Removing that barrier could help those in recovery find employment, said Rep. Lauren Davis, D-Shoreline.
“The best weapon we have to fight the opioid epidemic is the people that have survived it themselves,” she said.
A bill that passed the Legislature would allow social workers or those in a related field to work in a nursing home without having to meet certain qualifying criteria. Another bill which passed the Legislature would grant a probationary license to out-of-state behavioral health workers to encourage them to move to Washington.
Lawmakers also want to incentivize students to go into the field by increasing scholarship awards for those committed to practicing behavioral health and removing work requirements that can deter students. The House and Senate operating budget proposals both include money for new psychiatric residency positions at the University of Washington.
Another bill would extend a loan repayment program to certain behavioral health workers practicing in underserved communities.
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