How a new UW teaching hospital might help Washington state's mental-health crisis
Seattle Times - 3/25/2019
March 25-- Mar. 25--OLYMPIA -- The chairman of the Psychiatry and Behavioral Sciences Department at the University of Washington envisions a state-of-the-art hospital, up to eight stories high, with rooms for up to 150 patients and a key role in helping the state care for its mentally ill residents.
On the campus of Harborview Medical Center or Northwest Hospital, Dr. Jürgen Unützer says, the state could fund what would be a national model in treating psychiatric patients and training medical residents.
He says the state needs to stop trying to "reinvent the wheel" with Western State Hospital, an outdated campus with so many problems that it has lost federal funding, and move on to a facility that would be inviting and safe and bring Washington's behavioral health care into the 21st century.
With strong bipartisan support, the proposal spearheaded by Gov. Jay Inslee appears poised to become one of the nation's first behavioral health teaching facilities aimed at tackling both the workforce shortage plaguing the field and the lack of adequate beds for patients.
Democratic House Speaker Frank Chopp's House Bill 1593, which would get the ball rolling on the process to establish the teaching hospital by requiring UW Medicine to create a plan for developing and siting the facility and report to the Legislature by December, passed unanimously in the House this month.
A placeholder price for the project included in the governor's 10-year capital plan is $180 million, on top of a couple million for some design costs.
Washington has long struggled to meet the demand for psychiatric beds, despite some $900 million in investments in recent years to improve services and train workers. The issue was compounded by the June decertification of Western State Hospital in Lakewood, which includes approximately 850 beds, more than 500 of which are for civilly committed patients. The month before, Inslee announced a goal of removing all civil patients from Western State and placing them in smaller, community-based facilities across Washington by 2023.
But finding qualified personnel remains a challenge.
An Everett facility had to delay its opening until November because a nurse could not be found, despite plans to move 16 civilly committed patients from Western State Hospital, according to Rashi Gupta, a policy adviser in the governor's office.
The new hospital would include up to 150 beds for long-term patients civilly committed under the Involuntary Treatment Act, staying more than 90 days and living with a disorder such as schizophrenia. Twenty-four percent of Washington adults met the criteria in 2010-2011 for a mental-health disorder, according to the National Survey on Drug Use and Health. Meanwhile, about 7 percent met the criteria for serious mental illness, putting Washington in the top three states in terms of percentage of the population affected.
Lawmakers on both sides of the aisle hope shorter commitments, such as those for 14 days, could take place in smaller community facilities.
"We've reached the point in time where if people really need services, it's done on an emergency basis. It's done in emergency rooms. It's done in jails, It's been done in the state hospitals," said Sen. Manka Dhingra, D-Redmond, and chair of the Behavioral Health Subcommittee. She added later: "It is not a system that is actually meeting the needs of patients."
One third of civil-commitment patients at Western State don't need that intensive level of care, but there just aren't other facilities that can serve them in the community, according to Gupta.
With that goal in mind, lawmakers in Olympia hope the timeline on the teaching hospital could be accelerated to open by the end of 2023 and Unützer says that's the plan currently. He thinks the hospital could open in phases, with a telemedicine component bringing services to rural communities as early as this fall if given a few million dollars in funding. If open 24/7, this part could be staffed by 10 to 12 people giving consultations across the state.
"I could take somebody who is trained and works in the teaching hospital, who could provide a clinical consultation to a provider in any community hospital, emergency department anywhere in the state," Unützer said. "So that's one way to build something that doesn't just help people here locally, but also would really help the whole state."
Currently, 73 residents staff 166 inpatient beds, dispersed across the area, with some serving veterans dealing with post-traumatic stress and others working with children, according to Unützer.
That being said, he would love to develop more behavioral health workers to address the shortage. In a recent application cycle, about 1,400 people competed for just 15 or so residency spots, according to Unützer, so there is interest but not enough resources. The governor's proposed budget includes funding for five more residency positions at the UW's psychiatry program as part of a $4 million effort to address the workforce shortage.
Included in the governor's 2019-2021 budget is $675 million to radically reshape Washington's mental-health system, $2 million for design of the teaching hospital.
More than $30 million of that would be earmarked for nine facilities ranging in size from 16 and 48 beds to a few 150-bed hospitals.
"The philosophy of what works has changed," said Sen. Keith Wagoner, of Sedro-Woolley, who is the top Republican on the Behavioral Health Subcommittee. "What we've seen working in other states is more localized treatment centers. Where people can be close to their community, they do better."
House and Senate lawmakers are preparing to release their own budget plans this week, which should include information on funding. The teaching hospital has won broad agreement as a priority.
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