Washington’s psychiatric hospitals do not have enough beds to meet the demand for patients in need, but several construction projects are underway to help provide more capacity.
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Kelci Karl-Robinson, Coordinator for the Washington State House of Representatives’ Office of Program Research, discussed capacity issues at the two state psychiatric hospitals during a House Capital Budget Committee meeting on Thursday.
The Washington State Department of Social and Health Services (DSHS) operates both hospitals—Western State Hospital in Lakewood and Eastern State Hospital in Medical Lake—which care for both forensic and civil patients. As of Sept. 1st, Western had a total funded capacity of 747 beds, of which 400 were for forensic patients, with 347 for civil patients. Eastern was funded for 367 total beds, with 175 for forensic patients, Karl-Robinson said.
Forensic patients are adults who are referred when a court determines that a mental disability may prevent a criminal defendant from assisting in their own defense, Karl-Robinson said. They receive an evaluation to determine if they are competent to stand trial. The majority of those evaluations are conducted in a jail. If they are found to be incompetent, they are referred to a state hospital for up to 90 days of competency restoration treatment.
“An additional group of patients in a state hospital are those able to be determined competent and stand trial, but entered a plea of not guilty by reason of insanity,” Karl-Robinson said. “On the civil side, individuals are committed to a hospital for a 90-day or 180-day treatment period if they are determined to be a danger to themselves or others.”
In April 2015, a federal court ruled that DSHS was taking too long to provide competency evaluations and restoration services.
“In most cases DSHS is ordered to provide evaluations within 14 days and restoration services within seven days,” Karl-Robinson said.
The passage of House Bill 1394 in 2019 directed the Washington State Health Care Authority (HCA) to work with willing community hospitals and evaluation treatment facilities to provide treatment for adults on 90-day or 180-day commitment orders.
The HCA’s contracted bed capacity for 90-day and 180-day treatment is projected to increase over the next several years.
Civil patient use of beds has doubled at Western in the last four-and-a-half years to 304 individuals as of July, Karl-Robinson said.
“When you compare this number to the 287 projected bed capacity at Western, you can see there’s a civil capacity issue at Western,” she said. “The number of civil patients occupying forensic beds at Western has been growing. The forecasted bed need is projected to grow by 86 beds per year, therefore there is a projected gap of close to 250 beds in fiscal year 2023 and a projected gap of 250 beds in fiscal year 2027.”
Kevin Bovenkamp, Assistant Secretary of Behavioral Health at DSHS, discussed the state’s dire need for more beds.
“The state hospitals have reached a crisis point in admissions due to a sharp increase in referrals, roughly 40% over the last year alone,” Bovenkamp said.
Several projects are underway to help the state address patient demand. To meet future forensic bed capacity needs, two new wards are under construction at Western, Karl-Robinson said. The project will supply 58 additional beds, which are projected to be available in March 2023.
A new 350-bed forensic hospital is currently being designed for Western.
“If construction continues as planned, it is projected to be completed by July 2027,” Karl-Robinson said.
Columbia Cottage at Maple Lane is being converted to a 30-bed [not guilty by reason of insanity patient] ward, which is projected to open in September 2023, Karl-Robinson said.
To help address future civil bed capacity, a 16-bed community facility is under construction at Maple Lane and is projected to open in February 2023. A 48-bed community facility is under construction in Vancouver and is projected to open in January 2025, Karl-Robinson said.
Rep. Steve Tharinger (D-Dungeness) asked about the possibility of finding more community facilities for civil beds.
“If we can find placement in community hospitals for civil beds, there are some opportunities to maybe take back some beds at Western that could be used for forensic,” Bovenkamp said. “The current condition is a lot of civil patients sitting in forensic beds. So it has swung in the wrong direction.
There are some really difficult patients at Western. But there are also a number of patients that are pretty stabilized and probably could move out into community beds if they are available to us.”