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Mysterious influx of patients hits state's already strained mental hospitals
News Tribune - 9/15/2017
Sept. 15--The number of patients being referred to the criminal wards at Washington's congested psychiatric hospitals has spiked in the last year, a trend that has befuddled state officials and prompted them to scramble for answers.
The state's psychiatric facilities, including Western State Hospital in Lakewood, already have struggled for years to overcome crowding and lengthy wait lists for care. The result has been millions in fines and court orders to speed up required services for mentally ill defendants.
While in line to get help at the hospitals, patients accused of crimes have been left in local jails where they can't get proper treatment.
Yet the new and escalating rise in referrals to criminal, or forensic, wards makes the state's tall task of shortening hospital wait lists even more difficult, especially with little idea of why it's happening, said Thomas Kinlen, who oversees services for forensic patients for the state.
An August report from the state says the increase in referrals of forensic patients is leading to an increase in the admission wait list, "especially on the western side of the state."
State Rep. Laurie Jinkins, a Tacoma Democrat who serves on a committee focused on state psychiatric hospitals, said the influx of new patients is "incredibly troubling."
"And it's even more troubling that we're not really able to put our finger on what's causing that," she said.
Forensic wards serve mentally ill patients who have been accused or convicted of a crime.
Patients are referred there by courts to be evaluated to see if they're competent to stand trial. If they're not, they receive mental health treatment to restore competency.
Those found not guilty of a crime by reason of insanity also get mental health treatment at forensic wards.
State data show 1,450 patients in 2016 were referred to forensic wards at state psychiatric facilities for treatment to evaluate or restore their competency to stand trial. In 2015, the hospitals saw just 1,076 such referrals.
That's a roughly 35 percent jump. The previous four years saw growth only ranging from 0.4 percent to 10.5 percent.
Preliminary data from 2017 shows the influx continuing.
Referrals to forensic wards at 800-bed Western State Hospital have shot up 36 percent when comparing the first five months of 2017 to the same time period in 2016.
Western State is Washington's biggest -- and most crowded -- psychiatric facility. A federal judge repeatedly has fined the state for not providing timely competency services to forensic patients, particularly at Western State.
Some growth in forensic referrals is normal and planned for, Kinlen said, but not at this rate.
The uptick of forensic patients "skyrocketed" starting in August of 2016, Kinlen said. It hasn't relented.
"Here in the office we call it the spike," Kinlen said.
Kinlen said the state has begun reaching out to county officials for help determining the root of the issue. He said the uptick in patients is likely caused by a complex combination of factors.
But Kinlen said he wanted to explore ideas from the ordinary to the outlandish to find out. That could range from struggles with opioid addiction, greater recognition of mental health problems, or practices by defense lawyers, to "because the price of gas went up," he said.
Jinkins said lack of preventative care also could be an element of the problem. Many people aren't treated for mental health issues until they direly need hospitalization, she said.
State Rep. Morgan Irwin, a Republican from Enumclaw and a Seattle police officer, said he believes law enforcement is getting more training in recent times to properly steer people to the mental health system and help them navigate it.
Without knowing the spike's cause, reacting to it is more difficult, said Rep. Joe Schmick, a Republican from Colfax.
Whether the uptick is more of "a blip" or a longer-term trend requiring greater attention is unknown, said Schmick, who serves with Jinkins on the Select Committee on Quality Improvement in State Hospitals.
Schmick and Jinkins have been part of a bipartisan effort at the Legislature to battle crowding and safety problems at Western State and Eastern State Hospitals. The issues were exacerbated by budget cuts during the Great Recession.
Lawmakers have poured millions of dollars into state-run psychiatric hospitals and the overall mental health system to try and dodge fines and improve care in the last several years.
In the 2017 legislative session, lawmakers approved the beginnings of a transformation at the hospitals as part of a new strategy to reduce wait times for mentally ill patients.
Legislators plan to eventually shift nearly all civil, or noncriminal, patients from the two hospitals to other care settings around the state. A count Wednesday (Sept. 13) from Western State officials showed about 270 forensic and 560 civil patients at the hospital.
The transition frees up beds for forensic patients. Lawmakers also say civil patients are better treated closer to home rather than at large, centralized locations.
To start, the state plans to convert four 30-bed civil wards at Western State to forensic wards by 2021, according to information provided by House Democrats.
There's no target date for completing the overall transformation.
Schmick said faster, more aggressive change would be difficult because of a shortage of psychiatric workers.
Outside of the state-run hospitals, lawmakers put more money toward services that catch and treat mental health problems before they reach crisis level.
The state plans to build six new crisis walk-in centers with a total of 96 beds. Law enforcement could bring people to walk-in centers for treatment instead of arresting people for mental health problems, Jinkins said.
The construction plans are complicated by a legislative battle over rural water rights that tanked the state's construction budget for the first time in modern history. The construction budget was expected to have money for projects at Western State and elsewhere.
Lawmakers insist the money in this year's operating budget represents progress, even with the rise in forensic patients.
"I do think that overall we're on the right path," Schmick said. "I just wish we could get it done quicker because it affects every single community in our state."
Jinkins said when the committee on psychiatric hospitals reconvenes, its members plan to study the uptick in forensic patients and what the state is doing to address the increase.
She said they might look at expanding courts dedicated to mental health problems, and paying for more preventative services. They also might study other states that have managed to drive down the number of forensic patients requiring competency services.
Schmick agreed the increase in patients must be a priority.
"Why all of the sudden are we seeing this many more folks that need help?" he said. "We don't have a good answer."
Walker Orenstein: 360-786-1826, @walkerorenstein
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