SEATTLE — Washington state has agreed to better coordinate care for people who are leaving involuntary commitment at Western and Eastern state hospitals, according to a settlement reached this month with Disability Rights Washington.
The state’s Department of Social and Health Services and Health Care Authority have said they will improve the processes for discharging people by beginning planning earlier, by allowing behavioral health care providers and peers to connect with patients before the patients are released, and by presuming people can live independently with appropriate support services, instead of needing to find a group facility to live.
The agreement comes as Western State Hospital transitions to serve more patients who are accused of crimes and come to the facility through the criminal court system, also known as forensic patients, rather than people who have been committed through civil courts. Gov. Jay Inslee has called to reduce the number of civil beds at Western State, in the hopes that civil patients will instead get support from smaller, community-based health care centers.
While the push toward community-based care can help keep patients closer to home and their support systems, it also raises questions about where the patients will go and whether there are enough community resources available to support them.
The state has struggled to get forensic patients an evaluation for mental competency or restoration services within required time frames, under a different settlement referred to as the Trueblood case. The wait times are getting worse, meaning hundreds of incarcerated people remain in limbo for weeks or often months.
This reflects bottlenecks in the system, said Todd Carlisle, an attorney with Disability Rights Washington. Because there are delays in discharging civil patients, they are taking up beds needed by forensic patients whose charges have been dropped because they’ve been found not competent to stand trial, but who also can’t be discharged and need to move over to the civil side of the hospital. That backlog then leads to waits for forensic beds, leaving people stuck in county jails. And staying institutionalized for longer than necessary can cause people to decompensate and come off the discharge list.
“It’s a major problem. It’s expensive. It’s not efficient. And it’s illegal to keep people in an institutional setting significantly longer than necessary,” Carlisle said, referring to a case called the Olmstead decision, which found that people have a right to be served in the least restrictive setting that’s appropriate for their needs.
People leaving state hospitals are often discharged to an institutional setting like an assisted living facility. For many people, those are “too restrictive,” Carlisle said. Most people want to live in their own homes with adequate support systems, he said. The state agreed, through the settlement.
Another barrier delaying discharges is that most of the facilities are private and can choose which patients they will take — leading to extended waits to find a place willing to accept a specific person. It’s particularly difficult to find a placement for a person who has medical challenges or a history of violence, for example.
Under this settlement, the state will start with the presumption that a person can live independently with adequate support, like intensive community-based mental health care and rental subsidies, instead of relying on institutions accepting them.
Staffing shortages, technology issues and bureaucracy challenges contribute to other discharge delays.
When a treatment team says a patient is ready for discharge, “unfortunately, historically and currently, that’s the point at which their discharge planning starts,” Carlisle said. This agreement requires the state to begin planning discharge earlier so when the patient is ready, plans are already in place. Providers and peers — people with lived experiences with mental and behavioral health challenges — would be able to connect with people earlier and allow a more seamless transition into services.
“Now that the settlement is reached, the work starts to improve their discharge planning and to do everything that they need to do earlier, in order to not keep people waiting,” Carlisle said.
The settlement allows for up to 120 days for the state to meet with staff, providers and other workers in the system to discuss the new requirements. Goals related to updating computer systems have a 15-month window for implementation.
If the state does not adhere to the requirements, Carlisle said DRW would bring court action to enforce the agreement.
“We at the Department of Social and Health Services have a mutually shared interest with Disability Rights Washington in helping our civil patients discharge to facilities or locations that will be beneficial to their reintegration into the community, resulting in a higher likelihood that they do not return to the state hospitals in the future,” Tyler Hemstreet, a spokesperson for Washington’s Department of Social and Health Services, said in a statement.
“We also believe the parameters laid out in the agreement for a more detailed and refined system to track our patients’ progress will not only help them in the long run, but it will help our staff as well, as we continue to put the needs of our patients at the forefront of our discharge processes.”
Hemstreet said the state has the resources needed, including staffing and technology, to meet these requirements and negotiated the agreement to be “as budget neutral as possible.”
