By Walker Orenstein

The News Tribune

OLYMPIA — In the opening days of Washington’s legislative session, state lawmakers have made it clear they’re still at odds over how to comply with a court order to properly pay for public schools.

But when it comes to another priority on both sides of the aisle — reform of the state’s mental health system, particularly at the state-run psychiatric hospital Western State — there appears to be more agreement.

Key lawmakers from both parties are even endorsing a central concept of Democratic Gov. Jay Inslee’s plan to upgrade mental health infrastructure.

Inslee proposed shifting nearly all patients committed to the state’s two psychiatric hospitals in their civil — or noncriminal — wards to other treatment centers around the state.

The two hospitals, Western State and Eastern State, have about 830 beds for civil patients.

Specifics of implementing that shift, including how to pay for it, are in the beginning stages of negotiation, say lawmakers on a state committee dedicated to solving problems at the hospitals.

State Sen. Randi Becker, R-Eatonville, who serves on the committee, said there is support for such a change to the hospitals. That’s the case even in a year when lawmakers likely must come up with billions of dollars to meet the Washington State Supreme Court’s ruling in the McCleary education case.

“It’s critical that we don’t let all of the rest of the items, meaning K-12 (schools), take over and we don’t address Western State Hospital,” Becker said.

Western State, an approximately 800-bed hospital in Lakewood, has been struggling to fix safety and capacity issues for years.

The state has had trouble finding places outside Western State to send patients who are ready to be discharged but still need a place where they can continue mental health treatment.

Those patients, often under long-term care, contribute to a lack of hospital beds that can leave new patients in area hospital emergency departments or jails while waiting for a bed at Western State — a practice known as “boarding.”

A September report of issues at the hospital said cuts to staff and budget during the Great Recession exacerbated safety and quality of care problems. Poor management and cultural issues also were noted.

In recent years, local and federal courts have ordered the hospital to reduce patient assaults and escapes, speed competency services to mentally ill defendants and end “boarding.”

Since the hiring of new Western State CEO Cheryl Strange earlier this year, some lawmakers following the hospital and the governor have claimed progress at the hospital. The state made an agreement with federal regulators in June to fix safety problems that have threatened millions of dollars.

With the help of $145 million toward the mental health system since 2015, the hospital is adding staff.

Still, shifting civil patients from Western State is necessary because patients are better served in regional locations where they can be closer to family, friends, housing and employment, said state Rep. Laurie Jinkins, D-Tacoma.

Jinkins said other states, in part for that reason, don’t serve their civil patients in such a large, central location as Western State.

State Sen. Steve O’Ban, R-Tacoma, said Western State’s aging facilities and its host of issues make moving the patients an attractive prospect.

Clearing space at the hospital would open up beds for a forensic population that Strange said is growing.

In mid-December, Inslee unveiled a $300 million proposal to improve the mental health system, which includes shifting civil patients out of Western State by 2020. It also would pay for more staff at the hospital.

“Fundamentally I agree,” Becker said about shifting civil patients from Western State. “But I think it’s a longer-term process than meets the eye.”

Inslee’s plan would fund nine new 16-bed treatment centers operated by the state for civil patients to receive treatment instead of at Western State. It also would pay for new psychiatric beds in local communities at public and private care organizations.

In total, 1,000 beds would be added to the mental health system if the governor’s plan is implemented.

O’Ban, who serves on the hospital improvement committee and the Senate’s Health Care Committee, said he’s not positive some, or even all, of the new state-run facilities are necessary.

At least some civil patients could be served by existing private or public facilities reimbursed by the state — a more cost-effective option, he said.

Becker also questioned the amount of money in Inslee’s plan for new mental health employees, which she described as based on a “Cadillac staffing plan.”

But on shifting civil patients to other care facilities, O’Ban said, “There seems to be consensus. How we do that, how many facilities, that’s all kind of under consideration.”

Democratic lawmakers have similar expectations.

State Rep. Eileen Cody, D-Seattle, said fights over funding are inevitable, but said there’s “general agreement” on turning Western State into a hospital for mainly forensic patients. Cody is chairwoman of the House’s Health Care and Wellness Committee and serves on the psychiatric hospital improvement committee.

“I’m glad that we are finally getting some vision about where we want to go with mental health,” she said.

Leaders in the Legislature from both parties have made improving conditions at Western State a priority in recent years, but Inslee and legislators had at least one clash on the issue in the 2016 legislative session.

Inslee vetoed major parts of a plan sponsored by state Sen. Andy Hill that, among other reforms, would have used financial incentives to try and reduce use of the state hospitals.

The veto came despite wide support for the bill in the House and Senate.

Inslee did keep part of the bill that hired a consultant to review the hospital’s structure and financing, and said he wanted to see the report before making decisions on other parts of Hill’s proposal.

Hill, the Senate’s lead budget writer for several years, died of cancer Oct. 31.

Jinkins, who serves on the hospital improvement committee and the House’s Health Care and Wellness Committee, said getting agreement from both parties in both chambers on a big policy shift — even in concept — is “kind of rare.”

But she cautioned that doesn’t ensure reforms to Western State are a done deal. Changes might have to come slower, or more incrementally than Inslee proposed.

“Getting there takes money and in the environment we’re in that’s hard to come by,” she said.